69 results on '"Anderson JA"'
Search Results
2. Pharmacokinetic studies of cimetidine and ranitidine before and after treatment in peptic ulcer patients.
- Author
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Mihaly, GW, primary, Jones, DB, additional, Anderson, JA, additional, Smallwood, RA, additional, and Louis, WJ, additional
- Published
- 1984
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3. Search for medical information for chronic rhinosinusitis through an artificial intelligence ChatBot.
- Author
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Yassa A, Ayad O, Cohen DA, Patel AM, Vengsarkar VA, Hegazin MS, Filimonov A, Hsueh WD, and Eloy JA
- Abstract
Objectives: Artificial intelligence is evolving and significantly impacting health care, promising to transform access to medical information. With the rise of medical misinformation and frequent internet searches for health-related advice, there is a growing demand for reliable patient information. This study assesses the effectiveness of ChatGPT in providing information and treatment options for chronic rhinosinusitis (CRS)., Methods: Six inputs were entered into ChatGPT regarding the definition, prevalence, causes, symptoms, treatment options, and postoperative complications of CRS. International Consensus Statement on Allergy and Rhinology guidelines for Rhinosinusitis was the gold standard for evaluating the answers. The inputs were categorized into three categories and Flesch-Kincaid readability, ANOVA and trend analysis tests were used to assess them., Results: Although some discrepancies were found regarding CRS, ChatGPT's answers were largely in line with existing literature. Mean Flesch Reading Ease, Flesch-Kincaid Grade Level and passive voice percentage were (40.7%, 12.15%, 22.5%) for basic information and prevalence category, (47.5%, 11.2%, 11.1%) for causes and symptoms category, (33.05%, 13.05%, 22.25%) for treatment and complications, and (40.42%, 12.13%, 18.62%) across all categories. ANOVA indicated no statistically significant differences in readability across the categories ( p -values: Flesch Reading Ease = 0.385, Flesch-Kincaid Grade Level = 0.555, Passive Sentences = 0.601). Trend analysis revealed readability varied slightly, with a general increase in complexity., Conclusion: ChatGPT is a developing tool potentially useful for patients and medical professionals to access medical information. However, caution is advised as its answers may not be fully accurate compared to clinical guidelines or suitable for patients with varying educational backgrounds.Level of evidence: 4., Competing Interests: The authors declare that they have no conflict of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
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- 2024
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4. Association Between Modified Frailty Index and Postoperative Outcomes of Cricopharyngeal Myotomy.
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Haleem A, Herz D, Kumar KD, Chinta SR, Sibala DR, Hegazin M, and Eloy JA
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Objective: The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool previously validated in patients undergoing several surgical procedures. This study investigates the association between mFI-5 score and cricopharyngeal myotomy (CM) complications., Study Design: Retrospective database review., Setting: US hospitals., Methods: The National Surgical Quality Improvement Program database was queried for patients who underwent CM between 2005 and 2018. mFI-5 score was determined by assigning 1 point for comorbidities including: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and dependent health status. Univariate and multivariable analyses were conducted to determine associations between mFI-5 score and postoperative complications., Results: A total of 1075 patients undergoing CMs were queried and stratified into the following groups: mFI = 0 (n = 412 [38.3%]), mFI = 1 (n = 452 [42.0%]), and mFI ≥ 2 (n = 211 [19.6%]). Univariate analysis showed association between higher mFI-5 scores with older age, higher American Society of Anesthesiologists Classification class, obesity, smoking, dyspnea, and systemic sepsis. Higher mFI-5 was associated with a greater proportion of cumulative surgical complications, cumulative medical complications, pneumonia, myocardial infarction, cumulative morbidity, readmissions, unplanned readmissions, and reoperations. Multivariable analyses found associations between greater mFI-5 score and cumulative morbidity (odds ratio [OR] = 1.95, confidence interval [CI]: 1.29-2.96, P = .002), any surgical complication (OR = 1.80, CI: 1.15-2.79, P = .010), readmission (OR = 1.81, CI: 1.01-3.26, P = .047), and reoperations (OR = 1.96, CI: 1.04-3.68, P = .037)., Conclusion: Evaluating mFI-5 can help assess the risk of postoperative complications for patients undergoing CM., Level of Evidence: Level 4., (© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)
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- 2024
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5. Medical Student Research Activity in Otolaryngology.
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Chen T, Ho B, Decker M, Basta D, Hong EM, Durrant F, Eloy JA, and Benson B
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- Humans, Retrospective Studies, Internship and Residency, United States, Faculty, Medical statistics & numerical data, Efficiency, Otolaryngology education, Students, Medical statistics & numerical data, Biomedical Research
- Abstract
Objective: To investigate medical student research productivity by institutions associated with otolaryngology residency programs and identify correlates of productivity., Study Design: Retrospective review., Setting: N/A., Methods: A systematic search for articles indexed on PubMed published by 116 programs from January 1, 2016 to February 28, 2021 was conducted. Primary outcomes were number of faculty publications, first-author medical student publications and medical students from each institution. Secondary outcomes included geographic region, number of otolaryngology faculty members, and program rankings., Results: Nationally, the mean number of faculty per institution was 21.7 at the time of search. Over a 5-year period, there was a mean 98.7 total publications and 15.8 medical student first-author publications per institution consisting of a mean of 10.03 distinct medical students. One-way analysis of variance showed no statistically significant difference in medical student productivity (P = .09) or department size (P = .12) between regions. Number of medical student first-author publications positively correlated to number of faculty (R = .43, P < .05) and number of faculty publications (R = .63, P < .05). The top 30 programs ranked by United States News & World Report or National Institute of Health for funding had a statistically significantly greater mean number of medical student first-author publications and distinct medical student first authors than all other programs (P < .05)., Conclusion: Greater numbers of faculty members likely provide more mentorship and opportunities that allow medical students to engage in projects that lead to first-author publications. These findings allow institutions to reflect on efforts in medical student engagement and provide data to students for career planning., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)
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- 2024
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6. Association Between Modified Frailty Index and Postoperative Outcomes of Tracheostomies.
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Chinta S, Haleem A, Sibala DR, Kumar KD, Pendyala N, Aftab OM, Choudhry HS, Hegazin M, and Eloy JA
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- Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, United States epidemiology, Risk Assessment, Risk Factors, Databases, Factual, Tracheostomy, Postoperative Complications epidemiology, Frailty complications
- Abstract
Objective: The 5-item modified frailty index (mFI-5) has been used to stratify patients based on the risk of postoperative complications in several surgical procedures but has not yet been done in tracheostomies. This study investigates the association between the mFI-5 score and tracheostomy complications., Study Design: Retrospective database review., Setting: United States hospitals., Methods: The National Surgical Quality Improvement Program database was queried for tracheostomy patients between 2005 and 2018. The mFI-5 was calculated for each patient by assigning 1 point for each of the following comorbidities: diabetes mellitus, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Univariate and multivariable analyses were conducted to determine associations between the mFI-5 score and postoperative complications., Results: A total of 4438 patients undergoing tracheostomies were queried and stratified into the following groups: mFI = 0 (N = 1741 [39.2%], mFI = 1 (N = 1720 [38.8%]), mFI = 2 (N = 726 [16.4%]), and mFI of 3 or higher (N = 251 [5.7%]). Univariate analysis showed that patients with higher mFI-5 scores had a greater proportion of smoking, dyspnea, obesity, steroid use, emergency cases, complications, reoperations, and mortality (P < .001). Multivariable analyses found associations between mFI-5 score and any complication (odds ratio [OR]: 1.49, 95% confidence interval [CI]: 1.03-2.16, P = .035), mortality (OR: 2.32, 95% CI: 1.15-4.68, P = .019), and any medical complication (OR: 2.75, 95% CI: 1.88-4.02, P < .001)., Conclusion: This study suggests an association between the mFI-5 score and postoperative complications in tracheostomies. mFI-5 score can be used to stratify tracheostomy patients by operative risk., (© 2024 The Authors. Otolaryngology‐Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology‐Head and Neck Surgery Foundation.)
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- 2024
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7. Endoscopic Management of Rhinolithiasis: A Systematic Review.
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Nguyen J, Omiunu A, Patel R, Patel P, Fang CH, and Eloy JA
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- Humans, Male, Female, Adult, Rhinorrhea, Endoscopy methods, Lithiasis, Nose Diseases surgery, Nasal Obstruction etiology
- Abstract
Objective: This study reviews the presentation, management, and outcomes of patients with rhinolithiasis., Data Sources: An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews., Review Methods: Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow-up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp)., Results: Fifty-five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4-80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow-up of 8.5 months (range, 0.25-36 months)., Conclusion: Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long-standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
- Published
- 2023
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8. Analysis of Care and Outcomes for Epistaxis Weekend Admissions.
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Cohen DA, Thomas Perez LS, Chemas-Velez MM, Tseng CC, Eloy JA, and Fang CH
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- Humans, Length of Stay, Retrospective Studies, Multivariate Analysis, Hospital Mortality, Patient Admission, Epistaxis, Hospitalization
- Abstract
Objectives: To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday., Study Design: Retrospective database review., Setting: 2003 to 2014 National Inpatient Sample., Methods: Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions., Results: A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05)., Conclusion: Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
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- 2023
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9. Response to "Facility Volume and Pituitary Surgery".
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Lemdani MS, Choudhry HS, Tseng CC, Fang CH, Sukyte-Raube D, Patel P, and Eloy JA
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- Humans, Treatment Outcome, Postoperative Complications
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- 2023
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10. Kaposi Sarcoma of the Larynx: A Systematic Review.
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Barron K, Omiunu A, Celidonio J, Cruz-Mullane A, Din-Lovinescu C, Chemas-Velez MM, Baredes S, Eloy JA, and Fang CH
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- Humans, Male, Female, Middle Aged, Sarcoma, Kaposi therapy, Sarcoma, Kaposi drug therapy, Acquired Immunodeficiency Syndrome complications, Acquired Immunodeficiency Syndrome drug therapy, HIV Infections complications, HIV Infections drug therapy, Larynx pathology
- Abstract
Objective: Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes., Data Sources: PubMed, CINAHL, SCOPUS, and Cochrane Library., Review Methods: A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow-up, and outcome were analyzed., Results: A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8-81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS-associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow-up was 20.4 months (range, 0.75-120). Most patients with AIDS-associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow-up (n = 13)., Conclusion: This review contains the largest pool of laryngeal KS cases to date. Long-term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
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- 2023
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11. Effect of Hospital Safety Net Burden on Survival for Patients With Sinonasal Squamous Cell Carcinoma.
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Tseng CC, Gao J, Barinsky GL, Fang CH, Grube JG, Patel P, Hsueh WD, and Eloy JA
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- United States epidemiology, Humans, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck, Medicaid, Hospitals, Paranasal Sinus Neoplasms therapy
- Abstract
Objective: To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC)., Study Design: Retrospective database study., Setting: National Cancer Database from 2004 to 2016., Methods: SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low-burden hospitals, 26% to 75% for medium-burden hospitals, and >75% for high-burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival., Results: An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low-burden hospitals, 3314 (50.5%) at medium-burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028-1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036-1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868-47.980), and treatment at a higher-volume facility (P < .001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513-0.949), higher income (P < .05), or treatment modalities other than surgery alone (P < .05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log-rank P = .727)., Conclusion: In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
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- 2023
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12. Impact of Facility Volume on Patient Safety Indicator Events After Transsphenoidal Pituitary Surgery.
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Lemdani MS, Choudhry HS, Tseng CC, Fang CH, Sukyte-Raube D, Patel P, and Eloy JA
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- Humans, Male, Female, Retrospective Studies, Patient Safety, Hospitals
- Abstract
Objectives: To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS)., Study Design: Retrospective database review., Setting: National Inpatient Sample database (2003-2011)., Methods: The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed., Results: An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001)., Conclusion: PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
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- 2023
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13. Sex Disparities in Pediatric Acute Rhinosinusitis: A National Perspective.
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Shah VP, Haimowitz SZ, Desai AD, Barron K, Patel P, Fang CH, Grube JG, Baredes S, and Eloy JA
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- Acute Disease, Adult, Child, Female, Humans, Inpatients, Length of Stay, Male, Retrospective Studies, Young Adult, Sinusitis surgery
- Abstract
Objective: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS)., Study Design: Retrospective cohort study., Setting: National administrative database., Methods: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS ( ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates., Results: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P < .001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P = .464) and length of stay (5.8 vs 6.1 days, P = .263). However, male patients underwent more procedures (1.8 vs 1.5, P < .001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P = .664). Male patients also had increased odds for having orbital (OR, 1.58; P < .001) and intracranial (OR, 1.99; P < .001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P < .001) and intracranial (OR, 3.86; P < .001) complications., Conclusion: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex.
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- 2022
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14. Trends in HPV Testing for Patients With Sinonasal Squamous Cell Carcinoma: A National Analysis.
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Tseng CC, Gao J, Barinsky GL, Fang CH, Hsueh WD, Grube JG, Baredes S, and Eloy JA
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- Humans, Papillomaviridae, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck, Alphapapillomavirus, Carcinoma, Squamous Cell pathology, Papillomavirus Infections complications, Papillomavirus Infections diagnosis, Paranasal Sinus Neoplasms pathology
- Abstract
Objective: The objective of this study was to analyze national trends in human papillomavirus (HPV) testing for patients diagnosed with sinonasal squamous cell carcinoma (SNSCC)., Study Design: Retrospective database study., Setting: National Cancer Database (2010-2016)., Methods: Cases from 2010 to 2016 with a primary SNSCC diagnosis and known HPV testing status were extracted from the National Cancer Database. Univariate and multivariate analyses were then performed to assess differences in socioeconomic, hospital, and tumor characteristics between tested and nontested patients., Results: A total of 2308 SNSCC cases were collected, with 1210 (52.4%) HPV tested and 1098 (47.6%) not tested. On univariate analyses, patient age, insurance, income quartile, population density, treatment facility location, and tumor grade were significantly associated with HPV testing status. After multivariate logistic regression modeling, living in a suburban area had lower odds of HPV testing as compared with living in urban areas (odds ratio, 0.74 [95% CI, 0.55-0.99]; P = .041), while tumor grade III/IV had higher odds than grade I (odds ratio, 1.73 [95% CI, 1.29-2.33]; P < .001). HPV-tested patients had a similar 5-year overall survival to nontested patients (48.3% vs 45.3%, log-rank P = .405). A sharp increase in HPV testing rates was observed after 2010 ( P < .001)., Conclusion: Among patients with SNSCC, those with high-grade tumors were more likely to be tested for HPV, while patients with a suburban area of residence were less likely. Additionally, there was no significant survival benefit to HPV testing, with tested and nontested groups having similar overall survival., Level of Evidence: 4.
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- 2022
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15. Survival Predictors of Head and Neck Burkitt's Lymphoma: An Analysis of the SEER Database.
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Ahsanuddin S, Cadwell JB, Sangal NR, Grube JG, Fang CH, Baredes S, and Eloy JA
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- Adult, Head pathology, Humans, Male, Neck pathology, Neoplasm Staging, Prognosis, Proportional Hazards Models, Retrospective Studies, SEER Program, Burkitt Lymphoma diagnosis, Burkitt Lymphoma drug therapy
- Abstract
Objective: To analyze population-level data for Burkitt's lymphoma of the head and neck., Study Design: Retrospective study of a national cancer database., Setting: Academic medical center., Methods: The SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt's lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences., Results: A total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10-year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P < .001) and higher stage at presentation had increased risk of mortality ( P < .001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P < .001) and 1996 and 2005 (HR, 0.53; P = .001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival ( P < .001)., Conclusion: Burkitt's lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival.
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- 2022
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16. Landscape of Centralized Otolaryngology Research Efforts Grant Recipients Over the Past Decade.
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Roy SC, Wassef DW, Nasser WA, Farber NI, Fang CH, Baredes S, Gray ST, and Eloy JA
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- Adult, Career Choice, Ethnicity, Female, Humans, Internship and Residency, Male, Sex Factors, Societies, Medical, United States, Bibliometrics, Biomedical Research, Otolaryngology education, Research Support as Topic
- Abstract
Objective: To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career., Study Design: Analysis of grant recipients' bibliometrics., Setting: Academic medical center., Methods: The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology-Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h -index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall., Results: The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology ( P > .05). However, there were significantly more female recipients when adjusted for gender differences in the field overall ( P < .01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented ( P < .01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h -index of recipients decreased over the last decade ( P < .01). The h -index of duplicate winners was significantly higher than those of nonduplicate winners ( P < .01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions ( P < .01)., Conclusion: CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success.
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- 2022
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17. Extranodal Extension as an Indicator for Sinonasal Squamous Cell Carcinoma Prognosis.
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Tseng CC, Gao J, Barinsky GL, Fang CH, Grube JG, Eloy JA, and Hsueh WD
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- Aged, Aged, 80 and over, Carcinoma, Squamous Cell mortality, Databases, Factual, Female, Humans, Male, Middle Aged, Paranasal Sinus Neoplasms mortality, Prognosis, Retrospective Studies, Survival Rate, United States, Carcinoma, Squamous Cell pathology, Extranodal Extension pathology, Paranasal Sinus Neoplasms pathology
- Abstract
Objective: Although extranodal extension (ENE) is a known indicator of poor prognosis for head and neck malignancies, its value as an indicator for sinonasal squamous cell carcinoma (SCC) has not been well characterized. This study seeks to assess the usefulness of ENE as a prognostic marker for sinonasal SCC., Study Design: Retrospective database review., Setting: National Cancer Database from 2010 to 2015., Methods: The National Cancer Database was queried from 2010 to 2015 for all patients with sinonasal SCC with available ENE status (n = 355). These cases were divided into those with pathologically confirmed ENE (n = 146) and those without ENE (n = 209). Univariate and multivariate analyses were used to examine survival differences and predictors of ENE status., Results: Most patients with ENE were ≥60 years old (61.7%), male (61.6%), and white (83.6%). Patients aged 60 to 69 and 80+ years were more likely to have ENE than those under 60 years ( P < .05). Patients with ENE had worse 1-year overall survival than those without ENE (58.2% vs 70.8%, log-rank P = .008). After multivariate regression, however, there was no survival difference detected between ENE-positive and ENE-negative cases (hazard ratio, 1.14 [0.775-1.672], P = .508)., Conclusion: ENE status did not have a significant effect on survival in patients with sinonasal SCC. Thus, ENE alone may not necessarily be a helpful indicator for sinonasal SCC prognosis.
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- 2021
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18. Perioperative Desmopressin for Patients Undergoing Otolaryngologic Procedures: A Systematic Review.
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Barinsky GL, Buziashvili D, Svider PF, Carron MA, Folbe AJ, Hsueh WD, Eloy JA, and Johnson AP
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- Humans, Blood Loss, Surgical prevention & control, Deamino Arginine Vasopressin therapeutic use, Hemostatics therapeutic use, Otorhinolaryngologic Diseases surgery
- Abstract
Objective: Desmopressin (DDAVP) is a hemostatic agent used to manage bleeding in patients with hemostatic disorders, and there is a lack of published data to guide its use during otolaryngology procedures. The objective of this study was to conduct an evidence-based systematic review of the reported uses, efficacy, and adverse effects of DDAVP in the otolaryngology surgical setting., Data Sources: PubMed, MEDLINE, and EmBase were searched for articles on the use of DDAVP in otolaryngology., Review Methods: The Methodological Index for Non-Randomized Studies criteria and Cochrane bias tool were used to assess study quality. Patient demographics, DDAVP dosing and route, and outcomes such as bleeding and adverse events were collected. A summary of evidence table was created specifying levels of evidence, benefits, and harm., Results: Nineteen studies encompassing 440 patients were included. Sixteen studies discussed DDAVP for prophylaxis, and 3 discussed postoperative use. DDAVP effectively prevented bleeding in high-risk patients and successfully facilitated a dry surgical field when necessary. DDAVP had a 100% success rate when used symptomatically. Five studies described adverse effects, including hyponatremia (12.3%), nausea (2.0%), emesis (0.9%), and seizure (0.2%). The aggregate level of evidence for its use was Level B for adenotonsillectomy, septoplasty, and turbinate procedures and Level C for rhinoplasty., Conclusion: Current literature supports the use of DDAVP in otolaryngology surgical procedures as both a perioperative prophylactic agent and a postoperative symptomatic intervention for bleeding. Both modalities are effective with minimal adverse events. Further well-designed randomized trials are necessary to conclusively formulate guidelines for DDAVP use in otolaryngology.
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- 2019
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19. Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery.
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Crippen MM, Brady JS, Mozeika AM, Eloy JA, Baredes S, and Park RCW
- Subjects
- Adult, Aged, Cohort Studies, Databases, Factual, Esthetics, Female, Free Tissue Flaps transplantation, Graft Rejection, Graft Survival, Head and Neck Neoplasms pathology, Humans, Logistic Models, Male, Middle Aged, Neck Dissection methods, Odds Ratio, Postoperative Complications physiopathology, Postoperative Complications surgery, Quality Improvement, Plastic Surgery Procedures methods, Reference Values, Retrospective Studies, Wound Healing physiology, Body Mass Index, Free Tissue Flaps adverse effects, Head and Neck Neoplasms surgery, Obesity complications, Plastic Surgery Procedures adverse effects
- Abstract
Objective: Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction., Study Design and Setting: Retrospective cohort study., Subjects and Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ
2 and binary logistic regression analyses., Results: Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively)., Conclusion: Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient's fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.- Published
- 2018
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20. Predictors of Clinicopathologic Stage Discrepancy in Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study.
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Kılıç S, Kılıç SS, Shah KP, Eloy JA, Baredes S, Mahmoud OM, and Park RCW
- Subjects
- Aged, Aged, 80 and over, Carcinoma, Squamous Cell surgery, Databases, Factual, Female, Humans, Male, Middle Aged, Neoplasm Staging, Oropharyngeal Neoplasms surgery, Prognosis, Retrospective Studies, Survival Analysis, United States, Carcinoma, Squamous Cell pathology, Oropharyngeal Neoplasms pathology
- Abstract
Objective To determine the frequency, associated factors, and prognosis of clinicopathologic stage discrepancy in oropharyngeal squamous cell carcinoma (OPSCC). Study Design Retrospective study using a national database. Setting National Cancer Database. Subjects and Methods Cases of OPSCC diagnosed between January 1, 2004, and December 31, 2013, with full clinical and pathologic staging information available were identified. Demographic, clinicopathologic, and treatment variables associated with overall stage discrepancy were identified by multivariate logistic regression analysis. Results In total, 7731 cases of OPSCC were identified. Overall stage discrepancy was present in 30.2% of cases (21.9% upstaging, 8.2% downstaging). A total of 13.1% of cases were T-upstaged, and 10.5% of cases were T-downstaged; 22.9% of cases were N-upstaged, and 8.6% of cases were N-downstaged. Upstaging by overall stage was associated with a high Charlson-Deyo score, high tumor grade, number of lymph nodes examined, and increasing tumor size. No factors were positively associated with downstaging. High tumor grade was negatively associated with downstaging. For stage II, III, and IVA tumors, upstaging was associated with poorer OS. Conclusion Clinicopathologic stage discrepancy is common in OPSCC and is likely attributable to insensitive clinical staging techniques as well as to intrinsic tumor biologic properties. Upstaging is associated with poorer prognosis, which is likely due to advancement of disease.
- Published
- 2018
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21. A Population-Based Analysis of Survival for Sinonasal Rhabdomyosarcoma.
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Unsal AA, Chung SY, Unsal AB, Baredes S, and Eloy JA
- Subjects
- Adult, Demography, Female, Humans, Male, Paranasal Sinus Neoplasms pathology, Prognosis, Rhabdomyosarcoma pathology, SEER Program, Survival Rate, Treatment Outcome, United States, Paranasal Sinus Neoplasms mortality, Paranasal Sinus Neoplasms therapy, Rhabdomyosarcoma mortality, Rhabdomyosarcoma therapy
- Abstract
Objectives Literature detailing factors affecting survival in sinonasal rhabdomyosarcoma (SNRMS) is limited due to its rarity. We analyze the demographics, potential prognostic factors, overall survival, and treatment efficacy of SNRMS. Study Design and Setting Administrative database study. Methods SNRMS was queried in the SEER database (1973-2013; Surveillance, Epidemiology, and End Results). Data were analyzed for demographic and clinicopathologic trends. Kaplan-Meier model was utilized for assessing survival. Results A total of 286 cases of SNRMS were identified. The median age at diagnosis was 24.5 years, and the mean tumor size was 5.1 cm. Overall 5-, 10-, and 20-year disease-specific survival was 35.1%, 25.4%, and 12.0%, respectively. Regional lymph node involvement was present at diagnosis in more than half of cases (54.3%) and distant metastasis in 32.2% of cases. Alveolar rhabdomyosarcoma (54.9%) and embryonal rhabdomyosarcoma (23.8%) were the primary histologies. Alveolar-type SNRMS was more likely than the embryonal type to metastasize to distant sites (41.7% vs 24.1%), and it possessed poorer 5-year survival (29.2% vs 45.6%). Distant metastasis decreased 5-year survival from 35.1% to 3.8%, whereas lymph node involvement did not significantly affect survival. Patients <10 years old had the highest survival rates. Primary tumor origin by subsite did not significantly affect survival. Smaller tumor sizes and earlier Intergroup Rhabdomyosarcoma Study Group stages were associated with improved outcomes. Surgical therapy had the highest survival rates. Conclusion SNRMS has overall poorer prognosis than all other parameningeal rhabdomyosarcomas studied. Age <10 years, smaller tumor sizes, lack of distant metastasis, localized tumors, earlier Intergroup Rhabdomyosarcoma Study Group stages, and embryonal histology were all associated with improved outcomes.
- Published
- 2017
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22. A 10-Year Analysis of Head and Neck Injuries Involving Nonpowder Firearms.
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Dandu KV, Carniol ET, Sanghvi S, Baredes S, and Eloy JA
- Subjects
- Adolescent, Adult, Age Distribution, Child, Child, Preschool, Consumer Product Safety, Craniocerebral Trauma epidemiology, Craniocerebral Trauma physiopathology, Cross-Sectional Studies, Databases, Factual, Emergency Service, Hospital statistics & numerical data, Female, Humans, Incidence, Injury Severity Score, Male, Neck Injuries epidemiology, Neck Injuries physiopathology, Needs Assessment, Retrospective Studies, Risk Assessment, Sex Distribution, United States, Wounds, Gunshot etiology, Wounds, Gunshot physiopathology, Craniocerebral Trauma etiology, Firearms classification, Neck Injuries etiology, Play and Playthings, Wounds, Gunshot epidemiology
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Objectives Firearms have an enduring and visible presence within American culture. However, the public health impact of nonpowder firearms and other "toy" guns has not been fully studied. These guns-including BB guns (ie, ball bearing), paintball guns, and pellet guns-are typically marketed to a younger audience. The objective of this study is to analyze head and neck injuries related to nonpowder firearms. Study Design Cross-sectional analysis of a national database. Setting Academic medical center. Subjects and Methods The National Electronic Injury Surveillance System was queried for head and neck injuries involving nonpowder guns, including air, BB, and pellet guns, and associated ammunition. Analysis of age, sex, incidence, injury location, and diagnosis was performed. Results From 2005 to 2014, there were 1695 cases recorded, or 55,060 estimated emergency room visits, due to injuries related to nonpowder guns and fired ammunition. The majority of patients were male (80.9%). These injuries were most common in children 6 to 12 years of age (37.9%), followed by those 13 to 18 years old (27.1%) and adults (≥19 years old; 17.8%), while preschool children (0-5 years) represented 17.2%. The most common injury diagnosis was penetrating foreign body (34.9%), followed by lacerations (24.3%) and contusions/abrasions (13.7%). Conclusion Nonpowder and other nonlethal firearm-related injuries to the head and neck region are a frequent source of emergency room visits nationally. Safety measures and public education on a mainstream level are required.
- Published
- 2017
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23. Outcomes of Vestibular Schwannoma Surgery among the Elderly.
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Sylvester MJ, Shastri DN, Patel VM, Raikundalia MD, Eloy JA, Baredes S, and Ying YM
- Subjects
- Adult, Age Factors, Aged, Female, Hospital Charges, Humans, Length of Stay, Male, Middle Aged, Neuroma, Acoustic complications, Retrospective Studies, Socioeconomic Factors, Treatment Outcome, Neuroma, Acoustic surgery
- Abstract
Objective To compare comorbidities and in-hospital complications between elderly and nonelderly patients undergoing vestibular schwannoma (VS) surgery. To examine average length of stay (LOS) and hospital charges among elderly patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Retrospective analysis of the National Inpatient Sample for patients undergoing VS surgery from 2002 to 2010: 4137 patients met inclusion criteria, with 519 (12.5%) in the elderly cohort (≥65 years). Outcomes of elderly and nonelderly (<65 years) patient cohorts were compared. Results Compared with the nonelderly cohort, the elderly cohort had more comorbidities, including diabetes mellitus, hypertension, and pulmonary disease (all P < .001). Elderly patients had longer LOS (6.5 vs 5.4 days; P = .001) but did not incur significantly greater hospital charges. Rates of cerebrospinal fluid leak, meningitis, and facial nerve injury did not vary significantly between groups. The elderly cohort experienced higher rates of in-hospital complications, including acute cardiac events, iatrogenic cerebrovascular infarction/hemorrhage, postoperative bleeding (hemorrhage/hematoma), and in-hospital mortality (all P < .05). In binary logistic regression, correcting for patient demographics and presence of comorbidities, elderly status was associated with 1.848 (95% confidence interval, 1.167-2.927; P = .009) greater odds of medical complications and 13.188 (95% confidence interval, 1.829-95.113; P = .011) greater odds of in-hospital mortality. Conclusion Elderly patients undergoing VS surgery have more comorbidities, in-hospital complications, and longer LOS than nonelderly patients. The elderly cohort had a greater rate of in-hospital mortality, though rare. Interestingly, elderly patients did not have a higher rate of many known complications associated with VS surgery and did not incur more hospital charges.
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- 2017
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24. Laryngeal Verrucous Carcinoma.
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Echanique KA, Desai SV, Marchiano E, Spinazzi EF, Strojan P, Baredes S, and Eloy JA
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- Carcinoma, Verrucous mortality, Carcinoma, Verrucous pathology, Humans, Laryngeal Neoplasms mortality, Laryngeal Neoplasms pathology, Laryngectomy, Neoplasm Staging, Prognosis, Carcinoma, Verrucous therapy, Laryngeal Neoplasms therapy
- Abstract
Objective Laryngeal verrucous carcinoma (LVC) is a rare, locally invasive neoplasm comprising 1% to 3.4% of laryngeal carcinomas. Management strategies are a topic of ongoing conversation, and no definitive treatment protocol based on T stage and presentation exists. This review examines characteristics, treatment modalities, and patient outcomes of LVC. Data Sources PubMed, MEDLINE, EMBASE, and Web of Science. Methods Databases were searched through October 29, 2015, for literature detailing individual patient cases of LVC. Variables analyzed included patient demographics, tumor characteristics, tumor size, treatment, and outcomes. Results Thirty-seven articles with 369 cases were included. LVC was found more commonly in males (13.8:1), at an average age of 58.7 years, and located in the glottis (74.0%). Most patients had local disease at presentation (94.9%). The most common presenting symptom was hoarseness (92.3%). The most common primary treatment was surgery alone (72.3%), with local excision as the most common technique (56.8%). In patients with data available on both surgical modality and T stage, most patients who presented as T1 and were managed surgically underwent local excision (79.2%). Surgical treatment alone led to high rates of disease-free survival at follow-up (86.8%). A large number of patients presenting with T1 disease were disease free at follow-up (88.6%). Overall survival was 80.3%. Conclusion LVC is most often managed surgically. The extent of surgical resection may be guided by T stage, with smaller tumors resected via local excision and larger tumors via partial or total laryngectomy. Regardless of T stage or therapy, LVC has a good posttreatment prognosis.
- Published
- 2017
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25. Efficacy of Elective Neck Dissection in T1/T2N0M0 Oral Tongue Squamous Cell Carcinoma: A Population-Based Analysis.
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Patel TD, Vázquez A, Marchiano E, Sanghvi S, Eloy JA, Baredes S, and Park RC
- Subjects
- Carcinoma, Squamous Cell epidemiology, Elective Surgical Procedures, Female, Humans, Male, Middle Aged, Neoplasm Staging, Retrospective Studies, SEER Program, Survival Analysis, Tongue Neoplasms epidemiology, United States epidemiology, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Neck Dissection methods, Tongue Neoplasms pathology, Tongue Neoplasms surgery
- Abstract
Objective/hypothesis: The aim of this population-based study is to analyze the survival benefits of elective neck dissection (END) over neck observation in T1/T2N0M0 oral tongue squamous cell carcinoma (OT-SCC) cases., Study Design: Retrospective administrative database analysis., Subjects and Methods: The SEER database (Surveillance, Epidemiology, and End Results) was queried for patients diagnosed with T1/T2N0M0 OT-SCC from 1998 to 2011. Data included patient demographics, initial treatment, and survival outcomes. The Kaplan-Meier model and the Cox proportional hazards model were utilized for survival analysis., Results: Out of 7010 T1/T2N0M0 cases, END was performed in 1770 T1 and 950 T2 cases, and the neck was observed in 3278 T1 and 1001 T2 cases. Significantly poorer 5-year disease-specific survival (DSS) rates were noted for the neck observation group when compared with the END group for tumors with moderately differentiated (72.1% vs 86%, P < .0001) and poorly differentiated or undifferentiated (55.6% vs 71.5%, P = .0001) histologic grades. No significant survival benefit was seen between the END group and the neck observation group when tumor size was <1 cm, regardless of histology grade. However, those with tumors >1 cm had a significantly better 5-year DSS with END, except for the well-differentiated tumor cohort, which showed improved survival only when the tumors were >2 cm (5-year DSS: END vs neck observation, 83.5% vs 65.7%, P = .0002)., Conclusion: END improves DSS versus neck observation in T1/T2N0M0 OT-SCC patients with moderately differentiated, poorly differentiated, or undifferentiated histologic grade tumors >1 cm. Those with well-differentiated tumors benefited from END only when tumor size was >2 cm., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)
- Published
- 2016
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26. Survival Impact of Initial Therapy in Patients with T1-T2 Glottic Squamous Cell Carcinoma.
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Brady JS, Marchiano E, Kam D, Baredes S, Eloy JA, and Park RC
- Subjects
- Aged, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Combined Modality Therapy, Female, Humans, Laryngeal Neoplasms mortality, Laryngeal Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, SEER Program, Survival Rate, Carcinoma, Squamous Cell radiotherapy, Carcinoma, Squamous Cell surgery, Glottis pathology, Laryngeal Neoplasms radiotherapy, Laryngeal Neoplasms surgery
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Objective: Laryngeal cancer most commonly arises from the glottis. Comparable outcomes in survival have been shown in patients with early glottic squamous cell carcinoma treated with either surgery or radiotherapy., Study Design and Setting: Administrative database study., Subjects and Methods: The US National Cancer Institute's SEER database (Surveillance, Epidemiology, and End Results) was queried for cases of early glottic cancer (T1-T2N0M0, 1988-2012). We identified 13,312 qualifying cases. Patient demographics, therapeutic measures, and survival outcomes were examined with appropriate univariate and multivariate analyses., Results: Early glottic cancer has a mean age at diagnosis of 64.8 ± 11.6 years and a male:female ratio of 6.9:1. The most common treatment modality was radiotherapy alone (51.6%), followed by combination therapy with surgery first (31.5%). Overall, the 5-year disease-specific survival (DSS) rate was 88.4%. When stratified by treatment modality and stage, 5-year DSS for T1 tumors was 93.2% with surgery alone and 89.0% with radiation alone (P < .0001). With combination therapy, the 5-year DSS was 91.3% for surgery first and 84.9% for radiation first (P = .0239). In T2 tumors, 5-year DSS was improved with single-modality therapy versus multimodality therapy (81.1% vs 76.4; P = .0255)., Conclusion: In T1 disease, surgery alone shows improved 5-year DSS versus radiation alone, but this difference was not observed in T2 tumors. Additionally, surgery, rather than radiation, shows improved 5-year DSS when implemented as a first-line therapy. Combination therapy does not show improved 5-year DSS for early glottic cancer., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)
- Published
- 2016
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27. Impact of Nodal Level Distribution on Survival in Oral Cavity Squamous Cell Carcinoma: A Population-Based Study.
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Marchiano E, Patel TD, Eloy JA, Baredes S, and Park RC
- Subjects
- Aged, Carcinoma, Squamous Cell therapy, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Mouth Neoplasms therapy, Neck Dissection, Prognosis, Registries, Retrospective Studies, SEER Program, Survival Analysis, Treatment Outcome, Carcinoma, Squamous Cell pathology, Lymphatic Metastasis pathology, Mouth Neoplasms pathology
- Abstract
Objective: Regional lymph node metastasis is an important prognostic factor in squamous cell carcinoma of the head and neck, decreasing survival by up to 50%. Oral cavity squamous cell carcinoma (OC-SCCa) most commonly spreads to levels I, II, and III., Study Design: Retrospective analysis of a population-based tumor registry., Setting: Academic medical center., Subjects and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of OC-SCCa from 2004 to 2011 (22,973 cases). Resulting data including patient demographics, clinicopathological features, topographical distribution of nodal metastasis, and survival based on lymph node level involvement were analyzed., Results: In total, 8281 patients were identified with OC-SCCa who underwent neck dissection. Level I, closely followed by levels II and III, represented the most commonly involved nodal basins. The 5-year disease-specific survival (DSS) for patients with only level I, II, or III was 42.0% compared with 30.6% for the level IV group (P < .0001) and 26.4% for the level V group (P < .0001). Surgery with adjuvant radiotherapy improved 5-year DSS for patients with level I to III, level IV, and level V neck disease compared with surgery alone (50.7% vs 48.6%, P = .0109; 39.9% vs 23.2%, P < .0001; and 33.3% vs 9.1%, P = .0005, for levels I-III, IV, and V, respectively)., Conclusion: Oral cavity squamous cell carcinoma most commonly involves nodal levels I, II, and III. Involvement of nodal level IV or V portends a worse prognosis than patients with only level I to III disease, and multimodality therapy should be considered for these patients., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)
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- 2016
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28. Utility of Surgery/Radiotherapy in Distant Metastatic Head and Neck Squamous Cell Carcinoma: A Population-Based Approach.
- Author
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Patel TD, Marchiano E, Chin OY, Kilic S, Eloy JA, Baredes S, and Park RC
- Subjects
- Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Combined Modality Therapy, Female, Head and Neck Neoplasms mortality, Head and Neck Neoplasms pathology, Humans, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Staging, Quality of Life, Retrospective Studies, SEER Program, Survival Rate, Treatment Outcome, Carcinoma, Squamous Cell radiotherapy, Carcinoma, Squamous Cell surgery, Head and Neck Neoplasms radiotherapy, Head and Neck Neoplasms surgery
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Objectives: The aim of this study is to analyze the survival benefits of surgery and/or radiation therapy over no therapy in patients with metastatic (M1) squamous cell carcinoma of the head and neck region (HN-SCC)., Study Design: Retrospective administrative database analysis., Subjects and Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for M1 HN-SCC cases from 1988 to 2012 (6663 patients). Patient demographics, initial treatment, and survival outcomes were analyzed. Survival was analyzed with the Kaplan-Meier model., Results: Of the 6663 patients identified with M1 HN-SCC in the SEER database, 1669 patients received no therapy; 2459 patients, radiotherapy; 570 patients, surgery; and 1100 patients, surgery with adjuvant radiotherapy. The mean survival was 8.44 months for patients who did not undergo any therapy. In comparison, patients who underwent radiotherapy alone, surgery alone, or surgery with radiotherapy had mean survivals of 18.03 (P < .0001), 31.07 (P < .0001), and 39.93 (P < .0001) months, respectively. The 5-year disease-specific survival rates were 6.35% for no therapy, 17.51% for radiotherapy alone, 30.50% for surgery alone, and 33.75% for surgery with radiotherapy (P < .0001). Site-specific analysis revealed that surgery and/or radiation provides disease-specific survival benefit as compared with no therapy at all subsites within the head and neck region., Conclusions: Surgery and/or radiation-which has been shown to improve quality of life in patients with advanced cancer-is associated with an increased survival when utilized in patients with distant metastatic disease., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)
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- 2016
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29. Frontal Sinus Malignancies: A Population-Based Analysis of Incidence and Survival.
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Bhojwani A, Unsal A, Dubal PM, Echanique KA, Baredes S, Liu JK, and Eloy JA
- Subjects
- Female, Humans, Incidence, Male, Middle Aged, Retrospective Studies, SEER Program, Survival Analysis, United States epidemiology, Frontal Sinus pathology, Paranasal Sinus Neoplasms epidemiology, Paranasal Sinus Neoplasms pathology
- Abstract
Objective: Primary neoplasms originating in the frontal sinus are rare. As such, existing literature describing frontal sinus malignancies (a subset of frontal sinus neoplasms) is limited. Prognostic implications of these malignancies are difficult to determine. This study seeks to analyze trends in epidemiology, clinicopathology, incidence, and survival for these rare malignancies., Study Design: Retrospective database analysis., Methods: The SEER 18 database (Surveillance, Epidemiology, and End Results; 1973-2012) was searched for frontal sinus malignancies from 1973 to 2012 and analyzed for demographic and clinicopathologic trends. The Kaplan-Meier model was utilized for survival analysis., Results: A total of 171 cases of frontal sinus malignancies were identified. Incidence was 0.011 per 100,000 individuals. The mean age at diagnosis was 61.1 years, with males constituting the majority of cases (61.4%). 80.1% of patients were white, 9.4% Asian, and 8.2% black. The average tumor size was 3.8 cm. The most common histology encountered was squamous cell carcinoma (39.8%). Overall 5-year disease-specific survival was 44.2%. Five-year disease-specific survival was highest for mature B-cell non-Hodgkin's lymphomas (72.3%) and lowest for adenocarcinomas (15.4%)., Conclusions: Malignant tumors of the frontal sinus are rare and are more common in males. Squamous cell carcinoma is the most common entity encountered. Of the 4 most common histologies, survival is best for mature B-cell non-Hodgkin's lymphomas and worst for adenocarcinomas., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2016
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30. Laryngeal Adenoid Cystic Carcinoma: A Systematic Review.
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Marchiano E, Chin OY, Fang CH, Park RC, Baredes S, and Eloy JA
- Subjects
- Combined Modality Therapy, Diagnosis, Differential, Diagnostic Imaging, Humans, Neoplasm Recurrence, Local, Carcinoma, Adenoid Cystic diagnosis, Carcinoma, Adenoid Cystic epidemiology, Carcinoma, Adenoid Cystic therapy, Laryngeal Neoplasms diagnosis, Laryngeal Neoplasms epidemiology, Laryngeal Neoplasms therapy
- Abstract
Objective: Adenoid cystic carcinoma is a malignant minor salivary gland tumor that represents <1% of all laryngeal tumors. The submucosal location of laryngeal adenoid cystic carcinoma (LACC) results in delayed presentation. Here, we present the first systematic review of reported cases of LACC to determine trends in presentation, diagnostic and treatment modalities, and patient outcome., Data Sources: PubMed, Web of Science, MEDLINE, and EMBASE databases., Methods: A search of the above databases was done to identify articles reporting cases of LACC. The variables included in the analysis were patient demographics, presenting symptoms, tumor location, imaging, treatment, follow-up time, recurrence, and outcome., Results: A total of 50 articles and 120 cases were included in the review. The most common presenting symptom was dyspnea (48.8%), followed by hoarseness (43.9%). LACC arose most frequently from the subglottis (56.7%). At presentation, 14.6% (13 of 89) of patients had regional disease. The average follow-up time was 54.0 months. At follow-up, distant metastasis was reported in 30 cases (33.3%). Surgery alone (43.3%) and surgery with radiotherapy (43.3%) were used most frequently and resulted in 57.1% and 55.3% of patients alive with no evidence disease at follow-up, respectively., Conclusion: LACC was most often located in the subglottis. Patients commonly presented with dyspnea and hoarseness. In this systematic review, surgery with radiotherapy and surgery alone were the most commonly employed treatment modalities, and both resulted in slightly more than 50% of patients alive with no evidence of disease at follow-up., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2016
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31. Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Surgery.
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Raikundalia MD, Fang CH, Spinazzi EF, Vazquez A, Park RC, Baredes S, and Eloy JA
- Subjects
- Aged, Comorbidity, Female, Head and Neck Neoplasms surgery, Hospital Mortality trends, Humans, Length of Stay trends, Male, Retrospective Studies, Risk Assessment, Survival Rate trends, Diabetes Mellitus epidemiology, Head and Neck Neoplasms epidemiology, Inpatients, Neck Dissection, Population Surveillance methods, Postoperative Complications epidemiology, Registries
- Abstract
Objective: The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for patients undergoing surgery for head and neck cancer (HNCA) is not well established. We used the Nationwide Inpatient Sample to analyze the postoperative impact of DM on HNCA patients., Study Design: Population-based inpatient registry analysis., Setting: Academic medical center., Subjects and Methods: Discharge data from the Nationwide Inpatient Sample were analyzed for patients undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between HNCA patients with and without DM., Results: Of 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting comorbidities, had longer hospitalizations, and incurred greater hospital charges. Compared with the non-DM cohort, DM patients experienced significantly higher rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs 4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .794). On multivariate logistic regression corrected for age and race, DM patients had greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P < .001), and acute renal failure (2.023, P < .001)., Conclusions: DM is associated with greater length of stay and hospital charges among HNCA patients. DM patients have significantly greater rates of postoperative complications, including postoperative infections, cardiac events, and acute renal failure., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2016
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32. Subglottic Squamous Cell Carcinoma: A Population-Based Study of 889 Cases.
- Author
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Marchiano E, Patel DM, Patel TD, Patel AA, Xue YE, Eloy JA, Baredes S, and Park RC
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell therapy, Combined Modality Therapy methods, Disease-Free Survival, Female, Follow-Up Studies, Humans, Laryngeal Neoplasms therapy, Male, Middle Aged, New Jersey epidemiology, Prognosis, Retrospective Studies, Survival Rate trends, Young Adult, Carcinoma, Squamous Cell epidemiology, Forecasting, Laryngeal Neoplasms epidemiology, Population Surveillance methods, SEER Program
- Abstract
Objective: Subglottic squamous cell carcinoma (SCCa) is a rare malignancy representing <5% of all laryngeal cancers. Patients often present with late-stage disease, and survival outcomes are reportedly worse than those for SCCa in other regions of the larynx., Study Design: Analysis of a population-based tumor registry., Setting: Academic medical center., Subjects and Methods: The US National Cancer Institute's Surveillance, Epidemiology, and End Results database was queried for cases of subglottic SCCa from 1973 to 2011 (889 cases). Resulting data were analyzed, including patient demographics, therapeutic measures, and survival outcomes., Results: Subglottic SCCa most frequently occurred in the fifth to seventh decade of life, with a mean age at diagnosis of 65.7 ± 11.3 years. There was a strong male predilection, with a male:female ratio of 3.83:1. Most patients were stage III and IV (64.4%) per the American Joint Committee on Cancer. The most common treatment modality was a combination of radiotherapy and surgery (38.8%), followed by radiotherapy alone (33.9%), and surgery alone (17.0%). Overall 5-year disease-specific survival rate was 53.7%. When stratified by treatment modality, 5-year disease-specific survival was 62.4% for surgery alone, 56.7% for radiotherapy alone, and 55.1% for surgery with adjuvant radiotherapy (P = .3892)., Conclusion: This study represents the largest cohort of subglottic SCCa. It shows a strong predilection for men in the US population. Surgery with adjuvant radiotherapy was the most commonly employed treatment modality. No statistically significant differences were observed in 5-year DSS by treatment modality., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2016
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33. Comparative Analysis of Head and Neck and Non-Head and Neck Malignant Peripheral Nerve Sheath Tumors.
- Author
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Patel TD, Shaigany K, Fang CH, Park RC, Baredes S, and Eloy JA
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Survival Analysis, Survival Rate, Young Adult, Head and Neck Neoplasms diagnosis, Head and Neck Neoplasms mortality, Head and Neck Neoplasms therapy, Neurilemmoma diagnosis, Neurilemmoma mortality, Neurilemmoma therapy
- Abstract
Objectives: Malignant peripheral nerve sheath tumors (MPNSTs) are a group of tumors that arise from peripheral nerves or from the various elements of the nerve sheath, including Schwann cells and perineural fibroblasts. Head and neck MPNSTs (HN-MPNSTs) are rare, accounting for 8% to 16% of all soft tissue sarcomas. This study analyzes the demographic, clinicopathologic, and survival characteristics of HN-MPNSTs and establishes comparisons with MPNSTs at other body sites (other-MPNSTs)., Study Design: Analysis of population-based tumor registry., Setting: Academic medical center., Subjects and Methods: The SEER database (Surveillance, Epidemiology, and End Results; 1973-2012) was queried for HN-MPNSTs (324 cases) and other-MPNSTs (1680 cases). Data were analyzed comparatively with respect to various demographic and clinicopathologic factors. Disease-specific survival was analyzed with the Kaplan-Meier model., Results: Mean age at diagnosis for HN-MPNST was 49.1 years, compared with 46.1 years for other-MPNSTs (P = .0169). There was a sex predilection for males in HN-MPNSTs (60.2%) versus a female predilection for other-MPNSTs (54.2%; P < .0001). Average tumor size for HN-MPNSTs was 4.9 cm, compared with 8.7 cm for other-MPNSTs (P < .0001). HN-MPNSTs were more commonly of low histologic grade types, whereas other-MPNSTs were mostly of high histologic grade (P = .0073). HN-MPNSTs had a higher 5-year disease-specific survival than other-MPNSTs (65.1% vs 57.4%; P = .0209)., Conclusions: HN-MPNSTs are rare entities. This study represents the largest series of HN-MPNSTs to date. Although HN-MPNSTs and other-MPNSTs share a common histology, there are important clinical differences between the 2 groups., (© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.)
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- 2016
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34. "Beaned": A 5-Year Analysis of Baseball-Related Injuries of the Face.
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Carniol ET, Shaigany K, Svider PF, Folbe AJ, Zuliani GF, Baredes S, and Eloy JA
- Subjects
- Adolescent, Child, Cross-Sectional Studies, Databases, Factual, Facial Injuries, Female, Humans, Male, Baseball injuries
- Abstract
Objectives: Baseball remains one of the most popular and safest games played by children and adults in America and worldwide. Rules and equipment changes have continued to make the game safer. For youth leagues, pitching restrictions, safety balls, helmets, and face mask equipment continue to make the game safer. With increased utilization of safety equipment, the objective was to analyze recent trends in baseball-related facial injuries., Study Design: Cross-sectional analysis of a national database., Methods: The National Electronic Injury Surveillance System was searched for baseball-related facial injuries with analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations., Results: From 2009 to 2013, there were 5270 cases entries, or 187,533 estimated emergency department (ED) visits, due to baseball-related facial injuries. During this time, there was a significant decline in the incidence of ED visits (P = .014). Inclusion criteria were met by 3208 visits. The majority of injuries occurred in patients ≤18 years old (81.5%). The most common injury was laceration (33.2%), followed by contusion (29.7%) and fracture (26.9%), while the most common injury site on the face was the nose (24.9%). The injuries were most commonly due to impact from a baseball (70%) or a bat (12.5%)., Conclusion: The overall incidence of ED visits due to baseball-related facial injuries has decreased over the past 5 years, concurrent with increased societal use of protective equipment. Nonetheless, these injuries remain a common source for ED visits, and a continued effort to utilize safety measures should be made, particularly in youth leagues., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2015
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35. Laryngeal Neuroendocrine Carcinoma: A Population-Based Analysis of Incidence and Survival.
- Author
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Ghosh R, Dutta R, Dubal PM, Park RC, Baredes S, and Eloy JA
- Subjects
- Carcinoma, Neuroendocrine mortality, Carcinoma, Neuroendocrine therapy, Carcinoma, Small Cell epidemiology, Carcinoma, Small Cell mortality, Female, Humans, Laryngeal Neoplasms mortality, Laryngeal Neoplasms therapy, Male, Middle Aged, Neoplasm Grading, Neoplasm Staging, Prognosis, Proportional Hazards Models, Registries, United States epidemiology, Carcinoma, Neuroendocrine epidemiology, Laryngeal Neoplasms epidemiology
- Abstract
Objective: Laryngeal neuroendocrine carcinoma (LNEC) is a rare malignancy with various subtypes, each with different characteristics. Classification of these subtypes is used to delineate treatment and management, as most are clinically aggressive with poor prognosis. This study analyzes the characteristics and survival outcomes of LNEC using population-based data., Study Design: Analysis of a population-based tumor registry., Setting: Academic medical center., Subjects and Methods: The Surveillance, Epidemiology, and End Results (SEER) database (1973-2011) was queried for LNEC cases. Data analyzed included patient demographics, incidence, treatment modality, and survival., Results: In total, 257 LNEC cases were extracted from the SEER database. Sixty-three percent were male, and the mean age of diagnosis was 61.9 years. Most cases were located in the supraglottis (62.6%), were of the small cell carcinoma (52.9%) histologic subtype, and were grade IV (40.9%) and American Joint Committee on Cancer (AJCC) stage IV (59.4%). Surgery and radiotherapy were used as treatment modalities in 38.3% and 59.8% of patients, respectively. Overall 5-year disease-specific survival (DSS) for all LNEC was 30.2%, with lower grade, lower AJCC stage, and treatment with surgery having higher 5-year DSS., Conclusions: LNEC often presents as an aggressive tumor at an advanced stage and has poor survival outcomes. Poor prognostic factors include high histologic grade, advanced stage disease, and not undergoing surgical resection. LNEC may be best treated depending on its histologic differentiation, with surgery being beneficial for early grade tumors while radiotherapy is inconclusive in its benefit for late-stage disease., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2015
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36. Laryngeal Verrucous Carcinoma: A Population-Based Analysis.
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Dubal PM, Svider PF, Kam D, Dutta R, Baredes S, and Eloy JA
- Subjects
- Adult, Aged, Aged, 80 and over, Carcinoma, Verrucous diagnosis, Female, Humans, Incidence, Laryngeal Neoplasms diagnosis, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate trends, United States epidemiology, Carcinoma, Verrucous epidemiology, Laryngeal Neoplasms epidemiology, Population Surveillance methods, SEER Program
- Abstract
Objective: Verrucous carcinoma of the larynx (VCL) is a rare entity with reportedly favorable prognosis. Current analyses are limited primarily to case reports and case series, thus making a population-based analysis useful in characterizing frequency, incidence, and survival trends to guide clinical diagnosis and decision making., Study Design: Analysis of the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) database., Methods: Cases of VCL diagnosed between 1973 and 2011 were searched in the SEER database. Analysis was carried out with respect to patient demographics, tumor characteristics, incidence, treatment modality, and survival., Results: In sum, 516 patients with VCL were identified. Males composed 88.4% of cases. Whites accounted for 88.4% of cases, with 8.1% of cases occurring in black patients. Most cases (79.7%) arose in the glottis, a statistically significant predilection when compared with other laryngeal malignancies (P < .0001). Incidence of VCL decreased from 2000 to 2011, with an annual percent change of -5.4%. Overall 1-, 5-, and 10-year disease-specific survival for VCL was 97.5%, 88.0%, and 77.4%, while 1-, 5-, and 10-year relative survival was 98.1%, 85.5%, and 74.2%, respectively. Surgery seemed to confer better prognosis when compared with other treatment modalities., Conclusions: This large population-based analysis of VCL demonstrates that this entity has a good prognosis, arises in the glottis, and is decreasing in incidence. Five-year survival seems highest when surgery is utilized. However, this finding may be subject to selection bias in high-stage lesions., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
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- 2015
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37. Epithelial-Myoepithelial Carcinoma of the Salivary Glands: An Analysis of 246 Cases.
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Vázquez A, Patel TD, D'Aguillo CM, Abdou RY, Farver W, Baredes S, Eloy JA, and Park RC
- Subjects
- Demography, Female, Humans, Male, Middle Aged, Neoplasm Metastasis, Retrospective Studies, Myoepithelioma epidemiology, Myoepithelioma mortality, Myoepithelioma pathology, Myoepithelioma therapy, Salivary Gland Neoplasms epidemiology, Salivary Gland Neoplasms mortality, Salivary Gland Neoplasms pathology, Salivary Gland Neoplasms therapy
- Abstract
Objective: Epithelial-myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands. In this study, we aim to examine the demographic, clinicopathologic, and survival features of EMC using a population-based approach., Study Design and Setting: Retrospective cohort study., Subjects and Methods: The Surveillance, Epidemiology, and End Result (SEER) database (1973-2010) was queried for EMC of the major salivary glands. Data were analyzed with respect to various demographic and clinicopathologic factors. Survival was analyzed using the Kaplan-Meier and Cox proportional hazards models., Results: In total, 246 cases were available for frequency analysis and 207 for survival analysis. Mean ± SD age at diagnosis was 63.8 ± 15.4 years. EMC affected females more frequently (57.3%). Distant metastases were present at diagnosis in only 4.5% of cases. Overall disease-specific survival (DSS) at 60, 120, and 180 months was 91.3%, 90.2%, and 80.7%, respectively. Patients with low-grade histology had significantly better survival at 180 months relative to those with high-grade tumors (90.6% vs 0.0%, P = .0246). When stratified by tumor size, patients with lesions >4 cm had the worst survival at 180 months (58.8%, P = .0003). All but 9 of the 207 cases available for survival analysis underwent surgery. A total of 85 patients (41.1%) received radiotherapy in addition to surgery. No survival benefit was noted for patients who received radiotherapy compared with those who did not (P = .4832)., Conclusion: This report represents the largest series of EMC to date. Despite being regarded as a low-grade, indolent tumor, a significant fraction of our cohort underwent radiotherapy in addition to surgery, with no apparent added survival benefit., (© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.)
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- 2015
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38. Laryngeal Papillary Squamous Cell Carcinoma: A Population-Based Analysis of Incidence and Survival.
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Dutta R, Husain Q, Kam D, Dubal PM, Baredes S, and Eloy JA
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell therapy, Child, Child, Preschool, Female, Humans, Incidence, Infant, Infant, Newborn, Laryngeal Neoplasms mortality, Laryngeal Neoplasms therapy, Male, Middle Aged, Retrospective Studies, SEER Program, Sex Distribution, Survival Rate, United States epidemiology, Young Adult, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell pathology, Laryngeal Neoplasms epidemiology, Laryngeal Neoplasms pathology
- Abstract
Objective: Papillary squamous cell carcinoma has emerged as a distinct entity from the more common keratinizing squamous cell carcinoma. The basis behind this distinction relates not only to its histologic variation but also to its overall prognosis and survival. The objective of this study was to demonstrate the incidence, demographics, and long-term survival of laryngeal papillary squamous cell carcinoma (LPSCC) and how it relates to other laryngeal malignancies using a population-based database., Study Design: Analysis of a population-based tumor registry., Methods: The United States National Cancer Institute's Surveillance, Epidemiology, and End Results registry was used to perform a retrospective analysis. Patients diagnosed with LPSCC from 1973 to 2011 were identified. Data endpoints extracted included patient demographics, incidence, and survival., Results: Three-hundred seventy cases of LPSCC were identified, corresponding to 0.5% of all laryngeal tumors. There was a 3:1 male predilection, without a significant racial preference. Most tumors identified were localized (T1) and at stage 1. The 1-year, 5-year, and 10-year disease-specific survival (DSS) for LPSCC was 97.1%, 83.1%, and 73.9%, respectively, compared with 87.9%, 64.5%, and 50.5% for other laryngeal malignancies (P values <.0001). Surgery was associated with a higher overall DSS in both LPSCC (87.4% vs 78.8%) and other laryngeal malignancies (70% vs 59.4%) when compared with other treatment modalities., Conclusion: This analysis of the largest sample of LPSCC demonstrates a better prognosis for this pathology compared with other laryngeal malignancies., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)
- Published
- 2015
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39. Expert witness testimony guidelines: identifying areas for improvement.
- Author
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Svider PF, Eloy JA, Baredes S, Setzen M, and Folbe AJ
- Subjects
- Humans, Societies, Medical, United States, Expert Testimony ethics, Malpractice legislation & jurisprudence, Otolaryngology ethics
- Abstract
Expert witnesses play an invaluable, if controversial, role by deciphering medical events for juries in cases of alleged negligence. We review expert witness guidelines among major surgical societies and identify gaps within these standards, as our hope is that this spurs discussion addressing areas for improvement. Of 8 surgical societies with accessible guidelines, none included specific compensation guidelines or limits, detailed reporting mechanisms regarding unethical behavior by legal professionals, or addressed the appropriateness of testifying frequently and exclusively for one side. Several processes possibly deterring grossly inaccurate testimony have been adopted by other surgical societies and should potentially be addressed by the American Academy of Otolaryngology-Head and Neck Surgery. These include offering an expert witness testimony certification path, strengthening the formalized grievance process, and encouraging members to sign an affirmation statement., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)
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- 2015
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40. Do AAO-HNSF CORE Grants Predict Future NIH Funding Success?
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Eloy JA, Svider PF, Kanumuri VV, Folbe AJ, Setzen M, and Baredes S
- Subjects
- Humans, Publishing statistics & numerical data, United States, Biomedical Research economics, Financing, Organized economics, Foundations, National Institutes of Health (U.S.) economics, Otolaryngology economics
- Abstract
Objective: To determine (1) whether academic otolaryngologists who have received an American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) Centralized Otolaryngology Research Efforts (CORE) grant are more likely to procure future National Institutes of Health (NIH) funding; (2) whether CORE grants or NIH Career Development (K) awards have a stronger association with scholarly impact., Study Design and Setting: Historical cohort., Methods: Scholarly impact, as measured by the h-index, publication experience, and prior grant history, were determined for CORE-funded and non-CORE-funded academic otolaryngologists. All individuals were assessed for NIH funding history., Results: Of 192 academic otolaryngologists with a CORE funding history, 39.6% had active or prior NIH awards versus 15.1% of 1002 non-CORE-funded faculty (P < .0001). Higher proportions of CORE-funded otolaryngologists have received K-series and R-series grants from the NIH (P-values < .05). K-grant recipients had higher h-indices than CORE recipients (12.6 vs 7.1, P < .01). Upon controlling for rank and experience, this difference remained significant among junior faculty., Conclusions: A higher proportion of academic otolaryngologists with prior AAO-HNSF CORE funding have received NIH funding relative to their non-CORE-funded peers, suggesting that the CORE program may be successful in its stated goals of preparing individuals for the NIH peer review process, although further prospective study is needed to evaluate a "cause and effect" relationship. Individuals with current or prior NIH K-grants had greater research productivity than those with CORE funding history. Both cohorts had higher scholarly impact values than previously published figures among academic otolaryngologists, highlighting that both CORE grants and NIH K-grants awards are effective career development resources., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)
- Published
- 2014
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41. Regional differences in gender promotion and scholarly productivity in otolaryngology.
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Eloy JA, Mady LJ, Svider PF, Mauro KM, Kalyoussef E, Setzen M, Baredes S, and Chandrasekhar SS
- Subjects
- Bibliometrics, Female, Humans, Male, Sex Factors, Statistics, Nonparametric, United States, Faculty, Medical statistics & numerical data, Internship and Residency economics, Otolaryngology education
- Abstract
Objectives: To identify whether regional differences exist in gender disparities in scholarly productivity and faculty rank among academic otolaryngologists., Study Design and Setting: Academic otolaryngologists' bibliometric data analyses., Methods: Online faculty listings from 98 otolaryngology departments were organized by gender, academic rank, fellowship training status, and institutional location. The Scopus database was used to assess bibliometrics of these otolaryngologists, including the h-index, number of publications, and publication experience., Results: Analysis included 1127 otolaryngologists, 916 men (81.3%) and 211 women (18.7%). Female faculty comprised 15.4% in the Midwest, 18.8% in the Northeast, 21.3% in the South, and 19.0% in the West (P = .44). Overall, men obtained significantly higher senior academic ranks (associate professor or professor) compared to women (59.8% vs. 40.2%, P < .0001). Regional gender differences in senior faculty were found in the South (59.8% men vs. 37.3% women, P = .0003) and Northeast (56.4% men vs. 24.1% women, P < .0001) with concomitant gender differences in scholarly impact, as measured by the h-index (South, P = .0003; Northeast, P = .0001). Among geographic subdivisions, female representation at senior ranks was lowest in the Mid-Atlantic (22.0%), New England (30.8%), and West South Central (33.3%), while highest in Pacific (60.0%) and Mountain (71.4%) regions. No regional gender differences were found in fellowship training patterns (P-values > .05)., Conclusion: Gender disparities in academic rank and scholarly productivity exist most notably in the Northeast, where women in otolaryngology are most underrepresented relative to men at senior academic ranks and in scholarly productivity.
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- 2014
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42. AAO-HNSF CORE grant acquisition is associated with greater scholarly impact.
- Author
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Eloy JA, Svider PF, Folbe AJ, Setzen M, and Baredes S
- Subjects
- Bibliometrics, Head surgery, Neck surgery, United States, Academies and Institutes, Career Choice, Foundations, Otolaryngology, Research, Research Support as Topic
- Abstract
Objective: To determine whether receiving funding from the American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) Centralized Otolaryngology Research Efforts (CORE) grant program is associated with career choice (in terms of practice setting) and scholarly impact., Study Design and Setting: Examination of bibliometrics among academic otolaryngologists, including CORE grants funding history., Methods: An Internet search was conducted to determine the current practice setting and, for academic otolaryngologists, academic rank of individuals receiving CORE grants since 1985. The Scopus database was used to determine scholarly impact, as measured by the h-index, and publication experience (in years) of these practitioners along with a "control" cohort of nonfunded academic otolaryngologists., Results: Of 432 unique individuals receiving CORE grant funding since 1985, 44.4% are currently academicians. This cohort had a higher h-index (mean, 11.9; median, 10; interquartile range [IQR], 6-18) than their non-CORE grant-funded academic peers (mean, 9.2; median, 7; IQR, 3-13; P = .002) and colleagues who are not currently in academic practice (mean, 4.4; median, 3; IQR, 0-6; P < .001). CORE grant-funded academic otolaryngologists had a statistically higher scholarly impact on controlling for academic rank and among practitioners with greater than 10 years of publication experience. No statistical differences in academic promotion patterns were noted between those with and those without a CORE grant funding history., Conclusions: Procurement of an AAO-HNSF CORE grant is associated with greater scholarly impact, as measured by the h-index. This relationship persists among practitioners with more than 10 years of publication experience, as well as upon comparison of CORE grant-funded and non-CORE grant-funded otolaryngologists at all academic ranks. Practitioners awarded these grants may be more likely to go into and remain in academic practice.
- Published
- 2014
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43. Obstructive sleep apnea: strategies for minimizing liability and enhancing patient safety.
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Svider PF, Pashkova AA, Folbe AJ, Eloy JD, Setzen M, Baredes S, and Eloy JA
- Subjects
- Adult, Female, Humans, Male, Middle Aged, United States, Liability, Legal, Patient Safety legislation & jurisprudence, Physicians legislation & jurisprudence, Sleep Apnea, Obstructive surgery
- Abstract
Objective: To characterize malpractice litigation regarding obstructive sleep apnea (OSA) and educate physicians on frequently cited factors., Study Design and Setting: Analysis of the Westlaw legal database., Methods: Jury verdict and settlement reports were examined for outcome, awards, patient demographic factors, defendant specialty, and alleged causes of malpractice., Results: Out of 54 identified cases, 33 (61.1%) cases were resolved in favor of defendants, 12 (22.2%) via settlement, and 9 (16.7%) through jury award. Median settlement and jury awards did not significantly differ ($750,000 vs $550,000, P > .50). Age and gender did not affect outcome. Otolaryngologists and anesthesiologists were the most frequently named defendants. Forty-seven cases (87.1%) stemmed from OSA patients who underwent procedures with resultant perioperative adverse events. Common alleged factors included death (48.1%), permanent deficits (42.6%), intraoperative complications (35.2%), requiring additional surgery (25.9%), anoxic brain injury (24.1%), inadequate informed consent (24.1%), inappropriate medication administration (22.2%), and inadequate monitoring (20.4%)., Conclusion: Litigation related to OSA is frequently associated with perioperative complications more than nonoperative issues such as a failure to diagnose this disorder. Nonetheless, OSA is considerably underdiagnosed, and special attention should be paid to at-risk patients, including close monitoring of their clinical status and the medications they receive. For patients with diagnosed or suspected OSA with planned operative intervention, whether for OSA or an unrelated issue, a comprehensive informed consent process detailing the factors outlined in this analysis is an effective strategy to increase communication and improve the physician-patient relationship, minimize liability, and ultimately improve patient safety.
- Published
- 2013
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44. Malpractice in otology.
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Blake DM, Svider PF, Carniol ET, Mauro AC, Eloy JA, and Jyung RW
- Subjects
- Cerumen, Humans, Neuroma, Acoustic surgery, Otologic Surgical Procedures adverse effects, Otologic Surgical Procedures economics, Stapes Surgery economics, Stapes Surgery legislation & jurisprudence, United States, Malpractice economics, Malpractice statistics & numerical data, Otolaryngology legislation & jurisprudence, Otologic Surgical Procedures legislation & jurisprudence
- Abstract
Objective: (1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation., Study Design and Setting: Case series with record review., Methods: The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website., Results: Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively)., Conclusions: Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.
- Published
- 2013
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45. In response to "comparison of plaintiff and defendant expert witness qualification in malpractice litigation in otolaryngology".
- Author
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Eloy JA, Svider PF, Patel D, Setzen M, and Baredes S
- Subjects
- Humans, Expert Testimony standards, Malpractice legislation & jurisprudence, Otolaryngology legislation & jurisprudence, Societies, Medical standards
- Published
- 2013
- Full Text
- View/download PDF
46. Gender differences in successful NIH grant funding in otolaryngology.
- Author
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Eloy JA, Svider PF, Kovalerchik O, Baredes S, Kalyoussef E, and Chandrasekhar SS
- Subjects
- Faculty, Medical statistics & numerical data, Female, Humans, Male, Otolaryngology economics, Otolaryngology education, Radiology Department, Hospital economics, Radiology Department, Hospital statistics & numerical data, Research Support as Topic economics, Retrospective Studies, Sex Factors, United States, Financing, Government statistics & numerical data, National Institutes of Health (U.S.), Otolaryngology statistics & numerical data, Research Support as Topic statistics & numerical data
- Abstract
Objective: To evaluate gender differences in NIH funding among faculty in otolaryngology departments and discuss potential reasons for these differences., Study Design and Setting: Analysis of NIH funding data available on the online NIH RePORTER system., Methods: Fiscal year 2011 and 2012 NIH funding awards to principal investigators (PIs) in otolaryngology departments were obtained and used to examine faculty listings from otolaryngology departments for academic rank and gender. The Scopus database was used to determine publication range of these faculty members., Results: Individual mean NIH awards to men ($362,946 ± $21,247 standard error of mean) were higher than those to women ($287,188 ± $38,029). Male PIs were found to have higher mean NIH funding totals (aggregating grants for PIs with multiple awards) than female PIs ($498,593 vs $359,276). Upon organization by academic rank and years active, men had significantly higher funding levels at both the level of assistant professor and at 10 to 20 years of experience. Of all NIH grants awarded, men had a higher percentage of the more prestigious R-series grants (76.2%) than did women (63.4%)., Conclusions: Male faculty members have higher NIH funding levels than their female colleagues, a disparity that exists separate from career longevity, as it is true both at the rank of assistant professor and for those with 10 to 20 years of research experience. The larger proportion of R-series NIH grants awarded to male faculty may contribute to this finding. This discrepancy in percentage and dollars of funding exists despite the increasing percentages of women in higher ranks.
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- 2013
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47. Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in otolaryngology.
- Author
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Eloy JA, Svider PF, Patel D, Setzen M, and Baredes S
- Subjects
- Humans, Societies, Medical ethics, Societies, Medical legislation & jurisprudence, Expert Testimony standards, Malpractice legislation & jurisprudence, Otolaryngology legislation & jurisprudence, Societies, Medical standards
- Abstract
Objective: Malpractice litigation contributes to rising health care costs in the United States. The role of expert witness testimony has been controversial in the past, with medical professional societies issuing statements regarding ethical obligations of physicians. Our objectives were to examine the relative qualifications of expert witnesses testifying on behalf of plaintiffs vs defendants., Study Design and Setting: Analysis of expert witness and physician demographic data available on several databases., Methods: The Westlaw legal database (Thomson Reuters, New York, New York) was searched for otolaryngologist expert witness testimony. Length of experience, practice setting, and subspecialty training information were obtained from hospital, practice, departmental, and state licensing board sites. Scholarly impact was assessed using calculation of the h-index from the Scopus database., Results: Plaintiff expert witnesses had significantly less experience than those testifying for defendants (31.8 vs 35.4 years, P = .047) and lower scholarly impact (h = 6.3 vs 10, P = .045). A significantly higher proportion of defendant witnesses were in academic practice (49.3% vs 31.7%, P = .042). No differences were detected in postresidency fellowship training patterns., Conclusion: Upon comparison of otolaryngologist expert witnesses, practitioners testifying on behalf of plaintiffs had statistically fewer years of experience, had a lower scholarly impact, and were less likely to work in an academic setting. Otolaryngologists who repeatedly served as expert witnesses were more likely to be testifying on behalf of plaintiffs than defendants. Professional societies need to frequently update guidelines on expert witness testimony and address the ethical obligations of practitioners.
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- 2013
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48. Gender disparities in scholarly productivity within academic otolaryngology departments.
- Author
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Eloy JA, Svider P, Chandrasekhar SS, Husain Q, Mauro KM, Setzen M, and Baredes S
- Subjects
- Bibliometrics, Female, Humans, Male, Sex Factors, Statistics, Nonparametric, Biomedical Research statistics & numerical data, Career Mobility, Faculty, Medical statistics & numerical data, Otolaryngology, Publishing statistics & numerical data
- Abstract
Objective: To examine whether there are gender disparities in scholarly productivity within academic otolaryngology departments, as measured by academic rank and the h-index, a published, objective measure of research contributions that quantifies the number and significance of papers published by a given author., Study Design and Setting: Analysis of bibliometric data of academic otolaryngologists., Methods: Faculty listings from academic otolaryngology departments were used to determine academic rank and gender. The Scopus database was used to determine h-index and publication range (in years) of these faculty members. In addition, 20 randomly chosen institutions were used to compare academic otolaryngologists to faculty members in other surgical specialties., Results: Mean h-indices increased through the rank of professor. Among academic otolaryngologists, men had significantly higher h-indices than women, a finding also noted on examination of faculty members from other specialties. Men had higher research productivity rates at earlier points in their career than women did. The productivity rates of women increased and equaled or surpassed those of men later in their careers. Men had higher absolute h-index values at junior academic ranks. Women academic otolaryngologists of senior rank had higher absolute h-indices than their male counterparts., Conclusions: The h-index measures research significance in an objective manner and indicates that although men have higher overall research productivity in academic otolaryngology, women demonstrate a different productivity curve. Women produce less research output earlier in their careers than men do, but at senior levels, they equal or exceed the research productivity of men.
- Published
- 2013
- Full Text
- View/download PDF
49. Sinonasal adenoid cystic carcinoma: systematic review of survival and treatment strategies.
- Author
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Husain Q, Kanumuri VV, Svider PF, Radvansky BM, Boghani Z, Liu JK, and Eloy JA
- Subjects
- Adult, Aged, Biopsy, Needle, Carcinoma, Adenoid Cystic diagnosis, Combined Modality Therapy, Disease-Free Survival, Female, Humans, Immunohistochemistry, Kaplan-Meier Estimate, Male, Middle Aged, Neoplasm Staging, Otorhinolaryngologic Surgical Procedures methods, Paranasal Sinus Neoplasms diagnosis, Prognosis, Radiotherapy, Adjuvant, Retrospective Studies, Survival Analysis, Tomography, X-Ray Computed methods, Treatment Outcome, Young Adult, Carcinoma, Adenoid Cystic mortality, Carcinoma, Adenoid Cystic therapy, Cause of Death, Paranasal Sinus Neoplasms mortality, Paranasal Sinus Neoplasms therapy
- Abstract
Objective: This study reviews the published outcomes related to sinonasal adenoid cystic carcinoma (SNACC). Clinical presentation, radiographic diagnosis, pathology, treatment, and management outcomes of this uncommon disease are reported. Data Sources PubMed database., Methods: A systematic review of studies for SNACC from 1960 to 2012 was conducted. A PubMed search for articles related to SNACC, along with bibliographies of those articles, was performed. Articles were examined for both individual patient data (IPD) and aggregate patient data (APD) that reported survivability. Demographics, disease site and spread, treatment strategies, follow-up, outcome, and survival were described for IPD, and a meta-analysis for survival rates was performed for APD., Results: A total of 55 journal articles were included. Individual patient data were reported in 39 journal articles, comprising a total of 88 cases of SNACC. Sixteen articles, totaling 366 patients that reported aggregate 5-year survivorship pertaining to SNACC, were also included. Average follow-up in the IPD was 51.2 months (range, 1-198 months), and 5-year survivorship was 63.5%. In the studies reviewed, surgery followed by postoperative radiotherapy was the most common therapy used and resulted in the highest percentage of survivors. Aggregate patient data meta-analysis revealed a 5-year survival rate of 62.5%., Conclusion: This study contains the largest pool of SNACC patients to date. The data suggest that SNACC has a poor overall prognosis. It also suggests that surgery with postoperative radiotherapy is the most commonly used and may possibly be the most effective therapy.
- Published
- 2013
- Full Text
- View/download PDF
50. Readability assessment of patient education materials on major otolaryngology association websites.
- Author
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Eloy JA, Li S, Kasabwala K, Agarwal N, Hansberry DR, Baredes S, and Setzen M
- Subjects
- Humans, Comprehension, Internet, Otolaryngology, Patient Education as Topic
- Abstract
Objective: Various otolaryngology associations provide Internet-based patient education material (IPEM) to the general public. However, this information may be written above the fourth- to sixth-grade reading level recommended by the American Medical Association (AMA) and National Institutes of Health (NIH). The purpose of this study was to assess the readability of otolaryngology-related IPEMs on various otolaryngology association websites and to determine whether they are above the recommended reading level for patient education materials., Study Design and Setting: Analysis of patient education materials from 9 major otolaryngology association websites., Methods: The readability of 262 otolaryngology-related IPEMs was assessed with 8 numerical and 2 graphical readability tools. Averages were evaluated against national recommendations and between each source using analysis of variance (ANOVA) with post hoc Tukey's honestly significant difference (HSD) analysis. Mean readability scores for each otolaryngology association website were compared., Results: Mean website readability scores using Flesch Reading Ease test, Flesch-Kincaid Grade Level, Coleman-Liau Index, SMOG grading, Gunning Fog Index, New Dale-Chall Readability Formula, FORCAST Formula, New Fog Count Test, Raygor Readability Estimate, and the Fry Readability Graph ranged from 20.0 to 57.8, 9.7 to 17.1, 10.7 to 15.9, 11.6 to 18.2, 10.9 to 15.0, 8.6 to 16.0, 10.4 to 12.1, 8.5 to 11.8, 10.5 to 17.0, and 10.0 to 17.0, respectively. ANOVA results indicate a significant difference (P < .05) between the websites for each individual assessment., Conclusion: The IPEMs found on all otolaryngology association websites exceed the recommended fourth- to sixth-grade reading level.
- Published
- 2012
- Full Text
- View/download PDF
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