University of Pittsburgh Department of Otolaryngology 2022 Publications JANUARY

Joseph Dohar, MD

Title: Pediatric otolaryngology telemedicine amid a pandemic - And beyond

Authors: McCoy JL, Shaffer AD, Dohar JE

Journal: Int J Pediatr Otorhinolaryngol. 2021 Dec 28;153:111014; online ahead of print

Summary: We conclude that telemedicine was equally well received by patients as compared to traditional live assessments suggesting that virtual care is a viable post-pandemic paradigm change. Satisfaction was rated as "Good" or "Excellent", however, messaging when surgery is not recommended was less acceptable and must be improved to obtain increased caregivers' agreement in an era of shared decision making.

Link: https://pubmed.ncbi.nlm.nih.gov/34974276

Uma Duvvuri, MD, PhD

Title: Phase I trial of cetuximab, radiation therapy, and ipilimumab in locally advanced head and neck cancer

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE.

Journal: Clinical Cancer Research

Summary: Concurrent radiation therapy (RT) with cetuximab, an anti-EGFR monoclonal antibody (mAb), is a standard treatment for locally advanced head and neck squamous carcinoma (HNSCC). CTLA-4+ T regulatory cells (Treg) dampen cellular immunity and correlate negatively with clinical outcomes. This phase I study added antiCTLA-4 mAb ipilimumab to cetuximab-RT.

Link: https://clincancerres.aacrjournals.org/content/early/2022/01/28/1078-0432.CCR-21-0426.long

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head and Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10–5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07–27.6) after adjusting for multiple confounders. Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Link: https://onlinelibrary.wiley.com/journal/10970347

David Eibling, MD

Title: Is mandibular osteomyelitis a sequela of SSRI-induced dental implant failure? A systematic review & case report

Authors: Tarfa RA, Melder K, Mady LJ, Eibling D

Journal: American Journal of Otolaryngology

Summary: To determine if the utilization of selective serotonin reuptake inhibitors (SSRIs) increases the risk of osteomyelitis as a sequela of dental implant failure. We also report the case of a patient on long-term SSRIs who presented with dental implant failure and subsequently developed mandibular osteomyelitis. SSRIs are associated with increased risk of dental implant failure, and our results suggest that they may be independently associated with mandibular osteomyelitis in the setting of implant failure. Though there was no evidence of mandibular osteomyelitis specifically following SSRI-related dental implant failure, there were a few case reports on osteomyelitis resulting from failed dental implant osseointegration.

Link: https://pubmed.ncbi.nlm.nih.gov/34583289/

Noel Jabbour, MD

Title: Cost analysis of sialendoscopy for the treatment of salivary gland disorders in children.

Authors: Velasquez N, Gardiner L, Ramprasad V, Shaffer A, Jabbour N, Stapleton A.

Journal: Int J Pediatr Otorhinolaryngol.

Summary: Recent advances in Otolaryngology have changed the diagnosis and therapy for salivary gland disorders. Sialendoscopy-assisted surgery is a minimally invasive, conservative procedure for functional preservation of the affected gland. The goals of this study are to assess the indications, use, and outcomes of pediatric sialendoscopy at a tertiary pediatric institution as well as to analyze the direct cost related to the diagnosis and treatment of patients with sialolithiasis and Juvenile Recurrent Parotitis managed with sialendoscopy.

Link: https://doi.org/10.1016/j.ijporl.2021.111020

Title: The limits of pandemic precautions: Tympanostomy tube placement in children with cleft palate during COVID-19.

Authors: Kacin AJ, Jabbour N, Ford MD, Losee JE, Shaffer AD.

Journal: Am J Otolaryngol.

Summary: Coronavirus Disease-2019 (COVID-19) mitigation measures have led to a sustained reduction in tympanostomy tube (TT) placement in the general population. The present aim was to determine if TT placement has also decreased in children at risk for chronic otitis media with effusion (COME), such as those with cleft palate (CP).

Link: https://doi.org/10.1016/j.amjoto.2021.103279

Title: Applicant perspectives on virtual otolaryngology residency interviews.

Authors: Kraft DO, Bowers EMR, Smith BT, Jabbour N, Schaitkin BM, O'Leary MA, Groblewski JC, Young VN, Sridharan S.

Journal: Ann Otol Rhinol Laryngol.

Summary: Residency interviews serve as an opportunity for prospective applicants to evaluate programs and to determine their potential fit within them. The 2019 SARS-CoV2 pandemic mandated programs conduct interviews virtually for the first time. The purpose of this study was to assess applicant perspectives on the virtual interview.

Link: https://doi.org/10.1177/00034894211057374

Jonas Johnson, MD

Title: Association between patient-reported symptoms of dysphagia and psychological distress in head and neck cancer survivors

Authors: Eastburn K, Lyu L, Harrison C, Atchison K, Moore K, Pomfret S, Johnson J, Nilsen M.

Journal: Oncol Nurs Forum

Summary: To describe the prevalence of and the association between patient-reported dysphagia and psychological distress (anxiety and depression) in head and neck cancer (HNC) survivors.

Link: Association Between Patient-Reported Symptoms of Dysphagia and Psychological Distress in Head and Neck Cancer Survivors - PubMed (nih.gov)

Seungwon Kim, MD

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE

Journal: Clinical Cancer Research

Summary: Background: Concurrent radiation therapy (RT) with cetuximab, an anti-EGFR monoclonal antibody (mAb), is a standard treatment for locally advanced head and neck squamous carcinoma (HNSCC). CTLA-4+ T regulatory cells (Treg) dampen cellular immunity and correlate negatively with clinical outcomes. This phase I study added anti-CTLA-4 mAb ipilimumab to cetuximab-RT. Methods: A [3 + 3] design established the recommended phase II dose (RP2D) of ipilimumab, added at week 5 for four, q3-week doses to fixed, standard cetuximab-RT. Eligible subjects had stage III-IVb, high-risk (HPV-) or intermediate-risk (HPV+) HNSCC. Dose limiting toxicity (DLT) was defined as grade 4 adverse event (AE) except in-field radiation dermatitis or immune-related (ir) AE requiring {greater than or equal to} 2 weeks of systemic steroids. Tumor and blood were collected for correlatives. Results: From July 2013-May 2016, 18 patients enrolled. Two of 6 in cohort 1 (ipilimumab 3 mg/kg) experienced grade 3 dermatologic DLTs, triggering de-escalation of ipilimumab to 1 mg/kg. Dose Level -1 was expanded to N = 12 without DLT. irAE included: grade 1, 2, and 3 dermatitis (2, 1, and 3 cases), grade 4 colitis (1), and grade 1 hyperthyroidism (1). Three-year disease-free survival (DFS) and overall survival (OS) were 72% (90% CI: 57-92%) and 72% (90% CI: 56-92%). High expression of co-inhibitory receptors PD1/LAG3/CD39 on tumorinfiltrating Treg associated with worse DFS (HR=5.6, 95% CI: 0.83-37.8, p=0.08). Conclusions: The RP2D for ipilimumab plus cetuximab-RT is 1mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.

Link: https://pubmed.ncbi.nlm.nih.gov/35091445/

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head & Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10–5.93) and delay to adjuvant therapy(OR 4.48, 95%CI 1.07–27.6) after adjusting for multiple confounders. Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Link: https://pubmed.ncbi.nlm.nih.gov/35020252/

Title: The Nasoseptal Flap for Reconstruction of Lateral Oropharyngectomy Defects: A Clinical Series

Authors: Turner MT, Geltzeiler MN, Ramadan J, Moskovitz JM, Ferris RL, Wang EW, Kim S

Journal: Laryngoscope

Summary: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS)oropharyngectomy defects. Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1–3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with higharched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique. This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidityis limited to temporary nasaldyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage.

Link: https://pubmed.ncbi.nlm.nih.gov/34106472/

Mark Kubik, MD

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head & Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10–5.93) and delay to adjuvant therapy(OR 4.48, 95%CI 1.07–27.6) after adjusting for multiple confounders. Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Link: https://pubmed.ncbi.nlm.nih.gov/35020252/

Reema Padia, MD

Title: Effect of Insurance type on postoperative tympanostomy tube follow-up.

Authors: Patel TA, McCoy JL, Belsky MA, Sim ES, Konanur A, Yan A, Jabbour N, Padia R.

Journal: Otolaryngol Head Neck Surg. 2021 Dec 28; online ahead of print.

Summary: Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.

Link: https://www.ncbi.nlm.nih.gov/pubmed/34962848

Carl Snyderman, MD, MBA

Title: Rapidly progressive pituitary apoplexy in a patient with COVID-19 disease treated with endoscopic endonasal surgery.

Authors: Taneja C, Fazeli PK, Gardner PA, Wang EW, Snyderman CH, Mahmud H

Journal: J Neurol Surg Rep

Summary: This report describes a case of pituitary apoplexy with rapidly evolving hemorrhage in a 74-year-old female with coronavirus disease 2019 (COVID-19) disease. We discuss the potential implication of COVID-19 in the occurrence of pituitary apoplexy, in addition to the safety and success of endonasal surgery in this population.

Link: https://doi.org/10.1055/s-0041-1742104

Title: Contact endoscopy as a novel technique for intraoperative identification of normal pituitary gland and adenoma.

Authors: Jackson C, Kong DK, Gersey ZC, Wang EW, Zenonos G, Snyderman CH, Gardner PA

Journal: Neurosurg Focus Video

Summary: Two illustrative cases of endoscopic endonasal approaches (EEAs) for resection of pituitary adenoma illustrate the use of contact endoscopy in identifying tumor from gland and differentiating a thin section of normal gland draped over the underlying tumor, thereby allowing for safe extracapsular tumor resection.

Link: https://doi.org/10.3171/2021.10.FOCVID21199

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass.

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head & Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC).

Link: https://doi.org/10.1002/hed.26978

Shaum Sridharan, MD

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat M, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS.

Journal: Ann Otol Rhinol Laryngol

Summary: Residency interviews serve as an opportunity for prospective applicants to evaluate programs and to determine their potential fit within them. The 2019 SARS-CoV2 pandemic mandated programs conduct interviews virtually for the first time. The purpose of this study was to assess applicant perspectives on the virtual interview. Link: https://doi.org/10.1177/00034894211057374

Title: Applicant Perspectives on Virtual Otolaryngology Residency Interviews

Authors: Kraft DO, Bowers EMR, Smith BT, Jabbour N, Schaitkin BM, O’Leary MA, Groblewski JC, Young VN, Sridharan SS.

Journal: Head Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). Link: https://doi.org/10.1002/hed.26978

Amanda Stapleton, MD

Title: Olfaction before and after initiation of elexacaftor-tezacaftor-ivacaftor in a cystic fibrosis cohort.

Authors: Bacon DR, Stapleton A, Goralski JL, Ebert CS Jr, Thorp BD, Nouraie M, Shaffer AD, Senior BA, Lee SE, Zemke AC, Kimple AJ.

Journal: Int Forum Allergy Rhinol.

Summary: Disease-causing genetic mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene result in impaired chloride transport resulting in mucus dehydration, impaired mucociliary clearance and proliferation of microbial pathogens.1 While bronchiectasis is the primary driver of disease-related mortality in cystic fibrosis (CF), the sinonasal cavity is almost universally affected, and many patients experience chronic rhinosinusitis, nasal polyps and olfactory dysfunction (OD).

Link: https://doi.org/10.1002/alr.22891

Title: Cost analysis of sialendoscopy for the treatment of salivary gland disorders in children.

Authors: Velasquez N, Gardiner L, Ramprasad V, Shaffer A, Jabbour N, Stapleton A.

Journal: Int J Pediatr Otorhinolaryngol.

Summary: Recent advances in Otolaryngology have changed the diagnosis and therapy for salivary gland disorders. Sialendoscopy-assisted surgery is a minimally invasive, conservative procedure for functional preservation of the affected gland. The goals of this study are to assess the indications, use, and outcomes of pediatric sialendoscopy at a tertiary pediatric institution as well as to analyze the direct cost related to the diagnosis and treatment of patients with sialolithiasis and Juvenile Recurrent Parotitis managed with sialendoscopy.

Link: https://doi.org/10.1016/j.ijporl.2021.111020

Eric Wang, MD

Title: The nasoseptal flap for reconstruction of lateral oropharyngectomy defects: a clinical series.

Authors: Turner MT, Geltzeiler MN, Ramadan J, Moskovitz JM, Ferris RL, Wang EW, Kim S Journal: Laryngoscope

Summary: We conclude that the nasoseptal flap is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage.

Link: https://doi.org/10.1002/lary.29660

Title: Evolving concepts in the perioperative management of obstructive sleep apnea after endoscopic skull base surgery.

Authors: Rabinowitz MR, Chaskes M, Choby G, Wang EW, Thorp B, Toskala E, Nyquist GG, Rosen MR, Evans JJ

Journal: Int Forum Allergy Rhinol

Summary: The objective of this article was to review the most up-to-date literature regarding when it is safe to resume CPAP usage in the patient undergoing endoscopic skull base surgery.

Link: https://doi.org/10.1002/alr.22905

Title: Rapidly progressive pituitary apoplexy in a patient with COVID-19 disease treated with endoscopic endonasal surgery.

Authors: Taneja C, Fazeli PK, Gardner PA, Wang EW, Snyderman CH, Mahmud H

Journal: J Neurol Surg Rep

Summary: This report describes a case of pituitary apoplexy with rapidly evolving hemorrhage in a 74-year-old female with coronavirus disease 2019 (COVID-19) disease. We discuss the potential implication of COVID-19 in the occurrence of pituitary apoplexy, in addition to the safety and success of endonasal surgery in this population.

Link: https://doi.org/10.1055/s-0041-1742104

Title: Contact endoscopy as a novel technique for intraoperative identification of normal pituitary gland and adenoma.

Authors: Jackson C, Kong DK, Gersey ZC, Wang EW, Zenonos G, Snyderman CH, Gardner PA

Journal: Neurosurg Focus Video

Summary: Two illustrative cases of endoscopic endonasal approaches (EEAs) for resection of pituitary adenoma illustrate the use of contact endoscopy in identifying tumor from gland and differentiating a thin section of normal gland draped over the underlying tumor, thereby allowing for safe extracapsular tumor resection.

Link: https://doi.org/10.3171/2021.10.FOCVID21199

February-March 2022 PUBLICATIONS

David Chi, MD

Title: Cochlear implants in neurologically impaired children: A survey of health-related quality of life.

Authors: Anne S, Schwartz SR, McCoy JL, Haberkamp T, Hoffer ME, Chi DH.

Journal: Otolaryngol Head Neck Surg

Summary: This study suggests that HRQoL benefits of CI are perceived in most domains by parents of children with NCNIDD, albeit less strongly than children with ND. A survey sensitive to challenges of children with NCNIDD may better capture benefits that may not be apparent in this study.

Link: https://pubmd.ncbi.nlm.nih.gov/33618581

Title: Aerosol and droplet risk of common otolaryngology clinic procedures.

Authors: Boorgu DSSK, Dharmarajan H, Sim ES, Goyal L, Freiser ME, Weinstock M, Whelan R, Corcoran TE, Jabbour N, Wang E, Chi DH.

Summary: While patients' coughing and sneezing may create a baseline risk for providers, this study demonstrates that nasal endoscopy, flexible laryngoscopy, and suctioning inherently do not pose an additional risk in terms of aerosol and small droplet generation. An overarching generalization cannot be made about endoscopy or suctioning being an aerosol generating procedure.

Journal: Ann Otol Rhinol Laryngol

Link: https://pubmd.ncbi.nlm.nih.gov/33730891

Title: Advanced practice provider clinics: Expediting care For children undergoing tympanostomy tube placement.

Authors: Belsky MA, Konanur A, Sim E, Yan A, Shaffer AD, Williams K, Martsolf GR, Chi D, Jabbour N. Journal: Laryngoscope

Summary: Children seen by APPs received care more quickly than those seen by otolaryngologists. Patients seen by otolaryngologists tended to be more medically complex. Implementation of independent APP clinics may expedite and improve access to BMT for children with RAOM.

Link: https://pubmed.ncbi.nlm.nih.gov/33635578

Title: Impact of patient socioeconomic disparities on time to tympanostomy tube placement.

Authors: McCoy JL, Dixit R, Lin RJ, Belsky MA, Shaffer AD, Chi D, Jabbour N.

Journal: Ann Otol Rhinol Laryngol

Summary: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions.

Link: https://pubmed.ncbi.nlm.nih.gov/33978498

Title: Tympanostomy tubes or medical management for recurrent acute otitis media.

Authors: Hoberman A, Preciado D, Paradise JL, Chi DH, Haralam M, Block SL, Kearney DH, Bhatnagar S, Muñiz Pujalt GB, Shope TR, Martin JM, Felten DE, Kurs-Lasky M, Liu H, Yahner K, Jeong JH, Cohen NL, Czervionke B, Nagg JP, Dohar JE, Shaikh N.

Journal: N Engl J Med

Summary: Among children 6 to 35 months of age with recurrent acute otitis media, the rate of episodes of acute otitis media during a 2-year period was not significantly lower with tympanostomy-tube placement than with medical management. (Funded by the National Institute on Deafness and Other Communication Disorders and others; ClinicalTrials.gov number, NCT02567825.).

Link: https://pubmed.ncbi.nlm.nih.gov/33979487

Title: Repeat tympanostomy tubes in children with Down syndrome.

Authors: Omar M, McCoy JL, McCormick AA, Vellody K, Chi DH.

Journal: Int J Pediatr Otorhinolaryngol

Summary: Children with DS were more likely to undergo repeat TTI if they were of younger age and if the indication for surgery was COME. The repeat TTI rate for children with DS was high at 61.4%. Prospective studies are warranted to more precisely investigate factors associated with repeat TTIs in this unique patient population.

Link: https://pubmed.ncbi.nlm.nih.gov/34198227

Robert Ferris, MD, PhD

Title: Prospective evaluation of COVID-19 vaccine responses across a broad spectrum of immunocompromising conditions: the COVICS study

Authors: Haidar G, Agha M, Bilderback A, Lukanski A, Linstrum K, Troyan R, Rothenberger S, McMahon DK, Crandall MD, Sobolewksi MD, Enick PN, Jacobs JL, Collins K, Klamar-Blain C, Macatangay BJC, Parikh UM, Heaps A, Coughenour L, Schwartz MB, Dueker JM, Silveira FP, Keebler ME, Humar A, Luketich JD, Morrell MR, Pilewski JM, McDyer JF, Pappu B, Ferris RL, Marks SM, Mahon J, Mulvey K, Hariharan S, Updike GM, Brock L, Edwards R, Beigi RH, Kip PL, Wells A, Minnier T, Angus DC, Mellors JW

Journal: Clin Infect Dis.

Summary: Antibody responses to COVID-19 vaccines were lowest among SOT and anti-CD20 monoclonal recipients, and recipients of vaccines other than mRNA-1273. Among those with intermediate antibody levels, pseudovirus neutralization titers were lower in immunocompromised patients than HCW. Additional SARS-CoV-2 preventive approaches are needed for immunocompromised persons, which may need to be tailored to the cause of immunodeficiency.

Link: Prospective evaluation of COVID-19 vaccine responses across a broad spectrum of immunocompromising conditions: the COVICS study - PubMed (nih.gov)

Title: Phase I trial of cetuximab, radiation therapy, and ipilimumab in locally advanced head and neck cancer

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE.

Journal: Clin Cancer Research

Summary: The RP2D for ipilimumab plus cetuximab-RT is 1mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.

Link: Phase I trial of cetuximab, radiation therapy, and ipilimumab in locally advanced head and neck cancerPubMed (nih.gov)

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS.

Journal: Head and Neck

Summary: Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Link: Poor treatment tolerance in head and neck cancer patients with low muscle mass - PubMed (nih.gov)

Title: The prognosis of HPV-associated metastatic pharyngeal patients by primary and distant site.

Authors: Wang J, Tian Y, Huang H, Huang D, Liu Y, Tian Y, Zhu G, Zhang X, Ferris RL. The prognosis of HPVassociated metastatic pharyngeal patients by primary and distant site

Journal: Oral oncology

Summary: HPV-positive mHNSC-OP patients with lung metastasis show better survival than HPV-negative mHNSC-OP patients, providing key information to guide patient treatment approaches.

Link: The prognosis of HPV-associated metastatic pharyngeal patients by primary and distant site - PubMed (nih.gov)

Title: Investigating immune and non-immune cell interactions in head and neck tumors by single-cell RNA sequencing

Authors: Kürten CHL, Kulkarni A, Cillo AR, Santos PM, Roble AK, Onkar S, Reeder C, Lang S, Chen X, Duvvuri U, Kim S, Liu A, Tabib T, Lafyatis R, Feng J, Gao SJ, Bruno TC, Vignali DAA, Lu X, Bao R, Vujanovic L, Ferris RL.

Journal: Nature Communications

Summary: Head and neck squamous cell carcinoma (HNSCC) is characterized by complex relations between stromal, epithelial, and immune cells within the tumor microenvironment (TME). To enable the development of more efficacious therapies, we aim to study the heterogeneity, signatures of unique cell populations, and cell-cell interactions of non-immune and immune cell populations in 6 human papillomavirus (HPV)+ and 12 HPV- HNSCC patient tumor and matched peripheral blood specimens using single-cell RNA sequencing. Using this dataset of 134,606 cells, we show cell type-specific signatures associated with inflammation and HPV status, describe the negative prognostic value of fibroblasts with elastic differentiation specifically in the HPV+ TME, predict therapeutically targetable checkpoint receptor-ligand interactions, and show that tumor-associated macrophages are dominant contributors of PD-L1 and other immune checkpoint ligands in the TME. We present a comprehensive single-cell view of cell-intrinsic mechanisms and cell-cell communication shaping the HNSCC microenvironment.

Link: Investigating immune and non-immune cell interactions in head and neck tumors by single-cell RNA sequencing - PubMed (nih.gov)

Title: Evidence-based consensus recommendations for the evolving treatment of patients with high-risk and advanced cutaneous squamous cell carcinoma

Authors: Rabinowits G, Migden MR, Schlesinger TE, Ferris RL, Freeman M, Guild V, Koyfman S, Pavlick AC, Swanson N, Wolf GT, Dinehart SM.

Journal: JID Innov

Summary: Cutaneous squamous cell carcinoma is the second most common skin cancer in the United States. Currently, there is no standardized management approach for patients with cutaneous squamous cell carcinoma who develop metastatic or locally advanced disease and are not candidates for curative surgery or curative radiation. To address this issue, the Expert Cutaneous Squamous Cell Carcinoma Leadership program convened an expert steering committee to develop evidence-based consensus recommendations on the basis of a large, structured literature review. Consensus was achieved through modified Delphi methodology. The steering committee included five dermatologists, three medical oncologists, two head and neck surgeons, one radiation oncologist, and a patient advocacy group representative. The steering committee aligned on the following clinical topics: diagnosis and identification of patients considered not candidates for surgery; staging systems and risk stratification in cutaneous squamous cell carcinoma; the role of radiation therapy, surgery, and systemic therapy in the management of advanced disease, with a focus on immunotherapy; referral patterns; survivorship care; and inclusion of the patient's perspective. Consensus was achieved on 34 recommendations addressing 12 key clinical questions. The Expert Cutaneous Squamous Cell Carcinoma Leadership steering committee's evidencebased consensus recommendations may provide healthcare professionals with practically oriented guidance to help optimize outcomes for patients with advanced cutaneous squamous cell carcinoma.

Link: Evidence-Based Consensus Recommendations for the Evolving Treatment of Patients with High-Risk and Advanced Cutaneous Squamous Cell Carcinoma - PubMed (nih.gov)

Title: Prevalence of intratumoral regulatory T cells expressing neuropilin-1 is associated with poorer outcomes in patients with cancer

Authors: Chuckran CA, Cillo AR, Moskovitz J, Overacre-Delgoffe A, Somasundaram AS, Shan F, Magnon GC, Kunning SR, Abecassis I, Zureikat AH, Luketich J, Pennathur A, Sembrat J, Rojas M, Merrick DT, Taylor SE, Orr B, Modugno F, Buckanovich R, Schoen RE, Kim S, Duvvuri U, Zeh H, Edwards R, Kirkwood JM, Coffman L, Ferris RL, Bruno TC, Vignali DAA

Journal: Sci Transl Med

Summary: Despite the success of immune checkpoint blockade therapy, few strategies sufficiently overcome immunosuppression within the tumor microenvironment (TME). Targeting regulatory T cells (Tregs) is challenging, because perturbing intratumoral Treg function must be specific enough to avoid systemic inflammatory side effects. Thus, no Treg-targeted agents have proven both safe and efficacious in patients with cancer. Neuropilin-1 (NRP1) is recognized for its role in supporting intratumoral Treg function while being dispensable for peripheral homeostasis. Nonetheless, little is known about the biology of human NRP1+ Tregs and the signals that regulate NRP1 expression. Here, we report that NRP1 is preferentially expressed on intratumoral Tregs across six distinct cancer types compared to healthy donor peripheral blood [peripheral blood lymphocyte (PBL)] and site-matched, noncancer tissue. Furthermore, NRP1+ Treg prevalence is associated with reduced progression-free survival in head and neck cancer. Human NRP1+ Tregs have broad activation programs and elevated suppressive function. Unlike mouse Tregs, we demonstrate that NRP1 identifies a transient activation state of human Tregs driven by continuous T cell receptor (TCR) signaling through the mitogen-activated protein kinase pathway and interleukin-2 exposure. The prevalence of NRP1+ Tregs in patient PBL correlates with the intratumoral abundance of NRP1+ Tregs and may indicate higher disease burden. These findings support further clinical evaluation of NRP1 as a suitable therapeutic target to enhance antitumor immunity by inhibiting Treg function in the TME.

Link: Prevalence of intratumoral regulatory T cells expressing neuropilin-1 is associated with poorer outcomes in patients with cancer - PubMed (nih.gov)

Title: Prevalence of intratumoral regulatory T cells expressing neuropilin-1 is associated with poorer outcomes in patients with cancer

Authors: Kumar M, Molkentine D, Molkentine J, Bridges K, Xie T, Yang L, Hefner A, Gao M, Bahri R, Dhawan A, Frederick MJ, Seth S, Abdelhakiem M, Beadle BM, Johnson F, Wang J, Shen L, Heffernan T, Sheth A, Ferris RL, Myers JN, Pickering CR, Skinner HD.

Journal: Nature Communications

Summary: Despite radiation forming the curative backbone of over 50% of malignancies, there are no genomically-driven radiosensitizers for clinical use. Herein we perform in vivo shRNA screening to identify targets generally associated with radiation response as well as those exhibiting a genomic dependency. This identifies the histone acetyltransferases CREBBP/EP300 as a target for radiosensitization in combination with radiation in cognate mutant tumors. Further in vitro and in vivo studies confirm this phenomenon to be due to repression of homologous recombination following DNA damage and reproducible using chemical inhibition of histone acetyltransferase (HAT), but not bromodomain function. Selected mutations in CREBBP lead to a hyperacetylated state that increases CBP and BRCA1 acetylation, representing a gain of function targeted by HAT inhibition. Additionally, mutations in CREBBP/EP300 are associated with recurrence following radiation in squamous cell carcinoma cohorts. These findings provide both a mechanism of resistance and the potential for genomicallydriven treatment.

Link: Inhibition of histone acetyltransferase function radiosensitizes CREBBP/EP300 mutants via repression of homologous recombination, potentially targeting a gain of function - PubMed (nih.gov)

Joseph Furman, MD, PhD

Title: Vestibular rehabilitation for peripheral vestibular hypofunction: An updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association.

Authors: Hall CD, Herdman SJ, Whitney SL, Anson ER, Carender WJ, Hoppes CS, Cass SP, Christy JB, Cohen HS, Fife TD, Furman JM, Shepard NT, Clendaniel RA, Dishman JD, Goebel JA, Meldrum D., Ryan C. Wallace RL, Woodward NJ

Journal: J Neurol Phys Ther

Summary: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that onethird of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises

Link: https://pubmed.ncbi.nlm.nih.gov/34864777/

Jackie Gartner-Schmidt, PhD, CCC-SLP

Title: Clinician and patient perception of a voice therapy program utilizing a variably-occluded face mask: A pilot study

Authors: Gartner-Schmidt JL, Belsky MA, Awan S, Gillespie AI.

Journal: Folia Phoniatr Logop.

Summary: This pilot study represents the first investigation into clinician and patient perceptions of using a variably occluded face mask (VOFM). Reported measures via patient perception, as well as clinician perceptions, and some acoustic and aerodynamic measures showed that participants got better with VOFM voice therapy. Last, in general, both clinicians and patients liked utilizing a VOFM in voice therapy.

Link: Clinician and Patient Perception of a Voice Therapy Program Utilizing a Variably-Occluded Face Mask: A Pilot Study - PubMed (nih.gov)

Title: Development and validation of the exercise-induced laryngeal obstruction dyspnea index (EILODI)

Authors: Olin JT, Shaffer M, Nauman E, Durso CS, Fan EM, Staudenmayer H, Christopher KL, Gartner-Schmidt J Journal: J Allergy Clin Immunol

Summary: Two hundred nineteen subjects with mild to severe EILO participated in the exploratory factor analysis, which identified 7 factors within the preliminary outcome measure. After a process of item reduction, a 12-item metric with a total score ranging from 0 to 48 was developed. Mean scores of patients with EILO and healthy controls at baseline were 28.8 6 7.4 and 4.5 6 7.4, respectively. A minimal clinically important difference of 6 was determined by comparison of index change with changes in categorical self-assessments of improvement. This is the first patient-reported outcome measure specifically designed for adolescents and young adults with EILO.

Link: https://pubmed.ncbi.nlm.nih.gov/34619181/

Title: The patient experience: The relationship between vocal handicap, congruency, perceived present control, and mood across four voice disorders

Authors: Gartling G, van Mersbergan M, Crow K, Smith LJ, Lewandowski A, Gartner-Schmidt JL

Journal: Journal of Voice

Summary: This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.

Link: https://pubmed.ncbi.nlm.nih.gov/34615615/

Title: Singing in the mask: Effects of a variably occluded face mask on singing

Authors: Belsky M, Awan S, Rothenberger S, Gartner-Schmidt JL

Journal: Journal of Voice

Summary: There is an immediate effect of decreasing vocal effort in singing after training with a VOFM. Objective acoustic and aerodynamic effects were variable, though suggest that improvement in some measures may be achieved. The interactions between these variables, such as improvement in acoustic measures with increasing airflow and decreasing resistance, and their synergistic relationship leading to perceived changes in vocal effort, warrant future study. As SOVTE using masks continue to gain popularity among singers and their teachers, further research is needed to understand their immediate and long-term impact on singers.

Additionally, postoperative rehabilitation for singers using a VOFM could be valuable.

Link: https://pubmed.ncbi.nlm.nih.gov/34848103/

Barry Hirsch, MD

Title: Pain and pain control with opioid and nonopioid medications after otologic surgery

Authors: Godse NR, Tarfa RA, Perez PL, Hirsch BE, McCall AA

Journal: Otol Neurotol

Summary: Surgery with a postauricular approach is associated with higher pain and opioid use following otologic surgery. Patient- and approach-specific opioid prescribing is feasible following otologic surgery. Link: https://pubmed.ncbi.nlm.nih.gov/34753877/

Noel Jabbour, MD

Title: Operative surveillance of airway hemangiomas in PHACE syndrome.

Authors: Ramprasad VH, Konanur A, McCoy JL, McCormick A, Jabbour N, Padia R.

Journal: Ann Otol Rhinol Laryngol.

Summary: An IRB-approved retrospective cohort study was conducted on consecutive pediatric patients with head and neck infantile hemangioma (IH) evaluated in a multi-disciplinary vascular anomalies center between 2013 and 2019. Patients were included if they were being worked up for PHACE syndrome and had an otolaryngology evaluation. Demographics, clinical, and surgical variables were collected.

Link: Operative Surveillance of Airway Hemangiomas in PHACE Syndrome - PubMed (nih.gov)

Jonas Johnson, MD

Title: The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm

Authors: Mady LJ, Baddour K, Hodges JC, Magaña LC, Schwarzbach HL, Borrebach JD, Nilsen ML, Johnson JT, Hall DE

Journal: Oral Oncol

Summary: Across all levels of frailty, long term survival of HNC patients treated without surgery is either worse than or like those treated with surgery. These findings (1) challenge current practices of steering patients "too frail for surgery" towards non-surgical, "non-invasive" therapy, and (2) suggest equipoise warranting randomized trials to clarify treatment of frail patients.

Link: The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm - PubMed (nih.gov)

Title: Flourishing in head and neck cancer survivors

Authors: Harris A., Li J., Atchison K., Harrison C., Hall D., VanderWeele T., Johnson JT, Nilsen ML

Journal: Cancer Med

Summary: Common late- and long-term side effects of HNC treatment and financial hardship are associated with lower levels of flourishing or a more negative perception of life after treatment. Results highlight the importance of symptom burden for survivors' overall evaluation of their quality of life.

Link: Flourishing in head and neck cancer survivors - PubMed (nih.gov)

Title: The benefits and consequences of the COVID-19 pandemic for patients diagnosed with cancer and their family caregivers

Authors: Steel JL, Amin A, Peyser T, Olejniczak D, Antoni M, Carney M, Tillman E, Hecht CL, Pandya N, Miceli J, Reyes V, Nilsen M, Johnson J, Kiefer G, Pappu B, Zandberg DP, Geller D

Journal: Psychooncology

Summary: Psychological functioning for patients and caregivers was similar to that of pre-pandemic levels, however the decrease in health care utilization secondary to fear of COVID-19 was notable. While there were many negative effects of the pandemic, the majority of patients and caregivers reported some benefit to the pandemic.

Link: The benefits and consequences of the COVID-19 pandemic for patients diagnosed with cancer and their family caregivers - PubMed (nih.gov)

Title: Phase I trial of cetuximab, radiation therapy, and ipilimumab in locally advanced head and neck cancer

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE

Journal: Clin Cancer Res

Summary: The RP2D for ipilimumab plus cetuximab-RT is 1mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.

Link: Phase I trial of cetuximab, radiation therapy, and ipilimumab in locally advanced head and neck cancerPubMed (nih.gov)

Title: Quality of life in patients with recurrent and second primary head and neck cancer

Authors: Ramprasad VH, Li J, Atchison K, Zandberg DP, Clump DA, Johnson JT, Nilsen ML

Journal: Otolaryngol Head Neck Surg

Summary: Multimodality therapy, particularly with recurrent and second primary HNSCC, is more likely to contribute to diminished QOL and symptoms. This important consideration should play a role in framing informed discussions with patients regarding treatment.

Link: https://doi.org/10.1177/01945998221087712

Title: Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic

Authors: Zitelli L, Palmer C, Mamula E, Johnson J, Rauterkus G, Nilsen ML

Journal: Cancer Survivorship: Research and Practice

Summary: The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit.

Link: Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic | SpringerLink

Andrew McCall, MD

Title: Pain and pain control with opioid and nonopioid medications after otologic surgery

Authors: Godse NR, Tarfa RA, Perez PL, Hirsch BE, McCall AA

Journal: Otol Neurotol

Summary: Surgery with a postauricular approach is associated with higher pain and opioid use following otologic surgery. Patient- and approach-specific opioid prescribing is feasible following otologic surgery.

Link: https://pubmed.ncbi.nlm.nih.gov/34753877/

Reema, Padia, MD

Title: Operative surveillance of airway hemangiomas in PHACE syndrome

Authors: Ramprasad VH, Konanur A, McCoy JL, McCormick A, Jabbour N, Padia R

Journal: Ann Otol Rhinol Laryngol

Summary: Operative endoscopy remains useful in the workup of PHACE syndrome to identify subglottic hemangiomas, however there may be relatively low yield in asymptomatic patients. In office flexible laryngoscopy may be a less invasive means to examine the subglottic region. A multi-center prospective study would be necessary to evaluate incidence of subglottic hemangiomas in asymptomatic patients evaluated for PHACE.

Link: https://pubmed.ncbi.nlm.nih.gov/35227100

Catherine Palmer, PhD

Title: Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic

Authors: Zitelli L, Palmer C, Mamula E, Johnson J, Rauterkus G, Nilsen ML

Journal: Cancer Survivorship: Research and Practice

Summary: The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit.

Link: Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic | SpringerLink

Philip Perez, MD

Title: Pain and pain control with opioid and nonopioid medications after otologic surgery

Authors: Godse NR, Tarfa RA, Perez PL, Hirsch BE, McCall AA

Journal: Otol Neurotol

Summary: Surgery with a postauricular approach is associated with higher pain and opioid use following otologic surgery. Patient- and approach-specific opioid prescribing is feasible following otologic surgery.

Link: https://pubmed.ncbi.nlm.nih.gov/34753877/

Libby Smith, DO

Title: The patient experience: The relationship between vocal handicap, congruency, perceived present control, and mood across four voice disorders

Authors: Gartling GJ, van Mersbergen M, Crow K, Lewandowski A, Smith LJ, Gartner-Schmidt JL

Journal: Journal of Voice

Summary: There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures.

Link: https://pubmed.ncbi.nlm.nih.gov/34615615/

Title: Prospective, multi-center study of the anatomic distribution of recurrent respiratory papillomatosis

Authors: Benedict PA, Kravietz A, Achlatis E, Wang B, Zhang Y, Kidane J, Harrison T, Miller J, Drake VE, Best SR, McWhorter AJ, Jun Lin R, Rosen CA, Smith LJ, Amin MR

Journal: Laryngoscope

Summary: Recurrent respiratory papillomatosis lesions are significantly more likely to occur in the glottis, particularly the membranous vocal folds, compared to other subsites of the larynx or trachea. Despite this strong trend in lesion distribution, no differences were detected in disease behavior between anatomic subsites with respect to the rate of lesion recurrence, growth, or time to recurrence. Further research is required to elucidate the mechanisms of these phenomena.

Link: https://pubmed.ncbi.nlm.nih.gov/35129220/

Title: Modeling recurrence in idiopathic subglottic stenosis with mobile peak expiratory flow

Authors: Kimura K, Du L, Berry LD, Huang LC, Chen SC, Francis DO, Gelbard A, Smith, LJ; North American Airway Collaborative (NoAAC)

Journal: Laryngoscope

Summary: We provide normative PEF data on a large cohort of iSGS patients. The magnitude of improvement in PEF immediately after surgery was not associated with a longer procedure-free interval. However, a 30% decline in PEF over 90 days was associated with elevated risk of a recurrent procedure.

Link: https://pubmed.ncbi.nlm.nih.gov/34309022/

Carl Snyderman, MD, MBA

Title: Anatomical limits of the endoscopic contralateral transmaxillary approach to the petrous apex and petroclival region.

Authors: Mangussi-Gomes J, Alves-Belo JT, Truong HQ, Nogueira GF, Wang EW, Fernandez-Miranda JC, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: This study aimed to establish the anatomical landmarks for performing a contralateral transmaxillary approach (CTM) to the petrous apex (PA) and petroclival region (PCR), and to compare CTM with a purely endoscopic endonasal approach (EEA). Compared with a purely EEA, we concluded that the CTM provides significant "angle" and "reach" advantages for the PA and PCR.

Link: https://doi.org/10.1055/s-0040-1716693

Title: The selective role of open and endoscopic approaches for sinonasal malignant tumours.

Authors: Lopez F, Shah JP, Beitler JJ, Snyderman CH, Lund V, Piazza C, Makitie AA, Guntinas-Lichius O, Rodrigo JP, Kowalski LP, Quer M, Shaha A, Homma A, Sanabria A, Ferrarotto R, Lee AWM, Lee VHF, Rinaldo A, Ferlito A.

Journal: Adv Ther

Summary: Endoscopic endonasal surgery has been demonstrated to be effective in the treatment of selected cases of sinonasal cancers. However, in cases of locally advanced neoplasms, as well as recurrences, the most appropriate approach is still debated. The present review aims to summarize the current state of knowledge on the utility of open approaches to resect sinonasal malignant tumours.

Link: https://doi.org/10.1007/s12325-022-02080-x

Title: The incidence of stroke post neck dissection surgery and perioperative management.

Authors: Melachuri S, Melachuri M, Valappil B, Kim S, Snyderman CH

Journal: Am J Otolaryngol

Summary: Although the incidence of stroke post neck dissection is minimal, patients with multiple risk factors for stroke should be managed carefully to prevent deleterious outcomes.

Link: https://doi.org/10.1016/j.amjoto.2021.103360

Title: Postoperative care from the rhinologic and neurological perspectives.

Authors: Lee SE, Snyderman CH, Gardner PA

Journal: Otolaryngol Clin North Am

Summary: Postoperative care of patients undergoing endoscopic transsphenoidal pituitary surgery requires a multidisciplinary team approach, capitalizing on the complementary knowledge and skills of surgical and medical disciplines, including neurosurgery, otolaryngology, endocrinology, ophthalmology, and radiology.

Link: https://doi.org/10.1016/j.otc.2021.12.012

Ryan Soose, MD

Title: MEG-derived symptom-sensitive biomarkers with long-term test-retest reliability

Authors: Krieger D, Shepard P, Soose R, Puccio A, Beers S, Schneider W, Kontos AP, Collins MW, Okonkwo DO

Journal: Diagnostics

Summary: Neuroelectric measures derived from human magnetoencephalographic (MEG) recordings hold promise as aides to diagnosis and treatment monitoring and targeting for chronic sequelae of traumatic brain injury (TBI). This study tests novel MEG-derived regional brain measures of tonic neuroelectric activation for long-term test-retest reliability and sensitivity to symptoms. Resting state MEG recordings were obtained from a normative cohort (CamCAN, baseline: n = 613; mean 16-month follow-up: n = 245) and a chronic symptomatic TBI cohort (TEAM-TBI, baseline: n = 62; mean 6-month follow-up: n = 40). The MEG-derived neuroelectric measures were corrected for the empty-room contribution using a random forest classifier. The mean 16-month correlation between baseline and 16month follow-up CamCAN measures was 0.67; test-retest reliability was markedly improved in this study compared with previous work. The TEAM-TBI cohort was screened for depression, somatization, and anxiety with the Brief Symptom Inventory and for insomnia with the Insomnia Severity Index and was assessed via adjudication for six clinical syndromes: chronic pain, psychological health, and oculomotor, vestibular, cognitive, and sleep dysfunction. Linear classifiers constructed from the 136 regional measures from each TEAM-TBI cohort member distinguished those with and without each symptom, p < 0.0003 for each, i.e., the tonic regional neuroelectric measures of activation are sensitive to the presence/absence of these symptoms and clinical syndromes. The novel regional MEG-derived neuroelectric measures obtained and tested in this study demonstrate the necessary and sufficient properties to be clinically useful, i.e., good test-retest reliability, sensitivity to symptoms in each individual, and obtainable using automatic processing without human judgement or intervention. Link: https://pubmed.ncbi.nlm.nih.gov/35054252/

Title: Impact of body mass index and discomfort on upper airway stimulation: ADHERE registry 2020 update

Authors: Suurna MV, Steffen A, Boon M, Chio E, Copper M, Patil RD, Green K, Hanson R, Heiser C, Huntley C, Kent D, Larsen C, Manchanda S, Maurer JT, Soose R, de Vries N, Walia HK, Thaler E; ADHERE Registry Investigators

Journal: Laryngoscope

Summary: Data from ADHERE demonstrate high efficacy rates for UAS. Although surgical response rate differs between BMI32 and BMI35 patient groups, the AHI and ESS reduction is similar. Discomfort affects therapy adherence and efficacy. Thus, proper therapy settings adjustment to ensure comfort is imperative to improve outcomes.

Link: https://pubmed.ncbi.nlm.nih.gov/34626128/

Amanda Stapleton, MD

Title: Long term incidence and outcomes of sinonasal and otologic disease in patients with pyriform aperture stenosis and choanal atresia.

Authors: Godse NR, Lu N, Shaffer AD, Stapleton AL.

Journal: J Craniofac Surg.

Summary: The goal of this study was to investigate whether surgical intervention in PAS and CA is correlated with the long-term development of sinonasal disease or otologic disease (either recurrent acute otitis media or chronic otitis media with effusion).

Link: Long Term Incidence and Outcomes of Sinonasal and Otologic Disease in Patients With Pyriform Aperture Stenosis and Choanal Atresia - PubMed (nih.gov)

Title: Elexacaftor-Tezacaftor- Ivacaftor improves sinonasal outcomes in cystic fibrosis.

Authors: Stapleton AL, Kimple AJ, Goralski JL, Nouraie SM, Branstetter BF, Shaffer AD, Pilewski JM, Senior BA, Lee SE, Zemke AC.

Journal: J Cyst Fibros.

Summary: The study was a pre/post, observational cohort study conducted at two sites. Participants underwent a study visit prior to starting ELX/TEZ/IVA and a second visit at a median of 9 months on therapy. Each visit included sinus CT scan, rigid nasal endoscopy, and sweat chloride measurement. Symptoms were measured with the 22 item Sinonasal Outcome Test at scheduled intervals during the study. Regression models were used to test for improvement in symptoms, endoscopy, and CT scales.

Link: Elexacaftor-Tezacaftor- Ivacaftor improves sinonasal outcomes in cystic fibrosis - PubMed (nih.gov)

Eric Wang, MD

Title: Anatomical limits of the endoscopic contralateral transmaxillary approach to the petrous apex and petroclival region.

Authors: Mangussi-Gomes J, Alves-Belo JT, Truong HQ, Nogueira GF, Wang EW, Fernandez-Miranda JC, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: This study aimed to establish the anatomical landmarks for performing a contralateral transmaxillary approach (CTM) to the petrous apex (PA) and petroclival region (PCR), and to compare CTM with a purely endoscopic endonasal approach (EEA). Compared with a purely EEA, we concluded that the CTM provides significant "angle" and "reach" advantages for the PA and PCR.

Link: https://doi.org/10.1055/s-0040-1716693

Title: Advances in controlled drug delivery to the sinonasal mucosa.

Authors: Schilling AL, Cannon E, Lee SE, Wang EW, Little SR

Journal: Biomaterials

Summary: This review aims to highlight advances in biomaterial-based systems for sinonasal delivery. Delivery vehicles including nasal packs, dressings, sinus stents, polymeric meshes, nanoparticles, microparticles, and in situ hydrogels are reviewed.

Link: https://doi.org/10.1016/j.biomaterials.2022.121430

Title: A ready-to-use, thermoresponsive, and extended-release delivery system for the paranasal sinuses.

Authors: Schilling AL, Cannon E, Fullerton-Shirey SK, Lee SE, Wang EW, Little SR

Journal: Drug Deliv Transl Res

Summary: A drug delivery system for the paranasal sinuses consisting of a freeze-dried thermoresponsive hydrogel with degradable microspheres, called FD-TEMPS (Freeze Dried-Thermogel, Extended-release Microsphere-based delivery to the Paranasal Sinuses), was developed. Freeze drying enables this delivery system to be stored as a ready-to-use product for better ease of clinical translation without compromising the thermoresponsive or sustained release characteristics that would enable local delivery of therapeutics to the sinonasal mucosa.

Link: https://doi.org/10.1007/s13346-021-01069-3

Title: Three-dimensional models of the nasopharynx for the study of Epstein-Barr virus infection.

Authors: Ziegler P, Reznik AS, Kitchloo SP, Wang E, Lee SE, Green A, Myerburg MM, Sample CE, Shair KHY

Journal: Bio-Protocol

Summary: In this protocol, we provide step-by-step guide for the (i) conditional reprogramming of primary nasopharyngeal cells, (ii) differentiation of CRCs into pseudostratified epithelium in ALI culture (known as pseudoALI), and (iii) EBV infection of pseudo-ALI cultures. Additionally, we show that nasopharyngeal CRCs can be grown as organotypic rafts and subjected to EBV infection.

Link: https://doi.org/10.21769/BioProtoc.4365

April 2022 PUBLICATIONS

Joseph Dohar, MD

Title: Initiation of acid suppression therapy for laryngomalacia

Author: Dang S, McCoy JL, Shaffer AD, Tobey ABJ, Dohar JE, Simons JP, Maguire RC, Padia R

Journal: Am J Otolaryngol. 2022 Apr 8;43(3):103434; online ahead of print

Summary: Clinical symptom severity did not predict response to AST raising the question of utility of AST in LM. Severity of LM based on FFL, not clinical severity, was associated with decision to pursue SGP. Prospective randomized trials are needed to better understand the role of AST in LM.

Link: https://pubmed.ncbi.nlm.nih.gov/35483169

Uma Duvvuri, MD, PhD

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS.

Journal: Head and Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders. Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.

Link: https://onlinelibrary.wiley.com/doi/10.1002/hed.26978

Title: Phase I trial of cetuximab, radiotherapy, and ipilimumab in locally advanced head and neck cancer

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE.

Journal: Clinical Cancer Research

Summary: Concurrent radiotherapy with cetuximab, an anti-EGFR mAb, is a standard treatment for locally advanced head and neck squamous carcinoma (HNSCC). Cytotoxic T lymphocyte antigen-4-positive (CTLA-4+) regulatory T cells (Treg) dampen cellular immunity and correlate negatively with clinical outcomes. This phase I study added ipilimumab, an anti-CTLA-4 mAb, to cetuximab-radiotherapy.

Link: https://aacrjournals.org/clincancerres/article-abstract/28/7/1335/682203/Phase-I-Trial-of-CetuximabRadiotherapy-and?redirectedFrom=fulltext

Title: A benchmark for oncologic outcomes and model for lethal recurrence risk after transoral robotic resection of HPV-related oropharyngeal cancers

Authors: Brody RM, Shimunov D, Cohen RB, Lin A, Lukens JN, Hartner L, Aggarwal C, Duvvuri U, Montone KT, Jalaly JB, LiVolsi VA, Carey RM, Shanti RM, Rajasekaran K, Chalian AA, Rassekh CH, Cannady SB, Newman JG, O'Malley BW, Weinstein GS, Gimotty PA, Basu D

Journal: Oral Oncology

Summary: Increasing use of transoral robotic surgery (TORS) is likely to impact outcomes for HPV+ oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to describe oncologic outcomes for a large HPV+ OPSCC cohort after TORS and develop a risk prediction model for recurrence under this treatment paradigm.

Link: https://www.sciencedirect.com/science/article/pii/S1368837522000872?via%3Dihub

Title: Lysosomal inhibition sensitizes TMEM16A-expressing cancer cells to chemotherapy

Authors: Vyas A, Gomez-Casal R, Cruz-Rangel S, Villanueva H, Sikora AG, Rajagopalan P, Basu D, Pacheco J, Hammond GRV, Kiselyov K, Duvvuri U.

Journal: PNAS (Proc National Academic Science USA)

Summary: SignificanceCisplatin is the first line therapy for patients with head and neck cancer. However, resistance to cisplatin remains a major concern. High expression of the calcium-activated chloride channel

TMEM16A in tumors portends poor survival in these patients, possibly because of drug resistance. Here, we show that TMEM16A drives the sequestration of cisplatin into lysosomes. Subsequently, cisplatin is expelled via the delivery of lysosomes to the cell surface. We show that TMEM16A enhances this process, thereby promoting cisplatin resistance. We also show that lysosomal inhibition synergizes with cisplatin to induce tumor cell death. Our data uncovers a new fundamental feature of both lysosomal physiology and cancer cell biology that can potentially impact the treatment of patients with head and neck cancer Link: https://www.pnas.org/doi/10.1073/pnas.2100670119?url_ver=Z39.882003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Jackie Gartner-Schmidt, PhD, CCC-SLP

Title: Cough severity index in Brazilian Portuguese: Translation and cross-cultural adaptation

Authors: Ribeiro VV, Lopes LW, da Silva ACF, de Medeiros Neto AH, Gartner-Schmidt J, Behlau M

Journal: Journal of Voice

Summary: This is a study with observational, cross-sectional, and analytical design. The procedure for translation and cross-cultural adaptation followed the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust and was performed in five stages: translation, synthesis, back translation, committee review, and pretesting. The sample for the pretest consisted of 34 participants with refractory chronic cough, 11 males and 23 females, with an average age of 48 years and 1 month. This study resulted in the elaboration of a translated and cross-culturally adapted version of the Cough Severity Index in Brazilian Portuguese.

Link: https://pubmed.ncbi.nlm.nih.gov/32576524/

Title: Phonation with a variably occluded facemask: Effects of task duration

Authors: Gillespie AI, Fanucchi A, Gartner-Schmidt J, Belsky MA, Awan S

Journal: Journal of Voice

Summary: This study provides evidence that all three occlusion sizes may elicit beneficial changes for different patients; however, 5 minutes of phonation into a facemask with end occlusion of 6.4-mm diameter results in improved acoustic and aerodynamic voice outcomes for many patients with voice disorders. Future studies should further explore phonatory physiologic changes of the VOFM in a larger sample of patients and translate effects into clinical treatment for patients with voice disorders.

Link: https://pubmed.ncbi.nlm.nih.gov/32586639/

Noel Jabbour, MD

Title: The eyebrow approach for the management of pediatric frontal epidural abscesses secondary to diffuse sinusitis

Authors: Hallak H, Abou-Al-Shaar H, Mallela AN, McDowell MM, Jabbour N, Padia R, Greene S, Pollack IF.

Journal: Pediatric Neurosurgery

Summary: Minimally invasive approaches to the anterior cranial fossa have evolved over the past few decades. The management of frontal epidural abscesses (EDA) secondary to diffuse sinusitis in the pediatric population using minimally invasive techniques is scarcely reported in the literature. Herein, we report the utilization of a minimally invasive eyebrow approach for multidisciplinary concurrent evacuation of frontal EDA secondary to diffuse sinusitis and trephination of the frontal sinus in three pediatric patients.

Link: The Eyebrow Approach for the Management of Pediatric Frontal Epidural Abscesses Secondary to Diffuse Sinusitis - PubMed (nih.gov)

Raymond Maguire, DO

Title: Initiation of acid suppression therapy for laryngomalacia

Author: Dang S, McCoy JL, Shaffer AD, Tobey ABJ, Dohar JE, Simons JP, Maguire RC, Padia R

Journal: Am J Otolaryngol. 2022 Apr 8;43(3):103434; online ahead of print

Summary: Clinical symptom severity did not predict response to AST raising the question of utility of AST in LM. Severity of LM based on FFL, not clinical severity, was associated with decision to pursue SGP. Prospective randomized trials are needed to better understand the role of AST in LM.

Link: https://pubmed.ncbi.nlm.nih.gov/35483169

Reema, Padia, MD

Title: The eyebrow approach for the management of pediatric frontal epidural abscesses secondary to diffuse sinusitis

Authors: Hallak H, Abou-Al-Shaar H, Mallela AN, McDowell MM, Jabbour N, Padia R, Greene S, Pollack IF Journal: Pediatr Neurosurg. 2022 Apr 8 Online ahead of print

Summary: The eyebrow approach is a minimally invasive technique that should be considered as part of the armamentarium in the management of select EDA in the pediatric population. It allows for multidisciplinary collaboration between neurosurgeons and otolaryngologists for concomitant evacuation of the EDA and trephination of the frontal sinus. This approach is a feasible, safe, and effective minimally invasive technique that can be employed for the management of EDA secondary to diffuse sinusitis in the pediatric population. Link: https://pubmed.ncbi.nlm.nih.gov/35398851

Title: Initiation of acid suppression therapy for laryngomalacia

Author: Dang S, McCoy JL, Shaffer AD, Tobey ABJ, Dohar JE, Simons JP, Maguire RC, Padia R

Journal: Am J Otolaryngol. 2022 Apr 8;43(3):103434; online ahead of print

Summary: Clinical symptom severity did not predict response to AST raising the question of utility of AST in LM. Severity of LM based on FFL, not clinical severity, was associated with decision to pursue SGP. Prospective randomized trials are needed to better understand the role of AST in LM.

Link: https://pubmed.ncbi.nlm.nih.gov/35483169

Carl Snyderman, MD, MBA

Title: Characterization of the saddle nose deformity following endoscopic endonasal skull base surgery

Authors: Anstadt EE, Chen W, O'Brien J, Ickow I, Chow I, Bruce MK, Goldstein JA, Branstetter IV BF, Snyderman C, Wang EW, Gardner P, Schuster L

Journal: J Neurol Surg B Skull Base

Summary: The endoscopic endonasal approach (EEA) is commonly employed in skull base surgery for neoplasm resection. While nasal deformity following EEA is described, this study aimed to perform a detailed qualitative and quantitative assessment of the associated saddle nose deformity (SND) in particular.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1796-7984

Title: Poor treatment tolerance in head and neck cancer patients with low muscle mass.

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head & Neck

Summary: We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC).

Link: https://doi.org/10.1002/hed.26978

Title: Approach selection for resection of petroclival meningioma.

Authors: Jackson C, Tadokoro KS, Wang EW, Zenonos GA, Snyderman CH, Gardner PA

Journal: Neurosurg Focus Video

Summary: Petroclival meningiomas are surgically challenging tumors because of their deep location and involvement of critical neurovascular structures. A variety of approaches have been described, and selection of approach should be tailored to the location of the tumor relative to neurovascular structures and surgical experience. The authors present two patients with petroclival meningiomas with varying relationships to cranial nerves and skull base anatomy who underwent endoscopic endonasal and open petrosectomy approaches, to demonstrate the complementarity of the endonasal transpetrous and open transpetrosal corridors. Proficiency in both open and endonasal approaches is critical to appropriate approach selection and maximal safe resection.

Link: https://doi.org/10.3171/2022.1.FOCVID21252

Title: Transinfratemporal fossa transposition of the temporalis muscle flap for skull base reconstruction after endoscopic expanded nasopharyngectomy: an anatomical study and clinical application.

Authors: Sun X, Liu Q, Yu H, Wang H, Zhao W, Gu Y, Li H, Zhao K, Song X, Wang D, Fernandez-Miranda JC, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: Temporalis muscle flap (TMF) is widely used in traditional skull base surgery, but its application in endoscopic skull base surgery remains rarely reported. We aimed to investigate the surgical anatomy and clinical application of TMF for reconstruction of skull base defects after expanded endoscopic nasopharyngectomy.

Link: https://doi.org/10.1055/s-0040-1718764

Title: Dural sealants do not reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery

Authors: McDowell MM, Jacobs RC, Valappil B, Abou-Al-Shaar H, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: J Neurol Surg B Skull Base

Summary: The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-1743558

Title: Non-functional carotid body tumors in patients without somatic mutations may be considered for nonoperative management.

Authors: Reitz KM, Ramos A, Speranza G, Chaer R, Singh M, Snyderman C, Hager E

Journal: Ann Vasc Surg

Summary: Carotid Body Tumors (CBT) are rare neuroendocrine paragangliomas which are typically asymptomatic and benign with a low rate of biochemical functionality. Historically, early surgical excision was recommended to prevent development of CBT-related complications. Yet, CBT resection can result in significant cranial nerve and vascular injuries. Recent work has shown successful primary observation without resection of non-carotid body, cranial paragangliomas with slow growth and low rate of neuropathies. We hypothesize that primary observation of CBT is safe and may be considered for the majority of CBT.

Link: https://doi.org/10.1016/j.avsg.2022.04.021

Title: The role of endoscopic endonasal surgery in the management of prolactinomas based on their invasiveness into the cavernous sinus.

Authors: Abou-Al-Shaar H, Mallela AN, Patel A, Shariff RK, Shin SS, Choi PA, Faraji AH, Fazeli PK, Costacou T, Wang EW, Fernandez-Miranda JC, Snyderman CH, Gardner PA, Zenonos GA

Journal: Pituitary

Summary: The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.

Link: https://doi.org/10.1007/s11102-022-01221-3

Ryan Soose, MD

Title: Evaluation of upper airway stimulation for adolescents with down syndrome and obstructive sleep apnea

Authors: Yu PK, Stenerson M, Ishman SL, Shott SR, Raol N, Soose RJ, Tobey A, Baldassari C, Dedhia RC, Pulsifer MB, Grieco JA, Abbeduto LJ, Kinane TB, Keamy DG Jr, Skotko BG, Hartnick CJ

Journal: JAMA Otolaryngology Head and Neck Surgery

Summary: Upper airway stimulation was able to be safely performed for 42 adolescents who had Down syndrome and persistent severe OSA after adenotonsillectomy with positive airway pressure intolerance. There was an acceptable adverse event profile with high rates of therapy response and quality of life improvement.

Link: https://pubmed.ncbi.nlm.nih.gov/35446411/

Title: Cluster analysis of upper airway stimulation adherence patterns and implications on clinical care

Authors: Soose RJ, Araujo M, Faber K, Roy A, Lee K, Ni Q, Srivastava J, Strollo PJ

Journal: Sleep

Summary: Cluster analysis of early UAS usage patterns identified six distinct groups that may enable personalized interventions for improved long-term management. Differentiation of the patient clusters may have clinical implications with regard to sleep hygiene education, therapy discomfort, comorbid insomnia, and other conditions that impact adherence.

Link: https://pubmed.ncbi.nlm.nih.gov/35245933/

Eric Wang, MD

Title: Characterization of the saddle nose deformity following endoscopic endonasal skull base surgery

Authors: Anstadt EE, Chen W, O'Brien J, Ickow I, Chow I, Bruce MK, Goldstein JA, Branstetter IV BF, Snyderman C, Wang EW, Gardner P, Schuster L

Journal: J Neurol Surg B Skull Base

Summary: The endoscopic endonasal approach (EEA) is commonly employed in skull base surgery for neoplasm resection. While nasal deformity following EEA is described, this study aimed to perform a detailed qualitative and quantitative assessment of the associated saddle nose deformity (SND) in particular.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-1796-7984

Title: Approach selection for resection of petroclival meningioma.

Authors: Jackson C, Tadokoro KS, Wang EW, Zenonos GA, Snyderman CH, Gardner PA

Journal: Neurosurg Focus Video

Summary: Petroclival meningiomas are surgically challenging tumors because of their deep location and involvement of critical neurovascular structures. A variety of approaches have been described, and selection of approach should be tailored to the location of the tumor relative to neurovascular structures and surgical

experience. The authors present two patients with petroclival meningiomas with varying relationships to cranial nerves and skull base anatomy who underwent endoscopic endonasal and open petrosectomy approaches, to demonstrate the complementarity of the endonasal transpetrous and open transpetrosal corridors. Proficiency in both open and endonasal approaches is critical to appropriate approach selection and maximal safe resection.

Link: https://doi.org/10.3171/2022.1.FOCVID21252

Title: Dural sealants do not reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery

Authors: McDowell MM, Jacobs RC, Valappil B, Abou-Al-Shaar H, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: J Neurol Surg B Skull Base

Summary: The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-1743558

Title: The role of endoscopic endonasal surgery in the management of prolactinomas based on their invasiveness into the cavernous sinus.

Authors: Abou-Al-Shaar H, Mallela AN, Patel A, Shariff RK, Shin SS, Choi PA, Faraji AH, Fazeli PK, Costacou T, Wang EW, Fernandez-Miranda JC, Snyderman CH, Gardner PA, Zenonos GA

Journal: Pituitary

Summary: The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.

Link: https://doi.org/10.1007/s11102-022-01221-3

MAY 2022 PUBLICATIONS

Noel Jabbour, MD

Title: Foreign Body Aspiration

Authors: Cramer N, Jabbour N, Tavarez MM, Taylor RS.

Journal: StatPearls

Summary: Foreign body aspiration remains a significant cause of death in children for anatomic as well as developmental reasons. Choking is typically defined as an aerodigestive foreign body causing varying amounts of obstruction to the airway. The obstruction can lead to difficulties with ventilation and oxygenation thus resulting in significant morbidity or mortality.

Link: Foreign Body Aspiration - StatPearls - NCBI Bookshelf (nih.gov)

Jonas Johnson, MD

Title: Evaluation of neck disability using computed-tomography in head and neck cancer survivors

Authors: Harris A, Branstetter B, Li J, Piva SR, Johnson JT, Nilsen ML

Journal: Front Pain Res (Lausanne)

Summary: Our study shows that neck impairment and pain in head and neck cancer survivors is not sufficiently explained by cervical degeneration related to age or trauma, supporting the theory that post-treatment neck

disability occurs as a side effect of treatment. These results support the further assessment of structure and function of cervical musculature and degeneration following HNC treatment.

Link: Evaluation of Neck Disability Using Computed-Tomography in Head and Neck Cancer Survivors - PubMed (nih.gov)

Mark Kubik, MD

Title: A middle-aged women with parotid swelling

Authors: Stevens AR, Branstetter BF, Kubik MW

Journal: JAMA Otolaryngology-Head and Neck Surgery

Summary: This is a case report describing the rare occurrence of a spontaneous parotid hemorrhage in the setting of anticoagulation.

Link: https://pubmed.ncbi.nlm.nih.gov/35511199/

Reema Padia, MD

Title: Non-involuting congenital hemangioma with delayed hypertrophy: A case series

Authors: Konanur A, Jimenez JE, Kochin M, McCormick A, Salgado C, Yilmaz S, Bykowski M, Padia R

Journal: Int J Pediatr Otorhinolaryngol.

Summary: Although postnatal growth of NICH have been described, cases usually occur during the pre-adolescent period where growth is usually proportional to overall growth of the patient. This study describes two cases of rapid onset NICH hypertrophy occurring later in life. Knowledge of the potential for delayed hypertrophy may lead families to seek earlier intervention or opt for more definitive interventions. Additionally, recognition of these variable distinctions will contribute to a better understanding of CH and its various subtypes.

Link: https://pubmed.ncbi.nlm.nih.gov/35489230

JUNE 2022 PUBLICATIONS

Robert Ferris, MD, PhD

Title: A multicenter randomized phase II study of single agent efficacy and optimal combination sequence of everolimus and pasireotide LAR in advanced thyroid cancer

Authors: Bauman JE, Chen Z, Zhang C, Ohr JP, Ferris RL, McGorisk GM, Brandt S, Srivatsa S, Chen AY, Steuer CE, Shin DM, Saba NF, Khuri FR, Owonikoko TK

Journal: Cancers (Basel)

Summary: The combination of everolimus and pasireotide-LAR showed promising efficacy over single agent. The delayed combination of everolimus and pasireotide-LAR following progression on single agent everolimus appeared intriguing as a combination strategy.

Link: A Multicenter Randomized Phase II Study of Single Agent Efficacy and Optimal Combination Sequence of Everolimus and Pasireotide LAR in Advanced Thyroid Cancer - PubMed (nih.gov)

Title: Perspectives in immunotherapy: meeting report from the immunotherapy bridge

Authors: Ascierto PA, Avallone A, Bhardwaj N, Bifulco C, Bracarda S, Brody JD, Buonaguro L, Demaria S, Emens LA, Ferris RL, Galon J, Khleif SN, Klebanoff CA, Laskowski T, Melero I, Paulos CM, Pignata S, Ruella M, Svane IM, Taube JM, Fox BA, Hwu P, Puzanov I

Journal: Translational Med

Summary: Over the past decade, immunotherapy has become an increasingly fundamental modality in the treatment of cancer. The positive impact of immune checkpoint inhibition, especially anti-programmed death (PD)-1/PD-ligand (L)1 blockade, in patients with different cancers has focused attention on the potential for other immunotherapeutic approaches. These include inhibitors of additional immune checkpoints, adoptive cell transfer (ACT), and therapeutic vaccines. Patients with advanced cancers who previously had limited treatment options available may now benefit from immunotherapies that can offer durable responses and improved survival outcomes. However, despite this, a significant proportion of patients fail to respond to immunotherapy, especially those with less immunoresponsive cancer types, and there remains a need for new treatment strategies.The virtual Immunotherapy Bridge (December 1st-2nd, 2021), organized by the Fondazione Melanoma Onlus, Naples, Italy in collaboration with the Society for Immunotherapy of Cancer addressed several areas of current research in immunotherapy, including lessons learned from cell therapies, drivers of immune response, and trends in immunotherapy across different cancers, and these are summarised here.

Link: Perspectives in Immunotherapy: meeting report from the Immunotherapy Bridge, December 1st-2nd, 2021PubMed (nih.gov)

Title: Long-term outcomes with Nivolumab as first-line treatment in recurrent or metastatic head and neck cancer: Subgroup analysis of checkmate 141

Authors: Gillison ML, Blumenschein G, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington KJ, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Jayaprakash V, Wei L, Ferris RL

Journal: Oncologist

Summary: In the randomized, phase 3 CheckMate 141 trial, nivolumab significantly improved overall survival (OS) versus investigator's choice (IC) of chemotherapy at primary analysis among 361 patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN) post-platinum therapy. Nivolumab versus IC as first-line treatment also improved OS among patients with R/M SCCHN who progressed on platinum therapy for locally advanced disease in the adjuvant or primary setting at 1-year follow-up. In the present long-term follow-up analysis of patients receiving first-line treatment, OS benefit with nivolumab (n = 50) versus IC (n = 26) was maintained (median: 7.7 months versus 3.3 months; hazard ratio: 0.56; 95% confidence interval, 0.34-0.94) at 2 years. No new safety signals were identified. In summary, this long-term 2-year analysis of CheckMate 141 supports the use of nivolumab as a first-line treatment for patients with platinum-refractory R/M SCCHN. Link: Long-term Outcomes with Nivolumab as First-line Treatment in Recurrent or Metastatic Head and Neck Cancer: Subgroup Analysis of CheckMate 141 - PubMed (nih.gov)

Title: Systemic immune dysfunction in cancer patients driven by IL6 induction of LAG3 in peripheral CD8+ T cells

Authors: Somasundaram A, Cillo AR, Lampenfeld C, Workman CJ, Kunning S, Oliveri LN, Velez M, Joyce S, Calderon M, Dadey R, Rajasundaram D, Normolle DP, Watkins SC, Herman JG, Kirkwood JM, Lipson EJ, Ferris RL, Bruno TC, Vignali DAA

Journal: Cancer Immunol Res

Summary: Many cancer patients do not develop a durable response to the current standard of care immunotherapies, despite substantial advances in targeting immune inhibitory receptors. A potential compounding issue, which may serve as an unappreciated, dominant resistance mechanism, is an inherent systemic immune dysfunction that is often associated with advanced cancer. Minimal response to inhibitory receptor (IR) blockade therapy and increased disease burden have been associated with peripheral CD8+ T-cell dysfunction, characterized by suboptimal T-cell proliferation and chronic expression of IRs (eg. Programmed Death 1 [PD1] and Lymphocyte Activation Gene 3 [LAG3]). Here, we demonstrated that approximately a third of cancer patients analyzed in this study have peripheral CD8+ T cells that expressed robust intracellular LAG3

(LAG3IC), but not surface LAG3 (LAG3SUR) due to A Disintegrin and Metalloproteinase domain-containing protein 10 (ADAM10) cleavage. This associated with poor disease prognosis and decreased CD8+ T-cell function, which could be partially reversed by anti-LAG3. Systemic immune dysfunction was restricted to CD8+ T cells, including, in some cases, a high percentage of peripheral naïve CD8+ T cells, and was driven by the cytokine IL6 via STAT3. These data suggest that additional studies are warrented to determine if the combination of increased LAG3IC in peripheral CD8+ T cells and elevated systemic IL6 can serve as predictive biomarkers and identify which cancer patients may benefit from LAG3 blockade.

Link: Systemic immune dysfunction in cancer patients driven by IL6 induction of LAG3 in peripheral CD8+ T cellsPubMed (nih.gov)

Title: The quest to eradicate HPV-related oropharyngeal carcinoma: An opportunity not to miss

Authors: Lalonde CS, Teng Y, Burtness BA, Ferris RL, Ahmed R, Saba NF

Journal: J Natl Cancer Inst.

Summary: Since the 1970s, OPSCC has shifted from an environmentally triggered to virally mediated disease due to a sharp rise in human papillomavirus (HPV)-related SCC. Although a highly effective prophylactic vaccine is available, its current implementation is far below national targets and OPSCC incidence is predicted to further increase by 2045. However, we believe that with prompt action now, we can not only defy these predictions, but effectively eradicate HPV-related OPSCC in these next 20 years. We herein provide an overview of the necessary elements to eliminate this disease: improved primary vaccine uptake, a one-time universal vaccination effort, and implementation of novel therapeutics that have potential to cure existing disease.

Link: The Quest to Eradicate HPV-Related Oropharyngeal Carcinoma: An Opportunity Not to Miss - PubMed (nih.gov)

Title:. Oral human papillomavirus prevalence, persistence, and risk-factors in HIV-positive and HIV-negative adults

Authors: Riddell J 4th, Brouwer AF, Walline HM, Campredon LP, Meza R, Eisenberg MC, Andrus EC, Delinger RL, Yost ML, McCloskey JK, Thomas TB, Huang S, Ferris RL, Shin DM, Fakhry C, Ow T, Li D, Berlot A, Carey TE, Schlecht NF

Journal: Tumour Virus Res.

Summary: Risk of oral HPV infection and persistence was significantly higher in HIV + adults with a history of poorly controlled HIV, which may put them at increased risk of HPV-associated cancer.

Link: Oral human papillomavirus prevalence, persistence, and risk-factors in HIV-positive and HIV-negative adults - PubMed (nih.gov)

Title: Dual checkpoint targeting of B7-H3 and PD-1 with enoblituzumab and pembrolizumab in advanced solid tumors: interim results from a multicenter phase I/II trial

Authors: Aggarwal C, Prawira A, Antonia S, Rahma O, Tolcher A, Cohen RB, Lou Y, Hauke R, Vogelzang N, P Zandberg D, Kalebasty AR, Atkinson V, Adjei AA, Seetharam M, Birnbaum A, Weickhardt A, Ganju V, Joshua AM, Cavallo R, Peng L, Zhang X, Kaul S, Baughman J, Bonvini E, Moore PA, Goldberg SM, Arnaldez FI, Ferris RL, Lakhani NJ

Journal: S J Immunother Cancer

Summary: Checkpoint targeting with enoblituzumab and pembrolizumab demonstrated acceptable safety and antitumor activity in patients with CPI-naïve HNSCC and NSCLC.

Trial registration number: NCT02475213

Link: Dual checkpoint targeting of B7-H3 and PD-1 with enoblituzumab and pembrolizumab in advanced solid tumors: interim results from a multicenter phase I/II trial - PubMed (nih.gov)

Title: Genetic variation within the human papillomavirus type 16 genome is associated with oropharyngeal cancer prognosis

Authors: Lang Kuhs KA, Faden DL, Chen L, Smith DK, Pinheiro M, Wood CB, Davis S, Yeager M, Boland JF, Cullen M, Steinberg M, Bass S, Wang X, Liu P, Mehrad M, Tucker T, Lewis JS, Ferris RL, Mirabello L

Journal: Ann Oncol

Summary: HPV16 genetic variation is associated with HPV-OPC prognosis and can improve prognostic accuracy.

Link: Genetic variation within the human papillomavirus type 16 genome is associated with oropharyngeal cancer prognosis - PubMed (nih.gov)

Title:. Phase I trial of cetuximab, radiotherapy, and ipilimumab in locally advanced head and neck cancer

Authors: Ferris RL, Moskovitz J, Kunning S, Ruffin AT, Reeder C, Ohr J, Gooding WE, Kim S, Karlovits BJ, Vignali DAA, Duvvuri U, Johnson JT, Petro D, Heron DE, Clump DA, Bruno TC, Bauman JE

Journal: Clinical Cancer Res

Summary: The RP2D for ipilimumab plus standard cetuximab-radiotherapy is 1 mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.

Link: Phase I Trial of Cetuximab, Radiotherapy, and Ipilimumab in Locally Advanced Head and Neck CancerPubMed (nih.gov)

Title:. Poor treatment tolerance in head and neck cancer patients with low muscle mass

Authors: Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS

Journal: Head and Neck

Summary: The RP2D for ipilimumab plus standard cetuximab-radiotherapy is 1 mg/kg in weeks 5, 8, 11, and 14. The regimen is tolerable and yields acceptable survival without cytotoxic chemotherapy.

Link: Poor treatment tolerance in head and neck cancer patients with low muscle mass - PubMed (nih.gov)

Noel Jabbour, MD

Title: Prevalence and management of laryngomalacia in patients with pierre robin sequence.

Authors: Bakeman AE, Shaffer AD, Tobey ABJ, Jabbour N, Ford MD, Goldstein JA, Simons JP.

Journal: Cleft Palate Craniofac J.

Summary: To characterize the prevalence and presentation of laryngomalacia and efficacy of supraglottoplasty (SGP) in a cohort of patients with Pierre Robin Sequence (PRS).

Link: https://doi.org/10.1177/10556656221107298

Jonas Johnson, MD

Title: Corrigendum to "The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm"

Authors: Mady, LJ; Baddour, K; Hodges, JC; Magana, LC; Schwarzbach, HL; Borrebach, JD; Nilsen, ML; Johnson, JT; Hall, DE

Journal: Oral Oncol

Summary: By reduced physiologic reserve, frail patients are more vulnerable to poor outcomes. Differences in mortality by treatment in frail HNC patients have not been compared. Frail patients treated non-surgically had similar/higher mortality than counterparts. Prognostic equipoise is needed among surgical vs non-surgical treatment of the frail. Surgery in this group may be of benefit despite the perception of being “too frail.”

Mark Kubik, MD

Title: Standard fixed enoxaparin dosing for venous thromboembolism prophylaxis leads to low peak anti-factor Xa levels in both head and neck and breast free flap patients

Authors: Ambani SW, Bengur FB, Varelas LJ, Nguyen VT, De La Cruz C, Acarturk TO, Manders EK, Kubik MW, Sridharan S, Gimbel ML, Solair MG

Journal: Journal of Reconstructive Microsurgery

Summary: This is a retrospective study investigating our current prophylactic regimen to prevent venous thromboembolism (VTE) in microvascular free flaps. This study compares serum anti-factor Xa levels to clinical outcomes with respect to VTE. We find that fixed dosed prophylactic regimens often are associated with subtherapeutic levels. This generate the question as to whether weight based dosing of anticoagulants is indicated in complex head and neck reconstructive surgery.

Link: https://pubmed.ncbi.nlm.nih.gov/35714620/

Reema Padia, MD

Title: Non-involuting congenital hemangioma with delayed hypertrophy: A case series

Authors: Konanur A, Jimenez JE, Kochin M, McCormick A, Salgado C, Yilmaz S, Bykowski M, Padia R

Journal: Int J Pediatr Otorhinolaryngol.

Summary: Although postnatal growth of NICH have been described, cases usually occur during the pre-adolescent period where growth is usually proportional to overall growth of the patient. This study describes two cases of rapid onset NICH hypertrophy occurring later in life. Knowledge of the potential for delayed hypertrophy may lead families to seek earlier intervention or opt for more definitive interventions. Additionally, recognition of these variable distinctions will contribute to a better understanding of CH and its various subtypes.

Link: https://pubmed.ncbi.nlm.nih.gov/35489230

Barry Schaitkin, MD

Title: An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT)

Authors: Gulati, A; Cognetti, DM; Cohen, DS; Ogden, MA; Schaitkin, BM; Walvekar, RR; Ryan, WR; Chang, JL Journal: Laryngoscope

Summary: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms. Link: An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT)Gulati - - The Laryngoscope - Wiley Online Library

JULY 2022 PUBLICATIONS

Barry Hirsch, MD

Title: Comparison of endoscopic endonasal approach and lateral microsurgical infratemporal fossa approach to the jugular foramen: An anatomical study

Authors: Liu J, Pinheiro-Neto CD, Yang D, Wang E, Gardner PA, Hirsch BE, Snyderman CH, Fernandez-Miranda JC Journal: J Neurol Surg B Skull Base

Summary: The EEA to the jugular foramen is anatomically feasible but requires mobilization of the ICA to provide access to the anterior and medial aspects of the jugular foramen. The lateral infratemporal approach requires facial nerve transposition to provide access to the lateral and posterior parts of the jugular foramen. A deep

understanding of the complex anatomy of this region is paramount for safe and effective surgery of the jugular foramen. Both techniques may be complementary considering the different regions of the jugular foramen accessed with each approach.

Link: https://pubmed.ncbi.nlm.nih.gov/35832999/

Barry Schaitkin, MD

Title: An updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT)

Authors: Arushi Gulati 1, David M Cognetti 2, David S Cohen 3, M Allison Ogden 4, Barry M Schaitkin 5, Rohan R Walvekar 6, William R Ryan 1, Jolie L Chang 1 7

Summary: We developed the SPIT instrument to improve usability and content validity in chronic sialadenitis evaluation. The psychometric assessment demonstrated high construct validity and test-retest reliability. Further work will assess longitudinal changes with treatment.

Link: An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (SPIT)PubMed (nih.gov)

Libby Smith, DO

Title: Multicenter development and validation of the vocal cord paralysis experience (CoPE), a patient-reported outcome measure for unilateral vocal fold paralysis-specific disability

Authors: Fernandes-Taylor S, Damico-Smith C, Arroyo N, Wichmann M, Zhao J, Feurer ID, Francis DO

Journal: JAMA Otolaryngol Head Neck Surg.

Summary: The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (e.g., injection augmentation), and permanent surgical treatments for UVFP.

Link: https://pubmed.ncbi.nlm.nih.gov/35797026/

Ryan Soose, MD

Title: Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment

Authors: Luyster FS, Ni Q, Lee K, Harrison C, Ramprasad VH, Soose RJ, Strollo PJ

Journal: J Clin Sleep Med.

Summary: Insomnia with or without anxiety contributes to differing patient-reported experiences in high versus low user groups, with increased insomnia symptoms among low users. Improved understanding of the specific barrier and facilitators of UAS adherence may drive better long-term use and more personalized management strategies, including concomitant insomnia treatment.

Link: https://pubmed.ncbi.nlm.nih.gov/35689597/

Title: Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea?

Authors: Khan M, Stone A, Soose RJ, Cohen SM, Howard J, Capasso R, Itayem D, Gillespie MB, Mehra R, Chio E, Strollo PJ, Menzl A, Kaplan A, Ni Q

Journal: J Clin Sleep Med.

Summary: Our study found that there was no statistically significant difference in adherence or efficacy with UAS therapy between White and non-White individuals. However, the percent of non-White people implanted is low which suggests a need to expand access to this therapy for non-White populations with OSA who cannot tolerate PAP therapy.

Link: https://pubmed.ncbi.nlm.nih.gov/35681251/

Shaum Sridharan, MD

Title: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis in Laryngoscope Investigative Otolaryngology

Authors: Borson S, Shuai Y, Branstetter BF, Nilsen ML, Hughes MA, Fenton M, Kubik M, Sridharan S, Clump DA, Skinner HD, Johnson JT, Chiosea SI, Ohr J, Duvvuri U, Kim S, Traylor KS, Ferris R, Zandberg DP

Journal: Laryngoscope Investig Ontolaryngology

Summary: Data on the efficacy of including definitive local therapy to the primary site for head and neck squamous cell carcinoma (HNSCC) patients with synchronous distant metastasis are lacking. In multiple different solid tumor types, there has been benefit when using systemic therapy followed by local consolidative therapy (stereotactic ablative radiotherapy or surgery) directed at metastases. We proposed to retrospectively evaluate patients at our institution that received definitive treatment to the primary.

Link: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis - Borson - 2022Laryngoscope Investigative Otolaryngology - Wiley Online Library

Thanos Tzounopoulos, PhD

Title: Development of an automated screen for Kv7.2 potassium channels and discovery of a new agonist chemotype

Authors: Hernandez CC, Tarfa RA, Miguel I Limcaoco J, Liu R, Mondal P, Hill C, Keith Duncan R, Tzounopoulos T, Stephenson CRJ, O'Meara MJ, Wipf P

Journal: Bioorg Med Chem Lett

Summary: To identify pore domain ligands on Kv7.2 potassium ion channels, we compared wild-type (WT) and W236L mutant Kv7.2 channels in a series of assays with previously validated and novel agonist chemotypes. Positive controls were retigabine, flupirtine, and RL-81; i.e. Kv7.2 channel activators that significantly shift voltagedependent activation to more negative potentials (ΔV50) at 5 µM. We identified 6 new compounds that exhibited differential enhancing activity between WT and W236L mutant channels. Whole cell patch-clamp electrophysiology studies were conducted to identify Kv7.2. Kv7.2/3, Kv7.4, and Kv7.5 selectivity. Our results validate the SyncroPatch platform and establish new structure activity relationships (SAR). Specifically, in addition to selective Kv7.2, Kv7.2/3, Kv7.4. and Kv7.5 agonists, we identified a novel chemotype, ZK-21, a 4aminotetrahydroquinoline that is distinct from any of the previously described Kv7 channel modifiers. Using flexible receptor docking, ZK-21 was predicted to be stabilized by W236 and bind perpendicular to retigabine, burying the benzyl carbamate group into a tunnel reaching the core of the pore domain.

Link: https://pubmed.ncbi.nlm.nih.gov/35671848/

Title: Neuromodulatory Mechanisms Underlying Contrast Gain Control in Mouse Auditory Cortex

Authors: Cody PA, Tzounopoulos T

Journal: Journal of Neuroscience

Summary: When sound levels in the acoustic environment become more variable across time and frequency, the brain decreases response gain to maintain dynamic range and thus stimulus discriminability. This gain adaptation accounts for changes in perceptual judgments in humans and mice; however, the underlying neuromodulatory mechanisms remain poorly understood. Here, we report context-dependent neuromodulatory effects of synaptic zinc that are necessary for contrast gain control in A1. Understanding context-specific neuromodulatory mechanisms, such as contrast gain control, provides insight into A1 cortical mechanisms of adaptation and also into fundamental aspects of perceptual changes that rely on gain modulation, such as attention.

Link: https://www.jneurosci.org/content/42/28/5564

2022 PUBLICATIONS

Noel Jabbour, MD

Title: A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulators.

Authors: Michaels RE, Zugris NV, Cin MD, Monovoukas DA, Koka KK, Smith C, Bohm L, Kim J, Green G, Roby B, Jabbour N, Lind M, Goudy S, Zopf DA.

Journal: Int J Pediatr Otorhinolaryngol.

Summary: Our objective was to create and evaluate a novel virtual platform dissection course to complement pediatric otolaryngology fellowship training in the setting of the COVID-19 pandemic.

Link: A national pediatric otolaryngology fellowship virtual dissection course using 3D printed simulatorsPubMed (nih.gov)

Jonas Johnson, MD

Title: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis

Authors: Borson S, Shuai Y, Branstetter BF, Nilsen ML, Hughes MA, Fenton M, Kubik M, Sridharan S, Clump DA, Skinner HD, Johnson JT, Chiosea SI, Ohr J, Duvvuri U, Kim S, Traylor KS, Ferris R, Zandberg DP

Journal: Laryngoscope Investig Otolaryngol

Summary: We observed impressive survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary site in addition to induction and/or immunotherapy. Further study is warranted.

Link: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis - PubMed (nih.gov)

Carl Snyderman, MD, MBA

Title: Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery

Authors: Fields DP, McDowell MM, Schulien AJ, Algattas H, Abou-Al-Shaar H, Agarwal N, Alan N, Costacou T, Wang EW, Snyderman CH, Gardner PA, Zenonos GA

Journal: World Neurosurg

Summary: Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure; as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications.

Link: https://doi.org/10.1016/j.wneu.2022.07.102

Title: From research to clinical practice: long-term impact of randomized clinical trial examining the effect of lumbar drains on cerebrospinal fluid leak rates following endonasal skull base surgery

Authors: Lavigne P, Wang EW, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: Intraoperative cerebrospinal fluid (CSF) leaks are associated with increased risk of postoperative CSF leaks despite multilayered reconstruction with vascularized tissue. A recent randomized controlled trial (RCT) examining the use of perioperative lumbar drains (LD) in high-risk skull base defects identified a significant reduction in postoperative CSF leak incidence (21.2 vs. 8.2%; p = 0.017). This study was conducted to assess the

efficacy of the selective use of CSF diversion, for patients with intraoperative CSF leaks involving endoscopic endonasal approaches (EEA) to the skull base.

Link: https://doi.org/10.1055/a-1680-1870

Shaum Sridharan, MD

Title: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis

Authors: Borson S, Shuai Y, Branstetter BF, Nilsen ML, Hughes MA, Fenton M, Kubik M, Sridharan S, Clump DA, Skinner HD, Johnson JT, Chiosea SI, Ohr J, Duvvuri U, Kim S, Traylor KS, Ferris R, Zandberg DP

Journal: Laryngoscope Investig Otolaryngol

Summary: We observed impressive survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary site in addition to induction and/or immunotherapy. Further study is warranted.

Link: Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis - PubMed (nih.gov)

Title: Standard fixed enoxaparin dosing for venous thromboembolism prophylaxis leads to low peak anti-factor Xa Levels in both head and neck and breast free flap patients

Authors: Ambani SW, Bengur FB, Varelas LJ, Nguyen VT, Cruz C, Acarturk TO, Manders EK, Kubik MW, Sridharan S, Gimbel ML, Solari MG

Journal: J Reconstr Microsurg

Summary: Standard fixed enoxaparin dosing for postoperative VTE prophylaxis does not achieve target afXa levels for the majority of our free flap patients. H&N patients appear to be a particularly high-risk group that may require a more personalized and aggressive approach. Total body weight is the sole negative predictor of afXa level, supporting a role for weight-based enoxaparin dosing.

Link: Standard Fixed Enoxaparin Dosing for Venous Thromboembolism Prophylaxis Leads to Low Peak Anti-Factor Xa Levels in Both Head and Neck and Breast Free Flap Patients - PubMed (nih.gov)

Eric Wang, MD

Title: Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery

Authors: Fields DP, McDowell MM, Schulien AJ, Algattas H, Abou-Al-Shaar H, Agarwal N, Alan N, Costacou T, Wang EW, Snyderman CH, Gardner PA, Zenonos GA

Journal: World Neurosurg

Summary: Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure; as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications.

Link: https://doi.org/10.1016/j.wneu.2022.07.102

Title: Outcomes of dupilumab treatment versus endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps

Authors: Dharmarajan H, Falade O, Lee SE, Wang EW

Journal: Int Forum Allergy Rhinol

Summary: Outside of SINUS-24 (A Controlled Clinical Study of Dupilumab in Patients With Bilateral Nasal Polyps) and SINUS-52 (Controlled Clinical Study of Dupilumab in Patients With Nasal Polyps), there are limited data on the

efficacy of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The objective was to compare dupilumab with functional endoscopic sinus surgery (FESS) in patients with CRSwNP by assessing the change in nasal polyp and Sino-Nasal Outcome Test (SNOT-22) scores postintervention. Overall, both therapies are effective at reducing symptoms in patients with CRSwNP according to SNOT-22. Patients treated with dupilumab reported improved olfaction and decreased cough, postnasal drainage, and thick nasal drainage as compared with patients treated with FESS, while patients treated with FESS had a greater reduction in polyp burden.

Link: https://doi.org/10.1002/alr.22951

Title: From research to clinical practice: long-term impact of randomized clinical trial examining the effect of lumbar drains on cerebrospinal fluid leak rates following endonasal skull base surgery

Authors: Lavigne P, Wang EW, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: Intraoperative cerebrospinal fluid (CSF) leaks are associated with increased risk of postoperative CSF leaks despite multilayered reconstruction with vascularized tissue. A recent randomized controlled trial (RCT) examining the use of perioperative lumbar drains (LD) in high-risk skull base defects identified a significant reduction in postoperative CSF leak incidence (21.2 vs. 8.2%; p = 0.017). This study was conducted to assess the efficacy of the selective use of CSF diversion, for patients with intraoperative CSF leaks involving endoscopic endonasal approaches (EEA) to the skull base.

Link: https://doi.org/10.1055/a-1680-1870

SEPTEMBER 2022 PUBLICATIONS

Joseph Furman, MD, PhD

Title: Rating of perceived difficulty scale for measuring intensity of standing balance exercises in individuals with vestibular disorders

Authors: Alsubaie SF, Whitney SL, Furman JM, Marchetti GF, Sienko KH, Sparto PJ.

Journal: Journal of Vestibular Research

Summary: This study validated the use of ratings of perceived difficulty for estimation of balance exercise intensity in individuals with vestibular disorders. Eight participants with a confirmed diagnosis of a vestibular disorder and 16 healthy participants performed two sets of 16 randomized static standing exercises across varying levels of difficulty. Root Mean Square (RMS) of trunk angular velocity was recorded using an inertial measurement unit. In addition, participants rated the perceived difficulty of each exercise using a numerical scale ranging from 0 (very easy) to 10 (very difficult). To explore the concurrent validity of rating of perceived difficulty scale, the relationship between ratings of perceived difficulty and sway velocity was assessed using multiple linear regression for each group. The rating of perceived difficulty scale demonstrated moderate positive correlations RMS of trunk velocity in the pitch (r = 0.51, p < 0.001) and roll (r = 0.73, p < 0.001) directions in participants with vestibular disorders demonstrating acceptable concurrent validity.

Ratings of perceived difficulty can be used to estimate the intensity of standing balance exercises in individuals with vestibular disorders.

Link: https://pubmed.ncbi.nlm.nih.gov/36120749/

Jonas Johnson, MD

Title: Subjective and objective measures in assessing neck disability and pain in head and neck cancer

Authors: Magaña LC, Murati S, Riffitts M, Harrison C, Harris A, Sowa G, Johnson JT, Bell K, Nilsen M

Journal: Laryngoscope

Summary: This study notes that patients who report neck disability and pain have more limited ROM and velocity following HNC treatment. These data may improve treatment planning and care delivery by facilitating an understanding of the experiences of HNC survivors and the pathophysiology that must be targeted to address their psychosocial and functional deficits.

Link: Subjective and Objective Measures in Assessing Neck Disability and Pain in Head and Neck Cancer - PubMed (nih.gov)

Reema Padia, MD

Title: Long-term outcomes of vocal fold paralysis following patent ductus arteriosus ligation in neonates

Author: Orb Q, Dunya G, Padia R, King J, Holbrook J, Muntz H, Smith ME

Journal: Laryngoscope. 2022 Aug 20. doi: 10.1002/lary.30343. Online ahead of print

Summary: The incidence of LVFP after PDA ligation is high especially in extremely low birth weight children. The majority of patients recovered well with time, but further surgical intervention was required in uncompensated cases. Long-term follow-up of these patients is needed to ensure improvement.

Link: https://pubmed.ncbi.nlm.nih.gov/36054344

Carl Snyderman, MD, MBA

Title: Understanding the role of the otolaryngology hospitalist: tracheostomies and tracheostomy care.

Authors: Issa M, El-Kouri N, Mater S, Lee JY, Snyderman C, Lee Y

Journal: Ann Otol Rhinol Laryngol

Summary: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

Link: https://doi.org/10.1177/00034894211045775

Title: Risk factors in a pediatric population for postoperative intracranial infection following endoscopic endonasal skull base surgery and the role of antibiotic prophylaxis.

Authors: Palmieri DE, Champagne PO, Valappil B, McDowell M, Gardner PA, Snyderman CH

Journal: Am J Rhinol Allergy

Summary: The purpose of our study is to investigate risk factors for postoperative intracranial infection during EESBS in a pediatric population and help elucidate the role of antibiotic prophylaxis. This investigation represents one of the largest pediatric endoscopic skull base surgery cohorts. EESBS is safe to perform in pediatric populations, but transclival approaches and postoperative CSF leaks are risk factors for postoperative meningitis.

Link: https://doi.org/10.1177/19458924221123113

Title: The endoscopic anterior transmaxillary temporal pole approach for mesial temporal lobe epilepsies: a feasibility study.

Authors: Gonzalez-Martinez JA, Abou-Al-Shaar H, Mallela AN, McDowell MM, Henry L, Fernandes-Cabral D, Sweat J, Urban A, Fong J, Barot N, Castellano JF, Rajasekaran V, Bagic A, Snyderman CH, Gardner PA

Journal: J Neurosurg

Summary: In mesial temporal lobe epilepsy (MTLE), the ideal surgical approach to achieve seizure freedom and minimize morbidity is an unsolved question. Selective approaches to mesial temporal structures often result in suboptimal seizure outcomes. The authors report the results of a pilot study intended to evaluate the clinical feasibility of using an endoscopic anterior transmaxillary (eATM) approach for minimally invasive management of MTLEs. The described series demonstrates the feasibility and potential safety profile of a novel approach for medically refractory MTLE. The study affirms the feasibility of performing efficacious mesial temporal lobe resections through an eATM approach.

Link: https://doi.org/10.3171/2022.7.jns221062

Title: Trigeminal schwannoma: a retrospective analysis of endoscopic endonasal management, treatment outcomes, and neuropathic sequelae.

Authors: Patel VA, Polster SP, Abou-Al-Shaar H, Kalmar CL, Zenonos GA, Wang EW, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: Trigeminal schwannomas (TS) are rare skull base tumors that have been associated with significant neuropathic sequalae for patients. The authors aim to evaluate the clinical features, treatment outcomes, and neuropathic sequelae following endoscopic endonasal approach (EEA) for TS. Some degree of trigeminal dysfunction may be more common than previously reported following EEA for TS resection. Factors that appear to play a role in the development of trigeminal dysfunction include pre-existing pain syndromes such as facial pain/neuralgia or headache and preoperative medication utilization.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-1755592

Title: Endoscopic endonasal anterior clinoidectomy: volumetric assessment and feasibility.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: World Neurosurg

Summary: Transcranial removal of the anterior clinoid process (ACP) provides access to the clinoidal segment of the internal carotid artery (ICA) as well as superolateral decompression of the optic canal. Endoscopic endonasal approaches (EEAs) can access the entire medial and inferior portions of the optic canal, but no data exists to support what proportion of the anterior clinoid which could be safely resected via an EEA. We conclude that using the safe route above the optic canal, removal of 21% of the ACP can be achieved via EEA. Although substantially more of the ACP can be drilled by accessing the optic strut, the benefits of pursuing additional removal must be weighed against the significant risks of drilling in this narrow corridor bordered by the ICA, the third cranial nerve and the optic nerve.

Link: https://doi.org/10.1016/j.wneu.2022.09.101

Eric Wang, MD

Title: Trigeminal schwannoma: a retrospective analysis of endoscopic endonasal management, treatment outcomes, and neuropathic sequelae.

Authors: Patel VA, Polster SP, Abou-Al-Shaar H, Kalmar CL, Zenonos GA, Wang EW, Gardner PA, Snyderman CH

Journal: J Neurol Surg B Skull Base

Summary: Trigeminal schwannomas (TS) are rare skull base tumors that have been associated with significant neuropathic sequalae for patients. The authors aim to evaluate the clinical features, treatment outcomes, and

neuropathic sequelae following endoscopic endonasal approach (EEA) for TS. Some degree of trigeminal dysfunction may be more common than previously reported following EEA for TS resection. Factors that appear to play a role in the development of trigeminal dysfunction include pre-existing pain syndromes such as facial pain/neuralgia or headache and preoperative medication utilization.

Link: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0042-1755592

Title: Endoscopic endonasal anterior clinoidectomy: volumetric assessment and feasibility.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: World Neurosurg

Summary: Transcranial removal of the anterior clinoid process (ACP) provides access to the clinoidal segment of the internal carotid artery (ICA) as well as superolateral decompression of the optic canal. Endoscopic endonasal approaches (EEAs) can access the entire medial and inferior portions of the optic canal, but no data exists to support what proportion of the anterior clinoid which could be safely resected via an EEA. We conclude that using the safe route above the optic canal, removal of 21% of the ACP can be achieved via EEA. Although substantially more of the ACP can be drilled by accessing the optic strut, the benefits of pursuing additional removal must be weighed against the significant risks of drilling in this narrow corridor bordered by the ICA, the third cranial nerve and the optic nerve.

Link: https://doi.org/10.1016/j.wneu.2022.09.101

OCTOBER 2022 PUBLICATIONS

Noel Jabbour, MD:

Title: Progression of Subperiosteal Orbital Ab scess after Clinical Resolution on Intravenous Antibiotics and Steroids.

Authors: Fu R, Schempf T, Vloka C, Jabbour N, Bhatia A, Shinder R, Hodgson N.

Journal: Ocul Immunol Inflamm.

Summary: We present a case of a 7-year-old boy who was presented with a small medial subperiosteal orbital abscess (SPOA) and trace superior phlegmon and who was initially treated with intravenous (IV) antibiotics, corticosteroids, and observation.

Link: Progression of Subperiosteal Orbital Abscess after Clinical Resolution on Intravenous Antibiotics and Steroids - PubMed (nih.gov)

Seungwon Kim, MD

Title: Identifying metastatic renal cell carcinoma in thyroid fine needle aspirates by molecular testing

Authors: Freeman T, Taneja C, Ohori NP, Wald AI, Skaugen J, Yip L, Kim S, Ferris RL, Nikiforova MN, Roy S, Nikiforov YE

Journal: Endocrine-related Cancer

Summary: Renal cell carcinoma (RCC) is the most common type of cancer found to metastasize to the thyroid gland. These tumors may represent a diagnostic challenge on cytology. However, most RCC tumors carry VHL alterations, which are rare in primary thyroid tumors. The aim of this study was to evaluate the utility of molecular testing in detecting metastatic RCC in thyroid fine-needle aspiration (FNA) samples. From 11/2017 until 03/2022, thyroid FNA samples with ThyroSeq v3 results showing both VHL alterations and low/absent expression of thyroid cell markers were analyzed. Eighteen samples from 15 patients met the inclusion criteria. On molecular analysis, deleterious VHL mutations were found in 9 (50%) nodules, VHL copy number alteration (CNA) in 2 (11%), and both mutations and CNA in 7 (39%). None of the cases showed mutations commonly found in thyroid tumors. The mean age of these patients was 68 (range 49-89) years with a male to female ratio of 2:1. Eight (53%) patients

had multiple thyroid nodules on ultrasound. On cytology, 14 (78%) nodules were diagnosed as Bethesda III, 2 (11%) as Bethesda IV, and 2 (11%) as Bethesda V. At the time of cytology review, the history of RCC, sometimes remote, was available for 10 patients. Of the 14 patients with medical history or surgical follow-up available, all had the history of RCC or renal mass or revealed metastatic RCC on thyroidectomy. This study demonstrates that molecular testing can reliably identify metastatic RCC in thyroid nodules with indeterminate cytology, which could improve patient management.

Link: https://pubmed.ncbi.nlm.nih.gov/36205930/

Mark Kubik, MD

Title: Assessment of BMI and Venous Thromboembolism Rates in Patients on Standard Chemoprophylaxis Regimens After Undergoing Free Tissue Transfer to the Head and Neck

Authors: Saadoun R, Bengur FB, Moroni EA, Surucu Y, Veit JA, Khan NI, Daniels K, Rothenberger SD, Kubik M, Solari MG, Sridharan S

Journal: JAMA Otolaryngology Head & Neck Surgery

Summary: This cohort study found that obesity was associated with an increased risk of VTE in patients after microvascular H&N reconstruction and while on standard postoperative chemoprophylaxis regimens. This association may suggest insufficient VTE prophylaxis in this group and a potential indication for weight-based dosing.

Link: https://pubmed.ncbi.nlm.nih.gov/36201206/

Melonie Nance, MD

Title: Feasibility of clinical evaluation of individuals with increased risk for HPV-associated oropharynx cancer

Authors: Scott-Wittenborn N, D’Souza G, Aygun N, Tewari SR, Azadi J, Vosler P, Gooi Z, Mehta V, Mydlarz W, Nance M, Mlot S, Patel MR, Tan M, Miles BA, Troy T, Fakhry C

Journal: HEAD & NECK

Summary: Human papillomavirus-associated oropharynx squamous cell carcinoma (HPV-OPSCC) has no known pre-malignant lesion. While vaccination offers future primary prevention, there is current interest in secondary prevention. The feasibility of clinical evaluation of individuals at increased risk for HPV-OPSCC is unclear. Three hundred eight four Individuals with risk factors for HPV-OPSCC were enrolled in a prospective study (MOUTH) at several institutions including UPMC.

Clinical evaluations, including head and neck examination and imaging, are feasible in the context of a screening study for HPV-OPSCC.

Link: https://onlinelibrary.wiley.com/doi/10.1002/hed.27212

Barry Schaitkin, MD

Title: Changes in otolaryngology application requirements and match outcomes: are we doing any better?

Authors: De Ravin E, Frost AS, Godse NR, Shaffer AD, Jabbour N, Schaitkin BM, Newman J, Mady LJ

Journal: WJOHNS

Summary: ORTA and PSP correlated with decreased applicant numbers and increased match rate success. As programs seek ways to remove barriers to applying to otolaryngology, the potential consequences of an increasing pool of unmatched candidates must also be considered.

Link: Changes in otolaryngology application requirements and match outcomes: Are we doing any better? (wiley.com)

Carl Snyderman, MD, MBA

Title: Endoscopic techniques in vascular neurosurgery

Authors: Patel A, Abou-Al-Shaar H, Malella AN, Algattas H, McDowell MM, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: Neurosurg Clin N Am

Summary: This section reviews the selection criteria and best practices for endoscopic cerebrovascular surgery, focusing on purely endoscopic endonasal approaches. Although these approaches still play a limited role in open vascular neurosurgery, they offer a robust and potentially safer technique for establishing visualization and vascular control of particular, well-selected pathologies, such as aneurysms of the proximal circulation; this requires strong, multidisciplinary experience with endoscopic anatomy and surgical technique, advanced reconstruction techniques, and instruments designed to be maneuvered within this relatively novel corridor and application.

Link: https://doi.org/10.1016/j.nec.2022.06.005

Title: Sinonasal mixed transitional epithelial-seromucinous papillary glandular neoplasms with BRAF p.V600E mutations - sinonasal analogues to the sialadenoma papilliferum family tumors

Authors: Patel S, Snyderman CH, Muller SK, Agaimy A, Seethala RR

Journal: Virchows Arch

Summary: Sinonasal non-intestinal type adenocarcinoma (non-ITAC) is a heterogeneous category that may benefit from improved taxonomy. With the recognition that most non-ITAC are phenotypically seromucinous, stratification may be improved by applying salivary type morphologic criteria and molecular findings. We report two cases of papillary seromucinous adenocarcinoma with sinonasal papilloma-like surface components that show histologic and molecular features analogous to the salivary sialadenoma papilliferum family of tumors. Case 1 concerns a 50-year-old female who presented with a left anterior nasoethmoid polyp, while case 2 is that of a 74 year old female with nasal polyposis. Histologically, both cases demonstrated a surface transitional sinonasal papilloma-like component (more prominent in case 2) with a deeper bilayered glandular component showing papillary and tufted micropapillary growth of monomorphic columnar to cuboidal cells with eosinophilic cytoplasm. Case 1 also showed a deep cribriform/microcystic component. Immunostains showed a delimiting p63/p40 positive basal layer around the SOX-10 positive glandular elements, while the transitional sinonasal papilloma-like components were diffusely p63/p40 positive. Like sialadenoma papilliferum and related tumors, both cases demonstrated BRAF p.V600E mutations in both components and no other alterations. The patients remain disease free at 9 and 19 months respectively. Our cases illustrate a novel sinonasal lesion and suggest that improved morphologic and molecular categorization may refine and reduce the category of non-ITAC.

Link: https://doi.org/10.1007/s00428-022-03359-8

Ryan Soose, MD

Title: Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep apnea?

Authors: Khan M, Stone A, Soose RJ, Cohen SM, Howard J, Capasso R, Itayem D, Gillespie MB, Mehra R, Chio E, Strollo PJ, Menzl A, Kaplan A, Ni Q

Journal: J Clin Sleep Med

Summary: Our study found that there was no statistically significant difference in adherence or efficacy with upper airway stimulation therapy between White and non-White individuals. However, the percent of non-White people implanted is low, which suggests a need to expand access to this therapy for non-White populations with OSA who cannot tolerate positive airway pressure therapy.

Link: Does race-ethnicity affect upper airway stimulation adherence and treatment outcome of obstructive sleep

apnea? - PubMed (nih.gov)

Title: International consensus statement on obstructive sleep apnea

Authors: Chang JL, Goldberg AN, Alt JA, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin K, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, El Ali M, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Gillespie MB, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OMG, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman S, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SYC, MacKay SG, Magalang UJ, Malhotra A, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJL, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Woodson BT, Won CHJ, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM

Journal: International Forum of Allergy & Rhinology

Summary: This review of the literature in OSA consolidates the available knowledge and identifies the limitations of the current evidence. This effort aims to highlight the basis of OSA evidence-based practice and identify future research needs. Knowledge gaps and opportunities for improvement include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

Link: International consensus statement on obstructive sleep apnea - PubMed (nih.gov)

Shaum Sridharan, MD

Title: Assessment of BMI and venous thromboembolism rates in patients on standard chemoprophylaxis regimens after undergoing free tissue transfer to the head and neck

Authors: Saadoun R, Bengur FB, Moroni EA, Surucu Y, Veit JA, Khan NI, Daniels K, Rothenberger SD, Kubik M, Solari MG, Sridharan S

Journal: Jama

Summary: In patients undergoing head and neck microvascular reconstruction on fixed-dose chemoprophylaxis, elevated BMI was associated with an increased risk of VTE after head and neck reconstruction with free tissue transfer. This association may suggest insufficient VTE prophylaxis in high BMI groups and a potential indication for weight-based dosing. A higher Caprini score was not associated with VTE events, which may raise concerns about its utility in this specific population. Further studies are needed to identify the appropriate VTE chemoprophylaxis in this population.

Link: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2797289?guestAccessKey=26d9cf86cd4b-4816-94144424b1aaa4c8&utm_source=twitter&utm_medium=social_jamaoto&utm_term=7814507092&utm_campaign=art icle_alert&linkId=184535530

Eric Wang, MD

Title: Endoscopic techniques in vascular neurosurgery

Authors: Patel A, Abou-Al-Shaar H, Malella AN, Algattas H, McDowell MM, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: Neurosurg Clin N Am

Summary: This section reviews the selection criteria and best practices for endoscopic cerebrovascular surgery, focusing on purely endoscopic endonasal approaches. Although these approaches still play a limited role in open vascular neurosurgery, they offer a robust and potentially safer technique for establishing visualization and vascular control of particular, well-selected pathologies, such as aneurysms of the proximal circulation; this requires strong, multidisciplinary experience with endoscopic anatomy and surgical technique, advanced reconstruction techniques, and instruments designed to be maneuvered within this relatively novel corridor and application.

Link: https://doi.org/10.1016/j.nec.2022.06.005

NOVEMBER 2022 PUBLICATIONS

Carey Balaban, PhD

Title: New model of superior semicircular canal dehiscence with reversible diagnostic findings characteristic of patients with the disorder

Authors: Wackym PA, Balaban CD, Van Osch OJ, Morris BT, Tamakloe M-A, Salvatore VD, Duwadi S, Gay JD and Mowery TM

Journal: Front. Neurol.

Summary: Third window syndrome is a vestibular-cochlear disorder in humans in which a third mobile window of the otic capsule creates changes to the flow of sound pressure energy through the perilymph/endolymph. The nature and location of this third mobile window can occur at many different sites (or multiple sites); however, the most common third mobile window is superior semicircular canal dehiscence (SSCD). There are two essential objective diagnostic characteristics needed to validate a model of SSCD: the creation of a pseudoconductive hearing loss and cVEMP increased amplitude and decreased threshold.

Methods: Adult Mongolian gerbils (n=36) received surgical fenestration of the superior semicircular canal of the left inner ear. ABR and c+VEMP testing were carried out prior to surgery and over acute (small 1mm SSCD, 1–10 days) or prolonged (large 2mm SSCD, 28 days) recovery. Because recovery of function occurred quickly, condenser brightfield stereomicroscopic examination of the dehiscence site was carried out for the small SSCD animals posthoc and compared to both ABRs and c+VEMPs. Micro-CT analysis was also completed with representative samples of control, day 3 and 10 post-SSCD animals.

Results: The SSCD created a significant worsening of hearing thresholds of the left ear; especially in the lower frequency domain (1–4 kHz). Left (EXP)/right (CTL) ear comparisons via ABR show significant worsening thresholds at the same frequency representations, which is a proxy for the human pseudoconductive hearing loss seen in SSCD. For the c+VEMP measurements, increased amplitude of the sound-induced response (N1 2.5ms and P1 3.2ms) was observed in animals that received larger fenestrations. As the bone regrew, the c+VEMP and ABR responses returned toward preoperative values. For small SSCD animals, micro-CT data show that progressive osteoneogenesis results in resurfacing of the SSCD without bony obliteration. Conclusion: The large (2mm) SSCD used in our gerbil model results in similar electrophysiologic findings observed in patients with SSCD. The changes observed also reverse and return to baseline as the SSCD heals by bone resurfacing (with the lumen intact). Hence, this model does not require a second surgical procedure to plug the SSCD.

Link: 10.3389/fneur.2022.1035478

Noel Jabbour, MD

Title: Adherence to Tympanostomy Tube Clinical Practice Guidelines in an Advanced Practice Provider Clinic.

Authors: Sim ES, Belsky MA, Konanur A, Yan A, Shaffer AD, Williams K, Martsolf GR, Chi DH, Jabbour N.

Journal: Ann Otol Rhinol Laryngol

Summary: We compared adherence rates by attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) for children with recurrent acute otitis media (RAOM) undergoing bilateral myringotomy and tympanostomy tube placement (BMT).

Link: https://doi.org/10.1177/00034894221135282

Reema Padia, MD

Title: Genetic testing for vascular anomalies - American society of pediatric otolaryngology vascular anomalies task force practice patterns

Authors: Eljamri S, MacArthur C, Strub G, Bly R, Bonilla-Velez J, Rosenberg TL, Padia R

Journal: Int J Pediatr Otorhinolaryngol. 2022 Nov 9;163:111363Online ahead of print.

Summary: Genetic testing on vascular anomalies specimens is being incorporated at most respondent institutions for management of unclear or refractory diagnoses in pediatric vascular anomalies. The expansion of this approach to all patients may be limited by cost, insurance coverage, and resource limitations, suggesting the importance of academic collaborations across institutions in genetic testing. Reducing the barriers to genetic testing so that it may be utilized on all vascular anomalies will further the research in this field and advance treatment options.

Link: https://pubmed.ncbi.nlm.nih.gov/36395671

Barry Schaitkin:

Title: Association of comprehensive thyroid cancer molecular profiling with tumor phenotype and cancer-specific outcomes

Authors: Liu JB, Ramonell KM, Carty SE, McCoy KL, Schaitkin BM, Karslioglu-French E, Morariu EM, Ohori NP, Seethala RR, Chiosea SI, Nikiforova MN, Nikiforov YE, Yip L.

Journal: Surgery

Summary: Using modern comprehensive genotyping, the genetic profile of thyroid cancers can be categorized into 3 novel molecular risk groups that were associated with histopathologic phenotype and recurrence in shortterm follow-up.

Link: Association of comprehensive thyroid cancer molecular profiling with tumor phenotype and cancer-specific outcomes - PubMed (nih.gov)

Carl Snyderman, MD, MBA

Title: Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery.

Authors: Fields DP, McDowell MM, Schulien AJ, Algattas H, Abou-Al-Shaar H, Agarwal N, Alan N, Costacou T, Wang EW, Snyderman CH, Gardner PA, Zenonos GA

Journal: World Neurosurgery

Summary: Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure, as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and

infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications.

Link: https://doi.org/10.1016/j.wneu.2022.07.102

Title: A novel sublabial anterior trans-maxillary approach for medically refractory mesial temporal lobe epilepsy: a comparative anatomical study.

Authors: Gardner PA, McDowell MM, Orhorhoro O, Snyderman CH, Gonzalez-Martinez J.

Journal: Operative Neurosurgery

Summary: Current approaches for mesial temporal lobe epilepsy may result in suboptimal seizure control and cognitive decline. An incomplete treatment of the epileptogenic zone and unnecessary violation of functional cortical and subcortical areas may contribute to suboptimal results. The ATM approach is anatomically feasible, providing a direct and selective approach for the temporal pole and mesial temporal lobe structures, with a substantial angle of visualization because of its direct alignment with the mesial temporal lobe structures.

Link:https://journals.lww.com/onsonline/Fulltext/9900/A_Novel_Sublabial_Anterior_Transmaxillary_Approach.4 42.aspx

Title: The evolution of endoscopic endonasal approach for olfactory groove meningiomas.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: Operative Neurosurgery

Summary: There is controversy over the choice of optimal approach for olfactory groove meningiomas (OGM). The endoscopic endonasal approach (EEA) is one of the most recently described corridors, which provides direct access to the tumor base. The endoscopic endonasal approach for OGM significantly evolved over time, achieving lower cerebrospinal fluid leak rates while providing a high rate of Simpson grade 1 resection. Technical improvements minimized the frontal lobe impact. Current data support EEA as a safe and effective corridor to treat OGM.

Link:https://journals.lww.com/onsonline/Fulltext/9900/The_Evolution_of_Endoscopic_Endonasal_Approach_for. 445.aspx

Title: Effect of irrigation fluid composition on hemostasis in mouse bleeding models

Authors: Alsaadi N, Hassoune A, Haldeman S, Williamson KM, Plautz W, Hoteit L, Alvikas J, Andraska EA, Srinivasan AJ, Bonaroti J, Seshadri A, Mota-alvidrez R, Scott MJ, Gardner PA, Snyderman CH, Neal MD

Journal: Shock

Summary: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. While Ca2+- and TXA-supplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca2+, and Ca2+-supplemented NS mirrored LR in response, Ca2+ presence in the irrigation fluid seems key to improving solution's hemostatic ability. Since warming the fluids normalized the choice of agents, the data also suggest that Ca2+-containing fluids such as LR may be more suitable for hemostasis when used at RT.

Link: https://doi.org/10.1097/shk.0000000000002009

Eric Wang, MD

Title: Modified endoscopic Denker's approach for management of anterior maxillary sinus tumors: multicenter series of 58 cases.

Authors: McCormick JP, Suh JD, Wang EW, DeConde AS, Wang MB, Yang HH, Carle TR, Wung V, Lee JT.

Journal: American Journal of Rhinology and Allergy

Summary: Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications. The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.

Link: https://doi.org/10.1177/19458924221110652

Title: Low preoperative prealbumin levels are a strong independent predictor of postoperative cerebrospinal fluid leak following endoscopic endonasal skull base surgery.

Authors: Fields DP, McDowell MM, Schulien AJ, Algattas H, Abou-Al-Shaar H, Agarwal N, Alan N, Costacou T, Wang EW, Snyderman CH, Gardner PA, Zenonos GA

Journal: World Neurosurgery

Summary: Prealbumin levels correlate with overall nutritional status, and low values are associated with poor wound healing. We investigated whether low preoperative prealbumin levels predict risk of endoscopic endonasal skull base surgery (EESBS) reconstruction failure, as demonstrated by postoperative cerebrospinal fluid (CSF) leak and/or infection. Preoperative prealbumin levels are an independent predictor of EESBS associated CSF leak and infection. Future studies are needed to investigate the utility of screening and correcting prealbumin levels to limit postoperative complications.

Link: https://doi.org/10.1016/j.wneu.2022.07.102

Title: The evolution of endoscopic endonasal approach for olfactory groove meningiomas.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA

Journal: Operative Neurosurgery

Summary: There is controversy over the choice of optimal approach for olfactory groove meningiomas (OGM). The endoscopic endonasal approach (EEA) is one of the most recently described corridors, which provides direct access to the tumor base. The endoscopic endonasal approach for OGM significantly evolved over time, achieving lower cerebrospinal fluid leak rates while providing a high rate of Simpson grade 1 resection. Technical improvements minimized the frontal lobe impact. Current data support EEA as a safe and effective corridor to treat OGM.

Link:https://journals.lww.com/onsonline/Fulltext/9900/The_Evolution_of_Endoscopic_Endonasal_Approach_for. 445.aspx

DECEMBER 2022 PUBLICATIONS

Jonas Johnson, MD

Title: A phase II prospective trail of photobiomodulation therapy in limiting oral mucositis in the treatment of locally advanced head and neck cancer patients.

Authors: Taylor JK, Mady LJ, Baddour K, Iheagwara UK, Zhai S, Ohr JP, Zandberg DP, Gorantla VC, Ferris RL, Kim S, Duvvuri U, Kubik MW, Sridharan S, Johnson JT, Holeva KD, Quinn AE, Clump DA

Journal: World J Otorhinolaryngol Head Neck Surg.

Summary: Compared to historical outcomes, PBMT aides in decreasing severe OM in patients with locally advanced HNSCC. PBMT represents a minimally invasive, prophylactic intervention to decrease OM as a major treatment-related side effect.

Link: A phase Ⅱ prospective trial of photobiomodulation therapy in limiting oral mucositis in the treatment of locally advanced head and neck cancer patients - PubMed (nih.gov)

Barry Schaitkin, MD

Title: Applicant perspectives on virtual otolaryngology residency interviews

Authors: Kraft DO, Bowers EM, Smith BT, Jabbour N, Schaitkin BM, O’Leary MA, Groblewski JC, Young VV, Sridharan S

Journal: Ann Otol Rhinol Laryngol

Summary: While virtual interviews have limitations, applicants are generally satisfied with the experience. Advantages include cost and time savings for both applicants and programs, as well as easy use of technology. Continuation of the virtual interview format could be considered in future application cycles; geographical limitations may be overcome with in-person second looks, and increased emphasis should be placed on resident interactions during and prior to interview day.

Link: Applicant Perspectives on Virtual Otolaryngology Residency Interviews - PubMed (nih.gov)

Title: Will nasal airway surgery improve my sense of smell? A prospective observational study

Authors: Gillman GS, Bakeman AE, Soose RJ, Wang EW, Schaitkin BM, Lee SE, Chang YF, Mims MM

Journal: Int Forum Allergy Rhinol

Summary: Based on our data, subjective tests of olfaction may improve with nasal airway surgery in some patients. Changes in olfaction best correlate with the extent to which surgery can improve subjective nasal obstructive symptoms.

Link: Will nasal airway surgery improve my sense of smell? A prospective observational study - PubMed (nih.gov)

Carl Snyderman, MD, MBA

Title: Retrospective review of surgical site infections after endoscopic endonasal sellar and parasellar surgery: multicenter quality data from the North American Skull Base Society.

Authors: Saleh S, Sullivan SE, Bellile E, Roxbury C, Das P, Abi Hachem R, Ackall F, Jang D, Celtikci E, Sahin MM, D’Souza G, Evans JJ, Nyquist G, Khalafallah A, Mukherjee D, Rowan NR, Camp S, Choby G, Van Gompel JJ, Ghiam MK, Levine CG, Field M, Adappa N, Locke TB, Rassekh C, Sweis AM, Goyal N, Zacharia B, Wilson MN, Patel S, Gardner PA, Snyderman CH, Wang EW, Glancz LJ, Bagchi A, Dow G, Robertson I, Rangarajan SJ, Michael II LM, McKean EL.

Journal: J Neurol Surg B Skull Base

Summary: Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.

Link: https://doi.org/10.1055/a-1865-3202

Title: Dural sealants do not reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery.

Authors: McDowell MM, Jacobs RC, Valappil B, Abou-Al-Shaar H, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: J Neurol Surg B Skull Base

Summary: The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to

assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction. Among all patients undergoing EES with an intraoperative CSF leak, the addition of sealant to standard closure techniques did not reduce the rate of postoperative CSF leaks.

Link: https://doi.org/10.1055/s-0042-1743558

Title: Effect of irrigation fluid composition on hemostasis in mouse bleeding models.

Authors: Alsaadi N, Hassoune A, Haldeman S, Williamson KM, Plautz W, Hoteit L, Alvikas J, Andraska EA, Srinivasan AJ, Bonaroti J, Seshadri A, Mota-alvidrez R, Scott MJ, Gardner PA, Snyderman CH, Neal MD.

Journal: Shock

Summary: Intraoperative irrigation, usually with normal saline (NS), aids in bleeding identification and management. We investigated the effect of different irrigation fluids, with additives, on hemostasis using two bleeding models. Methods: C57BL/6 J mice were subjected to a tail bleed model or uncontrolled abdominal hemorrhage via liver laceration followed by abdominal cavity irrigation. We compared NS, lactated Ringer's (LR), and PlasmaLyte. We examined NS and LR at different temperatures. Normal saline or LR with calcium (Ca 2+ ) or tranexamic acid (TXA) was studied. Results: Compared with room temperature (RT), increasing the temperature of the irrigation fluid to 37°C and 42°C reduced tail vein bleeding times substantially in both NS and LR (all P < 0.001), with no significant differences between the two fluids. At RT, LR, but not PlasmaLyte, substantially reduced bleeding times in comparison to NS ( P < 0.0001). Liver injury blood loss was lower with LR ( P < 0.01). Normal saline supplemented with 2.7 mEq/L of Ca 2+ decreased bleeding time and blood loss volume ( P < 0.001 and P < 0.01, respectively) to similar levels as LR. Normal saline with 150 mg/mL of TXA markedly reduced bleeding time ( P < 0.0001), and NS with 62.5 mg/mL TXA decreased blood loss ( P < 0.01). Conclusion: Whereas Ca 2+ - and TXAsupplemented NS reduced bleeding, LR remained superior to all irrigation fluid compositions. As LR contains Ca 2+ , and Ca 2+ -supplemented NS mirrored LR in response, Ca 2+ presence in the irrigation fluid seems key to improving solution's hemostatic ability. Because warming the fluids normalized the choice of agents, the data also suggest that Ca 2+ -containing fluids such as LR may be more suitable for hemostasis when used at RT.

Link: https://doi.org/10.1097/shk.0000000000002009

Title: Endoscopic endonasal anterior clinoidectomy: volumetric assessment and feasibility.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: World Neurosurg

Summary: Transcranial removal of the anterior clinoid process (ACP) provides access to the clinoidal segment of the internal carotid artery as well as superolateral decompression of the optic canal. Endoscopic endonasal approaches (EEAs) can access the entire medial and inferior portions of the optic canal, but no data exist to support what proportion of the anterior clinoid could be safely resected via an EEA. Using the safe route above the optic canal, removal of 21% of the ACP can be achieved via EEA. Although substantially more of the ACP can be drilled by accessing the optic strut, the benefits of pursuing additional removal must be weighed against the significant risks of drilling in this narrow corridor bordered by the internal carotid artery, the third cranial nerve, and the optic nerve.

Link: https://doi.org/10.1016/j.wneu.2022.09.101

Shaum Sridharan, MD

Title: Applicant perspectives on virtual otolaryngology residency interviews

Authors: Kraft DO, Bowers EM, Smith BT, Jabbour N, Schaitkin BM, O’Leary MA, Groblewski JC, Young VV, Sridharan S

Journal: Ann Otol Rhinol Laryngol

Summary: While virtual interviews have limitations, applicants are generally satisfied with the experience. Advantages include cost and time savings for both applicants and programs, as well as easy use of technology. Continuation of the virtual interview format could be considered in future application cycles; geographical limitations may be overcome with in-person second looks, and increased emphasis should be placed on resident interactions during and prior to interview day.

Link: Applicant Perspectives on Virtual Otolaryngology Residency Interviews - PubMed (nih.gov)

Eric Wang, MD

Title: Retrospective review of surgical site infections after endoscopic endonasal sellar and parasellar surgery: multicenter quality data from the North American Skull Base Society.

Authors: Saleh S, Sullivan SE, Bellile E, Roxbury C, Das P, Abi Hachem R, Ackall F, Jang D, Celtikci E, Sahin MM, D’Souza G, Evans JJ, Nyquist G, Khalafallah A, Mukherjee D, Rowan NR, Camp S, Choby G, Van Gompel JJ, Ghiam MK, Levine CG, Field M, Adappa N, Locke TB, Rassekh C, Sweis AM, Goyal N, Zacharia B, Wilson MN, Patel S, Gardner PA, Snyderman CH, Wang EW, Glancz LJ, Bagchi A, Dow G, Robertson I, Rangarajan SJ, Michael II LM, McKean EL.

Journal: J Neurol Surg B Skull Base

Summary: Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.

Link: https://doi.org/10.1055/a-1865-3202

Title: Dural sealants do not reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery.

Authors: McDowell MM, Jacobs RC, Valappil B, Abou-Al-Shaar H, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: J Neurol Surg B Skull Base

Summary: The application of cranial tissue sealants to assist with postoperative closure is widespread, but data are lacking regarding its utility in endoscopic endonasal surgery (EEA). A prospective study was conducted to assess the effect of sealant usage on postoperative cerebrospinal fluid (CSF) leak rate following standard reconstruction. Among all patients undergoing EES with an intraoperative CSF leak, the addition of sealant to standard closure techniques did not reduce the rate of postoperative CSF leaks.

Link: https://doi.org/10.1055/s-0042-1743558

Title: Endoscopic endonasal anterior clinoidectomy: volumetric assessment and feasibility.

Authors: Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA.

Journal: World Neurosurg

Summary: Transcranial removal of the anterior clinoid process (ACP) provides access to the clinoidal segment of the internal carotid artery as well as superolateral decompression of the optic canal. Endoscopic endonasal approaches (EEAs) can access the entire medial and inferior portions of the optic canal, but no data exist to

support what proportion of the anterior clinoid could be safely resected via an EEA. Using the safe route above the optic canal, removal of 21% of the ACP can be achieved via EEA. Although substantially more of the ACP can be drilled by accessing the optic strut, the benefits of pursuing additional removal must be weighed against the significant risks of drilling in this narrow corridor bordered by the internal carotid artery, the third cranial nerve, and the optic nerve.

Link: https://doi.org/10.1016/j.wneu.2022.09.101