Publications by authors named "Ankita Patro"

8 Publications

  • Page 1 of 1

Outcomes of Initial Observation Versus Upfront Microsurgical Resection for Small to Medium-sized Vestibular Schwannomas.

Otol Neurotol 2021 Jun 18. Epub 2021 Jun 18.

Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center School of Medicine, Vanderbilt University, Nashville, Tennessee Department of Otolaryngology - Head and Neck Surgery, University Hospitals, ENT Institute, Case Western Reserve University, Cleveland, Ohio.

Objective: To assess postoperative outcomes and predictive factors of patients observed prior to microsurgery and those undergoing upfront resection for small and medium-sized VS.

Study Design: Retrospective cohort.

Setting: Tertiary referral center.

Patients: VS patients who had microsurgery from 2003 to 2018 for tumors up to 2.5 cm.

Main Outcome Measures: Postoperative outcomes including facial nerve function and interventions, complications, extent of resection, and salvage therapy.

Results: Of 220 patients, 120 were initially observed, and 100 pursued upfront microsurgery. There was no significant association between initial observation and upfront microsurgery for postoperative facial nerve function at 2 to 3 weeks (p = 0.18) or 12 months (p = 0.5), facial nerve intervention (p = 0.5), major/minor complications (p = 0.48/0.63), recurrence (p = 0.8), subtotal resection (p = 0.6), or salvage therapy (p = 0.9). Time from initial consultation to surgery did not significantly impact outcomes. Intrameatal tumors were more likely to be observed (odds ratios [OR] 2.93; 95% CI 1.53-5.63; p = 0.001). Patients with larger tumor volume (OR 0.52; 95% CI 0.37-0.72; p < 0.0001), brainstem compression (OR 0.28; 95% CI 0.09-0.91; p = 0.03), or higher PTA were less likely to undergo observation (OR 0.99; 95% CI 0.97-0.997; p = 0.02). On multivariable analysis, predictive factors for observation were smaller tumor volume (OR 0.53; 95% CI 0.38-0.75; p < 0.001), lower PTA (OR 0.99; 95% CI 0.98-0.999; p = 0.04), and diabetes (OR 2.54; 95% CI 0.95-6.83; p = 0.06).

Conclusions: Patients with worse hearing, larger tumor volume, and brainstem compression were more likely to pursue upfront microsurgery. A watchful waiting period does not appear to worsen outcomes and can be considered for patients with better hearing and smaller tumors without brainstem compression.
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http://dx.doi.org/10.1097/MAO.0000000000003243DOI Listing
June 2021

Impact of Adjuvant Medical Therapies on Surgical Outcomes in Idiopathic Subglottic Stenosis.

Laryngoscope 2021 Jun 12. Epub 2021 Jun 12.

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.

Objectives/hypothesis: Adjuvant medications including proton pump inhibitors (PPI), antibiotics (trimethoprim/sulfamethoxazole [TMP-SMX]), and inhaled corticosteroids (ICS) may be prescribed for patients with idiopathic subglottic stenosis (iSGS). We describe medication use with endoscopic dilation (ED) or endoscopic resection with medical treatment (ERMT) and evaluate impact on outcomes.

Study Design: International, prospective, 3-year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS.

Methods: Post hoc secondary analysis of prospectively collected North American Airway Collaborative data on outcomes linked with adjuvant medication utilization. Primary outcome was time to recurrent operation, evaluated using Kaplan-Meier curves and Cox regression analysis. Secondary outcomes of change in peak expiratory flow (PEF) and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score over 12 months were compared.

Results: Sixty-one of 129 patients undergoing ED received PPI (47%), and 10/143 patients undergoing ED received ICS (7%). TMP-SMX was used by 87/115 patients (76%) undergoing EMRT. PPI use in the ED group did not affect time to recurrence (hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.53-1.88; P = .99) or 12-month change in PEF (L/min) (median [interquartile range], 12.0 [10.7-12.2] vs. 8.7 [-5.1 to 24.9]; P = .59), but was associated with 12-month change in CCQ (-0.05 [-0.97 to 0.75] vs. -0.50 [-1.60 to 0.20]; P = .04). ICS did not affect outcome measures. TMP-SMX use in ERMT did not affect time to recurrence (HR = 0.842, 95% CI: 0.2345-3.023; P = .79), PEF at 12 months (75 [68-89] vs. 81 [68-89]; P = .92), or 12-month change in CCQ (0.20 [-1.05 to 0.47] vs. -0.30 [-1.00 to 0.10]; P = .45).

Conclusion: There is no standard practice for prescribing adjuvant medications. These data do not support that adjuvant medications prolong time to recurrence or increase PEF. Patients with iSGS and gastroesophageal reflux disease may experience some symptom benefit with PPI.

Level Of Evidence: Level 3 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29675DOI Listing
June 2021

Otolaryngology Residency Program Rankings and Social Media Usage: A Longitudinal Analysis.

Laryngoscope 2021 May 17. Epub 2021 May 17.

Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.

Objective: Social media is a powerful networking tool among health care organizations. This study determines correlations between program reputation and social media activity and popularity, specifically among otolaryngology residency programs.

Methods: Accredited programs, excluding military and osteopathic, in the United States were included. Activity and popularity on Facebook, Twitter, and Instagram were assessed during the same 7-month period from 2016 to 2020. Doximity Residency reputation scores (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with top hospitals versus those with unranked hospitals) were utilized to compare differences based on reputation.

Results: Of 104 programs, 91 (88%) had social media accounts. Instagram and Twitter were more commonly used than Facebook, with 78 (75%), 49 (47%), and 42 (40%) accounts, respectively. The cumulative use of all three platforms grew yearly, while Twitter (R  = 0.9863) and Instagram (R  = 0.9955) presence increased exponentially. Doximity's top quartile programs had more Facebook (P = .020), Twitter (P < .001), and Instagram (P = .102) accounts. First-quartile programs also adopted each platform months before fourth-quartile programs. Stratified by US News & World Report, ranked programs had more social media accounts, with 24 (53%) on Facebook (P = .028), 32 (71%) on Twitter (P < .001), and 37 (82%) on Instagram (P = .155). Programs with higher reputations were more active and exhibited increased likes and followers over time.

Conclusion: Social media use among otolaryngology programs has grown exponentially, with Instagram and Twitter becoming the dominant platforms. Higher ranked programs are more active on social media, have more followers, and adopt social media earlier.

Level Of Evidence: Level 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29621DOI Listing
May 2021

Teacher Prescreening for Hearing Loss in the Developing World.

Ear Nose Throat J 2021 Jun 13;100(3_suppl):259S-262S. Epub 2019 Oct 13.

Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.

The goal of this prospective cohort study was to characterize the ability of teachers to identify schoolchildren at risk of hearing loss in order to maximize hearing screening efficiency in low-resource settings. At 4 semirural schools in Malindi, Kenya, preselected schoolchildren perceived as hearing impaired were compared to children thought to have normal hearing using portable audiometry. Eight of 127 children (54% male) failed hearing screening, all of who were identified by schoolteachers as having a high risk of hearing loss. Thus, for every 5 children prescreened by schoolteachers, an average of 1 child would be identified as having hearing loss. Overall, teacher prescreening had a 100% hearing loss identification rate and a 20% referral rate. In conclusion, in resource-limited settings, where universal hearing screening is challenging, teachers can effectively identify children with hearing loss for early intervention.
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http://dx.doi.org/10.1177/0145561319880388DOI Listing
June 2021

Age-related causes of emergency department visits after pediatric adenotonsillectomy at a tertiary pediatric referral center.

Int J Pediatr Otorhinolaryngol 2019 Dec 4;127:109668. Epub 2019 Sep 4.

Texas Children's Hospital, Department of Otolaryngology, Head and Neck Surgery at Baylor College of Medicine, Houston, TX, USA. Electronic address:

Introduction: The complications of tonsillectomy and adenoidectomy (T&A) are well-described and include bleeding, dehydration, nausea, respiratory complications, and pain. After the immediate postoperative phase, the overall 30-day emergency department (ED) return rate is as high as 13.3%. However, few studies have examined the types and rates of late post-operative complications for children undergoing T&A stratified base on patient age. Herein, we aim to better characterize ED return visits for children of all ages, with special attention to those patients under three years of age.

Methods: This is a retrospective case series at a tertiary academic pediatric medical center. All patients 18 years of age or younger who underwent T&A over eighteen months were included. Data including ED return diagnosis, post-operative day of presentation, and need for surgical intervention was recorded for patients who presented to the ED within 30 days of their original surgery.

Results: 5,225 patients were identified, with an overall late complication rate of 12.8%. There was no difference in the 30-day ED readmission rate for children under the age of three, although children under the age of two were more likely to present to the ED. There was a significantly higher risk of dehydration for children under the age of four years, and a significantly higher bleeding risk and need for reoperation for control of post-tonsillectomy hemorrhage (PTH) for children over the age of six.

Conclusions: The overall ED visit rate in this study is 12.8%, with no difference based on age. Patients younger than three years of age are more likely to return to ED for dehydration, while bleeding and need for control of oropharyngeal hemorrhage is more common in older children. Knowledge of the age-related late complications of T&A may direct appropriate anticipatory peri-operative counseling of risks and return precautions.
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http://dx.doi.org/10.1016/j.ijporl.2019.109668DOI Listing
December 2019

Pediatric acute unilateral suppurative lymphadenitis: The role of antibiotic susceptibilities at a large tertiary pediatric care center.

Int J Pediatr Otorhinolaryngol 2019 05 30;120:11-14. Epub 2019 Jan 30.

Texas Children's Hospital, Department of Otolaryngology - Head and Neck Surgery at Baylor College of Medicine, Houston, TX, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ijporl.2019.01.024DOI Listing
May 2019

The Patient Who Continues to Smoke On-Treatment: An Ethical Dilemma.

Otolaryngol Head Neck Surg 2018 03 16;158(3):469-472. Epub 2018 Jan 16.

1 Bobby R. Alford Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.

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http://dx.doi.org/10.1177/0194599817752634DOI Listing
March 2018

Mid-Term Outcomes in Patients with Congenitally Corrected Transposition of the Great Arteries: A Single Center Experience.

J Am Coll Surg 2017 Apr 12;224(4):707-715. Epub 2017 Jan 12.

Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.

Background: Optimal management of patients with congenitally corrected transposition of the great arteries (ccTGA) is unclear. The goal of this study was to compare the outcomes in patients with ccTGA undergoing different management strategies.

Study Design: Patients with ccTGA believed suitable for biventricular circulation, treated between 1995 and 2016, were included. The cohort was divided into 4 groups: systemic right ventricle (RV) (patients without surgical intervention or with a classic repair), anatomic repair, Fontan palliation, and patients receiving only a pulmonary artery band (PAB) or a shunt. Transplant-free survival from presentation was calculated for each group.

Results: The cohort included 97 patients: 45 (46%) systemic RV, 26 (27%) anatomic repair, 9 (9%) Fontan, and 17 (18%) PAB/shunt. Median age at presentation was 2 months (range 0 days to 69 years) and median follow-up was 10 years (1 month to 28 years). At initial presentation, 10 (11%) patients had any RV dysfunction (8 mild, 2 severe), and 16 (18%) patients had moderate or severe tricuspid regurgitation (TR). During the study, 10 (10%) patients died, and 3 (3%) patients underwent transplantation. At last follow-up, 11 (11%) patients were in New York Heart Association class III/IV, 5 (5%) had moderate or severe systemic ventricle dysfunction, and 16 (16%) had moderate or severe systemic atrioventricular valve regurgitation. Transplant-free survivals at 10 years were 93%, 86%, 100%, and 79% for systemic RV, anatomic repair, Fontan palliation, and PAB/shunt, respectively (p = 0.33). On multivariate analysis, only systemic RV dysfunction was associated with a higher risk for death or transplant (p = 0.001).

Conclusions: Transplant-free survival in ccTGA appears to be similar between patients with a systemic RV, anatomic repair, and Fontan procedure. Systemic RV dysfunction is a risk factor for death and transplant.
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http://dx.doi.org/10.1016/j.jamcollsurg.2016.12.029DOI Listing
April 2017
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