Publications by authors named "Bobby A Tajudeen"

118 Publications

Histopathologic differences between adult and pediatric patients with chronic rhinosinusitis.

Int Forum Allergy Rhinol 2022 Jun 16. Epub 2022 Jun 16.

Department of Otorhinolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Background: Adult and pediatric patients with chronic rhinosinusitis (CRS) may have differing philosophies in therapeutic management. Few studies have examined sinonasal tissue-level comparisons of these groups. This study examines histopathologic differences between children and adults with CRS, with the goal of understanding disease pathogenesis and optimizing medical management for both populations.

Methods: In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery (FESS), demographic factors, pertinent comorbidities, and a structured histopathologic report of 13 variables were compared across pediatric and adult CRS patients with and without nasal polyps (pCRSwNP, pCRSsNP, aCRSwNP, aCRSsNP, respectively).

Results: A total of 378 adult (181 aCRSsNP, 197 aCRSwNP) and 50 pediatric (28 pCRSsNP, 22 pCRSwNP) patients were analyzed. Significantly more children compared with adults had a comorbid asthma diagnosis (64.5% vs. 37.2%, p = 0.003). Adults with CRS exhibited significantly more tissue neutrophilia (28.9% vs. 12.0%, p = 0.006), basement membrane thickening (70.3% vs. 44.0%, p < 0.001), subepithelial edema (61% vs. 30.0%, p < 0.001), squamous metaplasia (22.0% vs. 4.0%, p < 0.001), and eosinophil aggregates (22.8% vs. 4.0%, p < 0.001) than children with CRS. The majority (66.5%) of adult CRS patients exhibited a lymphoplasmacytic-predominant inflammatory background, whereas the majority (57.8%) of children with CRS exhibited a lymphocyte-predominant inflammatory background.

Conclusions: Sinonasal tissue of adult and pediatric CRS patients demonstrates clear histopathologic differences. Our findings provide insight into differing pathophysiology, which may enable optimization of targeted therapies for patients in each of these unique clinical groups.
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http://dx.doi.org/10.1002/alr.23037DOI Listing
June 2022

Postoperative protocols following endoscopic skull base surgery: An evidence-based review with recommendations.

Int Forum Allergy Rhinol 2022 Jun 9. Epub 2022 Jun 9.

Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA.

Background: Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence-based guidance.

Methods: The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated.

Results: A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction.

Conclusion: The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high-quality studies are needed in order to devise optimal postoperative ESBS protocols.
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http://dx.doi.org/10.1002/alr.23041DOI Listing
June 2022

Association of HPV status with survival after surgical salvage of oropharyngeal cancers.

Am J Otolaryngol 2022 Jul-Aug;43(4):103491. Epub 2022 May 4.

Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, United States of America.

Objectives: This study used the National Cancer Database to determine the effect of human papillomavirus (HPV) on survival outcomes for recurrent oropharyngeal cancer treated with salvage surgery after initial treatment with radiation therapy or chemoradiation therapy.

Methods: Patients with recurrent oropharyngeal cancer receiving salvage surgery after initial treatment with adjuvant therapy were identified through the National Cancer Database. Demographics, tumor characteristics, and survival data were collected. The data were analyzed to identify factors that may be associated with survival.

Results: A total of 169 patients were included, 59% of which were HPV-positive cases and 41% were HPV-negative. On univariate analysis, HPV-positive cases had higher overall survival compared to HPV-negative cases. However, on multivariate analysis, the association with HPV status was no longer statistically significant while positive surgical margins, higher T-stage at initial diagnosis, and a greater comorbidity burden were significantly associated with poorer survival.

Conclusion: In the salvage setting for treatment of recurrent oropharyngeal squamous cell carcinoma, HPV status may not be associated with improved survival.
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http://dx.doi.org/10.1016/j.amjoto.2022.103491DOI Listing
June 2022

See many, do one, teach many more: Assessing quality and reliability of publicly available endoscopic videos in rhinology.

Int Forum Allergy Rhinol 2022 Apr 2. Epub 2022 Apr 2.

Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA.

Objectives: The use of video recording is commonplace in rhinology given the increased use of endoscopes when evaluating patients in the office and the operating room and for its educational potential. This study aimed to determine the quality of publicly available endoscopic videos in rhinology.

Methods: A video search was performed on YouTube in April 2020 and included all videos since its inception in 2005 using terms related to rhinology found in the Accreditation Council for Graduate Medical Education (ACGME) Case Log Coding Guide. Videos which met inclusion criteria were evaluated for video metrics and quality using validated scoring systems: Video Power Index (VPI), modified Journal of American Medical Association (JAMA) benchmark criteria, modified global quality score (GQS), and modified DISCERN criteria.

Results: A total of 138 videos were evaluated, 114 of which were uploaded independently, and 24 videos were uploaded by an academic institution. Academic-affiliated videos have higher like ratio at 91.7 ± 7.55% compared with 86.27 ± 17.44% (p = 0.018). Academic-affiliated videos have higher JAMA benchmark scores, DISCERN criteria scores, and GQS values (1.71 ± 0.55 vs. 1.66 ± 0.49 [p = 0.66]), (3.33 ± 0.56 vs. 2.85 ± 0.65 [p < 0.001]), (4.38 ± 0.81 vs. 3.43 ± 1.01 [p < 0.001])], respectively. There was no significant difference in VPI (p = 0.73).

Conclusions: Endoscopic videos are rapidly growing in prominence and remain an important part of surgical education, but overall are heterogeneous in quality and reliability, necessitating an effort to establish both video sharing regulations and objective standards of quality.
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http://dx.doi.org/10.1002/alr.23006DOI Listing
April 2022

Effect of histopathological grade on treatment and survival in base of tongue adenocarcinoma.

Am J Otolaryngol 2022 May-Jun;43(3):103265. Epub 2021 Oct 14.

Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center Chicago, IL, USA. Electronic address:

Objectives: The purpose of this study was to investigate survival differences between low-grade and high-grade base of tongue (BOT) adenocarcinoma by examining demographics, tumor characteristics, and treatment modalities.

Methods: The National Cancer Database was queried for patients with BOT adenocarcinoma between 2004 and 2017. Univariate and multivariate analyses were performed for all cases of BOT adenocarcinoma. Subsequent analysis focused on low-grade (grade 1 and grade 2) and high-grade (grade 3 and grade 4) BOT adenocarcinoma.

Results: A total of 286 patients with BOT adenocarcinoma were included in the main cohort and divided into low grade (n = 137) and high grade (n = 66). The 5-year overall survival for all patients, low-grade, and high-grade was 67%, 85%, and 58%, respectively. Prognostic factors associated with decreased survival for the main cohort include advanced age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02-1.06), non-white race (HR: 1.79; 95% CI: 1.04-3.25), public insurance (HR: 1.79; 95% CI: 1.02-3.14) and high-grade 3,4 (HR: 2.63; 95% CI: 1.51-4.56). The prognostic factor associated with increased survival for the main cohort was surgery (HR: 0.59; 95% CI: 0.36-0.96). Radiotherapy was associated with improved overall survival for high-grade BOT adenocarcinoma (HR: 0.09; 95% CI: 0.02-0.49) but not for low-grade BOT adenocarcinoma (HR: 0.93; 95% CI: 0.38-2.32).

Conclusions: This investigation is the largest to date analyzing the association of treatment modalities with overall survival in BOT adenocarcinoma. Surgery remains standard of treatment, particularly in low-grade cases, with radiotherapy offering additional survival benefit for high-grade BOT adenocarcinoma.
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http://dx.doi.org/10.1016/j.amjoto.2021.103265DOI Listing
May 2022

Deep nasal sinus cavity microbiota dysbiosis in Parkinson's disease.

NPJ Parkinsons Dis 2021 Dec 8;7(1):111. Epub 2021 Dec 8.

Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, USA.

Olfactory dysfunction is a pre-motor symptom of Parkinson's disease (PD) that appears years prior to diagnosis and can affect quality of life in PD. Changes in microbiota community in deep nasal cavity near the olfactory bulb may trigger the olfactory bulb-mediated neuroinflammatory cascade and eventual dopamine loss in PD. To determine if the deep nasal cavity microbiota of PD is significantly altered in comparison to healthy controls, we characterized the microbiota of the deep nasal cavity using 16S rRNA gene amplicon sequencing in PD subjects and compared it to that of spousal and non-spousal healthy controls. Correlations between microbial taxa and PD symptom severity were also explored. Olfactory microbial communities of PD individuals were more similar to those of their spousal controls than to non-household controls. In direct comparison of PD and spousal controls and of PD and non-spousal controls, significantly differently abundant taxa were identified, and this included increased relative abundance of putative opportunistic-pathobiont species such as Moraxella catarrhalis. M. catarrhalis was also significantly correlated with more severe motor scores in PD subjects. This proof-of-concept study provides evidence that potential pathobionts are detected in the olfactory bulb and that a subset of changes in the PD microbiota community could be a consequence of unique environmental factors associated with PD living. We hypothesize that an altered deep nasal microbiota, characterized by a putative pro-inflammatory microbial community, could trigger neuroinflammation in PD.
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http://dx.doi.org/10.1038/s41531-021-00254-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655044PMC
December 2021

The possibility of short-term hypothalamic-pituitary-adrenal axis suppression with high-volume, high-dose nasal mometasone irrigation in postsurgical patients with chronic rhinosinusitis.

Int Forum Allergy Rhinol 2022 03 26;12(3):249-256. Epub 2021 Sep 26.

Rush Sinus Program, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Background: Medically refractory chronic rhinosinusitis (CRS) is often treated with functional endoscopic sinus surgery (FESS) and high-volume steroid nasal irrigation. While budesonide is the most common steroid irrigation for this indication, mometasone has a superior pharmacokinetic profile, which may allow dose escalation. The safety and efficacy of mometasone at higher concentrations than previously used in treating CRS have not been explored.

Methods: Patients were recruited from a tertiary level clinic between June 2018 and December 2019. Inclusion criteria included adults (>18 years); CRS diagnosis; previous FESS; pre-treatment morning cortisol within normal range; minimum of twice daily high-volume sinonasal mometasone irrigations (total dose of 4 mg) for 12 weeks; and post-treatment morning cortisol measured within 2 weeks following the study period. Patients with potential for endogenous or exogenous disruption of the HPA axis were excluded.

Results: 14 patients were enrolled in this prospective cohort study. In all but one patient, pre- and post-treatment morning cortisol levels were not significantly different and were within normal limits (6.7-25.4 μg/dL). Following an uninterrupted 12-week treatment course, no evidence of HPA axis suppression was found (P = 0.915). The single patient who was found to have a low (1.3 μg/dL) post-treatment morning serum cortisol level reportedly received an intraarticular steroid shot several days prior to the blood draw. She remained asymptomatic and her rechecked serum cortisol was within normal limits at 12.3 μg/dL.

Conclusions: High-volume 2 mg twice daily sinonasal mometasone irrigations did not cause HPA axis suppression in a representative sample of patients with refractory CRS post-FESS with normal baseline cortisol levels.
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http://dx.doi.org/10.1002/alr.22894DOI Listing
March 2022

Prognostic Indicators of Survival in Sinonasal Diffuse Large B-Cell Lymphoma: A National Cancer Database Analysis.

Laryngoscope 2022 08 20;132(8):1515-1522. Epub 2021 Sep 20.

Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Objectives/hypothesis: This study offers an update on the epidemiologic and prognostic factors and treatment-specific outcomes in patients diagnosed with sinonasal diffuse large B-cell lymphoma (DLBCL).

Study Design: Retrospective cohort study.

Methods: National Cancer Database was queried from 2004 to 2016 for patients with sinonasal DLBCL. Univariate Kaplan-Meier and multivariate Cox-regression analyses were performed to evaluate the association of suspected prognostic factors with overall survival (OS).

Results: A total of 2,222 patients with sinonasal DLBCL were analyzed. OS was 62% at 5 years and 42% at 10 years. Prognostic factors associated with increased survival included African-American race (HR: 0.48, 95% CI: 0.33-0.70), chemotherapy (HR: 0.30, CI: 0.25-0.35), and radiation (HR: 0.80, CI: 0.69-0.93). Prognostic factors associated with decreased survival included patients with Charlson-Deyo scores of 1 (HR: 1.51, CI: 1.25-1.84), 2 (HR: 2.25, CI: 1.67-3.03), and 3 (HR: 2.36, CI: 1.49-3.74) and patients with Lugano stage III (HR: 1.69, CI: 1.09-2.62) and IV (HR: 1.96, CI: 1.46-2.64) disease. Stage-based split multivariate analysis was performed and revealed chemotherapy was independently associated with increased OS in patients with stage I (HR: 0.24, CI: 0.19-0.30), II (HR: 0.17, CI: 0.11-0.28), and IV (HR: 0.41, CI: 0.26-0.64) disease. Radiotherapy was independently associated with increased OS in patients with stage I disease only (HR: 0.67, CI: 0.55-0.83), while immunotherapy was an independent prognostic factor in patients with stage IV disease only (HR: 0.60, CI: 0.37-0.98).

Conclusion: This study is the largest to date to analyze the association of demographic features and treatment modalities with OS in patients with sinonasal DLBCL. It is the first to investigate the association of immunotherapy with OS in this population. A combination treatment of immunochemotherapy or radioimmunochemotherapy confers increased survival, particularly in patients with advanced disease.

Level Of Evidence: 4 Laryngoscope, 132:1515-1522, 2022.
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http://dx.doi.org/10.1002/lary.29864DOI Listing
August 2022

Adjuvant Therapy and Prognosticators of Survival in Head and Neck Mucosal Melanoma.

Laryngoscope 2022 03 6;132(3):584-592. Epub 2021 Aug 6.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.

Objectives/hypothesis: To identify prognosticators and determine the efficacies of surgery with adjuvant radiotherapy (SR) and surgery with immunotherapy (SI) of head and neck mucosal melanoma (HNMM).

Study Design: Retrospective database study.

Methods: The 2004 to 2017 National Cancer Database was queried for HNMM patients. Cox proportional hazards and Kaplan-Meier analyses evaluated prognosticators of mortality and survival benefits conferred by SR, SI, or surgery with adjuvant radiotherapy and immunotherapy (SRI). Logistic regression identified predictors of adjuvant radiotherapy or immunotherapy use.

Results: Overall, 1,910 cases (845 surgery, 802 SR, 51 SI, 101 SRI) were analyzed, with 50.3% females and an average age of 68.6 ± 13.8 years. SI was associated with greater overall survival (OS) than surgery (hazard ratio [HR] 0.672; P = .036). SI (HR 0.425; P = .024) and SRI (HR 0.594; P = .045) were associated with superior OS than SR. Older age (HR 1.607; P < .001), female sex (HR 0.757; P = .006), paranasal sinus localization (HR 1.648; P < .001), T4 classification (HR 1.443; P < .001), N1 classification (HR 2.310; P < .001), M1 classification (HR 3.357; P < .001), and positive surgical margins (HR 1.454; P < .001) were survival prognosticators. Adjuvant radiotherapy use was negatively correlated with older age, oral cavity localization, and M0 or T3 tumors (all P < .05). Adjuvant immunotherapy use was positively correlated with younger age and M1 tumors (all P < .05).

Conclusions: Although SR did not confer survival benefits in HNMM patients, SI and SRI yielded greater OS than surgery alone. SRI was associated with superior survival outcomes than SR. Certain demographic and clinical factors were associated with increased mortality risk. Patient age and certain tumor characteristics were predictors of adjuvant radiotherapy or immunotherapy use.

Level Of Evidence: 4 Laryngoscope, 132:584-592, 2022.
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http://dx.doi.org/10.1002/lary.29807DOI Listing
March 2022

Defining the Allergic Endotype of Chronic Rhinosinusitis by Structured Histopathology and Clinical Variables.

J Allergy Clin Immunol Pract 2021 10 24;9(10):3797-3804. Epub 2021 Jun 24.

Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill. Electronic address:

Background: Atopy has a strong association with chronic rhinosinusitis (CRS).

Objective: To understand whether patients with atopy and CRS can be defined by markers of tissue histopathology, systemic biomarkers, and clinical factors, which may guide their response to new pharmacologic agents.

Methods: In a retrospective cohort of CRS patients who underwent functional endoscopic sinus surgery, a structured histopathology report consisting of 12 variables, comorbid conditions, preoperative total serum IgE levels, and preoperative modified Lund-Kennedy endoscopic and sinonasal outcome test (SNOT-22) scores were compared between atopic CRS (aCRS) and non-aCRS control patients in a multivariable model.

Results: A total of 380 CRS patients were enrolled, 286 of whom had comorbid atopy (aCRS). Compared with non-aCRS, aCRS patients had significantly higher preoperative total SNOT-22 scores (40.45 ± 22.68 vs 29.70 ± 20.68, P = .015) and symptom-specific SNOT-22 scores in all domains except psychological dysfunction. Relative to non-aCRS, aCRS patients had increased tissue eosinophilia (P < .0001), eosinophil aggregates (P < .0001), Charcot-Leyden crystals (P < .04), fibrosis (P < .02), total serum IgE levels (P < .04), polyploid disease (P < .001), and a prevalence of comorbid asthma (P < .0001) and aspirin exacerbated respiratory disease (AERD) (P < .003). Patients with aCRS demonstrated increased tissue eosinophilia compared with non-aCRS patients even after controlling for polypoid disease, asthma, and AERD.

Conclusion: In the context of CRS, atopy appears to be a specific predictor of CRS severity linked to specific histopathologic variables, including enhanced eosinophilic aggregates. Moving forward, allergic status may be a useful way to identify an atopic endotype of CRS patients. Furthermore, after surgery, patients are often maintained on intranasal corticosteroids. In patients whose disease is unresponsive to steroids, we may look to atopic status to identify another management therapy. Atopic CRS patients, irrespective of polyp and asthmatic status, could be optimal candidates for biologic agents such as T-helper cell, eosinophil, and/or IgE-targeted therapies.
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http://dx.doi.org/10.1016/j.jaip.2021.06.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511331PMC
October 2021

Neck Dissection in Salvage Surgery for Larynx Cancer: National Cancer Database Review.

Ann Otol Rhinol Laryngol 2022 Apr 10;131(4):379-387. Epub 2021 Jun 10.

Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.

Objective: Salvage laryngeal surgery is the preferred treatment after failure of non-surgical treatment of larynx cancer. This study aims to identify the impact of ND in salvage surgery on survival and factors predictive of nodal metastasis.

Methods: The National Cancer Database was used to identify patients who received salvage laryngeal surgery. Demographics, disease characteristics, and survival were compared between the subgroups of patients stratified according to performance of ND and presence of nodal metastasis.

Results: Sixty-two percent of patients underwent ND. A total of 26% of patients undergoing ND had nodal metastasis. Younger age and lesser time since radiation were associated with nodal metastasis. While undergoing ND did not significantly affect survival, those with nodal metastasis had poorer survival ( = .001).

Conclusions: Although ND did not show a survival benefit, younger patients and those who have had a shorter time elapsed between the start of radiation and salvage surgery may benefit from the prognostic data provided by ND. Nonetheless, the risks and benefits of elective ND in salvage larynx cancer treatment should be evaluated on an individual case basis as the data do not support a broadly applicable recommendation.
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http://dx.doi.org/10.1177/00034894211024062DOI Listing
April 2022

Distinct Histopathologic Features of Complicated Sinusitis.

Ann Otol Rhinol Laryngol 2021 May 3:34894211012598. Epub 2021 May 3.

Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.

Background: Sinusitis complicated by intracranial or orbital extension can be life-threatening and require emergent intervention. Histologic features of complicated sinusitis have yet to be determined and may have significant implications for understanding pathophysiology.

Methods: A structured histopathology report was utilized to analyze sinus tissue extracted during functional endoscopic sinus surgery (FESS). A total of 13 histopathology variables were compared between patients with complicated sinusitis (CS), CRS without nasal polyps (CRSsNP), and CRS with nasal polyps (CRSwNP).

Results: About 24 CS, 149 uncomplicated CRSsNP, and 191 uncomplicated CRSwNP patients were analyzed. Nasal tissue from CS and CRSwNP patients demonstrated similar levels of overall inflammation (66.7% vs. 69.6% with moderate/severe inflammation,   ). Relative to CRSsNP, CS patients showed significantly greater overall inflammation (66.7% vs. 41.6%,   ). CS patients demonstrated significantly fewer eosinophils per high power field (eos/HPF) and eosinophil aggregates compared to CRSwNP patients (20.8% vs. 70.7% with 5+eos/HPF,   ; 4.2% vs. 33.5%,   ). Relative to CRSsNP patients, CS patients demonstrated enhanced neutrophil infiltration (45.8% vs. 28.0%,   ). About 91.7% of CS patients demonstrated a lymphoplasmacytic predominant inflammatory infiltrate, compared to 69.8% of CRSsNP and 62.8% of CRSwNP patients (  ).

Conclusion: Significant histopathological differences were evident in patients with CS, CRSsNP, and CRSwNP. CS patients did not perfectly fit either a CRSsNP or CRSwNP profile, underscoring the importance of delineating the histopathological features of CS. This study offers insight into the histologic aspects of CS, providing initial evidence that it is an aggressive neutrophilic inflammatory process.
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http://dx.doi.org/10.1177/00034894211012598DOI Listing
May 2021

Patients' Perceptions of Resident Surgeon Involvement in Otolaryngology.

Laryngoscope 2021 11 1;131(11):2448-2454. Epub 2021 May 1.

Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Objectives: To assess patient acceptance of resident involvement in otolaryngologic procedures and to evaluate the impact of a written preoperative educational pamphlet.

Study Design: Prospective cohort study.

Methods: This is a prospective survey study at a large tertiary care academic center. In addition to standard perioperative instructions and informed consent, 87 out of 183 patients received a pamphlet with information on the role of the otolaryngology resident.

Results: Greater than 90% of all patients surveyed recognized that resident physicians are directly involved in delivering care at teaching hospitals and may have assisted in their surgical procedure. Ninety percent of patients receiving educational pamphlets were aware residents may have performed portions of their procedure versus 71% in the control group (P = .001). Ninety-seven percent of patients receiving pamphlets wanted to know how much of their procedure was performed by a resident versus 71% of the control group (P < .001), and patients undergoing single-surgeon procedures were less likely to want to know how much was performed by a resident (P < .05). Ninety-six percent in the pamphlet group agreed that residents improved the quality of their care versus 79% of the control group (P = .001).

Discussion: Resident surgeons are well received by the large majority of otolaryngology patients. Structured perioperative information regarding surgical training facilitates an honest and open informed consent discussion between the patient and surgeon and helps to establish a solid foundation of trust.

Conclusion: Implementation of this practice is simple and inexpensive. It should be considered for any clinical practice with a focus on surgical education.

Level Of Evidence: 4 Laryngoscope, 131:2448-2454, 2021.
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http://dx.doi.org/10.1002/lary.29599DOI Listing
November 2021

Temporal patterns of nasal symptoms in patients with mild severity SARS-CoV-2 infection.

Am J Otolaryngol 2021 Nov-Dec;42(6):103076. Epub 2021 Apr 24.

Department of Otorhinolaryngology - Head & Neck Surgery, Rush University Medical Center, Chicago, IL, United States of America. Electronic address:

Background: No study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient.

Methods: An internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis.

Results: 521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly (p < 0.001) to 8.94 at the time of diagnosis, remained elevated two weeks post-diagnosis (5.14, p = 0.004), and decreased significantly four weeks post-diagnosis (3.14, p = 0.004). Smell-specific SNOT-22 scores peaked at the time of diagnosis (2.05, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks post-diagnosis (0.64, p > 0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks after diagnosis (0.71, p > 0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints.

Conclusion: Sinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols.

Level Of Evidence: 4.
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http://dx.doi.org/10.1016/j.amjoto.2021.103076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064817PMC
October 2021

Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B-Cell Lymphoma.

Laryngoscope 2021 11 26;131(11):E2727-E2735. Epub 2021 Apr 26.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.

Objectives/hypothesis: This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients.

Study Design: Retrospective database study.

Methods: The National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality.

Results: A total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P < .001). Multivariable Cox proportional-hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late-stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post-2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunotherapy for late-stage patients (P = .326). Lastly, for all patients treated post-2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001).

Conclusions: Treatment protocol selection differs between early- and late-stage SN-DLBCL patients. Early-stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm.

Level Of Evidence: 3 Laryngoscope, 131:E2727-E2735, 2021.
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http://dx.doi.org/10.1002/lary.29584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502199PMC
November 2021

Laryngeal Chondrosarcoma Characteristics and Survival Analysis in the National Cancer Database.

Otolaryngol Head Neck Surg 2022 01 13;166(1):101-108. Epub 2021 Apr 13.

Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Objective: To highlight various patient, tumor, diagnostic, and treatment characteristics of laryngeal chondrosarcoma (LC) as well as elucidate factors that may independently affect overall survival (OS) for LCs.

Study Design: Retrospective cohort study.

Setting: National Cancer Database (NCDB).

Methods: All LC cases from 2004 to 2016 were extracted from the NCDB. Several demographic, diagnostic, and treatment variables were compared between LC subgroups using χ and analysis of variance tests. Univariate and multivariate survival analyses were performed for LCs using univariate Kaplan-Meier analysis and Cox proportional hazards regression models.

Results: There were 348 LCs included in the main cohort. LCs were predominantly non-Hispanic white males with similar rates of private and government insurance (49.4% vs 45.4%). Most LCs (81.6%) underwent primary surgery, particularly partial and total laryngectomy. The 1-, 5-, and 10-year survivals for LC were 95.7%, 88.2%, and 66.3%, respectively. On multivariate analysis, lack of insurance ( = .019; hazard ratio [HR], 8.21; 95% CI, 1.40-48.03), high grade ( = .001; HR, 13.51; 95% CI, 3.08-59.26), and myxoid/dedifferentiated histological subtypes ( = .0111; HR, 10.74; 95% CI, 1.71-67.33) correlated with worse OS. No difference in OS was found between partial and total laryngectomy.

Conclusion: This is the first multivariate survival analysis and largest single cohort study of LCs in the literature. Overall, LCs enjoy an excellent prognosis, with insurance status, grade, and histology as the main predictors of survival.
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http://dx.doi.org/10.1177/01945998211004578DOI Listing
January 2022

Petrous Apex Cephaloceles: Radiology Features and Surgical Management of a Rare Entity.

Otol Neurotol 2021 07;42(6):938-944

Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.

Objective: To characterize the radiologic findings of petrous apex cephalocele (PAC) in a patient cohort, and report the surgical management for three symptomatic PAC patients and cerebrospinal fluid (CSF) leak via the middle cranial fossa approach.

Study Design: Retrospective case series.

Setting: Academic center.

Patients: Thirty-five patients with PAC were identified by review of the imaging archive between 2008 and 2019 (29 females; mean, 55 yrs; range, 4-86 yrs). All patients underwent magnetic resonance imaging of the skull base and/or computed tomography examination.

Interventions: Surgical repair of PAC.

Main Outcome Measures: Radiologic features of PAC.

Results: Radiological features of PAC: 25.7% bilateral; partial or expanded empty sella in 82.9%; arachnoid pits in 14.2%; and enlarged CSF space of optic nerve sheath in 20.0%. Coexisting pathology included temporal, sphenoid, and bilateral jugular foramen meningocele; as well as cribriform, middle crania fossa, and right temporal defect. Three case studies describing the surgical course of spontaneous CSF leak secondary to PAC were managed with the middle cranial fossa approach.

Conclusions: PAC is an exceedingly unusual cause for CSF leak in the adult and pediatric population. A middle fossa approach may be used to treat CSF leak as a result of PAC. Typically, CSF otorrhea originates from an encephalocele that extends via a bony defect in the tegmen tympani or tegmen mastoideum. However, on occasion the source of the CSF otorrhea is not via the tegmen, instead defects in the middle fossa floor, medial to the ridge for the gasserian ganglion (tubercle of Princeteau), need to be considered.
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http://dx.doi.org/10.1097/MAO.0000000000003080DOI Listing
July 2021

Association of Air Pollutant Exposure and Sinonasal Histopathology Findings in Chronic Rhinosinusitis.

Am J Rhinol Allergy 2021 Nov 10;35(6):761-767. Epub 2021 Feb 10.

Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois.

Background: Ambient air pollution is well known to cause inflammatory change in respiratory epithelium and is associated with exacerbations of inflammatory conditions such as asthma and chronic obstructive pulmonary disease. However, limited work has been done on the impact of air pollution on pathogenesis of chronic rhinosinusitis and there are no reports in the literature of how pollutant exposure may impact sinonasal histopathology in patients with chronic rhinosinusitis.

Objective: This study aims to identify associations between certain histopathologic characteristics seen in sinus tissue of patients with chronic rhinosinusitis (CRS) and levels of particulate air pollution (PM) and ground-level ozone in their place of residence.

Methods: A structured histopathology report was created to characterize the tissues of CRS patients undergoing sinus surgery. An estimate for each patient's exposure to air pollutants including small particulate matter (PM) and ground-level ozone was obtained using the Environmental Protection Agency's (EPA) Environmental Justice Screening and Mapping Tool (EJSCREEN). Mean pollutant exposures for patients whose tissues exhibited varying histopathologic features were compared using logistic regression models.

Results: Data from 291 CRS patients were analyzed. Higher degree of inflammation was significantly associated with increased ozone exposure (p = 0.031). Amongst the patients with CRSwNP (n=131), presence of eosinophilic aggregates (p = 0.018) and Charcot-Leyden crystals (p = 0.036) was associated with increased ozone exposure.

Conclusion: Exposure to ambient air pollutants may contribute to pathogenesis of CRS. Increasing ozone exposure was linked to both higher tissue inflammation and presence of eosinophilic aggregates and Charcot-Leyden crystals in CRSwNP patients.
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http://dx.doi.org/10.1177/1945892421993655DOI Listing
November 2021

Levels of Evidence in Rhinology and Skull Base Surgery Research.

Otolaryngol Head Neck Surg 2021 09 9;165(3):477-482. Epub 2021 Feb 9.

Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.

Objective: The purpose of this study was to evaluate the quality of evidence of rhinology and rhinologic skull base surgery (RSBS) research and its evolution over the past decade.

Study Design: Review article.

Setting: We reviewed articles from 2007 to 2019 in 4 leading peer-reviewed otolaryngology journals and 3 rhinology-specific journals.

Methods: The articles were reviewed and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine 2011 guidelines. High quality was defined as level of evidence 1 or 2.

Results: In total, 1835 articles were reviewed in this study spanning a 13-year period. Overall, the absolute number of RSBS publications increased significantly 22.6% per year, from 108 articles in 2007 to 481 in 2019 ( < .001; 95% CI, 7.9-37.2). In 2007, only 13 articles, or 15%, were high quality, and this grew to 146 articles, or 39%, in 2019. A 14.0% per year exponential increase in the number of high-quality publications was found to be statistically significant ( < .001; 95% CI, 7.2, 20.7). Overall, high-quality publications represented just 25.8% of RSBS articles overall. There was no significant difference in quality between rhinology-specific journals and general otolaryngology journals (χ = 3.1, = .077).

Conclusion: The number of overall publications and of high-quality RSBS publications has significantly increased over the past decade. However, the proportion of high-quality studies continues to represent a minority of total RSBS research.
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http://dx.doi.org/10.1177/0194599820987131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8424609PMC
September 2021

Cytopathologic assessment of gloves and instruments after major head and neck surgery.

Am J Otolaryngol 2021 May-Jun;42(3):102876. Epub 2021 Jan 6.

Department of Otorhinolaryngology - Head and Neck Surgery Rush University Medical Center, Chicago, IL, USA. Electronic address:

Purpose: To investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials.

Materials And Methods: Pilot prospective study from April 2018-January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case).

Results: 18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei.

Conclusions: Malignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.
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http://dx.doi.org/10.1016/j.amjoto.2020.102876DOI Listing
October 2021

Chronic Sphenoiditis With Deep Neck Space Extension: Case Report With Review of the Literature and Postulated Mechanisms for Extracranial Extension.

Ear Nose Throat J 2021 Jan 20:145561321989453. Epub 2021 Jan 20.

Department of Otorhinolaryngology, 2468Rush University Medical Center, Chicago, IL, USA.

Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space.
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http://dx.doi.org/10.1177/0145561321989453DOI Listing
January 2021

Endometrial Sarcoma Metastasis to the Pterygopalatine Fossa: A Case Report and Review of the Literature.

Ear Nose Throat J 2021 Jan 8:145561320983943. Epub 2021 Jan 8.

Department of Otorhinolaryngology, Rush Sinus Program, 2468Rush University Medical Center, Chicago, IL, USA.

Metastatic skull base malignancies infrequently occur but, when present, typically arise from breast malignancies. Pterygopalatine fossa (PPF) metastasis of any malignancy is further seldom reported, and metastasis of gynecologic malignancies to the PPF has not been previously described in the literature. We present a single case of a 42-year-old female with the first likely case of high-grade endometrial sarcoma metastatic to the PPF. The patient presented with facial pain and numbness in the V2 distribution presented for evaluation. History was significant for several months of dysmenorrhea and metrorrhagia. Computed tomography, magnetic resonance imaging, and positron emission tomography imaging revealed a PPF mass with local extension and bony metastases. Endoscopic biopsy was performed, and final pathology was most consistent with metastatic high-grade endometrial stromal sarcoma. This is the first reported case of likely metastatic endometrial sarcoma to the PPF. This case report highlights the possibility of rare distant metastasis of gynecologic malignancy to this area of the skull base.
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http://dx.doi.org/10.1177/0145561320983943DOI Listing
January 2021

Inter-pathologist Agreement on Structured Histopathology Reporting in Chronic Rhinosinusitis.

Ann Otol Rhinol Laryngol 2021 Aug 8;130(8):899-903. Epub 2021 Jan 8.

Rush Sinus Program, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA.

Background: Structured histopathology reporting is increasingly being utilized in rhinology to characterize endotypes in chronic rhinosinusitis and guide management decisions after sinus surgery.

Objective: The goal of this investigation is to evaluate inter-observer agreement in structured histopathology reporting.

Methods: Two experienced head and neck pathologists independently compiled structured histopathology reports for tissue samples collected during functional endoscopic sinus surgery. Cohen's standard kappa (κ) coefficients were calculated for each histopathologic variable to assess inter-pathologist agreement.

Results: A total of 92 cases were analyzed. Substantial inter-pathologist agreement was reached on tissue eosinophil count (κ = 0.64,  < .001), the presence of eosinophil aggregates (κ = 0.62,  < .001), and the presence of fungal elements (κ = 0.74,  < .001). There was moderate agreement on the degree of inflammation (κ = 0.56,  < .001) and the presence of squamous metaplasia (κ = 0.46,  < .001). There was fair agreement on the presence of neutrophil infiltrates (κ = 0.33,  < .001), the presence of hyperplastic changes (κ = 0.40,  < .001), and the presence of fibrosis (κ = 0.24,  = .022). There was only slight agreement on the degree of subepithelial edema (κ = 0.20,  = .008). The κ coefficients for basement membrane thickening and mucosal ulceration were not statistically significant.

Conclusion: High inter-pathologist agreement was demonstrated for several salient histopathologic variables, including tissue eosinophil count and the presence of eosinophil aggregates. However, refining the definitions of certain histopathologic variables may improve the reproducibility of structured histopathology reporting.
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http://dx.doi.org/10.1177/0003489420987970DOI Listing
August 2021

Treatment modalities and overall survival outcomes for sinonasal extranodal natural killer/T-cell lymphoma.

Leuk Lymphoma 2021 03 15;62(3):727-730. Epub 2020 Oct 15.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.

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http://dx.doi.org/10.1080/10428194.2020.1834097DOI Listing
March 2021

Academic Rhinologists' Online Rating and Perception, Scholarly Productivity, and Industry Payments.

Am J Rhinol Allergy 2021 May 11;35(3):341-347. Epub 2020 Sep 11.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.

Introduction: The emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.

Methods: Websites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.

Results: A total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender ( = 0.58), geographic quartile ( = 0.48), social media presence ( = 0.41), or attending top-ranked medical school ( = 0.86) or residency programs ( = 0.89). Years of practice negatively correlated with RS (R = -0.22, <0.01), and academic ranking significantly influenced RS, with professors, associate professors, and assistant professors scoring 4.1 ± 0.6, 4.3 ± 0.4, and 4.4 ± 0.6, respectively ( = 0.03). Of the 3,304 narrative comments analyzed (3.1 ± 11.6 per rhinologist), 76% (positive) and 7% (negative) had elements of clinical knowledge/outcomes, 56% (positive) and 7% (negative) of communication/bedside manner, and 9% (positive) and 7% (negative) of office staff, cost, and wait-time. All negative comment categories had moderate negative correlation with RS, while positive comment categories regarding knowledge/competence and bedside manner weakly correlated with higher RS. Number of publications (48 ± 54) positively correlated with 2018 industry payments ($11,384 ± $19,025) among those receiving industry compensation >$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (<0.01) and H-index ( = 0.02).

Conclusion: Academic rhinologists' online RS was not associated with gender, geographic location, or attending a top-ranked training program, and their scholarly productivity was significantly correlated with total industry payments.
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http://dx.doi.org/10.1177/1945892420958366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258306PMC
May 2021

Occult Lymph Node Metastasis in Early-Stage Glottic Cancer in the National Cancer Database.

Laryngoscope 2021 04 18;131(4):E1139-E1146. Epub 2020 Aug 18.

Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Objectives: Early-stage glottic cancer (cT1-T2 cN0) may be treated by primary surgery or radiation. Elective treatment of the neck in clinically N0 disease is usually not performed due to low rates of regional lymph node metastasis. This study examines the role of elective neck dissection (END) and rate of occult nodal metastasis in cT1-T2 cN0 glottic cancer treated with primary surgery.

Study Design: Retrospective cohort study.

Methods: The National Cancer Database was used to identify patients treated for early-stage glottic cancer. Demographic variables, disease characteristics, and overall survival were compared between the subgroups of patients who did and did not receive END. Factors predictive of occult lymph node metastasis were also identified using a multivariate logistic regression model.

Results: Thirty-eight percent of the 991 patients in this cohort underwent END. Younger age, treatment at an academic facility, advanced T-stage, and higher tumor grade were associated with receiving END. Sixteen percent of the 372 patients undergoing END had occult nodal metastasis. Higher tumor histopathologic grade was associated with occult metastasis (P = .004). While undergoing END did not affect significantly survival, those with occult metastasis had poorer survival (P < .001).

Conclusions: END should be considered in cT1-T2 N0 glottic cancers with poorly differentiated or undifferentiated tumor histopathology. While END itself may not improve overall survival, identification of occult nodal metastasis is an important finding for prognostication.

Level Of Evidence: Level 3 Laryngoscope, 131:E1139-E1146, 2021.
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http://dx.doi.org/10.1002/lary.28995DOI Listing
April 2021

Targeted 595-gene genomic profiling demonstrates low tumor mutational burden in olfactory neuroblastoma.

Int Forum Allergy Rhinol 2021 01 18;11(1):58-64. Epub 2020 Jun 18.

Department of Otorhinolaryngology, Head and Neck Surgery, Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, IL.

Background: Olfactory neuroblastoma (ONB) is a rare skull-base malignancy associated with delayed local recurrence. Treatment options in recurrent disease are few and unreliable. We undertook analysis of the ONB exome and immune environment in order to identify potential future immunotherapy treatment options.

Methods: Retrospective chart review and next-generation targeted 595-gene genomic profiling was performed on a cohort of 14 ONB cases utilizing Tempus proprietary DNA and RNA sequencing technology. Tempus analysis provided a measurement of tumor mutational burden (TMB) and composition of the immune cell infiltrate present in tumor samples. Clinically relevant genomic alterations and associated targeted therapies were identified using cancer.gov and clinicaltrials.gov. TMB was tested by univariate analysis against clinical stage, pathologic grade, recurrence risk, and immune cell infiltration.

Results: The mean age for the subjects was 50 years (range, 13 to 76 years) with a male:female ratio of 1:1. TMB for ONB samples ranged from 1.3 to 9.6 mutations/megabase (Mb) with mean of 3.8 mutations/Mb. Univariate analysis showed no association between TMB and tumor stage, pathologic grade, risk of recurrence, or immune cell infiltration. Genomic profile revealed that 6 of 13 tumors had genetic alterations with targeted therapies in clinical trials, whereas 1 tumor demonstrated KRAS Q61R mutation with U.S. Food and Drug Administration (FDA)-approved targeted therapies.

Conclusion: TMB is a novel biomarker guiding the classification of neoplasms in the emerging era of immunotherapy. The characterization of ONB as a low-TMB pathology contributes to the overall taxonomy of all cancers and suggests limited utility of immunotherapy treatment.
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http://dx.doi.org/10.1002/alr.22595DOI Listing
January 2021

Disparate Nasopharyngeal and Tracheal COVID-19 Diagnostic Test Results in a Patient With a Total Laryngectomy.

Otolaryngol Head Neck Surg 2020 10 9;163(4):710-711. Epub 2020 Jun 9.

Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.

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http://dx.doi.org/10.1177/0194599820933605DOI Listing
October 2020
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