Publications by authors named "Madelyn N Stevens"

12 Publications

  • Page 1 of 1

Organ-Preserving Treatment Strategy for Extra-Axial Chordoma Metastatic to the Larynx Causing Airway Compromise.

Ear Nose Throat J 2021 Jul 31:1455613211037639. Epub 2021 Jul 31.

Department of Otolaryngology-Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA.

Chordomas are rare, malignant bone tumors that arise from embryological remnants of the notochord, typically affecting the skull base, mobile spine, and sacrum with uncommon metastasis to the larynx. Patients with metastasis to the larynx may present with slowly progressive dysphonia and dyspnea. Here, we report an organ-preservation treatment strategy for a patient with widely metastatic extra-axial chordoma presenting with airway compromise who was found to have a new metastasis to the cricoid cartilage.
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http://dx.doi.org/10.1177/01455613211037639DOI Listing
July 2021

Online Otolaryngology: A Comprehensive Model for Medical Student Engagement in the Virtual Era and Beyond.

Ear Nose Throat J 2021 Jul 5:1455613211029748. Epub 2021 Jul 5.

Guy M. Maness Professor and Chair of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

When in-person experiences were taken away from medical students and residency applicants during the COVID-19 pandemic, institutions had to pivot to virtual experiences. We present here a comprehensive overview of virtual engagement for medical students. As we increasingly embrace virtual opportunities, it may be possible to continue utilizing these programs for many years to come.
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http://dx.doi.org/10.1177/01455613211029748DOI Listing
July 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

Delayed Tracheal Perforation Following Total Thyroidectomy.

Laryngoscope 2021 Mar 30. Epub 2021 Mar 30.

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

Delayed tracheal rupture following total thyroidectomy (TT) is rare and represents a potential airway emergency. A 34-year-old female with Felty Syndrome underwent TT for Hashimoto's thyroiditis. On post-operative day 10, she presented with subcutaneous emphysema and an anterolateral tracheal perforation on CT scan. Urgent operative exploration revealed transmural tracheal necrosis and a 5 mm perforation. This was oversewn with non-absorbable suture and a strap muscle flap rotated over the defect to promote healing. Repeat direct laryngoscopy at 72 hours revealed healing tissue. Tracheal necrosis and perforation following TT constitutes a potential airway emergency and should be promptly explored and repaired. Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29534DOI Listing
March 2021

SARS-CoV-2 Nasopharyngeal Swab as a Foreign Body: A Case Report.

Ear Nose Throat J 2021 Feb 22:145561321996836. Epub 2021 Feb 22.

Department of Otolaryngology - Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA.

The SARS-CoV-2 pandemic response utilizes nasopharyngeal swabbing as a prolific testing method for presence of viral RNA. The depth of the swab to the nasopharynx coupled with breakpoints along the shaft leads to a risk for foreign body retention. Here, we present a case of a nasopharyngeal swab that became a retained foreign body during routine swabbing to test for the SARS-CoV-2 virus. Bedside flexible fiberoptic endoscopy was performed and did not reveal a foreign body in the nasopharynx or larynx. Subsequent computed tomography (CT) scan demonstrated the radiopaque retained foreign body at the distal gastroesophageal junction. The patient remained asymptomatic and did not have any upper airway or gastrointestinal symptoms. This unique case demonstrates a potential risk associated with SARS-CoV-2 nasopharyngeal swab testing and highlights management strategies that serve the patient while adequately protecting health care providers. A standardized approach to evaluation optimally includes bedside flexible endoscopy with appropriate personal protective equipment, prompt airway evaluation if aspiration is suspected, and noncontrasted CT imaging if the known foreign body is not identified via other modalities.
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http://dx.doi.org/10.1177/0145561321996836DOI Listing
February 2021

A Retrospective Study of Lymph Node Yield in Lateral Neck Dissection for Papillary Thyroid Carcinoma.

Ear Nose Throat J 2020 Oct 22:145561320967339. Epub 2020 Oct 22.

Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA.

Objective: Lateral neck dissection (LND) is important in managing papillary thyroid carcinomas (PTCs). This study aimed to evaluate the relationship between lymph node yield (LNY) for LND and patient outcomes, specifically postoperative serum thyroglobulin levels (sTG) and radioiodine uptake on thyroid scan, and to estimate a threshold LNY to signify adequate LND.

Methods: Patients diagnosed with PTC who underwent LND from 2006 to 2015 at a single institution were included. Linear regression with restricted cubic splines was used to characterize the association of LNY with outcomes. Outcomes were log-transformed to achieve a more symmetric distribution prior to regression. For nonlinear associations, a Monte Carlo Markov Chain procedure was used to estimate a threshold LNY associated with postoperative outcome. This threshold was then used to define high LNY versus low LNY in the subsequent analyses.

Results: In total, 107 adult patients were included. There was a significant relationship between LNY and postoperative sTG level ( = .004), but not radioiodine uptake ( = .64). An LNY of 42.96 was identified, which was associated with the maximum change in sTG level. No association was found between LNY groups (LNY ≥ 43 vs < 43) and radioiodine uptake, risk of complication, or longer operative times (all > .05). High LNY was associated with a decrease in log(sTG) (estimate = -1.855, = .03), indicating that adequacy of LND is associated with an 84.4% decrease in sTG.

Conclusion: These results suggest an association between LNY and postoperative sTG level, with an estimated threshold of 43 nodes. This has implications for adequate therapeutic LND; additional work is needed to validate thresholds for clinical practice.
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http://dx.doi.org/10.1177/0145561320967339DOI Listing
October 2020

Communication and Healthcare: Self-Reports of People with Hearing Loss in Primary Care Settings.

Clin Gerontol 2019 Oct-Dec;42(5):485-494. Epub 2018 Apr 27.

Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center , Durham , North Carolina , USA.

: To assess the experiences of people with hearing loss in healthcare environments to characterize miscommunication and unmet needs, and guide recommendations for improving outcomes and access. : Anonymous survey developed by subject-matter experts was posted on a large national hearing-loss consumer and advocacy organization website and email listserv. Data were collected and managed via RedCAP. : Responses were received from 1581 individuals. Respondents reported moderate or significant difficulty communicating with all listed providers. Three communication situations emerged as often presenting communication difficulties: hearing one's name when called in the waiting room, hearing when the speaker's back was turned, and hearing when communicating by telephone. Despite 93% of respondents indicating they sometimes or often let providers know about their hearing loss, 29.3% of all respondents still reported that no arrangements were made to improve communication. : This study clearly demonstrates the ongoing difficulties faced by individuals with hearing loss, particularly older adults, as they attempt to navigate both providers and situations associated with a typical primary care office visit. : Inexpensive and efficient changes to improve communication include (1) Improving one-on-one provider communication by facing the individual with good lighting, clear speaking, and not obstructing one's mouth; (2) Environmental changes such as using visual or tactile alerting devices in waiting rooms and adding noise-dampening carpeting and curtains; and (3) Avoiding telephones and conveying health information in writing.
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http://dx.doi.org/10.1080/07317115.2018.1453908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110317PMC
September 2020

Prevalence of Meibomian Gland Atrophy in a Pediatric Population.

Cornea 2018 Apr;37(4):426-430

Department of Ophthalmology, Duke University Eye Center, Durham, NC.

Purpose: To report the prevalence of meibomian gland atrophy and gland tortuosity in a pediatric population.

Methods: Participants who presented with no history of dry eye disease or meibomian gland dysfunction were recruited from the Duke University Eye Center. Meibography was performed and subjective symptoms were assessed through the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Grading of images was assessed by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and a 3-point scale for gland tortuosity (0-2).

Results: Ninety-nine eyes of 99 participants (50 females) aged 4 to 17 years (mean 9.6 years) were imaged. The mean meiboscore was 0.58 ± 0.80 (mean ± SD) for gland atrophy and 0.45 ± 0.64 for tortuosity. In all subjects, 42% (n = 42) had any evidence of meibomian gland atrophy (meiboscore >0) and 37% (n = 37) had any evidence of meibomian gland tortuosity. The majority of subjects had mild gland atrophy. No significant association was found between age, sex, or race and presence of gland atrophy. Males were significantly more likely to have gland tortuosity (P = 0.0124, odds ratio 3.36).

Conclusions: This study reveals a relatively high level of mild meibomian gland atrophy in the pediatric population, though moderate-severe gland atrophy was also present in this young population. This calls into question our current understanding of baseline gland architecture and suggests that perhaps clinicians should be examining young patients for meibomian gland atrophy and dysfunction because it may have implications for future development of dry eye disease.
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http://dx.doi.org/10.1097/ICO.0000000000001476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844582PMC
April 2018

What is the potential clinical utility of vHIT when assessing adult patients with dizziness?

Laryngoscope 2017 12 12;127(12):2689-2690. Epub 2017 Jul 12.

Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.

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http://dx.doi.org/10.1002/lary.26774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687996PMC
December 2017

Auditory contributions to maintaining balance.

J Vestib Res 2016 ;26(5-6):433-438

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.

Maintaining balance relies on integration of inputs from the visual, vestibular, and proprioceptive systems. The auditory system has not been credited with a similar contributory role, despite its ability to provide spatial orienting cues with extreme speed and accuracy. Here, we determined the ability of external auditory signals to reduce postural sway, measured as the root-mean-square velocity of center of pressure of a standing subject, in a series of subjects with varying levels of imbalance standing in the dark. The maximum root-mean-square center of pressure among our subjects decreased from 7.0 cm/sec in silence to 4.7 cm/sec.with the addition of external sound. The addition of sound allowed subjects to decrease sway by 41 percent. The amount of improvement due to sound was 54% of the amount of improvement observed in postural sway when visual cues only were provided to subjects standing in silence. These data support the significant effect of the auditory system in providing balance-related cues and suggest that interventions such as hearing aids or cochlear implants may be useful in improving postural stability and reducing falls.
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http://dx.doi.org/10.3233/VES-160599DOI Listing
February 2018

Short-term risk of falling after cochlear implantation.

Audiol Neurootol 2014 12;19(6):370-7. Epub 2014 Nov 12.

Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo., USA.

Cochlear implantation is a highly effective intervention for hearing loss, but insertion of an implant into the cochlea is often accompanied by loss of residual hearing function. Sometimes, postoperative testing also shows loss of function in the semicircular canals or otolith organs. The effect of this loss on equilibrium, particularly in the short term following surgery, and the risk of falling due to this loss is unknown. We prospectively measured balance in 16 consecutive adult cochlear implant patients before and 2 weeks after surgery. Subjects stood on a foam pad with eyes closed, feet together and arms at the side. The length of time over which this posture could be maintained was recorded up to a maximum value of 30 s indicating normal performance. Ten of 16 subjects reached a maximal time on preoperative testing. Nine of 16 subjects lost balance function after surgery. Four of the 10 subjects with normal preoperative balance function lost function. Subjects older than the age of 60 were more likely to lose balance function than younger subjects. We used previously published values relating balance performance on foam to risk of falling to calculate the fall risk among our subjects. The relative risk of falling increased after surgery by more than threefold in some patients. Imbalance after cochlear implantation may be much more common, particularly in the short term, than previously appreciated. This imbalance is accompanied by an increased risk of falling in many patients. Careful preoperative counseling before implantation and postoperative therapeutic intervention to improve comfort and reduce the chance of falling may be warranted, particularly in patients at a risk for injuries from falls (level of evidence: 2b).
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http://dx.doi.org/10.1159/000363214DOI Listing
September 2015

Improvement in sensorineural hearing loss during pregnancy.

Ann Otol Rhinol Laryngol 2014 Sep 28;123(9):614-8. Epub 2014 Mar 28.

Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

Objective: Hearing loss is known to occur in some pregnant women, but improvement in sensorineural thresholds has not been audiometrically characterized. Here, we describe a patient with a history of Ménière's disease and vestibular migraine who experienced temporary recovery of her hearing during pregnancy.

Methods: Audiograms were obtained from a 31-year-old female over the course of 2 successive pregnancies.

Results: Audiograms revealed a substantial improvement in hearing by the third trimester during each pregnancy, with a rapid return to baseline thresholds after delivery.

Conclusion: This case is unique in documenting improvements in hearing thresholds during pregnancy and substantiates the effects of hormonal changes on hearing thresholds in humans. It raises the intriguing possibility of hormonal therapy as a treatment for sensorineural hearing loss in specific clinical situations.
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http://dx.doi.org/10.1177/0003489414525590DOI Listing
September 2014
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