Publications by authors named "Matthew J Urban"

14 Publications

  • Page 1 of 1

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

Otolaryngol Head Neck Surg 2021 Apr 13:1945998211004578. 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
April 2021

Hypoglossal and Masseteric Nerve Transfer for Facial Reanimation: A Systematic Review and Meta-Analysis.

Facial Plast Surg Aesthet Med 2021 Feb 25. Epub 2021 Feb 25.

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

Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm,  = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4,  < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3,  < 0.001). Adverse effects were rare (<5%) for both procedures. Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.
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http://dx.doi.org/10.1089/fpsam.2020.0523DOI Listing
February 2021

Interest in Facial Cosmetic Surgery in the Time of COVID-19: A Google Trends Analysis.

Facial Plast Surg Aesthet Med 2021 Feb 24. Epub 2021 Feb 24.

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

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http://dx.doi.org/10.1089/fpsam.2020.0605DOI Listing
February 2021

Challenges in the Delivery of Rural Otolaryngology Care During the COVID-19 Pandemic.

Otolaryngol Head Neck Surg 2021 Feb 16:194599821995146. Epub 2021 Feb 16.

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

Though initially spared from the brunt of the COVID-19 pandemic, rural areas in the United States have been ravaged by the disease. With a higher-risk population at baseline and an already strained health care system, rural hospitals face severe challenges in delivering care during the pandemic. In otolaryngology specifically, there has been difficulty in ensuring patient access to care while maintaining safe environments for patients and staff. Partnership between academic medical centers and critical access rural hospitals is urgently needed to help improve care for vulnerable rural populations.
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http://dx.doi.org/10.1177/0194599821995146DOI Listing
February 2021

Beauty is in the eye of the follower: Facial aesthetics in the age of social media.

Am J Otolaryngol 2020 Nov - Dec;41(6):102643. Epub 2020 Jul 15.

Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, United States of America.

Background: The advent of social media has influenced the relationship between aesthetic surgeons and their patients, as well as the motivations of such patients to seek cosmetic surgery.

Aims & Objectives: To determine how the cephalometric proportions of modern social media models fit with historical canons of beauty.

Materials & Methods: Frontal and lateral photographs of 20 high-influence female Instagram models were obtained and evaluated for cephalometric measures. The means of these measures were compared with previous reports in the literature.

Results: Cephalometric measurements of social media models were in agreement with historical ideals of beauty for Nostril axis (120.7°), Goode's ratio (0.6), Nasofacial angle (35.7°), Nasofrontal angle (130.9°), and the horizontal thirds. Results were discrepant from historical ideals for the Nasolabial angle (82.6°) and the vertical facial fifths.

Conclusion: Cephalometric measurements of social media models in the digital age closely resemble the ideal values proposed by previous authors. Due to a preference for larger or altered lip profiles, nostril axis is a more reliable measure of nasal tip rotation than nasolabial angle.
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http://dx.doi.org/10.1016/j.amjoto.2020.102643DOI Listing
December 2020

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas.

Ann Otol Rhinol Laryngol 2020 Dec 18;129(12):1229-1238. Epub 2020 Jun 18.

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

Objectives: Historically, eventual loss of cochlear nerve function has limited patients with neurofibromatosis type 2 (NF2) to auditory brainstem implants (ABI), which in general are less effective than modern cochlear implants (CI). Our objective is to evaluate hearing outcomes following ipsilateral cochlear implantation in patients with NF2 and irradiated vestibular schwannomas (VS), and sporadic VS that have been irradiated or observed.

Methods: Multi-center retrospective analysis of ipsilateral cochlear implantation in the presence of observed and irradiated VS. MESH search in NCBI PubMed database between 1992 and 2019 for reported cases of cochlear implantation with unresected vestibular schwannoma.

Results: Seven patients underwent ipsilateral cochlear implantation in the presence of observed or irradiated vestibular schwannomas. Four patients had sporadic tumors with severe-profound contralateral hearing loss caused by presbycusis/hereditary sensorineural hearing loss, and three patients with NF2 lost contralateral hearing after prior surgical resection. Prior to implantation, one VS was observed without growth for a period of 7 years and the others were treated with radiotherapy. Mean post-operative sentence score was 63.9% (range 48-91) at an average of 28 (range 2-84) months follow up. All patients in this cohort obtained open set speech perception. While analysis of the literature is limited by heterogenous data reporting, 85% of implants with observed schwannomas achieved some open set perception, and 67% of patients previously radiated schwannomas. Furthermore, blending literature outcomes for post implantation sentence testing in quiet without lip-reading show 59.0 ± 35% for patients with CI and observed tumors and 55.7 ± 35% for patients with radiated tumors, with both groups ranging 0 to 100%.

Conclusion: This retrospective series and literature review highlight that hearing outcomes with CI for VS patients are superior to those achieved with ABI. However, important considerations including imaging, delayed hearing loss, and observation time cannot be ignored in this population.
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http://dx.doi.org/10.1177/0003489420935482DOI Listing
December 2020

Management of Upper Airway Bleeding in COVID-19 Patients on Extracorporeal Membrane Oxygenation.

Laryngoscope 2020 11 3;130(11):2558-2560. Epub 2020 Aug 3.

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

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http://dx.doi.org/10.1002/lary.28846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283688PMC
November 2020

Implementation of Preoperative Screening Protocols in Otolaryngology During the COVID-19 Pandemic.

Otolaryngol Head Neck Surg 2020 08 26;163(2):265-270. Epub 2020 May 26.

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

Objective: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic.

Methods: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented.

Results: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure ( = .92).

Discussion: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities.

Implications For Practice: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.
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http://dx.doi.org/10.1177/0194599820931041DOI Listing
August 2020

Rural-Urban Disparities in Otolaryngology: The State of Illinois.

Laryngoscope 2021 01 6;131(1):E70-E75. Epub 2020 Apr 6.

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

Objectives/hypothesis: To highlight rural-urban disparities in otolaryngology, and to quantify the disparities in access to otolaryngology specialist care across Illinois. Several studies across disciplines have shown increased prevalence and severity of disease in rural communities, relative to their urban counterparts. There is very little published quantifying a disparity in rural access to otolaryngologists.

Study Design: Population study.

Methods: Counties in Illinois were classified based on urbanization level on a scale from I (most urban) to VI (least urban) using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification scheme. The six urbanization levels include four metropolitan (I-IV) and two nonmetropolitan levels (V and VI). The name and practice location of all registered otolaryngologists in Illinois were collected using the American Academy of Otolaryngology website (ENTnet.org). Population data were recorded from the most recent US Census (2010).

Results: Two hundred seventy-eight academy-registered otolaryngologists were identified in Illinois. One hundred fifty-one of these providers were located in a single county categorized as a level I by the NCHS scheme. There are over 18,000 square miles and 600,000 persons living in NCHS level VI counties in Illinois with zero registered otolaryngologists. Overall, metropolitan counties (I-IV) averaged 1.32 otolaryngologists per 100,000 population, whereas nonmetropolitan counties (V and VI) averaged 0.46 otolaryngologists per 100,000 (P < .01).

Conclusions: There is a paucity of academy-certified otolaryngologists with primary practice locations in rural counties of Illinois. There is a significant rural population and massive land area with limited spatial access to otolaryngologic specialist care.

Level Of Evidence: NA Laryngoscope, 131:E70-E75, 2021.
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http://dx.doi.org/10.1002/lary.28652DOI Listing
January 2021

The Selfie View: Perioperative Photography in the Digital Age.

Aesthetic Plast Surg 2020 06 9;44(3):1066-1070. Epub 2020 Jan 9.

Section of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison Street; Suite 550, Chicago, IL, USA.

Background: The aesthetics of social media have become increasingly important to cosmetic surgery patients in recent years; however, aesthetic treatments have not kept pace with the desires of modern patients. The current study investigates the most common angles employed by various user cohorts when posting a selfie on social media platforms and proposes that aesthetic surgeons consider utilizing a selfie angle alongside standard pre- and postoperative photographic views.

Methods: Full face photographs published on the social media platform Instagram™ with the tag #selfie were divided into three cohorts: female models/influencers, amateur females, and amateur males. Each cohort contained 100 photographs. The photographs were analyzed using cloud-based facial analysis software for facial pan, roll, and tilt relative to the camera.

Results: One hundred photographs from each cohort were analyzed and demonstrated that amateur females (AF) take photographs from higher angles than amateur males (AM) or model females (MF). Roll-off-midline was significantly greater for AF and MF as compared to AM. The MF group had significantly a greater pan-off-midline as compared to AF and AM, while AF had significantly a greater pan-off-midline than AM.

Conclusions: Common photography practices employed within selfie photographs utilize angles not captured in standard perioperative photographs. This study supports the implementation of a selfie photograph into the standard set of pre- and postoperative photographs taken by aesthetic surgeons to evaluate the effects of interventions in the context of selfie photography. The angle employed can vary depending upon the demographic profile of the patient.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-019-01593-1DOI Listing
June 2020

The anesthesia airway evaluation: Correlation with sleep endoscopy findings.

Am J Otolaryngol 2020 Mar - Apr;41(2):102362. Epub 2019 Nov 23.

Rush University Medical Center, Department of Otorhinolaryngology - Head & Neck Surgery, Chicago, IL 60612, United States of America.

Purpose: Drug-induced sleep endoscopy (DISE) is a cost-effective, safe, and reliable tool to evaluate obstructive sleep apnea (OSA) patients by revealing upper airway sites, patterns, and severity of obstruction. DISE provides valuable data because reliable evaluation of the OSA airway while awake has remained elusive. Few studies (with mixed results) have analyzed the correlation between pre-operation, awake airway assessments routinely performed by anesthesia and DISE results.

Methods: Preoperative anesthesia evaluation records and subsequent DISE reports were obtained for 99 adult patients undergoing DISE between 2016 and 2018. All patients carried the diagnosis of OSA, based on polysomnography. Anesthesia-collected variables were compared with DISE findings in an effort to determine if commonly-utilized physical exam findings correlated to patterns of upper airway collapse observed on sleep endoscopy.

Results: Most anesthesia preoperative evaluation variables were not found to be predictive of any identifiable patterns of collapse on DISE, including Mallampati score, ability to prognath, and overall airway assessment score. Obesity did not correlate with circumferential collapse at the velopharynx, or to multi-level collapse. Thyromental distance <6.5 cm was found to be statistically correlated to total epiglottic collapse (E = 2+). Friedman tongue position scores were found to be correlated to velopharyngeal collapse (p < 0.05).

Conclusions: Anesthesia airway assessment algorithms and physical exam findings do not correlate well with findings on sleep endoscopy. DISE remains the gold standard for evaluating levels of collapse and operative planning in the OSA population.
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http://dx.doi.org/10.1016/j.amjoto.2019.102362DOI Listing
August 2020

Asymmetric Laryngopharyngeal Reflux Findings Following Sleep in the Lateral Recumbent Position.

Ear Nose Throat J 2020 May 9;99(4):NP44-NP45. Epub 2019 Apr 9.

Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia PA, USA.

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http://dx.doi.org/10.1177/0145561319838406DOI Listing
May 2020

Hemilaryngeal Microsomia: An Anatomic Variant.

J Voice 2017 Sep 25;31(5):601-604. Epub 2017 Jan 25.

Department of Otolaryngology-Head and Neck Surgery, Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address:

Objectives: This study aims to describe a congenital laryngeal structural variant, hemilaryngeal microsomia (HLM), and to correlate identification on physical examination with computerized tomography scan (CT) and laryngoscopy findings.

Methods: The study was conducted at a tertiary care center. Six patients presenting with hoarseness were admitted to a tertiary care otolaryngology office. These patients had asymmetrical thyroid cartilage prominence on palpation during physical examination. A diagnosis of HLM was made. All patients underwent laryngostroboscopy and CT scan. Four control patients with normal thyroid cartilage anatomy on physical examination, CT, and stroboscopy results were included for comparison.

Results: Disparities in thyroid cartilage angles correlated with documented physical examination findings for six out of six HLM patients. On CT scan, the average difference in left and right thyroid laminar angles was 30.2° ± 18.3° in HLM patients vs 4.00° ± 1.63° in control patients (P = 0.023). Strobosocopic findings also correlated with HLM. The arytenoid cartilage was anteriorly or medially displaced on the microsomic side in all six HLM patients. Three patients had anterior placement of the vocal process resulting in shortening of the vocal fold on the microsomic side of the larynx.

Conclusions: HLM is a congenital structural anomaly of the larynx that may be palpated on physical examination. HLM found on physical examination can be correlated with asymmetries found on CT scan and endoscopy. There is no evidence that the structural features of HLM were causally related to voice symptoms, but the findings on HLM may lead to misdiagnosis. A larger study is indicated to confirm laryngeal structural differences between patients with HLM on physical examination and the general population. Whether or not HLM affects clinical or surgical outcomes remains to be studied.
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http://dx.doi.org/10.1016/j.jvoice.2016.12.006DOI Listing
September 2017

Efficacy of CDP and ENG in Detecting Balance Impairment Associated With Cerebral White Matter Changes.

Otol Neurotol 2016 10;37(9):1457-61

*Drexel University College of Medicine†Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Objective: To examine the relationship between white matter changes (WMCs) and abnormal balance test results on computerized dynamic posturography (CDP) and electronystagmography (ENG). Also, to compare the utility of CDP with ENG for this purpose.

Study Design: Retrospective case review.

Setting: Tertiary care referral center.

Patients: A retrospective review of 137 subjects was conducted. The CDP and ENG results were compared between patients with (80) and without (57) WMCs as detected byT2/fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI).

Main Outcome Measures: CDP analysis consisted of both sensory organization test (SOT) and motor control test (MCT) results, and ENG analysis included positional, oculomotor, and bithermal caloric testing. Multivariate logistic regression was performed to control for age and hearing loss discrepancies between the two groups.

Results: Ninety three percent of patients with WMCs had an abnormal CDP result, as compared with 44% of patients lacking WMCs (p < 0.001). Eighty six percent of patients with WMCs had an abnormal ENG, as did 81% of patients without WMCs (p = 0.435). Multivariate regression analysis maintained that an abnormal CDP result was significantly associated with WMCs when controlling for age and hearing loss (p < 0.001).

Conclusion: These findings suggest that patients with cerebral small-vessel ischemic changes are significantly more likely to have an abnormal balance result as detected by CDP, than by ENG. Hence, CDP may be a better study to identify and document patients who have balance dysfunction associated with this central finding. Such identification will permit additional evaluation and treatment based on objective confirmation of balance dysfunction, in this group of balance-impaired subjects who may have normal ENG's.
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http://dx.doi.org/10.1097/MAO.0000000000001198DOI Listing
October 2016