Publications by authors named "Mehdi Abouzari"

65 Publications

Tinnitus and Subjective Hearing Loss are More Common in Migraine: A Cross-Sectional NHANES Analysis.

Otol Neurotol 2021 Jul 7. Epub 2021 Jul 7.

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

Objectives: To investigate whether migraine is independently associated with tinnitus and subjective hearing loss (HL) in a large national database.

Methods: The de-identified 1999 to 2004 National Health and Nutrition Examination Survey database was retrospectively queried for subjects aged 18 to 65. HL and tinnitus were subjectively reported by subjects.

Results: A total of 12,962 subjects (52.9% female) with a mean age of 38.1 ± 14.6 years were included. This consisted of 2,657 (20.5%), 2,344 (18.1%), and 2,582 (19.9%) subjects who had migraine, subjective-HL, and tinnitus, respectively. In patients with tinnitus or subjective-HL, migraine was reported in 35.6% and 24.5%, respectively. Migraineurs were more likely to have subjective-HL (25.0% vs. 16.6%, p < 0.001) and tinnitus (34.6% vs. 16.9%, p < 0.001) compared to the nonmigraineurs. This corresponded to migraine having an odds ratio of 1.5 (95% confidence interval [CI] 1.3-1.7, p < 0.001) and 2.2 (95% CI 2.0-2.4, p < 0.001) for subjective-HL and tinnitus, respectively. After adjusting for confounders, subjective-HL (odds ratio [OR] = 1.2, 95% CI 1.1-1.4, p = 0.003), tinnitus (OR = 2.1, 95% CI 1.9-2.3, p < 0.001), and neck pain (OR = 4.0, 95% CI 3.6-4.5, p < 0.001) were more common in migraineurs. Among migraineurs, a higher proportion of those with tinnitus also had subjective-HL compared to those without tinnitus (40.0% vs. 15.3%, p < 0.001), and a higher proportion of those with subjective-HL also had tinnitus compared to those without HL (58.1% vs. 27.3%, p < 0.001).

Conclusions: This study suggests an independent association between migraine with subjective-HL and tinnitus. Otologic migraine, which is the effects of migraine on the ear, may be partly responsible for the link between HL, tinnitus, neck pain, and migraine.
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http://dx.doi.org/10.1097/MAO.0000000000003247DOI Listing
July 2021

A Web-Based Deep Learning Model for Automated Diagnosis of Otoscopic Images.

Otol Neurotol 2021 Jun 4. Epub 2021 Jun 4.

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

Objectives: To develop a multiclass-classifier deep learning model and website for distinguishing tympanic membrane (TM) pathologies based on otoscopic images.

Methods: An otoscopic image database developed by utilizing publicly available online images and open databases was assessed by convolutional neural network (CNN) models including ResNet-50, Inception-V3, Inception-Resnet-V2, and MobileNetV2. Training and testing were conducted with a 75:25 breakdown. Area under the curve of receiver operating characteristics (AUC-ROC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare different CNN models' performances in classifying TM images.

Results: Our database included 400 images, organized into normal (n = 196) and abnormal classes (n = 204), including acute otitis media (n = 116), otitis externa (n = 44), chronic suppurative otitis media (n = 23), and cerumen impaction (n = 21). For binary classification between normal versus abnormal TM, the best performing model had average AUC-ROC of 0.902 (MobileNetV2), followed by 0.745 (Inception-Resnet-V2), 0.731 (ResNet-50), and 0.636 (Inception-V3). Accuracy ranged between 0.73-0.77, sensitivity 0.72-0.88, specificity 0.58-0.84, PPV 0.68-0.81, and NPV 0.73-0.83. Macro-AUC-ROC for MobileNetV2 based multiclass-classifier was 0.91, with accuracy of 66%. Binary and multiclass-classifier models based on MobileNetV2 were loaded onto a publicly accessible and user-friendly website (https://headneckml.com/tympanic). This allows the readership to upload TM images for real-time predictions using the developed algorithms.

Conclusions: Novel CNN algorithms were developed with high AUC-ROCs for differentiating between various TM pathologies. This was further deployed as a proof-of-concept publicly accessible website for real-time predictions.
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http://dx.doi.org/10.1097/MAO.0000000000003210DOI Listing
June 2021

Migraine Features in Patients with Persistent Postural-Perceptual Dizziness.

Ann Otol Rhinol Laryngol 2021 Apr 3:34894211007233. Epub 2021 Apr 3.

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

Objectives: To evaluate the presence of migraine features in patients with persistent postural-perceptual dizziness (PPPD).

Methods: In a retrospective survey study, consecutive patients presenting to a tertiary care neurotology clinic during an 18-month period were given questionnaires about headache and dizziness symptoms. The survey responses plus history and examination of the patient were used to diagnose patients with PPPD. The prevalence of migraine headache, vestibular migraine (VM), and migraine characteristics was evaluated.

Results: In total, 36 subjects with PPPD were included in the study. The mean age of the subjects was 56 ± 16 years with a female (72%) predominance. A total of 19 (53%) patients met the International Classification of Headache Disorders criteria for migraine headache, and 6 of those (17%) met the criteria for definite VM. Of the patients who did not meet full migraine headache criteria, 6 (17%) patients met 4 of 5 criteria, and 5 (14%) patients met 3 of 5 criteria. There was no significant difference between PPPD patients who fulfilled full migraine headache criteria and those who did not in sensitivity to light, sound, smells, weather changes, feelings of mental fog/confusion, and sinus pain/facial pressure.

Conclusions: This study demonstrates that a majority of patients with PPPD fulfill the criteria for migraine headache. A large proportion of PPPD patients who do not meet the full criteria for migraine headache still meet a majority of the migraine headache criteria. This suggests an association between the 2 conditions. PPPD may be a part of the spectrum of otologic migraine, where migraine manifests as otologic symptoms.
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http://dx.doi.org/10.1177/00034894211007233DOI Listing
April 2021

Treatment of Long-term Sudden Sensorineural Hearing Loss as an Otologic Migraine Phenomenon.

Otol Neurotol 2021 08;42(7):1001-1007

Department of Otolaryngology-Head and Neck Surgery.

Objectives: To describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy.

Methods: Patients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate.

Results: Twenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p < 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial < 50% WRS, 8 (73%) had improved posttreatment >50% WRS with an average improvement of 39 ± 9%.

Conclusions: Migraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.
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http://dx.doi.org/10.1097/MAO.0000000000003111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282717PMC
August 2021

In Reference to A Modern Case Sheds Light on a Classical Enigma: Beethoven's Deafness.

Laryngoscope 2021 06 1;131(6):E2044. Epub 2021 Mar 1.

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

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http://dx.doi.org/10.1002/lary.29470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106653PMC
June 2021

Online Ratings and Perceptions of Pediatric Otolaryngologists.

Laryngoscope 2021 Feb 24. Epub 2021 Feb 24.

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

Objective/hypothesis: To assess and characterize online ratings and comments on pediatric otolaryngologists and determine factors that correlate with higher ratings.

Study Design: Online database analysis.

Methods: All American Society of Pediatric Otolaryngology (ASPO) members were queried on Healthgrades, Vitals, RateMDs, and Yelp for their online ratings and comments as of June 2020. Ratings were normalized for comparison on a five-point Likert scale. All comments were categorized based on context and positive or negative quality.

Results: Of the 561 ASPO members, 489 (87%) were rated on at least one online platform. Of those rated, 410 (84%) were on Healthgrades, 429 (88%) on Vitals, 236 (48%) on RateMDs, and 72 (15%) on Yelp. Across all platforms, the average overall rating was 4.13 ± 0.03 (range, 1.00-5.00). We found significant positive correlations between overall ratings and specific ratings (P < .001) on all individual topics. In addition, the majority of all narrative comments were related to perceived physician bedside manner and clinical outcome, with negative comments correlating negatively with overall score (P < .05). Time spent with the physician was the only category in which both positive and negative comments showed significant correlation with the overall physician rating (P = .016 and P = .017, respectively). Attending a top-ranked medical school or residency program did not correlate with higher or lower ratings.

Conclusions: Online ratings and comments for pediatric otolaryngologists are largely influenced by patient and parent perceptions of physician competence, comforting bedside manner, and office and time management.

Level Of Evidence: N/A Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29479DOI Listing
February 2021

Treatment Analysis and Overall Survival Outcomes of Patients With Bilateral Vestibular Schwannoma.

Otol Neurotol 2021 04;42(4):592-597

Department of Otolaryngology-Head and Neck Surgery.

Objectives: To investigate the clinical presentation, treatment breakdown, and overall survival (OS) outcomes of patients with neurofibromatosis type 2 (NF2)-associated bilateral vestibular schwannoma (NVS).

Methods: The 2004 to 2016 National Cancer Database was queried for patients with a diagnosis of VS. The "Laterality" code was used to stratify patients into sporadic unilateral vestibular schwannoma (UVS) and NVS.

Results: Of the 33,839 patients with VS, 155 (0.46%) were coded for NVS with an average age and tumor size of 37.4 ± 20.5 years and 23.5 ± 18.2 mm. Patients underwent observation (45.3%), surgery (29.3%), and radiotherapy (20.0%), and had a 5.8% 5-year mortality rate. Compared with UVS, NVS was negatively associated with receiving surgery (40.2% versus 29.3%, p = 0.02) while watchful observation was more prevalent (30.1% versus 45.3%, p = 0.001). In NVS, undergoing surgery was associated with larger tumor size (34.5 ± 21.2 versus 17.8 ± 13.3 mm, p = 0.001) and shorter diagnosis-to-treatment time (49.1 ± 60.6 versus 87.0 ± 78.5 d, p = 0.02), radiotherapy was associated with older age (44.4 ± 18.9 versus 35.2 ± 20.6 yr, p = 0.02) and longer diagnosis-to-treatment time (85.9 ± 77.9 versus 53.9 ± 65.5 d, p = 0.04), and observation was associated with smaller tumor size (17.8 ± 15.9 versus 28.0 ± 19.2 mm, p = 0.01). Kaplan-Meier log-rank analysis demonstrated similar 10-year OS between NVS and UVS patients (p = 0.58) without factoring the earlier age of presentation. Furthermore, there were no temporal changes in presentation/management of NVS, and OS was not dependent on the received treatment (p = 0.30).

Conclusions: With younger age, larger tumors, and more conservative management, NVS's OS was not treatment-dependent and was similar to sporadic UVS, though the latter should not be interpreted as similar life expectancies due to the much earlier presentation.
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http://dx.doi.org/10.1097/MAO.0000000000002984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080845PMC
April 2021

Migraine Features in Patients With Recurrent Benign Paroxysmal Positional Vertigo.

Otol Neurotol 2021 03;42(3):461-465

Department of Otolaryngology-Head and Neck Surgery.

Objectives: To identify migraine features present in a cohort of patients with recurrent benign paroxysmal positional vertigo (BPPV).

Methods: Patients presenting with recurrent BPPV were surveyed. Recurrent BPPV was defined as three episodes or greater in 6 months before presentation, with resolution of symptoms after Epley maneuver. Current or past migraine headache (MH) diagnosis was made according to the International Headache Society guidelines.

Results: Fifty-eight patients with recurrent BPPV with a mean age of 53.8 ± 17.4 years were included. Half (29 patients) fulfilled criteria for MH and half (29 patients) did not meet the criteria for MH (non-MH). No statistically significant difference was found in a majority of migraine-related symptoms between the MH and non-MH cohorts with recurrent BPPV. History of migraine medication usage (p = 0.008), presence of a weekly headache (p = 0.01), and duration of dizziness after positional vertigo (p = 0.01) were the only variables that were different on multivariate analysis between the MH and non-MH cohorts.

Conclusions: Half of recurrent BPPV patients suffer from migraine headaches. The other half presented with migraine-related symptoms, but do not meet criteria for MH. The high comorbidity of MH in our recurrent BPPV cohort as well as the absence of a statistically significant difference in a majority of migraine-related features among patients who did and did not fulfill criteria for MH may suggest that recurrent BPPV has a relationship with migraine. Recurrent BPPV may potentially be a manifestation of migraine in the inner ear, which we term otologic migraine including cochlear, vestibular, or cochleovestibular symptoms.
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http://dx.doi.org/10.1097/MAO.0000000000002976DOI Listing
March 2021

Machine learning models to predict length of stay and discharge destination in complex head and neck surgery.

Head Neck 2021 03 3;43(3):788-797. Epub 2020 Nov 3.

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

Background: This study develops machine learning (ML) algorithms that use preoperative-only features to predict discharge-to-nonhome-facility (DNHF) and length-of-stay (LOS) following complex head and neck surgeries.

Methods: Patients undergoing laryngectomy or composite tissue excision followed by free tissue transfer were extracted from the 2005 to 2017 NSQIP database.

Results: Among the 2786 included patients, DNHF and mean LOS were 421 (15.1%) and 11.7 ± 8.8 days. Four classification models for predicting DNHF with high specificities (range, 0.80-0.84) were developed. The generalized linear and gradient boosting machine models performed best with receiver operating characteristic (ROC), accuracy, and negative predictive value (NPV) of 0.72-0.73, 0.75-0.76, and 0.88-0.89. Four regression models for predicting LOS in days were developed, where all performed similarly with mean absolute error and root mean-squared errors of 3.95-3.98 and 5.14-5.16. Both models were developed into an encrypted web-based interface: https://uci-ent.shinyapps.io/head-neck/.

Conclusion: Novel and proof-of-concept ML models to predict DNHF and LOS were developed and published as web-based interfaces.
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http://dx.doi.org/10.1002/hed.26528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904593PMC
March 2021

Short-Term Morbidity and Predictors of Adverse Events Following Esthesioneuroblastoma Surgery.

Am J Rhinol Allergy 2021 Jul 29;35(4):500-506. Epub 2020 Oct 29.

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

Introduction: The short-term adverse events and predictors of morbidity in surgical resection of esthesioneuroblastoma (ENB) are largely unknown, and investigating these variables can help direct planning for at-risk patients.

Methods: The 2005-2017 National Surgical Quality Improvement Program database was queried to identify patients with a diagnosis of ENB undergoing skull base surgery for tumor resection. Information regarding demographics, patient morbidity score, pre-operative and intra-operative data, and post-operative outcomes were extracted. Cox proportional hazard analysis was utilized to assess complication and readmission/reoperation rates.

Results: A total of 95 patients undergoing skull base surgery for resection of ENB were included. Mean age, BMI, operation time, and post-operative length of stay (LOS) of the cohort were 53.6 ± 16.2 years, 29.1 ± 6.5, 392.0 ± 204.6 minutes, and 5.8 ± 4.6 days, respectively. In total, 31 patients (32.6%) experienced at least one 30-day adverse event, which included blood transfusion intra-operatively or within 72 hours from the operation (22.1%), readmission (10.7%), intubation >48 hours (7.4%), reintubation (4.2%), organ or space infection (4.2%), reoperation (4.0%), superficial or deep surgical site infection (2.1%), sepsis (2.1%), pulmonary embolism (1.1%), and myocardial infarction (1.1%). Patients who experienced at least one adverse event had significantly higher operation time (486.8 ± 230.4 vs. 347.5 ± 176.2 minutes,  = 0.002), LOS (9.2 ± 5.6 days vs. 4.2 ± 3.0,  < 0.001), and lower hematocrit (37.3 ± 5.9 vs. 41.2 ± 3.8,  < 0.001) and albumin levels (3.8 ± 0.6 vs. 4.2 ± 0.3,  = 0.009). Patients with a higher American Society of Anesthesiologists (ASA) score (HR = 2.39;  = 0.047) or longer operation time (HR = 1.004;  = 0.001) had a significantly higher risk for experiencing adverse events. Obesity was not associated with different intra- or post-operative outcomes, but older patients had shorter operations ( = 0.002) and LOS ( = 0.0014).

Conclusion: Longer operation time and lower pre-operative hematocrit and albumin levels may all increase complication rates in ENB resection. Patients with high ASA score or more advanced age may have different short-term outcomes.
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http://dx.doi.org/10.1177/1945892420970468DOI Listing
July 2021

Perilymphatic Fistula: A Review of Classification, Etiology, Diagnosis, and Treatment.

Front Neurol 2020 15;11:1046. Epub 2020 Sep 15.

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

A perilymphatic fistula (PLF) is an abnormal communication between the perilymph-filled inner ear and the middle ear cavity, mastoid, or intracranial cavity. A PLF most commonly forms when the integrity of the oval or round window is compromised, and it may be trauma-induced or may occur with no known cause (idiopathic). Controversy regarding the diagnosis of idiopathic PLF has persisted for decades, and the presenting symptoms may be vague. However, potential exists for this condition to be one of the few etiologies of dizziness, tinnitus, and hearing loss that can be treated surgically. The aim of this review is to provide an update on classification, diagnosis, and treatment of PLF. Particular attention will be paid to idiopathic PLF and conditions that may have a similar presentation, with subsequent information on how best to distinguish them. Novel diagnostic criteria for PLF and management strategy for PLF and PLF-like symptoms is presented.
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http://dx.doi.org/10.3389/fneur.2020.01046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522398PMC
September 2020

Adapting Personal Therapies Using a Mobile Application for Tinnitus Rehabilitation: A Preliminary Study.

Ann Otol Rhinol Laryngol 2021 Jun 8;130(6):571-577. Epub 2020 Oct 8.

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

Objectives: To develop a smartphone application providing sound therapy and cognitive behavioral therapy (CBT) for treating tinnitus and performing a proof-of-concept pilot study evaluating its potential efficacy.

Methods: An interactive smartphone application available on iOS and Android platforms was developed, which provided an 8-week tinnitus-specific CBT and personalized and frequency-matched sound therapy. Included patients presented to our tertiary clinic between 2017 and 2018, while those waitlisted were regarded as controls. Three surveys were administrated: Tinnitus Handicap Inventory (THI), Generalized Anxiety Disorder 7-item (GAD-7), and Perceived Stress Scale (PSS).

Results: A total of 30 patients enrolled in this study consisting of 20 treatment and 10 control patients and mean age was 55.4 ± 11.6 years. Treatment and control patients had similar age, sex, and pre-enrolment GAD and PSS (all  > .05). Baseline THI scores were also similar between treatment and control cohorts (50.1 ± 21.9 vs 62.0 ± 20.7;  = .15). After 8 weeks, though changes in GAD and PSS scores were similar ( > .05), the treatment group reported a significantly greater improvement in THI scores (17.7 ± 15.8 vs 5.3 ± 10.5,  = .04).

Conclusions: This pilot study demonstrated potentially promising efficacy of a smartphone-based CBT and sound therapy platform for treating tinnitus and encourages future randomized controlled trials on this treatment modality.
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http://dx.doi.org/10.1177/0003489420962818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051360PMC
June 2021

The association of age, body mass index, and frailty with vestibular schwannoma surgical morbidity.

Clin Neurol Neurosurg 2020 10 28;197:106192. Epub 2020 Aug 28.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA. Electronic address:

Objective: To evaluate whether increased body mass index (BMI), age, or frailty influence vestibular schwannoma (VS) short-term surgical morbidity.

Methods: The 2005-2017 National Surgical Quality Improvement Program database was queried for patients with VS undergoing surgical resection. Age was stratified according to age <50, 50-64, and ≥65, while BMI was stratified based on a threshold of 30. Frailty score (0-5) was indicated based on functional status, diabetes, chronic obstructive pulmonary disease, congestive heart failure, and hypertension.

Results: A total of 1405 patients were included consisting of 56.7 % females with a mean age of 50.7 ± 13.8 years and mean BMI of 29.4 ± 6.6. Patients <50 (n = 604), 50-64 (n = 578), and ≥65 (n = 223), had different duration of surgery (428 ± 173 vs. 392 ± 149 vs. 387 ± 154 min; p < 0.001) and 30-day mortality rates (0.7 % vs. 0% vs. 1.8 %; p = 0.01). However, post-operative length of stay (LOS) (p = 0.16), readmission (p = 0.08), reoperation (p = 0.54), and complication rates were similar. Post-operative myocardial infarction (p = 0.03) and wound infection (p = 0.02) were more commonly observed in the obese cohort (BMI≥30) but readmission (p = 0.18), reoperation (p = 0.44), and complication rates were similar to those with BMI<30. Severely obese patients (BMI≥35) also had higher rates of deep vein thrombosis (p = 0.004). Frailty score 0 (n=921), 1 (n=375), and 2-4 (n=109) was associated with LOS (4.7±3.5 vs. 5.3 ± 4.1 vs. 6.7 ± 6.6 days, p < 0.001) and prolonged intubation rates (1.0 % vs. 2.4 % vs. 3.7 %; p = 0.03).

Conclusions: Increased age, BMI, and frailty among VS patients were associated with different post-operative complication rates, operation time, or LOS. Knowledge of these can optimize care for at-risk patients.
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http://dx.doi.org/10.1016/j.clineuro.2020.106192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572702PMC
October 2020

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

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process.

Laryngoscope 2021 03 3;131(3):E738-E743. Epub 2020 Sep 3.

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

Objectives: To investigate how the decision to report United States Medical Licensing Examination (USMLE) Step 1 score as pass/fail will influence future otolaryngology residency application and match processes.

Study Design: Survey study.

Methods: An anonymous and voluntary survey approved by the Otolaryngology Program Directors Organization was administered to academic faculty members from April 24, 2020 through May 19, 2020.

Results: Two hundred fifty-seven surveys were received from department chairs (17.5%), program directors (24.1%), associate program directors (12.5%), and department faculty (45.9%). USMLE Step 1 has been the most heavily weighted metric for offering interviews (44.0%), and it has correlated with residents' medical knowledge (77.0%) and in-service performance (79.8%) but not with surgical skills (57.6%) or patient care (47.1%). In total, 68.1% disagreed with the decision to make USMLE Step 1 pass/fail. This change is anticipated to lead to an increase in significance of USMLE Step 2 CK (89.1%), core clerkship grades (80.9%), elective rotation at the respective institutions (65.7%), Alpha Omega Alpha and other awards (64.6%), and letters of recommendation (63.8%). The new scoring is also anticipated to especially benefit students from top-ranked schools (70.8%), increase medical students' anxiety/uncertainty regarding obtaining interview invites (59.1%), and negatively affect international (51.4%), doctor of osteopathic medicine (45.9%), and underrepresented students (36.9%). Indication that USMLE Step 2 CK will significantly increase in weight varied according to department position (P = .049), geographic region (P = .047), years of practice (P < .001), and residency program size (P = .002).

Conclusion: Most academic otolaryngologists disagreed with changing USMLE Step 1 scoring to pass/fail and believe that it will increase other objective/subjective metrics' weight and put certain student populations at a disadvantage.

Level Of Evidence: N/A. Laryngoscope, 131:E738-E743, 2021.
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http://dx.doi.org/10.1002/lary.29072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051359PMC
March 2021

The Relationship Between Vestibular Migraine and Motion Sickness Susceptibility.

Otol Neurotol 2020 09;41(8):1116-1121

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

Objectives: To determine the relationship between vestibular migraine (VM) and motion sickness (MoS) susceptibility and their comorbidity in a large student population, and to assess whether experiencing MoS is associated with higher susceptibility for VM.

Methods: Surveys including Motion Sickness Susceptibility Questionnaire (MSSQ) and questions assessing migraine-related symptoms as well as family history of motion sickness and migraine headache were distributed to the university undergraduate students through Facebook and email. Diagnosis of definite VM (dVM) was based on the criteria of the International Classification of Headache Disorders.

Results: Of 277 survey responders, 148 (53%) were found to be susceptible to MoS in which 74 (50%) met the criteria for dVM. Only childhood MSSQ score was significantly higher in participants with dVM compared with those without dVM (25.78 ± 15.89 versus 20.77 ± 14.28, p = 0.04); however, its significance faded out by regression analysis. Multivariate logistic regression showed having 1st degree relative with migraine headache (p = 0.02), neck stiffness (p = 0.001), and sinus pain, facial pressure, or headache with wind exposure (p = 0.02) to be independently associated with presence of dVM in MoS subjects.

Conclusions: Though participants with MoS and dVM had significantly greater rates of migraine-related symptoms and family history of migraine headache compared with those with MoS only, childhood and adulthood MSSQ scores were similar. This and the high prevalence of dVM in our MoS cohort may suggest an existing association between MoS susceptibility and VM.
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http://dx.doi.org/10.1097/MAO.0000000000002705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8063720PMC
September 2020

A bench-top model of middle ear effusion diagnosed with optical tympanometry.

Int J Pediatr Otorhinolaryngol 2020 Jul 20;134:110054. Epub 2020 Apr 20.

Beckman Laser Institute, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA. Electronic address:

Objectives: To assess the validity of a bench-top model of an optical tympanometry device to diagnose in vitro model of middle ear effusion (MEE).

Methods And Materials: We illuminated an in vitro model of ear canal and tympanic membrane with broadband light and relayed remitted light to a spectrometer system. We then used our proprietary algorithm to extract spectral features that, together with our logistic regression classifiers, led us to calculate a set of simplified indices related to different middle ear states. Our model included a glass vial covered with a porcine submucosa (representing the tympanic membrane) and filled with air, water, or milk solution (representing different MEE), and a set of cover-glass slips filled with either blood (representing erythema) or cerumen. By interchanging fluid types and cover-glass slips, we made measurements on combinations corresponding to normal healthy ear and purulent or serous MEE.

Results: Each simulated condition had a distinct spectral profile, which was then employed by our algorithm to discriminate clean and cerumen-covered purulent and serous MEE. Two logistic purulent and serous MEE classifiers correctly classified all in vitro middle ear states with 100% accuracy assessed by leave-one-out and k-fold cross validation.

Conclusions: This proof-of-concept in vitro study addressed an unmet need by introducing a device that easily and accurately can assess middle ear effusion. Future in vivo studies aimed at collecting data from clinical settings are warranted to further elucidate the validity of the technology in diagnosing pediatric acute otitis media.
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http://dx.doi.org/10.1016/j.ijporl.2020.110054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282940PMC
July 2020

Prediction of vestibular schwannoma recurrence using artificial neural network.

Laryngoscope Investig Otolaryngol 2020 Apr 17;5(2):278-285. Epub 2020 Feb 17.

Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery University of California Irvine California.

Objectives: To compare two statistical models, namely logistic regression and artificial neural network (ANN), in prediction of vestibular schwannoma (VS) recurrence.

Methods: Seven hundred eighty-nine patients with VS diagnosis completed an online survey. Potential predictors for recurrence were derived from univariate analysis by reaching the cut off value of .05. Those nine potential predictors were years since treatment, surgeon's specialty, resection amount, and having incomplete eye closure, dry eye, double vision, facial pain, seizure, and voice/swallowing problem as a complication following treatment. Multivariate binary logistic regression model was compared with a four-layer 9-5-10-1 feedforward backpropagation ANN for prediction of recurrence.

Results: The overall recurrence rate was 14.5%. Significant predictors of recurrence in the regression model were years since treatment and resection amount (both < .001). The regression model did not show an acceptable performance (area under the curve [AUC] = 0.64; = .27). The regression model's sensitivity and specificity were 44% and 69%, respectively and correctly classified 56% of cases. The ANN showed a superior performance compared to the regression model (AUC = 0.79; = .001) with higher sensitivity (61%) and specificity (81%), and correctly classified 70% of cases.

Conclusion: The constructed ANN model was superior to logistic regression in predicting patient-answered VS recurrence in an anonymous survey with higher sensitivity and specificity. Since artificial intelligence tools such as neural networks can have higher predictive abilities compared to logistic regression models, continuous investigation into their utility as complementary clinical tools in predicting certain surgical outcomes is warranted.
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http://dx.doi.org/10.1002/lio2.362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178452PMC
April 2020

Adjuvant Migraine Medications in the Treatment of Sudden Sensorineural Hearing Loss.

Laryngoscope 2021 01 3;131(1):E283-E288. Epub 2020 Apr 3.

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

Objectives/hypothesis: To examine the hearing outcomes of patients with sudden sensorineural hearing loss (SSNHL) treated with oral and intratympanic (IT) steroid only or a combination of steroid and migraine treatment. Our hypothesis was that adjuvant migraine medications may improve outcomes in SSNHL.

Methods: A retrospective chart review at a tertiary otology center was conducted to identify patients with SSNHL who received oral steroid and IT dexamethasone injection(s) with or without migraine medications (a combination of nortriptyline and topiramate).

Results: A total of 47 patients received oral steroid and IT dexamethasone injection(s) only, and 46 patients received oral steroid and IT dexamethasone injection(s) as well as migraine lifestyle changes plus a combination of nortriptyline and topiramate. There were no significant differences in demographics and baseline audiometric data between the two groups. Both groups demonstrated improvements in pure tone average (PTA) and hearing thresholds at 250 Hz and 8000 Hz posttreatment. However, compared to steroid-only group, the adjuvant migraine medications group had significantly greater improvements in hearing thresholds at the lower frequencies (250 Hz, 500 Hz, 1000 Hz). Patients in the latter cohort also had greater improvement in PTA (P = .01) and received fewer IT injections (P = .04) PTA improvement of ≥ 10 dB was observed in 36 patients (78%) in the adjuvant migraine medications group and 22 patients (46%) in the control group (P < .001).

Conclusion: In multimodal treatment of SSNHL, supplementing oral and IT steroid with migraine medications may result in greater improvements in lower frequency hearing thresholds and PTA. Furthermore, adjuvant migraine treatment can lead to decrease in number of IT injections, thus reducing procedure-related risks and complications.

Level Of Evidence: 3 Laryngoscope, 131:E283-E288, 2021.
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http://dx.doi.org/10.1002/lary.28618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011356PMC
January 2021

Endoscopic versus nonendoscopic surgery for resection of pituitary adenomas: a national database study.

J Neurosurg 2020 Mar 13;134(3):816-824. Epub 2020 Mar 13.

1Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California.

Objective: For symptomatic nonsecreting pituitary adenomas (PAs), resection remains a critical option for treatment. In this study, the authors used a large-population national database to compare endoscopic surgery (ES) to nonendoscopic surgery (NES) for the surgical management of PA.

Methods: The National Cancer Database was queried for all patients diagnosed with histologically confirmed PA who underwent resection between 2010 and 2016 in which the surgical approach was specified. Due to database limitations, microsurgery and craniotomy were both categorized as NES.

Results: Of 30,488 identified patients, 16,373 (53.7%) underwent ES and 14,115 (46.3%) underwent NES. There was a significant increase in the use of ES over time (OR 1.16, p < 0.01). Furthermore, there was a significant temporal increase in ES approach for tumors ≥ 2 cm (OR 1.17, p < 0.01). Compared to NES, patients who underwent ES were younger (p = 0.01), were treated at academic centers (p < 0.01), lived a greater distance from their treatment site (p < 0.01), had smaller tumors (p < 0.01), had greater medical comorbidity burden (p = 0.04), had private insurance (p < 0.01), and had a higher household income (p < 0.01). After propensity score matching to control for age, tumor size, Charlson/Deyo score, and type of treatment center, patients who underwent ES had a shorter length of hospital stay (LOS) (3.9 ± 4.9 days vs 4.3 ± 5.4 days, p < 0.01), although rates of gross-total resection (GTR; p = 0.34), adjuvant radiotherapy (p = 0.41), and 90-day mortality (p = 0.45) were similar. On multivariate logistic regression, African American race (OR 0.85, p < 0.01) and tumor size ≥ 2 cm (OR 0.89, p = 0.01) were negative predictors of receiving ES, whereas diagnosis in more recent years (OR 1.16, p < 0.01), greater Charlson/Deyo score (OR 1.10, p = 0.01), receiving treatment at an academic institution (OR 1.67, p < 0.01) or at a treatment site ≥ 20 miles away (OR 1.17, p < 0.01), having private insurance (OR 1.09, p = 0.01), and having a higher household income (OR 1.11, p = 0.01) were predictive of receiving ES. Compared to the ES cohort, patients who started with ES and converted to NES (n = 293) had a higher ratio of nonwhite race (p < 0.01), uninsured insurance status (p < 0.01), longer LOS (p < 0.01), and higher rates of GTR (p = 0.04).

Conclusions: There is an increasing trend toward ES for PA resection including its use for larger tumors. Although ES may result in shorter LOS compared to NES, rates of GTR, need for adjuvant therapy, and short-term mortality may be similar. Factors such as tumor size, insurance status, facility type, income, race, and existing comorbidities may predict receiving ES.
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http://dx.doi.org/10.3171/2020.1.JNS193062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080843PMC
March 2020

Association Between Vestibular Migraine and Migraine Headache: Yet to Explore.

Otol Neurotol 2020 03;41(3):392-396

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

Objectives: To evaluate if patients with a diagnosis of vestibular migraine (VM) by the International Classification of Headache Disorders (ICHD) criteria have meaningful differences in symptomatology and disease characteristics when compared to patients with concurrent vestibular symptoms and migraine that do not meet ICHD criteria.

Methods: Patients who presented for the evaluation of vertigo were provided a detailed questionnaire about dizziness and migraine symptoms. Patients were assigned to either VM cohort (met ICHD criteria for VM) or migraine headache (MH) cohort (met ICHD criteria for migraine with or without aura but not VM). Disease characteristics, symptomatology, quality of life, and perceived stress score were compared between the cohorts.

Results: The VM cohort demonstrated a shorter duration of vertigo episodes, 11 ± 22 hours versus 84 ± 146 hours in the MH cohort. In the VM cohort, 81% reported experiencing migraine headaches during episodes of vertigo, versus 61% in the MH cohort. All patients in the VM cohort reported a previous diagnosis of migraine headache, whereas 9% of the MH cohort had not been previously diagnosed by another physician. There was no difference in quality of life or perceived stress scores between the cohorts.

Conclusions: A large proportion of vertigo patients with migrainous features do not meet the ICHD criteria for VM. The differences between cohorts represent selection bias rather than meaningful features unique to the cohorts. As such, VM and MH with vestibular symptoms may exist on a spectrum of the same disease process and may warrant the same treatment protocols.
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http://dx.doi.org/10.1097/MAO.0000000000002528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040771PMC
March 2020

Efficacy of Multi-Modal Migraine Prophylaxis Therapy on Hyperacusis Patients.

Ann Otol Rhinol Laryngol 2020 May 1;129(5):421-427. Epub 2019 Dec 1.

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

Objectives: To evaluate the efficacy of a multi-modal migraine prophylaxis therapy for patients with hyperacusis.

Methods: In a prospective cohort, patients with hyperacusis were treated with a multi-modal step-wise migraine prophylactic regimen (nortriptyline, verapamil, topiramate, or a combination thereof) as well as lifestyle and dietary modifications. Pre- and post-treatment average loudness discomfort level (LDL), hyperacusis discomfort level measured by a visual analogue scale (VAS), and scores on the modified Khalfa questionnaire for severity of hyperacusis were compared.

Results: Twenty-two of the 25 patients (88%) reported subjective resolution of their symptoms following treatment. Post-treatment audiograms showed significant improvement in average LDL from 81.3 ± 3.2 dB to 86.4 ± 2.6 dB ( < .001), indicating increased sound tolerability. The VAS discomfort level also showed significant improvement from a pre-treatment average of 7.7 ± 1.1 to 3.7 ± 1.6 post-treatment ( < .001). There was also significant improvement in the average total score on modified Khalfa questionnaire (32.2 ± 3.6 vs 22.0 ± 5.7, < .001).

Conclusions: The majority of patients with hyperacusis demonstrated symptomatic improvement from migraine prophylaxis therapy, as indicated by self-reported and audiometric measures. Our findings indicate that, for some patients, hyperacusis may share a pathophysiologic basis with migraine disorder and may be successfully managed with multimodal migraine prophylaxis therapy.
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http://dx.doi.org/10.1177/0003489419892997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040770PMC
May 2020

Proposal for a new diagnosis for U.S. diplomats in Havana, Cuba, experiencing vestibular and neurological symptoms.

Med Hypotheses 2020 Mar 18;136:109499. Epub 2019 Nov 18.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA. Electronic address:

Between 2016 and 2017, several U.S. Diplomats in Havana, Cuba, experienced perplexing vestibular and neurological symptoms attributed to an unknown source. They presented with significant vestibular and headache symptoms similar to individuals who experience vestibular migraine (VM). As such, we hypothesize that VM may be a possible explanation for the Havana cohort's presenting symptoms. To evaluate this hypothesis, we compared symptoms reported by the affected individuals in Havana, Cuba, to symptoms reported by corresponding patients from a tertiary academic neurotology clinic with a chief complaint of vertigo or disequilibrium, who met the International Classification of Headache Disorders criteria for VM. The prevalence of the Havana subjects experiencing various symptomatic domains was compared with the VM cohort, leading to 26 unique domains and statistical comparisons between the cohorts. Of the 26 domains compared between the two cohorts, 18 were not significantly different. This included the two most important components of meeting criteria for VM, namely the co-existence of headache and vestibular symptoms. On regression analysis, the only feature which kept its significant difference between the two cohorts was acute intense head pressure (P = 0.007). The domains with similar occurrence ratios included dizziness, headache, light sensitivity, hearing reduction, and tinnitus. In other words, multiple headache and vestibular symptoms, consistent with VM criteria, were similar between the two cohorts. The considerable similarities across various domains between VM patients and Havana subjects could be due to migraine as a possible common etiology for both groups. We propose VM as a potential etiology for the symptomatology in the U.S. diplomats in Cuba.
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http://dx.doi.org/10.1016/j.mehy.2019.109499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028449PMC
March 2020

A hypothetical proposal for association between migraine and Meniere's disease.

Med Hypotheses 2020 Jan 12;134:109430. Epub 2019 Oct 12.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA. Electronic address:

Meniere's disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.
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http://dx.doi.org/10.1016/j.mehy.2019.109430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957735PMC
January 2020

Facial Nerve Paralysis Due to Spontaneous Intracranial Hypotension.

Ear Nose Throat J 2021 Mar 23;100(3):NP137-NP138. Epub 2019 Sep 23.

Department of Otolaryngology-Head and Neck Surgery, 8788University of California, Irvine, Irvine, CA, USA.

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http://dx.doi.org/10.1177/0145561319864577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040767PMC
March 2021

Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta-analysis.

Int Forum Allergy Rhinol 2019 12 20;9(12):1443-1450. Epub 2019 Sep 20.

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

Background: Recently, there has been mounting evidence suggesting the efficacy of steroid-eluting stents (SES) for management of chronic rhinosinusitis after endoscopic sinus surgery (ESS). This meta-analysis serves to evaluate the efficacy of SES in improving postoperative outcomes after ESS.

Methods: A systematic literature search was performed of PubMed for articles published between 1985 and 2018. The outcome variables were reported at, on average, 30 days postintervention.

Results: Seven of the 76 published studies, all of which were industry-sponsored, were included for a collective cohort of 444 SES and 444 control sinuses. In patients who received SES vs controls, collective odds ratios (ORs) for postoperative need for intervention, surgery, and oral steroid were 0.45 (95% confidence interval [CI], 0.33-0.62; p < 0.001), 0.30 (95% CI, 0.18-0.52; p < 0.001), and 0.58 (95% CI, 0.40-0.84; p = 0.004), respectively. In addition, collective ORs for frontal sinus ostia (FSO) patency, moderate-to-severe adhesion/scarring, and increase in polyp score were 2.53 (95% CI, 1.61-3.97; p < 0.001), 0.28 (95% CI, 0.13-0.59; p < 0.001), and 0.42 (95% CI, 0.25-0.74; p = 0.002), respectively. Collective mean differences for FSO/ethmoid inflammation and FSO diameter were -10.86 mm (p < 0.001) and +1.34 mm (p < 0.001), respectively.

Conclusion: Aggregate evidence suggests that SES can improve ESS outcomes by reducing rates of postoperative intervention and recurrent polyposis and inflammation, while promoting FSO patency. All included and analyzed studies were industry-sponsored and ruling-out publication bias was not possible. Future independent and nonsponsored studies to further evaluate SES's long-term efficacy are warranted.
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http://dx.doi.org/10.1002/alr.22443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901756PMC
December 2019

In-office ossicular chain reconstruction using hydroxyapatite cement.

Clin Otolaryngol 2019 11 2;44(6):1228-1230. Epub 2019 Oct 2.

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

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http://dx.doi.org/10.1111/coa.13428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034986PMC
November 2019

Are Acoustic Neuroma Association Patients Characteristically Different Than the General Population Patients? The Benefits and Drawbacks of Survey-Based Studies.

Otol Neurotol 2019 08;40(7):979-980

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

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http://dx.doi.org/10.1097/MAO.0000000000002307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048122PMC
August 2019

Hyams grading as a predictor of metastasis and overall survival in esthesioneuroblastoma: a meta-analysis.

Int Forum Allergy Rhinol 2019 09 28;9(9):1054-1062. Epub 2019 Jun 28.

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

Background: Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor.

Methods: A systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates.

Results: Of the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively.

Conclusion: HGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.
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http://dx.doi.org/10.1002/alr.22373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276257PMC
September 2019

Characteristics of Mid-Frequency Sensorineural Hearing Loss Progression.

Otol Neurotol 2019 06;40(5):e497-e502

Department of Otolaryngology-Head and Neck Surgery.

Objectives: To characterize the progression of mid-frequency sensorineural hearing loss (MFSNHL) over time.

Methods: A retrospective chart review spanning 2012 to 2017 was performed at a tertiary care audiology and neurotology center. Our cohort included 37 patients met the criteria for MFSNHL also known as "cookie bite hearing loss." It was defined as having a 1, 2, and 4 kHz average pure tone audiometry greater than 10 dB in intensity compared with the average threshold at 500 Hz and 8 kHz.

Results: Average age at initial presentation was 11.8 years (range, 8 mo to 70 yr). Across all individuals, the average mid-frequency threshold was 47 dB, compared with 27 dB at 500 Hz and 8 kHz. Twenty-three patients (62%) had multiple audiograms with 4-year median follow up time. Average values across all frequencies (0.5, 1, 2, 4, 8 kHz) in the initial audiogram was 37 dB, compared with an average of 39 dB demonstrated on final audiogram. Of those with serial audiograms, only five patients demonstrated threshold changes of 10 dB or more. Of these five patients, only one was found to have clinical worsening of MFSNHL.

Conclusions: MFSNHL is an uncommon audiometric finding with unspecified long-term outcomes. We demonstrated that most patients (96%) with MFSNHL do not experience clinical worsening of their hearing threshold over almost 4 years of follow up. Future prospective studies aimed at collecting longer-term data are warranted to further elucidate the long-term trajectory of MFSNHL patients.
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http://dx.doi.org/10.1097/MAO.0000000000002232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040769PMC
June 2019
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