Publications by authors named "Shaun A Nguyen"

243 Publications

Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma of the Tonsil versus Base of Tongue: A Systematic Review and Meta-Analysis.

Cancers (Basel) 2022 Aug 8;14(15). Epub 2022 Aug 8.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.

Transoral Robotic Surgery (TORS) has become widely adopted for the surgical removal of oropharyngeal squamous cell carcinoma (OPSCC), with the most common locations being in the tonsil and base of tongue (BOT). However, it is currently unknown if TORS has equal efficacy and outcomes in patients with tonsillar or BOT OPSCC. Therefore, the aim of this study was to compare the margin status and recurrence rates of tonsillar and BOT OPSCC after TORS. Per PRISMA guidelines, PubMed, Scopus, and CINAHL were systematically searched from inception to 2/28/2022. Articles including the surgical management of OPSCC with TORS that compared margin status, complications, and recurrence between tonsil and BOT were included. Meta-analyses of proportions and odds ratios were performed. A total of 28 studies were included, comprising 1769 patients with tonsillar OPSCC and 1139 patients with BOT OPSCC. HPV positivity was seen in 92.3% of tumors. BOT OPSCC had a higher rate of positive margins compared to tonsillar OPSCC (28.1% [95%CI 15.1-43.3] vs. 7.5% [95%CI 3.3-13.3]). No differences were seen in recurrence between BOT and tonsillar OPSCC (OR 1.1 [95%CI 0.8-1.5], = 0.480). In addition, no differences in postoperative hemorrhage were seen between tonsillar and BOT OPSCC (10.7% [95%CI 6.1-16.5] vs. 8.8% [95% CI 1.5-21.3]). While a higher rate of positive margins was seen in BOT OPSCC when compared to tonsil OPSCC, this did not translate to a higher recurrence rate in the BOT group. Future research on which subset of patients with BOT is more likely to have positive margins is warranted to improve the utility of TORS further.
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http://dx.doi.org/10.3390/cancers14153837DOI Listing
August 2022

Revision dacryocystorhinostomy: systematic review and meta-analysis.

Orbit 2022 Aug 8:1-10. Epub 2022 Aug 8.

Department of Ophthalmology-Oculoplastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Purpose: The goal of this study is to determine if a certain revision DCR approach (external, endoscopic endonasal, laser transcanalicular) is superior to others. Additionally, this investigation evaluates the effect of the primary surgery on success of revision.

Methods: This investigation is a systematic review and meta-analysis. All studies specifying type of primary DCR and revision DCR were included. Proportion of successes of each revision for every primary surgery was obtained from the included studies. Meta-analyses were performed to determine cumulative proportions of successes across studies.

Outcome Measures: Significant differences in the proportions yielded by meta-analysis of successes among different surgical approaches.

Results: The type of primary surgery did not significantly influence overall revision success if the same procedure was used for the revision. Overall successes per each revision type were not significantly different. When performing subgroup analyses per each primary surgery, all methods of revisions were similar in efficacy with one exception: when the primary surgery was done using the laser transcanalicular approach, external revision outperformed repetition of the primary method.

Conclusions: Regarding success of re-operation, surgeons can use the method they are most comfortable with to perform DCR revisions. However, primary transcanalicular laser DCRs should be revised, if necessary, using the external approach.
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http://dx.doi.org/10.1080/01676830.2022.2109178DOI Listing
August 2022

Association of Sinonasal Computed Tomography Scores to Patient-Reported Outcome Measures: A Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg 2022 Aug 2:1945998221114078. Epub 2022 Aug 2.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Objective: To perform a systematic review of proposed sinus computed tomography (CT) scoring systems and determine their association with patient-reported outcome measures (PROMs).

Data Sources: PubMed, CINAHL, Scopus, and Cochrane Library.

Review Methods: A systematic search was conducted following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) for studies describing CT scores and PROMs in patients with chronic rhinosinusitis.

Results: A total of 144 studies were included. Out of 20,741 patients, 53.6% were male and 55.5% had nasal polyposis. A meta-analysis of correlations revealed a moderate correlation between Lund-McKay (LM) and the 22-item Sinonasal Outcome Test (SNOT-22; = 0.434, < .001) and a weaker correlation between LM and the 20-item Sinonasal Outcome Test (SNOT-20; = 0.257, = .039). Meta-regression also revealed a weak association between LM and SNOT-20 (n = 25 studies) but no significant associations between Zinreich score and SNOT-22 or LM scores and PROMs, including SNOT-22 (n = 94 studies), Rhinosinusitis Disability Index (n = 25), nasal obstruction visual analog scale (n = 15), Chronic Sinusitis Survey (n = 12), Total Nasal Symptom Score (n = 4), Total Symptom Score (n = 3), and 12-Item Short Form Health Survey (n = 3).

Conclusion: There is essentially little association between radiologic grade and PROMs. CT grading systems with improved clinical utility are needed.
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http://dx.doi.org/10.1177/01945998221114078DOI Listing
August 2022

Cleft Lip and/or Palate Repair in Children With Hypopituitarism: Analysis of the Kids' Inpatient Database.

Cleft Palate Craniofac J 2022 Jul 29:10556656221117435. Epub 2022 Jul 29.

Department of Otolaryngology - Head and Neck Surgery, 2345Medical University of South Carolina, Charleston, SC, USA.

Objective: Children with hypopituitarism (CwHP) can present with orofacial clefting, frequently in the setting of multiple midline anomalies. Hypopituitarism (HP) can complicate medical and surgical care; the perioperative risk in CwHP during the traditionally lower risk cleft lip and/or palate (CL/P) repair is not well described. The objective of this study is to examine the differences in complications and mortality of CL/P repair in CwHP compared to children without hypopituitarism (CwoHP).

Design: A retrospective cross-sectional analysis.

Setting: The 1997 to 2019 Kids' Inpatient Databases (KID).

Patients: Children 3 years old and younger who underwent CL/P repair.

Main Outcome Measure(s): Complications and mortality.

Results: A total of 34 106 weighted cases were analyzed, with 86 having HP. CwHP had a longer length of stay (3.0 days [IQR 2.0-10.0] vs 1.0 day [IQR 1.0-2.0],  < .001) and higher rates of complications and mortality (12.8% vs 2.9%,  < .001) compared to CwoHP. Controlling for demographic factors, CwHP had 6.61 higher odds of complications and mortality than CwoHP (95% CI 3.38-12.94,  < .001).

Conclusions: CwHP can present with a CL/P and other midline defects that can increase the complexity of their care. These data show a significant increase in length of stay, complications, and mortality in CwHP undergoing CL/P repair. Increased multidisciplinary attention and monitoring may be needed for these children peri- and postoperatively, especially if additional comorbidities are present. Further studies on perioperative management in this population are warranted to reduce morbidity and mortality.
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http://dx.doi.org/10.1177/10556656221117435DOI Listing
July 2022

Parental Presence at Induction of Anesthesia to Reduce Anxiety-A Systematic Research and Meta-Analysis.

J Perianesth Nurs 2022 Jul 24. Epub 2022 Jul 24.

Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC.

Purpose: Perioperative anxiety can significantly alter outcomes for pediatric patients. Parental presence at induction of anesthesia (PPIA) is one method of anxiety reduction, but the efficacy remains unclear. This systematic review and meta-analysis aimed to determine if PPIA affects child and caretaker perioperative anxiety levels.

Design: Systematic Review and Meta-analysis METHODS: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search of PubMed, Scopus, CINAHL, PsycINFO, and Cochrane Library databases was performed on June 29, 2021. Search terms were related to parental presence in the operating room, anesthesia or anesthesia induction, and pediatric patients. The literature search identified English-language studies comparing children receiving PPIA to controls or studies examining attitudes toward PPIA.

Findings: A total of 21 articles (n = 9573) met inclusion criteria. Seven studies (n = 776) quantified child anxiety with validated scales, and seven studies quantified parent anxiety (n = 621). There was no significant difference in preoperative anxiety between PPIA and controls for patients (P = .27) or caretakers (P = .99). PPIA patients had 8.40 [0.16, 16.64] (P = .05) lower Modified Yale Preoperative Anxiety Scale scores compared to control at induction, and parents had 3.41 [0.32, 6.50] (P = .03) lower State-Trait Anxiety Inventory State scores. Three studies concluded that PPIA did not increase operating room time or induction time. Twenty-three studies examined parental attitudes toward PPIA and found that 98.03% [96.09%, 99.32%] of parents present at induction would like to be present at subsequent surgeries. Contention in support for PPIA was seen amongst healthcare providers, but attitudes increasingly favored PPIA after implementation.

Conclusions: PPIA reduces parental and patient anxiety, may increase parental satisfaction, and may not impede operating room efficiency. PPIA should be considered as a valuable tool to improve surgical outcomes and patient and family satisfaction.
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http://dx.doi.org/10.1016/j.jopan.2022.03.008DOI Listing
July 2022

Improving Pneumococcal Vaccination Rates in Cochlear Implant Programs: A Systematic Review and Meta-analysis.

Otolaryngol Head Neck Surg 2022 Jul 19:1945998221113310. Epub 2022 Jul 19.

Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina, USA.

Objective: To review the literature on pneumococcal vaccination compliance rates among cochlear implant (CI) patients and to examine the utility of intervention programs on increasing vaccination rates.

Data Sources: PubMed, Scopus, and CINAHL.

Review Methods: A systematic review was performed following PRISMA guidelines. Studies of pneumococcal vaccination rates at baseline and before and after the implementation of a quality improvement (QI) intervention were included. A total of 641 studies were screened, and 13 studies met inclusion criteria. Meta-analyses of pneumococcal vaccination rates pre- and post-QI intervention in CI patients were performed.

Results: A total of 12,973 children and adults were included. The baseline PCV13 and PPSV23 vaccination rates were 53.45% (95% CI, 37.02%-69.51%) and 42.53% (95% CI, 31.94%-53.48%), respectively. Comparing children and adults, PCV13 and PPSV23 baseline vaccination rates were not statistically significant. The PPSV23 vaccine rate after QI initiatives was significantly higher than the baseline rate at 83.52% (95% CI, 57.36%-98.46%). After these interventions, patients had a 15.71 (95% CI, 4.32-57.20, < .001) increased odds of receiving PPSV23 vaccination compared to before QI implementation.

Conclusions: The baseline rates of PCV13 and PPSV23 are highly variable and lower than expected, given current vaccination recommendations for CI patients. QI programs appear successful in increasing compliance rates with the PPSV23 vaccination; however, they are still far from full compliance. Further intervention programs with stricter surveillance, monitoring, and follow-up systems are needed to achieve improved compliance with the PCV13 and PPSV23 vaccination in CI recipients.
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http://dx.doi.org/10.1177/01945998221113310DOI Listing
July 2022

Association of computed tomography scores to psychophysical measures of olfaction: A systematic review and meta-analysis.

Int Forum Allergy Rhinol 2022 Jun 30. Epub 2022 Jun 30.

Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina, USA.

Background: While various sinus computed tomography (CT) scoring systems have been proposed and used in the literature, no single system has been identified as superior. The strength of associations between CT scoring systems and measures of olfaction also remains unclear.

Methods: A systematic review of PubMed, CINAHL, Scopus, and the Cochrane Library was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported both CT scores and measures of olfaction in a cross-sectional manner were included.

Results: A total of 37 studies were eligible for meta-analysis. Of 8035 patients with chronic rhinosinusitis, 55.6% were male patients and 53.2% had chronic rhinosinusitis with nasal polyps. Analysis by meta-regression was performed of Lund-Mackay (LM) versus Smell Identification Test-40 (SIT-40; 12 studies), Brief Smell Identification Test (BSIT; 10 studies), Sniffin' Sticks (SS; 10 studies), and Toyota & Takagi (T&T) olfactometry (four studies). A significant moderate association was found between LM and SIT-40 (R = 0.612, p < 0.001) and LM and SS (R = 0.612, p < 0.001). An association between LM and BSIT approached significance (R = 0.461, p = 0.054). No significant associations were noted between LM and T&T olfactometry and between LM and SS when stratified by nasal polyp status.

Conclusion: There is a significant moderate association of current CT scoring systems to SIT-40 and SS. Further research should focus on associations of objective measures of olfaction to CT scores of the nasal cavity, sinuses, and olfactory cleft, as well as other disease markers.
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http://dx.doi.org/10.1002/alr.23053DOI Listing
June 2022

Comparison of pediatric nasal foreign body removal by care setting: A systematic review and meta-analysis.

Int J Pediatr Otorhinolaryngol 2022 07 4;158:111162. Epub 2022 May 4.

Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, SC, USA.

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http://dx.doi.org/10.1016/j.ijporl.2022.111162DOI Listing
July 2022

Evaluating the management timeline of tracheoesophageal fistulas secondary to button batteries: A systematic review.

Int J Pediatr Otorhinolaryngol 2022 Jun 3;157:111100. Epub 2022 May 3.

Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA.

Introduction: During the SARS-CoV-2 pandemic, the incidence of pediatric button battery (BB) ingestions has risen. Children have spent more time at home from school, while many parents try to balance working from home and childcare. Additionally, the amount of electronics powered by BB has increased. Tracheoesophageal fistula (TEF) secondary to a retained aerodigestive BB is a devastating development. Management is challenging, and the clinical timeline of watchful waiting versus surgical intervention for TEF is poorly defined in the literature.

Methods: In accordance with PRISMA guidelines, databases searched include PubMed, Scopus, and CINAHL from database date of inception through August 13, 2021. All study designs were included, and no language, publication date, or other restrictions were applied. Case series and reports of TEFs secondary to BBs were included. Clinical risk factors and outcomes were compared between the spontaneous closure and surgical repair groups.

Results: A total of 79 studies with 105 total patients were included. Mortality was 11.4%. There were 23 (21.9%) TEFs that spontaneously closed and 71 (67.6%) that underwent surgical repair. Median time to spontaneous closure compared to surgical repair was significantly different (8.0 weeks [IQR 4.0-18.4] vs. 2.0 weeks [IQR 0.1-3.3], p<0.001). Smaller TEFs were more likely to spontaneously close versus being surgically repaired (9.3 mm ± 3.5 vs. 14.9 mm ± 8.3, p=0.022). Duration of symptoms before BB discovery, BB size, time between BB removal and TEF discovery, and location of the TEF were not statistically different between the spontaneous closure and surgical repair groups.

Conclusion: A TEF secondary to BB ingestion is a potentially deadly complication. Timing of reported TEF spontaneous closure varies significantly. While smaller TEFs may be amenable to healing without surgical repair, no other significant factors were identified that may be associated with spontaneous closure. If clinical status permits, these data suggest a period of observation of at least 8 weeks prior to surgical intervention may be practical for many BB-induced TEFs.
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http://dx.doi.org/10.1016/j.ijporl.2022.111100DOI Listing
June 2022

Comparison of Care Settings for Pediatric External Auditory Canal Foreign Bodies: A Meta-Analysis.

Ann Otol Rhinol Laryngol 2022 Apr 30:34894221093584. Epub 2022 Apr 30.

Baylor College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Houston, TX, USA.

Objective: To compare the success and complication rates of pediatric external auditory canal foreign body (EAC FB) removal between Emergency Departments (ED), Primary Care Providers (PCP), and Otolaryngologists (ENT).

Methods: PubMed, Scopus, and Embase were searched through January 13, 2022. Studies mentioning EAC FB removal success rates and types of healthcare settings were included. Pooled measures included abrasions/lacerations, TM perforations, and success rate stratified by healthcare setting.

Results: Thirteen studies and 3891 patients were included in the meta-analysis. Most comparisons between EAC FB removal success rates for EDs versus PCPs versus ENTs were statistically significant. The highest FB removal success rate was in patients who presented to ENTs without previous removal attempts (92.9% [95% CI 84.6-98.2]). EDs had the lowest success rates (64.0% [95% CI 48.3-78.3]). For patients that had a previous attempt at FB removal, ENTs had a success rate of 64.1% [95% CI 42.0-83.5].

Conclusions: For ENTs treating pediatric EAC FB, removal success rates decrease if a different healthcare provider previously attempted EAC FB removal. This effect likely is due to decreased patient cooperativeness or increased FB complications (eg, canal edema and bleeding limiting visualization) after previous removal attempts. Individual institutions should identify conditions that increase EAC FB removal failure rates and necessitate ENT referral. Therefore, the communication and concerted efforts between EDs, PCPs, and ENTs are critical for the improved outcomes of pediatric EAC FBs.
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http://dx.doi.org/10.1177/00034894221093584DOI Listing
April 2022

Comparison of validated psychophysical olfactory tests and olfactory-specific quality of life.

Int Forum Allergy Rhinol 2022 Apr 27. Epub 2022 Apr 27.

Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, Charleston, South Carolina, USA.

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http://dx.doi.org/10.1002/alr.23012DOI Listing
April 2022

Should Propranolol Remain the Gold Standard for Treatment of Infantile Hemangioma? A Systematic Review and Meta-Analysis of Propranolol Versus Atenolol.

Ann Otol Rhinol Laryngol 2022 Apr 25:34894221089758. Epub 2022 Apr 25.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.

Background: Although propranolol has been established as the gold standard when treatment is sought for infantile hemangioma, concerns over its side effect profile have led to increasing usage of atenolol, a beta-1 selective blocker.

Methods: A systematic review of PubMed, Scopus, CINAHL, Google Scholar, and Cochrane was conducted following PRISMA guidelines using MeSH terms and keywords for the terms propranolol, atenolol, and infantile hemangioma, including alternative spellings. All randomized control trials (RCTs) or cohort studies directly comparing outcomes of hemangioma treatment with atenolol and propranolol were included. A meta-analysis with pooled mean differences, pooled odds ratios, and analysis of proportions was performed.

Results: A total of 669 participants in 7 studies (3 RCTs and 4 cohort) were included. Propranolol showed a significantly higher rate of complete response compared to atenolol (73.3% vs 85.4%,  = .0004). The pooled mean difference of 0.07 (95% CI -0.12, 0.27) in Hemangioma Activity Score (HAS) was not statistically significant. In terms of side effects, there were significantly more agitation and bronchial hyperreactivity events in the propranolol group ( = .0245 and  < .0001, respectively). Overall, there was a significantly greater number of adverse events in the propranolol group compared to the atenolol group (185 vs 117,  < .00001). The overall pooled odds ratio was 2.70 (95% CI 1.90, 3.84), indicating that there is 2.7 times higher odds of adverse events in the propranolol group.

Conclusion: Propranolol treatment leads to a significantly higher rate of complete response than atenolol. However, its use must be weighed against its greater side effect profile.
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http://dx.doi.org/10.1177/00034894221089758DOI Listing
April 2022

Obstructive sleep apnea in children with nonsyndromic cleft palate: a systematic review.

J Clin Sleep Med 2022 Aug;18(8):2063-2068

Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina.

Study Objectives: To characterize obstructive sleep apnea in children with nonsyndromic cleft palate based on polysomnographic parameters relative to primary palatoplasty.

Methods: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched: PubMed, Scopus, CINAHL, and Cochrane. Studies were only considered for inclusion if they examined exclusively patients with nonsyndromic cleft palate and reported polysomnogram data.

Results: Seven studies met inclusion criteria, providing information on a total of 151 patients with a weighted mean age of 5.2 ± 5.0 years (range 0.1-12 years). Five studies presented data from either the pre- or postoperative period. Two studies investigated both pre- and postpalatoplasty polysomnogram data, and neither observed a significant change in apnea-hypopnea index (AHI) values following surgery (mean preoperative AHI of 2.7 events/h, mean improvement of 0.6 events/h). The entire cohort had a prepalatoplasty weighted mean AHI of 11.4 events/h (range 1.5-16.1) and postpalatoplasty AHI of 1.5 events/h (range 0.2-5.2). Interpretation of polysomnographic data was limited by heterogeneity; however, the AHI values for children with nonsyndromic cleft palate largely demonstrated mild to moderate obstructive sleep apnea following palatoplasty.

Conclusions: The full effect of cleft palate repair on obstructive sleep apnea in children with nonsyndromic cleft palate remains understudied. While published data are heterogenous, few studies support the worsening of obstructive AHI after palatoplasty in children with nonsyndromic cleft palate. Further studies with standardized polysomnographic parameters are needed to provide guidance for management of this population.

Citation: Jungbauer WN Jr, Poupore NS, Nguyen SA, Carroll WW, Pecha PP. Obstructive sleep apnea in children with nonsyndromic cleft palate: a systematic review. . 2022;18(8):2063-2068.
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http://dx.doi.org/10.5664/jcsm.10020DOI Listing
August 2022

Reply to Letter to the Editor regarding "Occult nodal metastasis rate in salivary malignancies".

Head Neck 2022 07 21;44(7):1749-1750. Epub 2022 Apr 21.

Head and Neck Oncology | Sarah Cannon National Group, Charleston, South Carolina, USA.

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http://dx.doi.org/10.1002/hed.27060DOI Listing
July 2022

A Systematic Review of Eustachian Tube Procedures for Baro-challenge Eustachian Tube Dysfunction.

Laryngoscope 2022 Apr 20. Epub 2022 Apr 20.

Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.

Objective: To examine the effectiveness of Eustachian tube procedures for the treatment of baro-challenge Eustachian tube dysfunction.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases, including PubMed (National Library of Medicine, National Institutes of Health), Scopus (Elsevier), and CINAHL (EBSCO), were searched for articles examining the effectiveness of Eustachian tube procedures for baro-challenge Eustachian tube dysfunction. Outcome measures included symptom resolution, ability to return to work, equalization problems (EP) scores, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and pressure chamber testing parameters. Pooled meta-analysis was performed for dichotomous measures and ETDQ-7 scores.

Results: Eleven articles with 81 patients were included. Seventy-two patients from 10 articles underwent balloon Eustachian tube dilation; nine patients in 1 study underwent laser Eustachian tuboplasty (LET). All 81 patients were preoperatively symptomatic with barometric pressure change, and 26/30 (86.7%) were unable to work due to symptoms. On meta-analysis, after balloon dilation Eustachian tuboplasty (BDET), 82.5% (n = 30 [95% confidence interval: 42%-100%]) had improvement in ability to valsalva, 79.1% (n = 16 [57.9%-94.1%]) in ability to return to work, and 84.3% (n = 69 [69.8%-94.7%]) in any symptom. Of 25 patients with individual ETDQ-7 scores, 79.1% [51.4, 96.9] had improvements after BDET. For four case series with 36 patients, ETDQ-7 scores decreased by 1.2 [0.7, 1.7] (p < 0.00001). Of 20 patients with preoperative ETDQ-7 scores >2.0, there was a mean decrease of 2.1 [1.3, 2.8] (p < 0.00001).

Conclusion: From the available evidence, Eustachian tube procedures appear to be effective at improving symptoms of baro-challenge Eustachian tube dysfunction. However, higher quality evidence is needed to support making definite recommendations for the use of balloon Eustachian tube dilation or LET for these patients. Laryngoscope, 2022.
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http://dx.doi.org/10.1002/lary.30132DOI Listing
April 2022

Systematic review of neuroendocrine carcinomas of the oropharynx.

Head Neck 2022 07 18;44(7):1725-1736. Epub 2022 Apr 18.

Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

Data describing features and management of oropharyngeal neuroendocrine carcinomas (NEC) remain sparse. A systematic review was performed. Patients were stratified by treatment modality and examined for disease progression and survival outcomes. Ninety-four patients from 50 publications were included. Average age at diagnosis was 59.7 years (range 14-83). 73.4% were male. Most studies did not document HPV status. Forty patients (85.1%) were p16 positive, and 34 (85.0%) were HPV-ISH positive. Overall survival was 75.4% at 1 year, and 40.0% at 2 years. Of patients with locoregional disease, 33.8% developed distant metastasis. 12.5% of patients developed locoregional recurrence. Patients who developed distant metastases had worse overall survival (p = 0.0004). No significant difference was found between treatment modalities. Human papilloma virus may be associated with oropharyngeal NEC. Current treatments provide locoregional control, but distant metastases are common and confer low overall survival.
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http://dx.doi.org/10.1002/hed.27055DOI Listing
July 2022

The Utility of CTA in Pediatric Oropharyngeal Trauma: A Systematic Review and Meta-Analysis.

Laryngoscope 2022 Apr 8. Epub 2022 Apr 8.

Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.

Objective(s): To analyze the utility of computed tomography angiography (CTA) in identifying internal carotid artery (ICA) injury and reducing cerebrovascular accident (CVA) incidence in children presenting with normal neurologic exams after oropharyngeal trauma (OT).

Data Sources: PubMed, Scopus, CINAHL, and Cochrane.

Review Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. Of 1,185 studies screened, 95 studies of pediatric OT met inclusion criteria. Meta-analysis of proportions was performed.

Results: A total of 1224 children with OT were analyzed. Excluding case reports, the weighted proportion of a CVA after OT was 0.31% (95% CI 0.06-0.93). If a child presented without neurologic deficits, 0.30% (95% CI 0.05-0.95) returned with new neurologic deficits. An ICA injury was identified in 0.89% (95% CI 0.16-2.74) of screening CTAs. No difference in CVA incidence was seen in children with screening CTA (0.52% [95% CI 0.02-2.15]) compared to children without screening CTA (0.42% [95% CI 0.06-1.37]). Patients who developed CVA had a higher proportion of injuries >2 cm, injuries at the posterior pillar or tonsil, and injuries with a writing utensil or popsicle stick compared to patients without CVA.

Conclusion: The proportion of children experiencing an ICA injury leading to CVA after sustaining OT is low. CTAs infrequently show ICA changes in children with normal neurological exams. Children who receive CTAs do not have a significantly lower incidence of CVAs than children who do not receive CTAs. Clinicians should weigh the risks and benefits of a CTA based on an individual child's presentation and discuss this with caregivers for shared decision-making. Laryngoscope, 2022.
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http://dx.doi.org/10.1002/lary.30133DOI Listing
April 2022

Pathogenesis and Etiology of Ménière Disease: A Scoping Review of a Century of Evidence.

JAMA Otolaryngol Head Neck Surg 2022 04;148(4):360-368

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.

Importance: Ménière disease is a rare chronic benign disorder of the inner ear with a natural history of multiple clinical phenotypes of variable severity and a tendency to burnout with time. Although multiple treatment modalities have been shown to improve the disease process-some adversely affecting cochleovestibular function-it remains uncertain whether one, several separate, or a combination of pathophysiologic mechanisms affect the disease process. A scoping review of the evidence underlying proposed pathophysiologic mechanisms of Ménière disease is needed to determine which processes are most likely to be etiopathogenic factors.

Observations: Of the 4602 relevant articles found through Embase, Ovid, and PubMed, 444 met inclusion criteria. The most common reported causes of Ménière disease were autoimmune or immune-mediated, genetic, or structural dysfunction of the inner ear. During the study period from inception to March 2021, etiologic theories shifted from structural dysfunction to autoimmune and genetic causes of Ménière disease.

Conclusions And Relevance: This scoping review found that Ménière disease is a multifactorial disease with lifelong comorbidities and loss of quality-associated life-years whose most commonly reported causes were structural dysfunction, immunologic damage, and genetic susceptibility. Recent studies have examined how autoinflammatory processes and vestibular migraine may be associated with Ménière disease. Large heterogeneity among studies may be explained by historical differences in the clinical understanding of the disease, as well as evolving intervention methodologies and practitioner expertise. Ménière disease is a multifactorial disease with lifelong comorbidities and loss of quality-associated life-years; therefore, future studies of reliable biomarkers of endolymphatic hydrops and real-time imaging are warranted to improve understanding and treatment.
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http://dx.doi.org/10.1001/jamaoto.2021.4282DOI Listing
April 2022

A National Analysis of Inpatient Pediatric Adenoidectomy.

Ann Otol Rhinol Laryngol 2022 Jan 6:34894211067615. Epub 2022 Jan 6.

Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.

Objective: Hospital admission following pediatric adenoidectomy without tonsillectomy is not well characterized. The objective of our study is to better characterize risk factors for post-operative complications in younger children undergoing inpatient adenoidectomy.

Methods: A cross-sectional analysis using data derived from the Kid's Inpatient Database (KID) was performed. Study participants included children <3 years of age who underwent an adenoidectomy and were admitted to hospitals participating in the KID for years 1997, 2000, 2003, 2006, 2009, and 2012. Descriptive statistical analysis and a multivariate logistic regression analysis were performed to identify risk factors for post-operative complication.

Results: A total of 3406 children (mean age 1.1 ± 0.7 years) were included. The overall post-operative bleeding and respiratory complication rates were 0.6% and 5.4%, respectively. Children less than 18 months of age demonstrated increased rates of post-operative respiratory complications ( = .009), but not bleeding complications ( = .857). Presence of cardiopulmonary congenital malformations (OR 1.54, 95% CI 1.07-2.20), chronic respiratory disease of the newborn (OR 5.03, 95% CI 2.86-8.85), and neuromuscular disorders (OR 1.97, 95% CI 1.09-3.57) were associated with post-operative respiratory distress.

Conclusions: This analysis of a national dataset suggests that otherwise healthy children less than 18 months of age and children 18 months to 3 years of age with certain comorbidities may benefit from overnight observation following adenoidectomy.
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http://dx.doi.org/10.1177/00034894211067615DOI Listing
January 2022

Eustachian tube dysfunction (ETD) in chronic rhinosinusitis with comparison to primary ETD: A systematic review and meta-analysis.

Int Forum Allergy Rhinol 2022 Jul 5;12(7):942-951. Epub 2022 Jan 5.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.

Background: Otologic symptoms consistent with Eustachian tube dysfunction (ETD) are common in patients with chronic rhinosinusitis (CRS), but can also occur independently of CRS as primary ETD. It is unclear if CRS+ETD is similar to primary ETD or how treatment outcomes compare.

Methods: A systematic search of PubMed, CINAHL, Scopus, and Cochrane Library was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Any study describing ETD in CRS was included. Primary ETD studies were limited to those with preoperative and postoperative Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores in ETD treated only with Eustachian tube balloon dilation (ETBD).

Results: Sixteen studies were included: nine studies with 1336 consecutive patients with CRS and seven studies with 161 patients with primary ETD. In studies with specific data, 225 (47.2%) patients with CRS had a score >14.5, consistent with ETD. In CRS+ETD, baseline mean ± standard deviation (SD) ETDQ-7 score was 20.7 ± 8.4 and did not differ by polyp status. In primary ETD, mean ETDQ-7 score was significantly higher than CRS+ETD (29.5 ± 8.1, p < 0.0001). Regarding treatment outcomes, CRS+ETD treated with endoscopic sinus surgery (ESS) alone resulted in mean ETDQ-7 in the normal range (13.2 ± 5.3), with a mean change of -7.4 (95% confidence interval [CI], -10.82 to -3.99) (p < 0.00001). Patients with primary ETD treated with ETBD had postoperative ETDQ7 scores of 14.9 ± 7.5 with mean change of -13.9 (95% CI, -18.01 to -9.88), p < 0.00001.

Conclusion: ETD is noted in approximately half of patients with CRS. Outcomes of CRS+ETD treated with ESS alone are similar to those of patients with primary ETD treated with ETBD.
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http://dx.doi.org/10.1002/alr.22942DOI Listing
July 2022

Tissue Doppler echocardiography in children with OSA before and after tonsillectomy and adenoidectomy: A systematic review and meta-analysis.

Int J Pediatr Otorhinolaryngol 2022 Jan 5;152:111002. Epub 2021 Dec 5.

Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA.

Background: When to order an echocardiogram in children with obstructive sleep apnea (OSA) is debated. Studies evaluating the utility of pre-operative standard echocardiography are inconsistent. Tissue Doppler imaging (TDI) is an additional technique that quantifies the velocity of myocardial motion to assess cardiac function. The utility of TDI in pediatric OSA remains unclear.

Methods: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines using PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of echocardiographic findings using TDI in children with polysomnogram confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were included. 1,423 studies were screened, and 4 studies met inclusion criteria. Meta-analysis of echocardiographic findings was performed.

Results: Data from 560 children were analyzed. Study groups included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A S' wave at the tricuspid annulus (S' RV) was decreased with a mean difference of -1.04 [95% CI -1.57, -0.52, p < 0.001] and E'/A' ratio at the mitral annulus (E'/A' LV) was decreased with a mean difference of -0.74 [95% CI -0.85, -0.64, p < 0.001] when compared to controls. These variables were not statistically different when comparing post-T&A to controls.

Conclusions: TDI appears to successfully detect subclinical changes in cardiac function in children with OSA. However, echocardiography parameters of post-T&A and non OSA control children were similar. Further prospective studies stratified by OSA severity are needed with both TDI and standard echocardiography to define the utility of pre-operative cardiac imaging.
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http://dx.doi.org/10.1016/j.ijporl.2021.111002DOI Listing
January 2022

Changes in Sleep Quality Following Treatment for Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis.

Am J Rhinol Allergy 2022 May 10;36(3):386-396. Epub 2021 Dec 10.

Department of Otolaryngology-Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background: Chronic rhinosinusitis (CRS) presents with broad and systemic manifestations, including impaired sleep; however, the impact of CRS treatments upon sleep is unknown.

Objective: To establish the effect of medical or surgical CRS treatment on subjective and objective sleep metrics for patients not previously diagnosed with sleep apnea.

Methods: Review of PubMed, Scopus, Web of Science, and the Cochrane Library was performed from the databases' date of inception through August 13, 2020, for studies evaluating the effect of CRS treatment on sleep quality. All studies reporting on subjective and objective sleep parameters for patients with CRS, with completed pre- and posttreatment data were included. Studies composed of patients with diagnosed sleep apnea were excluded.

Results: Sixteen unique studies reporting data on a total of 1770 patients (mean age, 50.6 ± 15.6 (n = 1675) years) following treatment for CRS were included. Patient-reported outcome measures, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Fatigue Severity Scale, demonstrated mean posttreatment differences of -2.8 (95% CI: -4.9 to -0.7), -2.4 (95% CI: -3.7 to -1.2), and -1.2 (95% CI: -1.6 to -0.7), respectively. The SNOT-22 and its sleep domain demonstrated a mean posttreatment difference of -23.5 (95% CI: -31.7 to -15.3) and -5.4 (95% CI: -6.8 to -4.0), respectively. EpSS, FSS and SNOT-22 exceeded their respective reported MCID values. Objective findings did not significantly change with treatment; mean difference: AHI: 0.7 (95% CI: -1.5 to 2.9), oxygen nadir: 0.3 (95% CI: -0.4 to 0.9).

Conclusions: Treatment of CRS may lead to clinically meaningful reduction in disease burden and improvements in both overall sleep quality and patient-reported fatigue. Despite clinically meaningful quality of life improvements, objective sleep parameters did not demonstrate corresponding posttreatment improvements.
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http://dx.doi.org/10.1177/19458924211061442DOI Listing
May 2022

Elective neck dissection in salivary gland malignancies: Systematic review and meta-analysis.

Head Neck 2022 02 4;44(2):505-517. Epub 2021 Dec 4.

Head and Neck Tumor Center, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.

We defined the occult nodal metastasis (ONM) rate of clinical node-negative salivary gland malignancies and examined the role of elective neck dissection (END). Meta-analysis querying four databases, from inception of databases to March 25th, 2020. Fifty-one studies with 11 698 patients were included. ONM rates were 64% for salivary ductal carcinoma (SDC), 51% for undifferentiated carcinoma, 34% for carcinoma ex-pleomorphic adenoma (CXPA), 32% for adenocarcinoma not otherwise specified (ANOS), 31% for lymphoepithelial carcinoma (LE), 20% for mucoepidermoid carcinoma, 17% for acinic cell carcinoma, and 17% for adenoid cystic carcinoma. T3/T4 tumors had a 2.3 times increased risk of ONM than T1/T2 tumors. High-grade tumors had a 3.8 times increased risk of ONM than low/intermediate-grade tumors. ONM rates were exceedingly high for T3/T4, high-grade, and undifferentiated, SDC, ANOS, CXPA, and LE tumors, indicating the potential role of END.
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http://dx.doi.org/10.1002/hed.26923DOI Listing
February 2022

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review.

Am J Rhinol Allergy 2022 May 26;36(3):367-377. Epub 2021 Nov 26.

2345Medical University of South Carolina, Charleston, South Carolina, USA.

Background: Chronic rhinosinusitis (CRS) describes a heterogenous group of diseases including CRS with (CRSwNP) or without nasal polyps (CRSsNP), aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis (AFRS). It affects 10 to 15% of the US population and is more common in women and White patients. However, these estimates are based on survey and database studies with innate diagnostic inaccuracy. Additionally, few studies report subtype-specific demographics. We explore the demographic differences of CRS in the U.S. by subtype and region.

Objective: To characterize demographic differences between the CRS population and the overall US population, and also between different CRS subtype populations.

Methods: We performed a systematic review for articles reporting on US demographics of adults with CRS. Study participants were required to have been diagnosed using consensus criteria. Data on demographics, geographic region, and CRS subtype were analyzed.

Results: Our study analyzed 31 unique studies representing 8409 patients with 50.7% females and weighted mean age of 48.0 years. Compared to the overall US population, CRS patients were predominantly White (78.5%) and non-Hispanic (94.5%) with under-representation of other races. Grouped by subtype, CRSwNP affected a significantly higher proportion of men (59.8%). AFRS affected a significantly higher proportion of Black patients (53.8%) while CRSsNP was more prevalent in White patients (84.2%). When grouped by region, the South had a significantly higher proportion of female (53%) and Black (17.8%) CRS patients. The West had a significantly higher proportion of Asian (4.5%) and Hispanic (12.3%) patients.

Conclusions: Significant demographic differences exist in CRS patients based on subtype and region. These data provide an estimation of the demographic make-up of CRS, but further high-level demographic studies are needed.
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http://dx.doi.org/10.1177/19458924211056294DOI Listing
May 2022

Immune Checkpoint Inhibitors for Advanced Cutaneous Squamous Cell Carcinoma: A Systematic Review with Meta-Analysis.

Target Oncol 2021 11 22;16(6):743-752. Epub 2021 Oct 22.

Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.

Background: Results of early trials led to FDA approval of immune checkpoint inhibitors (ICIs) for advanced and recurrent/metastatic (R/M) cutaneous squamous cell carcinoma (CSCC). Updated data from these trials are pending and extent of survival outcomes is undetermined.

Objective: The aim of this study was to assess the efficacy of ICIs in advanced CSCC, comprising locally advanced (LA), locoregionally advanced (LR), and recurrent or metastatic (R/M) disease.

Patients And Methods: A systematic review of four databases (PubMed, Scopus, OVID, Cochrane) and meta-analysis of proportions was performed. Phase I and II prospective clinical trials were included.

Results: Six trials evaluating cemiplimab (n = 3) and pembrolizumab (n = 3) were eligible for inclusion. Overall survival (OS) was not reached at data-cutoff. Pooled analysis of 392 patients demonstrated that ICIs conferred an objective response rate (ORR) of 42.43% (95% CI 37.53-47.45) and disease control rate (DCR) of 58.05% (95% CI 53.04-62.95). Patients with LR or distant metastatic lesions achieved equivalent ORRs and DCRs. Duration of response (DOR) was not reached in all trials and 92% of all responders continued to have therapeutic response at data cut-off. Tolerability was favorable, with only 27.12% (95% CI 10.89-47.38) of patients experiencing grade ≥ 3 adverse events.

Conclusion: Surgical treatment of CSCC remains the guideline-based standard of care for curative intent of local, LA, and LR disease. ICIs demonstrate promising results for LA, LR, and R/M CSCC not amenable to surgery. Endpoints assessing survival and durability of response have not been reached, warranting additional trials exploring neoadjuvant or adjuvant therapy in combination with local treatment.
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http://dx.doi.org/10.1007/s11523-021-00844-zDOI Listing
November 2021

Concerns and Needs of Patients With Head and Neck Cancer in the COVID-19 Era.

OTO Open 2021 Jul-Sep;5(3):2473974X211047794. Epub 2021 Sep 30.

School of Medicine, Indiana University, Indianapolis, Indiana, USA.

Objective: To evaluate the concerns and needs of patients and survivors of head and neck cancer (HNC) in the COVID-19 era.

Study Design: Prospective cross-sectional survey.

Setting: Contact lists of 5 North American HNC advocacy groups.

Methods: A 14-question survey was distributed to the contact lists of 5 HNC advocacy groups evaluating patient and survivor needs and concerns related to their cancer care and COVID-19.

Results: There were 171 respondents, with 75% in the posttreatment period. The most common concern was contraction of COVID-19 (49%). More patients in active treatment preferred in-person visits than those in the early (≤5 years) and late (>5) survivorship period (72% vs 61% vs 40%, < .001). A higher percentage of late survivors preferred virtual visits (38% vs 28%, = .001). In total, 91 (53.2%) respondents sought emotional support outside of immediate family and friends. This included cancer support groups (36.2%), the medical team (29.7%), and other sources outside of these (34.1%), including faith-based organizations and online communities. A higher proportion of women than men (62% vs 41%, = .001) were seeking emotional support outside of immediate family and friends.

Conclusions: During the early stages of the COVID-19 pandemic, patients with HNC who were actively undergoing treatment had increased need for support resources and preferred in-person provider visits. Alternatively, a higher percentage of patients >5 years from treatment preferred virtual visits. Emotional support outside of family and friends was sought out by a majority of respondents. Further research is needed to determine what support and educational resources are needed to best aid these various populations.
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http://dx.doi.org/10.1177/2473974X211047794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8489761PMC
September 2021

Medical Management for Eustachian Tube Dysfunction in Adults: A Systematic Review and Meta-Analysis.

Laryngoscope 2022 04 4;132(4):849-856. Epub 2021 Oct 4.

Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.

Objective: Medical treatment for eustachian tube dysfunction (ETD) is varied, with physician preference driving treatment choice and limited guidance for these options. An evaluation of the efficacy of medical management (MM) for ETD is warranted.

Methods: A systematic review of three databases (PubMed, Scopus, and Embase) was performed through December 2020. Adults treated nonsurgically for ETD were included. Exclusion criteria were as follows: patulous ETD, ETD deriving from craniofacial anomalies, or surgical treatment. Data were extracted independently by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis of continuous measures, proportions, and risk ratio was conducted.

Results: Twelve articles were identified by systematic review, with either level 2 or 3 evidence. A meta-analysis of available data was performed on nine studies. A pooled cohort found 50.3% (95% confidence interval [CI], 41.7-59.0) of patients experienced symptomatic improvement with MM. ETDQ-7 scores improved in a clinically nonsignificant manner by -0.88 (95% CI, -1.12 to -0.64) following medical treatment. Further, MM benefited from subacute and chronic symptoms in 30% to 64% and 11% to 50% of cases, respectively. Intranasal corticosteroids (INCS) were not efficacious, improving only 11% to 18% of chronic cases. Therapies such as Politzer devices and Valsalva therapy had minimally beneficial results.

Conclusion: Our review did not find any level 1 evidence for MM of ETD in adults. Available evidence indicates INCS are ineffective for chronic symptoms and the efficacy of nonsurgical options for subacute ETD has yet to be determined. Further randomized controlled trials are needed to discern efficacy of single-agent medical therapies. Laryngoscope, 132:849-856, 2022.
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http://dx.doi.org/10.1002/lary.29878DOI Listing
April 2022

Effect of Medical Therapy in Allergic Rhinitis: A Systematic Review and Meta-Analysis.

Am J Rhinol Allergy 2022 Mar 21;36(2):269-280. Epub 2021 Sep 21.

2345Medical University of South Carolina, Charleston, SC, USA.

Background: Intranasal corticosteroids (INCS), oral antihistamines (POAH), and allergen-specific immunotherapy (ASIT) are widely used in the treatment of allergic rhinitis (AR); however, appraisal of treatment effect has been heterogenous, and few studies have interpreted these outcomes in context with measures of nasal airflow.

Objective: To provide a systematic review and meta-analysis of randomized placebo-controlled trials for common therapy classes for AR to assess standardized treatment effect on validated patient-reported outcomes and physiologic measures of airflow.

Methods: A systematic search was performed in PubMed, Scopus, OVID, and Cochrane library databases to identify randomized controlled trials meeting inclusion criteria. Treatment effects of INCS, POAH, and ASIT on total nasal symptom score (TNSS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and peak nasal inspiratory flow (PNIF) were analyzed by meta-analysis.

Results: Twenty-two studies with 4673 AR patients were identified, with 5 INCS, 8 POAH, and 9 ASIT trials. INCS improved TNSS (mean difference [MD] 0.90;  = .002) and PNIF (MD 13.31 L/min [ = .0007]. POAH improved quality of life assessed by RQLQ [MD 0.36;  < .001], but no improvement was found in PNIF. ASIT improved RQLQ [MD 0.65;  < .001], with a trend toward improvement in TNSS.

Conclusion: Overall, INCS resulted in a clinically and statistically meaningful improvement in symptom scores and physiologic measures in AR. POAH and ASIT both improved symptom scores and quality of life, but their impacts upon nasal airflow are uncertain. There is a lack of studies assessing the effect of INCS on quality of life and the effect of POAH on symptom severity, particularly for mild AR. Future studies should assess the effect of treatment for each of these patient-reported measures.
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http://dx.doi.org/10.1177/19458924211041438DOI Listing
March 2022

Subtotal Petrosectomy with Cochlear Implantation or Osseointegrated Hearing Rehabilitation: A Single Institutional Study.

Otol Neurotol 2021 12;42(10):1499-1506

Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.

Objective: To examine audiologic outcomes and operative considerations for patients undergoing subtotal petrosectomy (STP) followed by implantable hearing restoration.

Study Design: Retrospective review.

Setting: Tertiary academic referral hospital.

Patients: All patients who underwent STP and implantable hearing restoration from 2014 to 2020.

Interventions: Single or staged STP with cochlear implantation (CI) or placement of an osseointegrated hearing implant (OHI).

Main Outcome Measures: Indications for STP and CI or OHI; postoperative complication and reoperation rates; audiologic outcomes through speech recognition thresholds, AzBio sentence scores, and consonant-nucleus-consonant scores.

Results: Twenty-six adults (age 33-85) and six children (age 1-17) underwent 37 STP procedures with 33 CIs and four OHI. Thirty-one cases were planned single-stage, but six (16%) cases required revision surgery postoperatively due to refractory postauricular infection and breakdown of wound closure. Therefore, 25 cases were single procedures and 12 were staged. Indications for staged procedures included extensive cholesteatoma (n = 5, 42%), chronic middle ear inflammation (n = 5, 42%), and osteoradionecrosis (n = 2, 17%). No patients with OHI required revision surgery. For patients undergoing CI, the mean speech recognition thresholds improved from 80 ± 21 dB to 31 ± 9 dB (p < 0.001), mean aided AzBio scores improved from 11% to 43% (p = 0.002) and aided consonant-nucleus-consonant word scores improved from 6% to 47% (p < 0.001) in quiet.

Conclusions: Subtotal petrosectomy is effective for creating a safe, dry ear in patients with chronic inflammation or anatomically challenging ears. Rehabilitative hearing options following STP can be achieved safely, restoring hearing to an acceptable level with CI. Careful consideration should be undertaken to approach as a single or staged procedure.
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http://dx.doi.org/10.1097/MAO.0000000000003326DOI Listing
December 2021
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