Publications by authors named "Vishal Narwani"

8 Publications

  • Page 1 of 1

Adverse Events Associated With Corticosteroid-Eluting Sinus Stents: A MAUDE Database Analysis.

Otolaryngol Head Neck Surg 2021 Apr 13:1945998211006930. Epub 2021 Apr 13.

Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objective: Corticosteroid-eluting stents (CESs) are increasingly used after endoscopic sinus surgery to reduce the need for revision surgery, but their use is not without risks. The objective of this study is to describe adverse events related to CESs.

Study Design: Retrospective cross-sectional study.

Setting: The US Food and Drug Administration's MAUDE database (2011-2020; Manufacturer and User Facility Device Experience).

Methods: The MAUDE database was queried for reports of adverse events involving the use of CESs approved by the Food and Drug Administration, including Propel, Propel Mini, Propel Contour, and Sinuva (Intersect ENT).

Results: There were 28 reported adverse events in total, with all events being related to the Propel family of stents and none related to Sinuva stents. Overall, 22 were categorized as patient-related adverse events and 6 as device-related events. The most common adverse event was related to postoperative infection, accounting for 39% (n = 11) of all complications. Four of these patients developed periorbital cellulitis, and 5 developed a fungal infection. The second-most common adverse event was migration of the stent, representing 21% of all complications (n = 6). Overall, 8 patients (29%) in our cohort required reintervention in the operating room, with subsequent removal of the CES.

Conclusion: The most commonly reported adverse events were postoperative infection, including multiple cases of fungal infection, followed by migration of the stent. An increased awareness of the complications associated with CESs can be used to better inform patients during the consenting process as well as surgeons in their surgical decision making.
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April 2021

Does alleviate tinnitus? A review of the current literature.

Laryngoscope Investig Otolaryngol 2020 Dec 30;5(6):1147-1155. Epub 2020 Oct 30.

Division of Otolaryngology - Head and Neck Surgery, Department of Surgery Yale University School of Medicine New Haven Connecticut USA.

Objectives: Endocannabinoid pathways have been proposed to affect the underlying pathophysiology of tinnitus. The aim of this study is to evaluate the scope and findings of existing literature on the relationship between and cannabinoid pathways and tinnitus.

Methods: We conducted a review of animal, clinical and survey studies investigating the relationship between the use of -derived agents and tinnitus. Using pertinent keywords and MeSH terms on PubMed, relevant studies were identified, yielding four animal studies, two large cross-sectional survey studies, one clinical cross-over study, and one case report.

Results: Animal studies revealed that cannabinoid receptor expression in the cochlear nucleus varied with tinnitus symptomatology and the use of cannabinoid agents either increased or had no effect on tinnitus-related behavior. Survey studies yielded conflicting results between use and tinnitus in the general population. Clinical data is largely lacking, although a small cohort study showed a dose-dependent relationship between tetrahydrocannabinol consumption and frequency of tinnitus episodes in patients receiving treatment for cancer.

Conclusion: While animal studies have revealed that cannabinoid receptors likely have a role in modulating auditory signaling, there is no compelling data either from animal or human studies for the use of cannabinoids to alleviate tinnitus. Further research is necessary to elucidate their precise role to guide development of therapeutic interventions.

Level Of Evidence: NA.
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December 2020

Application of a Modified Endoscopy Face Mask for Flexible Laryngoscopy During the COVID-19 Pandemic.

Otolaryngol Head Neck Surg 2020 07 19;163(1):107-109. Epub 2020 May 19.

Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA.

Diagnostic flexible laryngoscopy (DFL) is a critical tool in the armamentarium of an otolaryngologist. However, in the midst of the COVID-19 pandemic, DFL represents a high-risk procedure for patients and otolaryngologists due to the risk of aerosolization. In cases where DFL is required, in patients with COVID-19 positivity or unknown COVID-19 status, we describe the use of a modified endoscopy face mask as an adjunct to personal protection equipment to reduce occupational transmission of COVID-19 while performing DFL. Our modified endoscopy mask provides an additional barrier against the transmission of airborne pathogens. The modified endoscopy face mask may also serve as a useful tool for otolaryngologists as they return to performing more aerosol-generating procedures in the outpatient setting.
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July 2020

Medicare Reimbursement for Balloon Catheter Dilations Among Surgeons Performing High Volumes of the Procedures to Treat Chronic Rhinosinusitis.

JAMA Otolaryngol Head Neck Surg 2020 03;146(3):264-269

Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.

Importance: Chronic rhinosinusitis is among the most common and costly conditions treated by physicians. After failure of medical treatment, surgical intervention in the form of endoscopic sinus surgery is traditionally offered. Balloon catheter dilation (BCD) has become a less-invasive alternative with increasing popularity among otolaryngologists.

Objective: To evaluate the most recent BCD data in the Medicare population, with a specific focus on the percentage of procedures performed by surgeons who perform high volumes of this procedure, their reimbursements, and their national geographic distributions.

Design, Setting, And Participants: This retrospective review included data from 2011 through 2017 from Medicare Part B National Summary Data Files and Medicare Provider Utilization and Payment Data. Patients with procedures including Current Procedural Terminology codes 31295 (maxillary sinus dilation), 31296 (frontal sinus dilation), and 31297 (sphenoid sinus dilation) were included.

Exposures: Balloon catheter dilation of the paranasal sinuses.

Main Outcomes And Measures: Total and mean reimbursements over time to physicians for BCDs, as well as the percentage of BCDs performed by and reimbursed to ear, nose, and throat (ENT) surgeons who perform high volumes of BCDs (>10 procedures) in a given year.

Results: The total number of BCDs rose from 7496 in 2011 to 43 936 in 2017 (a 486% increase). The overall reimbursement increased from $11 773 049 in 2011 to $63 927 591 in 2017 (a 433% increase). From 2012 to 2016, ENT surgeons who performed high volumes of the procedures rose from 101 to 382 surgeons (a 270% increase). In 2016, 25 214 of 41 960 BCDs (60.1%) were performed by ENT surgeons performing high volumes of the procedure, compared with 5603 of 13 109 procedures (42.7%) in 2012. In a line of best fit, at the 75th percentile of procedure volume, there was an increase of 4.2 BCDs in the median number of procedures done per physician per year, compared with an increase of 1.5 BCD procedures per physician per year in the line of best fit for the 50th percentile.

Conclusions And Relevance: Balloon catheter dilation continues to increase in popularity among otolaryngologists treating chronic rhinosinusitis. Most BCDs are performed by ENT surgeons who perform high volumes of the procedure.
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March 2020

Readability and quality assessment of internet-based patient education materials related to laryngeal cancer.

Head Neck 2016 Apr 22;38(4):601-5. Epub 2015 Jun 22.

Department of Otolaryngology, St George's Hospital, Tooting, London, United Kingdom.

Background: Patients are increasingly using the internet to access health-related information. The purpose of this study was to assess the readability and quality of laryngeal cancer-related websites.

Methods: Patient education materials were identified by performing an internet search using 3 search engines. Readability was assessed using Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI). The DISCERN instrument was utilized to assess quality of health information.

Results: A total of 54 websites were included in the analysis. The mean readability scores were as follows: FRES, 48.2 (95% confidence interval [CI] = 44.8-51.6); FKGL, 10.9 (95% CI = 10.3-11.5); and GFI, 13.8 (95% CI = 11.3-16.3). These scores suggest that, on average, online information about patients with laryngeal cancer is written at an advanced level. The mean DISCERN score was 49.8 (95% CI = 45.4-54.2), suggesting that online information is of variable quality.

Conclusion: Our study suggests much of the laryngeal cancer information available online is of suboptimal quality and written at a level too difficult for the average adult to read comfortably.
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April 2016

Absolute lymphocyte count at day 29 of treatment is a powerful predictor of outcome in multiple myeloma.

Clin Lymphoma Myeloma Leuk 2015 Apr 23;15(4):222-6. Epub 2014 Oct 23.

Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Brighton, United Kingdom; Royal Sussex County Hospital, Eastern Road, Brighton, United Kingdom. Electronic address:

Background: Survival outcomes for patients who receive treatment for newly diagnosed multiple myeloma (MM) are highly variable.

Patients And Methods: We conducted a retrospective analysis of 38 unselected MM patients who received treatment with cyclophosphamide, thalidomide, and dexamethasone to evaluate the prognostic value of the absolute lymphocyte count at diagnosis and at the end of the initial cycle of treatment defined as day 29, termed ALC-29. The median follow-up was 54 months (range, 2-83 months).

Results: We found that ALC-29, as a continuous variable, was a predictor of overall survival (OS) in MM patients (hazard ratio, 0.208; 95% confidence interval, 0.093-0.689; P = .007). Patients with an ALC-29 ≥ 0.8 × 10(9)/L (n = 16) experienced a superior median OS compared with patients with an ALC-29 < 0.8 × 10(9)/L (n = 22) with a median OS of 58.3 months versus 42.5 months respectively (P = .006). Multivariate analysis confirmed that ALC-29 ≥ 0.8 × 10(9)/L was an independent prognostic indicator of OS in our cohort of MM patients.

Conclusion: We concluded that the ALC-29 is a useful and simple predictor of outcome in newly diagnosed MM patients who receive standard chemotherapy. Our results support the hypothesis that host immunity plays an important role in tumor control in MM.
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April 2015

How frequently are bedside glucose levels measured in hospital inpatients on glucocorticoid treatment?

Clin Med (Lond) 2014 Jun;14(3):327-8

Department of Medicine and Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.

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June 2014

Venous thromboembolism in ENT surgery: a review of the literature and completed audit cycle of adherence to national guidance.

Eur Arch Otorhinolaryngol 2013 Sep 30;270(9):2559-64. Epub 2013 Apr 30.

Department of Otolaryngology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, IP4 5PD, UK.

Venous thromboembolism (VTE) risk assessment of elective ENT patients is essential to minimize the risk of mortality and morbidity. The study is standard-based audit of VTE risk assessment against the ENT UK guidelines and intervention includes instructional poster and departmental presentation. 23 patients on eight operating lists were audited in the first cycle (C1). A total of 27 patients on ten operating lists were re-audited in the second cycle (C2). There were marked improvements in the number of VTE risk assessments completed (C1 = 3/23; C2 = 26/27; p < 0.0001), the number of patients encouraged to mobilize (C1 = 0/23; C2 = 26/27; p < 0.0001), and the number of VTE leaflets provided upon discharge (C1 = 1/23; C2 = 27/27; p < 0.0001) following the intervention. The introduction of a poster and a departmental presentation proved to be simple, cheap, and effective measures to improve adherence of national VTE guidelines.
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September 2013