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  • 1
    In: The Laryngoscope, Wiley, Vol. 130, No. 3 ( 2020-03), p. 632-636
    Abstract: To characterize procedural trends in facial plastic and reconstructive surgery procedures in relation to the United States economy. Methods Retrospective cohort study examining annual procedure rates were determined from the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Procedural Statistics from January 1 2007 to December 30, 2017. Procedures were compared to economic activity of the United States as measured by gross domestic product (GDP) were compared using Kolmogorov‐Smirnov goodness of fit testing and piecewise multivariate regression modeling. Results Annual trends in procedural rates showed an overall decrease in the rates of rhinoplasty (284,960 to 218,924), blepharoplasty (240,660 to 209,571), and otoplasty (28,571 to 23,433) from 2007 to 2017. Total cosmetic surgery remained fairly stable, while minimally invasive cosmetic surgery increased in frequency over the study period. On piecewise regression analysis, rhinoplasty ( P = .02), rhytidectomy ( P = .007), invasive cosmetic surgery ( P   〈  .001) were significantly associated with GDP, whereas otoplasty ( P = .98) and reconstructive surgery ( P = .11) were not associated with GDP. Conclusion Cosmetic plastic surgery procedures show a greater correlation to GDP than reconstructive procedures. Trends in plastic surgery cases over the last decade show a decreasing number of rhinoplasty, otoplasty, and blepharoplasty, with stabilization in the last few years. An increasing number of reconstructive cases are found. Level of Evidence 4 Laryngoscope , 130:632–636, 2020
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2026089-1
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  • 2
    Online Resource
    Online Resource
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 1 ( 2021-01), p. 48-53
    In: The Laryngoscope, Wiley, Vol. 131, No. 1 ( 2021-01), p. 48-53
    Abstract: To characterize the acetaminophen and narcotic use pattern of the postoperative rhinoplasty patient. To describe a pain level and pain medication usage pattern of the typical post‐rhinoplasty patient and identify demographic considerations. Study Design Prospective cohort study at a tertiary care center. Methods Rhinoplasty patients were given standardized perioperative pain instructions and narcotic medication (18 tabs oxycodone) along with a pain medication use survey. Postoperatively, survey and tracking information was collected regarding narcotic and acetaminophen use at their first postoperative appointment. Patients were asked about non‐steroidal anti‐inflammatory drug, aspirin, and chronic opioid use. Narcotic and acetaminophen use along pain levels (1–10) at time of use were recorded by patients at 4‐hour increments postoperatively until their first postoperative visit. Results Pain medication usage (oxycodone and acetaminophen) peaked on (postoperative day 1) POD1. Pain was significantly higher in younger patients (30 years old or younger), female patients, and primary rhinoplasty patients. Pain was correlated with acetaminophen and oxycodone use for women, and acetaminophen used for men. Autologous rib grafting was not correlated with higher narcotic use. Conclusion Describing a pain medication usage pattern for the typical post‐rhinoplasty patient provides both patients and clinicians important knowledge of postoperative pain expectations and has the potential to reduce both the amount of narcotic prescribed by providers and the amount of narcotic used by patients. Level of Evidence 4 (Case Series) Laryngoscope , 131:48–53, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 3
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    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Otology & Neurotology Vol. 41, No. 1 ( 2020-01), p. 21-24
    In: Otology & Neurotology, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 1 ( 2020-01), p. 21-24
    Abstract: Increased body mass index (BMI) has been associated with postoperative complications in multiple surgical specialties. In otologic surgery involving the stapes, where appropriate patient positioning and surgical dexterity are necessary for proper prosthesis placement, patients with higher BMI could make surgery more challenging. The purpose of this study is to evaluate the impact of BMI on outcomes after stapes surgery. Methods: Medical records were examined from January 2015 to December 2017 in patients undergoing stapedectomy or stapedotomy at two tertiary care facilities. A retrospective cohort analysis comparing hearing outcomes on postoperative audiogram following procedural intervention with BMI was performed. The primary outcome was postoperative air-bone gap (dB) on audiogram. Results: Two hundred sixty three stapedotomy and stapedectomy patients were included in the study. Six percent had BMI less than 18.5 (underweight), 30% had BMI between 18.6 and 24.9 (normal weight), 38% had BMI between 25 and 29.9 (overweight), 24% had BMI above 30 (obese). The mean preoperative and postoperative air-bone gap (ABG) was 27.0 dB (standard deviation [SD] 15) and 10.4 dB (SD 10.6), respectively, with a postoperative ABG less than or equal to 20 dB in 87% of cases. There were no significant differences in postoperative ABG results when comparing the BMI categories ( p  = 0.11). Conclusions: Stapedotomy and stapedectomy are effective surgeries that can be performed by experienced surgeons with successful hearing improvement. While high BMI patients may be a challenge to position appropriately for their surgery, this does not translate to altered otologic outcomes for these patients.
    Type of Medium: Online Resource
    ISSN: 1531-7129 , 1537-4505
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2058738-7
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  • 4
    In: The Laryngoscope, Wiley, Vol. 129, No. 11 ( 2019-11), p. 2563-2567
    Abstract: To determine the relationship between force metrics measured by the laryngeal force sensor (LFS) during suspension microlaryngoscopy (SML) and perioperative narcotic requirements. Study Design Prospective observational study. Methods Compressive tissue forces were recorded during SML using the LFS and correlated with postoperative narcotic requirements in the postanesthesia care unit (PACU) at an academic tertiary center. Patients were prospectively enrolled and had force metrics recorded throughout each procedure including maximum force, average force, suspension time, and total impulse. Narcotic administration in the intraoperative period and PACU were also recorded and converted into intravenous morphine equivalents (ME). Surgeons were blinded to the force recordings during surgery to prevent operator bias. Results Eighty‐two patients completed the study. Of these patients, the mean perioperative ME requirement was 16.96 mg (range, 0.15–79.82 mg). Univariate analysis demonstrated a positive correlation between perioperative narcotic requirements and total suspension time ( P 〈 .001) as well as total impulse ( P = .007). A positive correlation was also seen with maximum force, although not significantly. On multiple linear regression, total suspension time was a significant predictive variable for perioperative narcotic use, with a marginal incremental increase of 0.273 mg of ME per minute of total suspension time (0.273 mg/min, 95% confidence interval: 0.040‐0.507 mg/min, P = .022). Conclusions Intraoperative force metrics including total suspension time are predictive of increased perioperative narcotic requirement after SML. Total impulse during SML may also correlate with increased perioperative narcotic requirements. Level of Evidence 2 Laryngoscope , 129:2563–2567, 2019
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2026089-1
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  • 5
    In: The Laryngoscope, Wiley, Vol. 131, No. 10 ( 2021-10)
    Abstract: Sleep medicine is a multidisciplinary field that includes otolaryngology. After 2011, sleep medicine board eligibility required completion of a dedicated sleep medicine fellowship. The objective of our study is to describe the characteristics and geographic distribution of the dual board‐certified sleep otolaryngology workforce and to assess the impact of the 2011 change. Methods A cross‐sectional analysis of sleep‐certified otolaryngologists registered with the American Board of Otolaryngology‐Head and Neck Surgery in 2019 was performed to characterize the sleep otolaryngology workforce. County and regional analysis of provider density was conducted by comparing provider characteristics with county‐level data from the United States Census Bureau. Results There were 275 active dual board‐certified sleep otolaryngologists, or approximately 1 for every 1.12 million Americans. 77.8% were in private practice and 2.9% had American Society of Pediatric Otolaryngology membership. Eighty‐eight percent were male, with females more likely than males to be in an academic setting (36.4% for females compared to 20.2% for males; P  = .045). The South Atlantic and South Central regions had the highest number of sleep board‐certified otolaryngologists per capita. Before 2011, an average of 75.7 otolaryngologists took the sleep board exam per 2‐year cycle, compared to 14.3 otolaryngologists after 2011 ( P  = .029). Conclusion There are few dual board‐certified sleep otolaryngologists across the country, which may affect care for patients with sleep‐disordered breathing. Increased resident exposure and otolaryngology training in sleep medicine can strengthen the otolaryngology contribution to the multidisciplinary care of these patients. Level of Evidence 4 Laryngoscope , 131:E2712–E2717, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 6
    Online Resource
    Online Resource
    Georg Thieme Verlag KG ; 2020
    In:  Facial Plastic Surgery Vol. 36, No. 04 ( 2020-08), p. 487-492
    In: Facial Plastic Surgery, Georg Thieme Verlag KG, Vol. 36, No. 04 ( 2020-08), p. 487-492
    Abstract: The objective of this paper is to investigate the differences between unilateral and bilateral nasal obstruction with subjective symptomatology in nasal obstruction. This is a retrospective chart review of prospectively collected data of patients with nasal obstruction presenting to a facial plastic and reconstructive surgery clinic for evaluation and treatment. Patient demographics including age and gender were recorded along with nasal physical exam findings. These included internal valve narrowing (IVN), external valve narrowing, internal valve collapse, external valve collapse, and septal deviations (inferior and superior). Findings were reported for the left, the right, and both sides. Nasal valve and septal findings were recorded on 3- and 4-point Likert scales, respectively, for each side of the nose. A total of 1,646 patients were included in the study. On univariate analysis, a significant correlation was seen between Nasal Obstruction Symptom Evaluation (NOSE) scores and all individual exam findings (p  〈  0.001). On multiple linear regression, total, left, and right septal deviation (p  〈  0.001, p = 0.001, p = 0.007, respectively) and total, left, and right IVN (p  〈  0.001, p = 0.003, p  〈  0.001) were all predictive of an increased NOSE score. Patients with unilateral septal deviation or internal nasal valve narrowing have symptoms of nasal obstruction similar to those with bilateral nasal obstruction. Unilateral and bilateral septal deviation and internal nasal valve narrowing are predictive of having an increased NOSE score. Unilateral nasal obstruction should be recognized and treated as a cause for severe symptomatic nasal obstruction despite a normal contralateral nasal exam.
    Type of Medium: Online Resource
    ISSN: 0736-6825 , 1098-8793
    RVK:
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 7
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Plastic & Reconstructive Surgery Vol. 148, No. 4 ( 2021-10), p. 592e-600e
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 148, No. 4 ( 2021-10), p. 592e-600e
    Type of Medium: Online Resource
    ISSN: 0032-1052
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2037030-1
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  • 8
    In: Journal of Neurological Surgery Reports, Georg Thieme Verlag KG, Vol. 80, No. 04 ( 2019-10), p. e41-e43
    Abstract: Introduction Human papillomavirus (HPV) related multiphenotypic sinonasal carcinoma (HMSC) is a newly described entity. The prognosis of this neoplasm is not well understood, but cases often demonstrate high-grade features and paradoxically indolent behavior. Case Report We present the case of a 65-year-old man referred with unilateral nasal congestion and epistaxis. Nasal endoscopy and imaging revealed an expansile mass filling the left nasal cavity. The patient underwent endoscopic-assisted medial maxillectomy, with complete resection and negative margins. Pathology revealed a basaloid tumor consisting of solid nests with multiple foci of cribriform architecture, with positivity for high-risk HPV, thus supporting the diagnosis of HMSC. Postoperatively, the patient received 66.6-Gy adjuvant three-dimensional proton therapy. Twenty-three months after surgical resection, he developed enlarging pulmonary nodules with biopsy features consistent with the primary sinonasal tumor. He was treated with three cycles of chemotherapy and eight cycles of immunotherapy, progressing on both therapies. He remains on palliative chemotherapy. Conclusion Here, we present a case of HMSC with early and progressive distant metastasis. We aim to add to an understanding of the behavior of this entity. Although this neoplasm may typically be indolent, further classification of high-risk features is necessary to identify rare aggressive cases.
    Type of Medium: Online Resource
    ISSN: 2193-6358 , 2193-6366
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2019
    detail.hit.zdb_id: 2677885-3
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  • 9
    In: Journal of Neurological Surgery Part B: Skull Base, Georg Thieme Verlag KG, Vol. 83, No. 01 ( 2022-02), p. 099-104
    Abstract: Objectives This article examines a national cohort of patients with nasopharyngeal adenoid cystic carcinoma (ACC) for incidence, skull base invasion, overall survival, and treatment paradigms. Design, Setting, and Participants Retrospective national population-based study using Surveillance, Epidemiology, and End Results program data of patients with ACC of the nasopharynx (NACC) and skull base between 2004 and 2016. Main Outcomes and Measures Primary outcomes included 5-year overall survival and odds of radiation treatment. Statistical analysis was performed using STATA 15.0 (STATACorp). p-Values  〈  0.05 were considered statistically significant. Results Of the 2,385 cases of ACC, 70 cases were classified as NACC. Twenty-one percent (15) involved invasion of the skull base or posterior pharyngeal wall, and 42% (30) were either stage 3 or stage 4. The 5-year overall survival for patients with NACC without skull base invasion was 67% which dropped to 40% with invasion into the skull base. Radiation was used as the primary form of therapy for 62% of NACC and 73% of NACC invading into skull base. Odds of receiving radiation therapy and 5-year survival were not affected by socioeconomic status or density of providers. Conclusion NACC is rare in incidence and was most commonly treated with radiation therapy when advanced in stage. Prognosis was dependent on invasion through posterior pharyngeal wall and skull base. Provider density and socioeconomic status did not affect odds of radiation or overall survival for NACC.
    Type of Medium: Online Resource
    ISSN: 2193-6331 , 2193-634X
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
    detail.hit.zdb_id: 2653367-4
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  • 10
    Online Resource
    Online Resource
    American Medical Association (AMA) ; 2020
    In:  JAMA Otolaryngology–Head & Neck Surgery Vol. 146, No. 5 ( 2020-05-01), p. 397-
    In: JAMA Otolaryngology–Head & Neck Surgery, American Medical Association (AMA), Vol. 146, No. 5 ( 2020-05-01), p. 397-
    Type of Medium: Online Resource
    ISSN: 2168-6181
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
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