bluuebunny/crossref_metadata_2025_split huggingface dataset:
American Academy of Otolaryngology—Head and Neck Surgery Foundation Clinical Practice Guidelines: Allergic Rhinitis
Authors: Seidman Michael D. , Gurgel Richard K. , Lin Sandra Y. , Schwartz Seth R. 
Published: September 2014

Program Description:Allergic rhinitis is a worldwide health problem affecting 30 to 60 million people in the United States annually, including up to 30% of adults and as many as 40% of children. The multidisciplinary, AAO‐HNSF‐developed Clinical Practice Guideline: Allergic Rhinitis, will be presented. The evidence‐based recommendations are designed for clinicians involved in the diagnosis and management of patients with allergic rhinitis.Educational Objectives:(1) Properly diagnosis allergic rhinitis. (2) Differentiate between allergic and non‐allergic rhinitis. (3) Know when to perform allergy testing; and understand the role of immunotherapy (sublingual and subcutaneous).
Food Allergy 2014: State of the Science
Authors: Reisacher William R. , Calhoun Karen H. , Damask Cecelia , Veling Maria C. 
Published: September 2014

Program Description:This miniseminar includes 3 didactic lectures, an audience‐interactive section, and Q&A. The lectures will focus on why food allergies develop by taking a critical look at the latest scientific evidence available in the literature, the role of oral tolerance in human evolution, and the relationship of failure to achieve oral tolerance on the health of the individual, relevant immunology, nonimmunologic food reactions versus immunologic reactions, both IgE‐mediated and non–IgE‐mediated, current methods of diagnosing food allergies, cutting‐edge strategies such as component‐resolved testing, skin and in vitro methods versus double‐blind, placebo‐controlled food challenge. Treatment options for food allergy will also be discussed.Educational Objectives:(1) Evaluate the scientific basis of IgE‐ and non–IgE‐mediated food allergy. (2) Describe the manifestations of food allergy in the head and neck region. (3) Use the currently available treatments for food allergy as well as future directions.
Take the Media Plunge: Become an Expert, Enhance Your Practice, Engage Your Patients
Authors: Stern Wendy B. , Tylor Dale A. , Jameson Marni , Medalie Melissa 
Published: September 2014

Program Description:Unprecedented availability of health‐related information on the Internet, television, radio, and print has empowered our patients to play larger roles in medical decision making. Increasingly, to help educate a knowledge‐hungry public and to help build their practices, otolaryngologists must interact with journalists. Formal media training is often lacking in residency or fellowship, making this task seem daunting. This miniseminar reveals the multitude of media opportunities, including those on the Academy Web site, and how to best interact with journalists and the public. Speakers include renowned television and print health journalists and otolaryngologists with media experience. Audience participation is encouraged.Educational Objectives:(1) Improve their communication with journalists. (2) Recognize the opportunities within and outside the Academy for print, television, radio, and online media exposure. (3) Increase involvement with the media to enhance your practice and educate your patients.
Postop Care after Endoscopic Sinus Surgery: Packing, Spacers, or Nothing
Authors: Citardi Martin J. , Han Joseph , Marple Bradley F. , Orlandi Richard R. , Wormald Peter J. 
Published: September 2014

Program Description:Since the introduction of endoscopic sinus surgery, surgeons have debated the merits of middle meatus packing. Many surgeons favor a middle meatal spacer, rather than packing, since the former implies an intentional design for better wound healing. Recently, the emphasis has been upon dissolvable or fragmentable materials that may exert positive effects upon wound healing, and a dissolvable stent that provides drug delivery has also been introduced. In addition, some surgeons do not use any materials whatsoever in the middle meatus after surgery. This miniseminar will feature evidence‐based reviews of the published trials, as well as practical knowledge from experienced surgeons.Educational Objectives:(1) Comprehend the principles of biomaterials selection for placement in the nose and paranasal sinuses. (2) Review principles of postoperative care with an emphasis on integration into the global surgical strategy. (3) Compare various middle meatal spacers, including chitosan, esterified hyaluronic acid, steroid‐releasing implant, and synthetic fragmental foam sponge.
Tackling Problematic Chronic Rhinosinusitis: Technical Pearls on Optimizing Outcomes from Endoscopic Sinus Surgery
Authors: Lal Devyani , Casiano Roy R. , Chandra Rakesh K. , Hwang Peter H. , Senior Brent A. , Stankiewicz James A. 
Published: September 2014

Program Description:Failure of adequate response to endoscopic sinus surgery (ESS) is a frequent cause of frustration to chronic rhinosinusitis patients and their surgeons. Technical execution of ESS may be a factor in some common findings at revision ESS (middle meatal adhesions, lateralized middle turbinate, missed maxillary ostium, residual uncinate process, residual anterior and posterior ethmoid cells, sphenoid ostium stenosis, and frontal recess scarring). Using real‐life demonstrative cases, our expert panel will share practical and key technical pearls on optimizing results from ESS. These include simple modifications in surgical techniques, selection of procedure appropriate to disease, and incorporation of state‐of‐the‐art technology (endoscopes, instrumentation, navigation, etc).Educational Objectives:(1) Recognize technical causes of failure of satisfactory response from ESS. (2) Implement changes in surgical techniques to optimize technical execution of ESS. (3) Learn to use technology and instrumentation to improve execution and completeness of ESS.
Controversies in Management of the Nasal Airway and Sleep Disorders
Authors: Woodson B. Tucker , Rotenberg Brian , Soose Ryan J. , Friedman Michael , Ishman Stacey L. 
Published: September 2014

Program Description:Surgical and medical management of the nasal airway has traditionally not been considered primary indication for sleep disorders’ treatment. Controversy exists over nasal surgery as primary treatment of snoring and sleep apnea. Algorithms to manage sleep‐disordered breathing often ignore or dismiss the nasal airway. This miniseminar addresses the following controversies: (1) Is the nasal airway an important contributor to sleep disorders? (2) Does nasal surgery affect sleep? (3) Does nasal treatment affect the use of continuous positive airway pressure? and (4) What is the role and documented effect of nasal surgery sleep apnea treatment in adults and children?Educational Objectives:(1) Justify using appropriate evidence‐based outcome metrics of medical and surgical treatment of the nose for specific sleep‐related breathing disorders. (2) Compare medical outcomes of sleep apnea treatment with and without treatment of nasal obstruction. (3) Describe potential differences and obstacles in treating nasal obstruction using traditional definitions versus treating it as a spectrum of sleep disordered breathing.
Palate Surgery in Obstructive Sleep Apnea: How to Choose among the Options
Authors: Kezirian Eric J. , Weaver Edward M. , Li Hsueh‐Yu , Woodson B. Tucker , Friedman Michael , Cahali Michel B. , Pang Kenny P. 
Published: September 2014

Program Description:Palate surgery is the primary surgical approach for treatment of obstructive sleep apnea. Although uvulopalatopharyngoplasty (UPPP) was described 30 years ago, the past 10 to 15 years have witnessed the development of alternative palatoplasty techniques. This miniseminar draws from leading surgeons who have developed these procedures and/or performed clinical trials related to them. Findings from published studies will enable attendees to learn more about selection from among the procedures for their patients.Educational Objectives:(1) Interpret evidence regarding the range of palatoplasty techniques: UPPP, modified expansion sphincter pharyngoplasty (aka functional expansion pharyngoplasty), relocation pharyngoplasty, lateral pharyngoplasty, Z‐palatoplasty, and palatal advancement. (2) Identify the key patient characteristics to guide the selection among palate surgery techniques.
Persistently Elevated Parathyroid Hormone Despite Successful Parathyroid Surgery
Authors: Kim Anna , Duke William S. , Terris David J. 
Published: September 2014

Objectives:(1) Recognize that a number of patients with primary hyperparathyroidism will continue to manifest elevated parathyroid hormone (ePTH) despite achieving eucalcemia after curative parathyroidectomy. (2) Identify the preoperative factors that may contribute to this phenomenon. (3) Counsel patients and physicians regarding these factors to prevent unnecessary reoperative surgical procedures in response to postoperative elevated parathyroid hormone.Methods:Records of all patients who underwent curative primary surgery for single gland parathyroid adenomas at Georgia Regents Department of Otolaryngology Head and Neck Surgery between January 2009 and April 2013 were retrospectively reviewed. Patient demographic data and preoperative PTH, calcium, ionized calcium, 25‐OH‐vitamin D, creatinine, and glomerular filtration rate (GFR) levels were recorded, along with postoperative calcium, ionized calcium, and PTH levels. The values from patients with ePTH and normal PTH postoperatively were compared.Results:Of 119 patients meeting inclusion criteria, 30 (25.2%) demonstrated postoperative ePTH with eucalcemia. This group had significantly higher preoperative PTH (P =. 0021) and creatinine (P =. 0065) levels and a lower GFR (P =. 0016) than those with a normal postoperative PTH. The preoperative vitamin D level was not significantly associated with ePTH postoperatively (odds ratio [OR] = 1.56). Preoperative compromised renal function, specifically abnormal GFR (OR = 12.8), was significantly associated with ePTH postoperatively.Conclusions:The postoperative PTH levels remain elevated in 25.2% of patients achieving eucalcemia after surgery for primary hyperparathyroidism. This phenomenon was associated with compromised preoperative renal function. Physicians and patients must be aware of this condition to avoid subjecting patients to unnecessary further intervention.
Predictors of Adverse Events after Neck Dissection: An Analysis of the 2006 to 2011 NSQIP Data Sets
Authors: Somerville Jessica M. , Verhalen Jon , Samant Sandeep , Jain Umang , Kim John , Saha Sujata 
Published: September 2014

Objectives:Studies evaluating complications after neck dissection alone or in conjunction with other procedures are sparse. We looked for predictors of adverse events after neck dissection using the American College of Surgeons National Surgical Quality Improvement Program (ACS‐NSQIP), which tracks 30‐day complication rates in patients undergoing surgery at participating centers.Methods:In this retrospective review, 619 patients were identified using CPT codes specific for neck dissection. Clinical factors, comorbidities, epidemiologic factors, and procedure characteristics were analyzed with multiple regression to evaluate relationship to complication rates.Results:Twenty‐three percent of patients (142 of 619 patients) underwent neck dissection and experienced either a medical or surgical complication. Factors associated with adverse events included previous cardiac surgery (odds ratio [OR] 3.376, 95% confidence interval [CI] 1.084‐10.516, P =. 036), dyspnea (OR 2.568, 95% CI 1.06‐6.22, P =. 037), total work RVUs (OR 1.085, OR 1.041–1.131, P =. 001), and anesthesia time (OR 1.005, 95% CI 1‐1.009, P =. 036). Importantly, smoking, age, ASA class, and prior radiation or chemotherapy were not significant. Injury to accessory nerve and chyle leak are not specifically tracked in NSQIP.Conclusions:This study presents important benchmarks for medical and surgical complication rates, reoperation, and mortality observed with neck dissection in a large nationally abstracted patient sample. Cardiorespiratory morbidity and surgical complexity were found to be major drivers of complications. The true complication rates may be underrepresented due to inadequate tracking of procedure specific complications in NSQIP.
Relationship between Obesity, Diabetes, and the Risk of Thyroid Cancer
Authors: Oberman Benjamin S. , Khaku Aliasgher , Camacho Fabian , Goldenberg David 
Published: September 2014

Objectives:Analyze the relationship between obesity and type‐2 diabetes (DM‐II) and the development of differentiated thyroid cancer (DTC).Methods:Randomized case‐controlled retrospective chart review conducted for outpatient clinic patients between January 2005 and December 2012 at an academic medical center. Forty‐nine DTC patients were compared with 70 control group patients diagnosed with hyperparathyroidism with documented euthyroid state. Exposure variables consisted of the most recent body‐mass index (BMI) within 6 months prior to diagnosis of DTC and any report of DM‐II. Multivariate logistic regressions adjusting for sex, age, and year of body mass index (BMI) were used to assess the odds ratio of DTC with both BMI and DM‐II. No interventions were performed.Results:Comparison of means shows BMI was greater in patients with DTC (BMI = 37.83) than controls (30.36), P <. 0001, and DM‐II was more frequent in patients with DTC (29%) than controls (16%), P =. 08. The adjusted Odds Ratio for BMI was 1.12 (95% 1.06, 1.19, P <. 0002); the DM‐II adjusted Odds Ratio was 3.24 (95% 1.21, 8.70), P =. 0196. A Hosmer‐Ledeshow test did not detect misfit (p <. 05) in either model. The C‐value for the BMI model was 0.82 (bivariate = 0.81) and for the DM‐II model was 0.73.Conclusions:Our preliminary results show that obesity, and to a slightly lesser degree DM‐II, are significantly associated with DTC. BMI in particular was a strong predictive variable for DTC (C = 0.81 bivariate, C = 0.82 multivariate).
Robust Differences in Distant Metastases for p16 ± OPSCC: Implications for Future Targeted Therapy
Authors: Murrill Lauren L. , Jaber James J. , Mehta Vikas , Zender Chad A. , Kim Seungwon , Johnson Jonas T. 
Published: September 2014

Objectives:Historically, head and neck squamous cell carcinoma (HNSCC) has been considered a lymphatic malignancy with regional disease. Recently, this has been called into question. Our study aims to (1) illustrate the robust differences between p16+ and p16‐ oropharyngeal squamous cell carcinoma (OPSCC), and (2) provide circumstantial evidence that p16+ OPSCC has a predilection toward active vasculature invasion and hematogenous spread.Methods:A multi‐institutional, retrospective study of 1060 patients with OPSCC undergoing definitive treatment between 1979 and 2012. Patients were divided into 2 cohorts: p16+ and p16‐ OPSCC. Differences in distant metastases (DM) between the 2 cohorts were assessed for risk factors, rate and temporal differences, phenotypic behavior, and post‐DM progression‐free and disease‐specific survival.Results:Of the 1060 patients, 105 patients had DM. Thirty‐four were p16‐ and 71 were p16+. Full statistical analysis has yet to be completed, but preliminary findings conclude that of the p16‐ patients with DM, only 6% had disseminated disease (distant metastases at >1 site) as compared with 70% of p16+ patients with DM. Distant disease in p16+ patients included brain and unique bilateral lung findings.Conclusions:Our large, multi‐institutional study supports the previously reported claim that patients with p16+ OPSCC have a unique phenotypic disseminated behavior. This calls into question the belief that HNSCC is a lymphatic malignancy. Our data suggest that p16+ disease has a predilection toward active vasculature invasion evidenced by atypical end‐organ DM and dissemination profile. This study's findings coupled with data in the literature may have implications for future p16+ OPSCC targeted therapy.
The Role of Targeted Therapy and Oncogene Dependence on the PIK3CA Mutation
Authors: Wirtz Eric D. , Hoshino Daisuke , Weaver Alissa M. 
Published: September 2014

Objectives:(1) Determine the role of oncogene dependence on one of the more common and targetable oncogenes in head and neck squamous cell carcinoma (HNSCC) PIK3CA. (2) Evaluate the consequence of this oncogene on the effectiveness of newly developed targeted therapies.Methods:A basic science study was performed to test the hypothesis that PI3KCA hot spot mutations confer increased sensitivity or oncogene addiction to PI3K and related inhibitors. The PI3KCA hotspot mutations—E545K and H1047R—were engineered within the HNSCC cell line SCC25. Cell viability was measured using high throughput microscopy to determine the survivability cell lines expressing the hotspot mutations compared with control cell lines when treated with increasing concentrations of newly developed targeted therapies 17‐AAG, GDC‐0941, and Trametinib.Results:Surprisingly, hotspot E545K and H1047R mutations conferred increased rather than reduced survivability when treated with increased concentrations of the respective HSP90, PI3K, and MEK inhibitors, 17‐AAG, GDC‐0941, and Trametinib compared to the SCC25 control cell lines.Conclusions:(1) The PIK3CA mutations within our engineered cell model did not lead to oncogene dependent cell death when treated with targeted therapy including direct inhibition of the Phosphatidylinositol 3‐kinase (PI3K) enzyme. (2) Oncogene addiction to PIK3CA hot spot mutations, if it occurs, is likely to evolve in vivo in the context of additional molecular changes that remain to be identified.
Surgical Outcomes in Primary Parotid Cancer
Authors: Cannon Richard B. , Buchmann Luke O. , Terakedis Breanne E. , Hitchcock Ying J. , Hunt Jason P. 
Published: September 2014

Objectives:Surgeries performed for primary parotid malignancies vary, and the oncologic outcomes are undetermined. This study aims to: (1) Describe surgical outcomes of superficial versus total parotidectomy, and (2) describe surgical outcomes of observation versus cervical lymphadenectomy in patients with a N0 neck.Methods:Records of 129 consecutive patients with non‐metastatic primary parotid cancer treated from 1988 to 2010 at the University of Utah and Intermountain Healthcare were reviewed. Treatment was superficial (47%) or total (53%) parotidectomy, 31% underwent concurrent cervical lymphadenectomy, and 67% received adjuvant radiotherapy due to high‐risk features. Patient demographics, tumor characteristics, surgical treatments, and oncologic outcomes were statistically analyzed.Results:Average age at diagnosis was 52 years. Mean follow‐up was 7.4 years. Patient demographics, tumor grade, and histology were not predictive of recurrence or survival. Matching patients with Stage I/II disease (n = 74) and comparing superficial versus total parotidectomy, there was no difference in 5‐year disease free rate, and 5‐ and 10‐year overall survival rates (85%, 95%, and 88% versus 84%, 84% and 67%, respectively). Also, for Stage III (n = 18) and IV (n =33) disease there was no difference. For 101 patients with a N0 neck, 81 were observed and 20 underwent an elective cervical lymphadenectomy; there was no difference in outcomes (76%, 85%, and 72% versus 73%, 87%, and 67%, respectively).Conclusions:Treatment of primary parotid cancer requires meticulous surgical dissection and gross tumor resection; however, superficial versus total parotidectomy or observation versus elective cervical lymphadenectomy does not affect tumor recurrence rates or overall survival outcomes.
Transoral Surgery versus Primary Chemoradiation for Advanced Stage Head and Neck Squamous Cell Carcinoma
Authors: Lo Emily J. , Truelson John M. , Myers Larry L. , Nedzi Lucien , Yordy John , Hughes Randall , Sumer Baran D. 
Published: September 2014

Objectives:Compare functional and survival outcomes between patients with advanced stage head and neck squamous cell cancer (HNSCC) treated with primary transoral surgery versus primary chemotherapy and radiation.Methods:Retrospective case‐control trial at an academic tertiary referral center. We identified a surgical group (SG) comprised of 37 patients with previously untreated stage III and IV HNSCC who underwent either transoral robotic surgery (TORS) or transoral laser microsurgery (TLMS) and a nonsurgical group (NSG) of 75 patients treated with primary chemotherapy and radiation between July 2007 and November 2011. NSG was matched to SG by age, sex, tumor location, stage, tobacco and alcohol use, and ECOG status. Tracheostomy and percutaneous gastrostomy tube (PEG) rates during treatment and at follow‐up, as well as survival outcomes, were examined.Results:There were no statistically significant differences in the matched variables. Significantly fewer patients in the SG compared with the NSG still had PEG at follow‐up, 8% versus 25%, respectively (P =. 031). All patients in the SG versus 92% of the NSG were eventually decannulated. Seventy‐eight percent of the SG required postoperative radiation. The SG received an average radiation dose of 6164 ± 340 cGY versus 6854 ± 264 cGy for the NSG (P =. 001). Kaplan‐Meier analysis showed no significant difference in survival outcomes.Conclusions:Comparison between the primary transoral surgery and primary chemoradiation groups for treatment of advanced HNSCC demonstrates similar survival outcomes. Patients who undergo surgery receive significantly lower doses of radiation, and most are able to regain functional swallow and be successfully decannulated.
Widespread Vitamin D Deficiency in Patients Undergoing Thyroidectomy
Authors: Singer Michael C. , Chaudhary Hamad 
Published: September 2014

Objectives:Vitamin D deficiency is thought to increase the risk of symptomatic hypocalcemia after thyroidectomy. While often assessed after surgery in patients who develop hypocalcemia, many surgeons do not routinely evaluate vitamin D status preoperatively. This study (1) characterized the frequency preoperatively of vitamin D deficiency in patients undergoing thyroid surgery in the northern United States and (2) identified groups at increased risk of vitamin D deficiency.Methods:Case series with prospectively maintained database at an: academic medical center. Patients undergoing thyroid surgery between January and December 2013 were included. Preoperative 25‐hydroxy vitamin D, parathyroid hormone (PTH), and ionized calcium levels were obtained on all patients. Patients with 25‐hydroxy vitamin D levels less than 20 ng/mL were considered deficient and were repleted.Results:Of 110 patients who underwent thyroid surgery during the 12‐month study period, 44 (40%) were vitamin D deficient. A total of 33 out of 44 deficient patients had secondary hyperparathyroidism. Black and Hispanic patients (P =. 003), those undergoing surgery for hyperthyroidism (P =. 007), and patients under 50 years old were more likely to be deficient (P =. 01).Conclusions:While select groups are more susceptible, in the northern United States vitamin D deficiency is pervasive in patients undergoing thyroidectomy. Given its impact on postoperative calcium status, surgeons should consider routinely assessing preoperative vitamin D status and, if necessary, supplementation.