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Parotid Pleomorphic Adenoma and Apparent Diffusion Coefficient: A Novel Clinical Prediction Tool
Audrey Abend – Graham Keir – Karthik Krishnan – Jessica Kim – Sara Strauss – David Kutler
Abstract
Objective
Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. MRI is a non-invasive diagnostic tool, but its sensitivity and specificity varies. Incorporating diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) assessment may enhance preoperative diagnosis. Our primary objective was to determine if including these variables in a clinical tool would enhance the diagnostic utility of MRI.
Methods
A retrospective study was conducted at Weill Cornell Medical Center, including patients with parotid masses who underwent surgical resection and preoperative MRI (2006–2022). Patient and MRI characteristics, including ADC values, were analyzed to identify predictors of PA. A logistic regression model was developed and internally validated.
Results
Among 157 patients, 86 (55%) had PA. MRI sensitivity and specificity for PA were 56% and 96%, respectively. Key predictors of PA included higher ADC values (p < 0.001), T2 hyperintense signal (p = 0.006), lobulated tumor contour (p = 0.021), and absence of dumbbell shape (p = 0.047). The final model achieved a sensitivity of 83% and specificity of 82%, with an area under the curve of 0.87. False negatives were significantly associated with lower ADC values, qualitative diffusion restriction, non-uniform tumor enhancement pattern, and intermediate/hypointense T2 signal.
Conclusions
Qualitative MRI features combined with quantitative ADC values offer a non-invasive, accurate approach for diagnosing PA. The proposed clinical calculator enhances preoperative planning, though external validation is warranted.
Level of Evidence: 3.
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Promoting Diversity in Otolaryngology Residency Programs: Underrepresented in Medicine Funding for Visiting Medical Student Electives
Audrey M. Abend AB – Shaila T. Man – Li-Xing Man MSc, MD, MPA
Abstract
Objective
This study aims to report the prevalence and characteristics of underrepresented in medicine (URiM) funding for visiting medical student clerkships in Otolaryngology–Head and Neck Surgery (OHNS) residency programs in the United States.
Study Design
Manual online review of Accreditation Council for Graduate Medical Education (ACGME)-accredited OHNS residency programs as of January 2024, reflective of typical medical student search methodology.
Setting
An online review.
Methods
For each program, at least 2 authors captured presence of funding, the funding amount, funding origin, and eligibility criteria. Presence and amount funding were analyzed for possible associations with program type (by FREIDA™ program description), urbanization level, cost of living, and degree of racial and ethnic diversity in the program’s geographic location.
Results
Of 131 programs, 49 (37.4%) offered URiM funding, primarily through diversity, equity, and inclusion (DEI) entities (67.3%) or OHNS departments (32.7%). Mean funding per 1-month rotation was $1908. Eligibility criteria varied, with 63.2% using a non-specific URiM definition and 18.4% following the Association of American Medical Colleges definition. Funding presence did not differ by geographic region (P = .06), program type, urbanization level, or cost of living. However, funding amounts varied significantly by region (P < .01) and were significantly different between programs in diversity index 35.0% to 44.9% versus 45.0% to 54.9% and 55.0% to 64.9% (P = .007 and P = .002, respectively).
Conclusions
URiM funding is available in a minority of OHNS programs, with substantial variability in funding amount and eligibility criteria. Standardized guidance on defining URiM eligibility may benefit students and institutions. Funding may correlate with local racial and ethnic diversity, warranting further research.
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Evaluation of Sleep Stages During Drug-Induced Sleep Endoscopy in Pediatric Patients with Obstructive Sleep Apnea: A Pilot Study
Audrey Abend – Chase Hintelmann – Katherine H. Dinh – Darius Uknuis – Usman Shah – Maya Ramagopal – Kelvin Kwong
Abstract
Introduction
Drug-induced sleep endoscopy (DISE) is a valuable tool for the assessment of the upper airway in paediatric obstructive sleep apnoea (OSA). General anaesthesia induces sleep-like conditions during DISE; however, there is limited understanding of the neurophysiological aspects of this sleep. We conducted a prospective cohort pilot study recording electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) data in paediatric OSA patients during DISE.
Objectives
Demonstrate the safety and feasibility of collecting sleep stages during DISE in paediatric patients with OSA. Characterise sleep stages of paediatric OSA patients undergoing DISE.
Design
Prospective cohort pilot study.
Setting
Academic medical centre.
Participants
Patients between two (2) and 18 years old (inclusive) with a history of OSA and preoperative polysomnography (PSG) were recruited. Patients with known craniofacial abnormalities were excluded. Non-English or non-Spanish speaking subjects were excluded.
Results
We recruited 13 subjects aged 3 to 13 years old. EEG, EOG, and EMG data was collected during the DISE procedure. Raw data was scored by a board-certified sleep medicine physician. Six subjects experienced N1 sleep, 12 subjects experienced N2 sleep, and 5 subjects experienced N3 sleep. Most subjects spent the majority of their time in N2 sleep. No subjects experienced REM sleep. The primary intravenous sedative agent used was dexmedetomidine.
Conclusions
This pilot study gives the first insight into sleep stages of paediatric OSA patients undergoing DISE. Additional investigation of the neurophysiology and the effects of different intravenous anaesthetics during the DISE procedure is warranted.
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Characterizing the Impact of Facial Rehabilitation on Acute Facial Paralysis
Audrey Abend – Lauren Perillo – Jenna DeSimone – Danielle F Eytan
Abstract
Objective
Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores.
Methods
A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data.
Results
Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01).
Conclusions and Relevance
FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted.
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- https://pubmed.ncbi.nlm.nih.gov/38471659/
- https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2285-6557
https://www.researchgate.net/publication/378931774_Characterizing_the_Impact_of_Facial_Rehabilitation_on_Acute_Facial_Paralysis
https://discovery.researcher.life/article/characterizing-the-impact-of-facial-rehabilitation-on-acute-facial-paralysis/13edae9649f738d8803bcd888552d36d
https://ouci.dntb.gov.ua/en/works/4MWYAwB9/
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/a-2285-6557?device=mobile&innerWidth=980&offsetWidth=980
Characterizing Long-Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach
Ahmed Toure – Audrey Abend – Rachel S Lipsky – David I Kutler
Abstract
Objectives
Assess the frequency and severity of long-term swallowing and voice complaints, follow-up care, risk factors for the development of long-term swallowing and voice complications in patients who underwent anterior transcervical approach (ACA). (2) Determine incidence of long-term swallowing and voice complications requiring follow-up otolaryngologic care and assess the frequency of otolaryngologic follow-up for postoperative swallowing and voice complaints.
Methods
Retrospective cohort study of patients between January 2017 and March 2020 who underwent ACA. Demographic information, data from preoperative evaluation, operative records, and data from postoperative visits were collected. Patients were contacted to complete the Eating Assessment Tool and the “Impairment” subset of the Voice Symptoms Scale.
Results
A total of 48 patients (10.6%) followed up with a head and neck surgeon for swallowing complaints and 31 patients (6.8%) for voice complaints. Otolaryngology follow-up for swallowing complaints among patients with at least 3 and 12 months of follow-up was 16.4% and 17.8%, respectively. Otolaryngology follow-up for voice complaints among patients with at least 3 and 12 months of follow-up was 11.7% and 11.9%, respectively. Swallowing function was abnormal in 40.7% at least 3 months after surgery and in 41.8% 12 months after. Voice function was abnormal in 55.7% of respondents at least 3 months after surgery and in 54.5% of respondents 12 months after.
Conclusions
ACA is associated with otolaryngologic complications that include dysphagia and dysphonia. This study demonstrates that long-term swallowing and voice dysfunction appear to persist longer than what is noted by patient utilization of follow-up otolaryngologic care.
Level of evidence: 4 Laryngoscope, 134:3201-3205, 2024.
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- https://pubmed.ncbi.nlm.nih.gov/38366777/
https://onlinelibrary.wiley.com/doi/10.1002/lary.31340
https://onlinelibrary.wiley.com/doi/abs/10.1002/lary.31340
https://www.x-mol.net/paper/article/1760202861442732032
https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A12548333/detailv2?bquery=audrey%20abend&page=1
Chronic Rhinosinusitis With Nasal Polyposis Treated With Dupilumab: Real-World Use and Outcomes
Isaac L. Schmale – Alexander Poulakis – Audrey Abend – Martha E. Luitje – Li-Xing Man
Abstract
Background
Biologic medications are increasingly incorporated into chronic rhinosinusitis with nasal polyps (CRSwNP) management. However, little is known about prescribing patterns in real-world settings and how this relates to proposed international guidelines and outcomes.
Objectives
To characterize use patterns of dupilumab for CRSwNP better in relation to proposed guidelines and explore real-world outcomes.
Methods
We used the TriNetX Web-based tool to identify patients who were prescribed dupilumab for CRSwNP. Patients prescribed dupilumab for a CRSwNP indication were included for analysis. Dupilumab initiation criteria were determined via the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020).
Results
In total, 121 patients were identified who were prescribed dupilumab for a CRSwNP indication. Of these, 86 (71%) met EPOS2020 indications for biologic initiation and 35 (29%) did not. Overall, patients had significant improvements in the 22-item SinoNasal Outcome Test scores (mean improvement of 24.3 points) and nasal polyp scores (mean improvement of 1.0 point). However, 20 patients (30%) did not show meaningful improvement in the 22-item SinoNasal Outcome Test scores. Twenty-one patients (17%) failed a previous biologic attempt. Therapy was discontinued by six patients (5%) due to side effects, and by six (5%) owing to a lack of efficacy.
Conclusions
In our experience, patients prescribed dupilumab for CRSwNP frequently may not meet EPOS2020 Guidelines. Over 25% of those who do not meet criteria may not have CRSwNP. Overall, dupilumab use among well-selected patients appears to be safe and effective. Further real-world study of biologic use for CRSwNP will help improve its judicious use and identify populations who benefit most from biologic therapies.
Read the full article:
- https://pubmed.ncbi.nlm.nih.gov/37543087/
- https://www.sciencedirect.com/science/article/abs/pii/S2213219823008127
- https://www.researchgate.net/publication/372945890_Chronic_rhinosinusitis_with_nasal_polyposis_treated_with_dupilumab_real-world_use_and_outcomes
https://ouci.dntb.gov.ua/en/works/73LjN6q4/
https://ouci.dntb.gov.ua/en/works/42a2ene7/
https://www.jaci-inpractice.org/article/S2213-2198(23)00812-7/abstract
Real-world Outcomes of Dupilumab Therapy for Nasal Polyposis in Patients with Aspirin-Exacerbated Respiratory Disease
Isaac Schmale – Alexander Poulakis – Audrey Abend – Martha Luitje, MD – Li-Xing Man, MSc, MD, MPA
Rationale
Dupilumab has been integrated into the management of chronic rhinosinusitis with nasal polyposis (CRSwNP), but there is limited data regarding real-world use and sinonasal outcomes for patients with aspirin-exacerbated respiratory disease (AERD). The aim of this study is to investigate the sinonasal outcomes of dupilumab for patients with CRSwNP and coexistent AERD.
Methods
Data for patients with and without AERD prescribed dupilumab from 2018 to 2021 for nasal polyps and captured in the electronic medical record of the University of Rochester Medical Center was analyzed.
Results
Of the 131 CRSwNP patients identified, 56 (43%) also had a diagnosis of AERD. Within the cohort of AERD patients with complete SinoNasal Outcome Test (SNOT)-22 data, 24 (73%) met the minimal clinically important difference (MCID) of 8.9. Among those with complete nasal polyp scores (NPS), 21 (72%) had at least a 1.0 improvement. The mean improvement SNOT-22 and NPS were -22.3 and -1.3, respectively. Nineteen patients (34%) failed another biologic prior to starting dupilumab, but were just as likely to respond well to dupilumab compared to first-time biologic users (75% achieved MCID on SNOT-22 vs. 72%, p=0.865). Two patients (4%) discontinued treatment due to lack of perceived effect, and 4 (7%) discontinued due to intolerable side effects.
Conclusions
Real-world use of dupilumab appears to improve subjective and objective measures of CRSwNP control in AERD patients. For patients who failed another biologic, a switch to dupilumab was safe and similarly efficacious compared to the overall cohort.
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https://www.researchgate.net/publication/368269154_Real-world_Outcomes_of_Dupilumab_Therapy_for_Nasal_Polyposis_in_Patients_with_Aspirin-Exacerbated_Respiratory_Disease
https://www.jacionline.org/article/S0091-6749(22)02334-X/fulltext
- https://www.em-consulte.com/article/1570956/real-world-outcomes-of-dupilumab-therapy-for-nasal
Characterization of an Antimicrobial, Non-Ribosomal Lipopeptide from the Flavobacterium, Aquimarina muelleri
Audrey Abend
Abstract
The alarming prevalence of multi drug-resistant bacterial pathogens has made novel antimicrobial drug development a focal point for current molecular biology research. Specifically, researchers have targeted small molecule products of non- ribosomal peptide synthetase (NRPS) enzymes, which produce structurally diverse peptides and lipopeptides (LPs). Many current drugs in clinical use today originate from or are semi-synthetic forms of such small molecules. Thus, efforts to isolate new sources of these peptides have been focused on genome mining for secondary metabolite-producing biosynthetic gene clusters (BGCs) across bacterial genomes, in the hopes of identifying novel natural sources for antimicrobial small molecules. Though Actinobacteria have been studied extensively as prolific producers of such compounds, genetic analysis and bioassay-based research from the Donia Lab has shown species of the phylum Bacteroidetes are also rich in bioactive compounds. One such compound, a predicted lipopeptide, from the marine bacterium, Aquimarina muelleri, has shown remarkable broad-spectrum antibacterial activity in disc diffusion bioassays [1]. Here, we present results from ongoing research into the purification and characterization of the identified compound, in addition to preliminary genetic analyses into the predicted BGCs encoding for the peptide in the A. muelleri genome. Our research included large-scale cultivation of and extraction from A. muelleri, in addition to a series of chemical separation experiments utilizing both gravity flow columns and HPLC columns. We aimed to isolate as pure a concentrated sample of the target compound as possible (>95%) to be able to use high resolution nuclear magnetic resonance spectroscopy (NMR) to confirm the molecular structure of the lipopeptide. High resolution tandem mass spectrometry (MS/MS) analysis proved unprofitable, due to poor fragmentation. Currently, we have an approximately 80- 85% pure sample and are continuing purifications before NMR analysis.
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https://dataspace-staging.princeton.edu/handle/88435/dsp01j9602324m