Amin Mahmoodi

The Role of In-Office Ultrasound in the Diagnosis of Neck Masses:

To evaluate the efficacy of otolaryngologist-performed in-office ultrasound (US) in the clinical assessment of lateral neck masses, we performed a retrospective review of patients with lateral neck masses who had both a surgeon-performed US and US-guided fine-needle aspiration (USGFNA) at our tertiary academic center from 2012 to 2015. Fifty-nine patients were included. USGFNA results included 32 (54%) malignant lesions, 23 (39%) benign lesions, and 4 (6%) nondiagnostic lesions. USGFNA demonstrated 85% accuracy. In 22 (37%) patients, in-office US revealed additional findings that were not identified on physical examination (eg, nonpalpable lymph nodes or elucidated anatomical structures), which either assisted in surgical planning or altered treatment. In-office US and USGFNA on initial evaluation by the otolaryngologist augment physical examination and have potential value as the primary imaging and diagnostic modality in the workup of lateral neck masses.

The Utility of In-Office Ultrasound in the Diagnosis of Parotid Lesions.

Objective To determine whether the use of in-office ultrasound (US) by a head and neck surgeon is a useful adjunct to clinical assessment of parotid lesions and decrease the need of additional imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT). Study Design Case series with chart review. Setting Tertiary care academic center. Subjects Seventy patients presenting with a parotid lesion who obtained an in-office US and ultrasound-guided fine-needle aspiration (USGFNA) from a head and neck surgeon from 2006 to 2015. Methods US images were retrospectively reviewed for 70 patients and characterized by a radiologist and a head and neck surgeon. Results Of the 70 patients, 6 had US characteristics that demonstrated a statistically significant association with a benign/malignant diagnosis: depth from surface; irregular borders; presence of calcifications, which included either micro- or macro-calcifications; posterior echogenicity enhancement; irregular shape; and homogeneous/heterogeneous echotexture. Imaging was performed prior to referral in 25 cases (35.7%); of those, 17 (68%) were for superficial, small (<2 cm) tumors where prereferral imaging studies did not provide additional information to that obtained with US. Of the 55 patients without MRI or CT performed prior to referral, MRI or positron emission tomography–CT scan was obtained in only 4 patients (7.3%) in cases involving recurrent parotid lesions, large tumors, or workup of a malignant neoplasm. Conclusions Several US characteristics individually assist in lesion characterization. In-office US and USGFNA are an appropriate first-line modality in the assessment of parotid lesions, can allow for immediate parotid lesion assessment, and can decrease the need for additional imaging.

Functional and Histological Effects of Chronic Neural Electrode Implantation.

Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation.

Chronic Subdural Hematoma: A Perspective on Subdural Membranes and Dementia

OBJECTIVE To review the complex pathogenesis of the subdural membrane and the link between head trauma, dementia, and dural lymphatics. METHODS A thorough literature search of published English-language articles was performed using PubMed, Ovid, and Cochrane databases. RESULTS Chronic subdural hematoma (cSDH) is a common intracranial pathology and a leading cause of reversible dementia. cSDH is projected to affect at least 60,000 new individuals in the United States annually by 2030. This condition can result from mild to moderate head trauma that leads to hemorrhaging in the dura-arachnoid interface. The short-term and long-term effects of cSDH and the subdural membrane on the pathogenesis of dementia and the newly discovered dural lymphatics is a topic of increasing importance. CONCLUSIONS Further research into the possible link between traumatic brain injury and cSDH in particular and dural lymphatics and intracranial fluid dynamics is warranted.

Chronic Subdural Hematoma: A Historical and Clinical Perspective

BACKGROUND This review aims to highlight the clinical complexity of chronic subdural hematoma (cSDH) while presenting a brief historical discussion of cSDH. METHODS A thorough literature search of published English-language papers was performed in PubMed, Ovid, and Cochrane databases. RESULTS cSDH affects 1-5.3 per 100,000 individuals annually, with the incidence expected to rise as the U.S. population ages. The symptoms of cSDH are often nonspecific, with headaches being the most common complaint. Other symptoms include weakness, balance and gait problems, and memory problems. CONCLUSIONS A variety of clinical factors must be taken into account in the treatment of cSDH, and the multifaceted treatment paradigms continue to evolve.

Interactive iBook-Based Patient Education in a NeuroTrauma Clinic

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text‐based educational material. OBJECTIVE: To determine the effects of educational interventions in the outpatient setting on self‐reported patient knowledge, with a focus on iPad‐based (Apple, Cupertino, California) interactive modules. METHODS: Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS: All subjects (n = 152) significantly improved on self‐reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI). CONCLUSION: Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self‐reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeons recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

Use of interactive iBooks for patient education in otology

INTRODUCTION Physicians in the ambulatory setting face challenges in adequately educating patients in a brief office encounter. OBJECTIVE To evaluate the efficacy of an iPad-based interactive educational module (iBook) in various otologic pathologies. METHODS Patients presenting with symptoms of tinnitus, dizziness, hearing loss, or cochlear implant evaluation were included. In total, 44 patients received the iBook and 22 patients served as controls. Prior to viewing the iBook, patients completed a pre-survey to assess baseline knowledge. After viewing the iBook, patients completed a post-survey to assess changes in perception and knowledge of their disease. Results were compared to that of the control group who did not receive iBook supplementation prior to being seen by the physician. RESULTS Paired t-test analysis showed significant improvements (p<0.01) in both self-reported perception and concrete understanding in various concepts when compared to pre-iBook results. This was further compared to the control group, which showed a significant gain in factual knowledge (p=0.02). CONCLUSION Patients who viewed the iBook, personalized to their diagnosis, displayed significantly improved understanding of their condition. Increased use of interactive educational modalities, such as the iBook, can be of benefit to an otologic practice in improving patient education and satisfaction.

Interfacing with the nervous system: a review of current bioelectric technologies

The aim of this study is to discuss the state of the art with regard to established or promising bioelectric therapies meant to alter or control neurologic function. We present recent reports on bioelectric technologies that interface with the nervous system at three potential sites—(1) the end organ, (2) the peripheral nervous system, and (3) the central nervous system—while exploring practical and clinical considerations. A literature search was executed on PubMed, IEEE, and Web of Science databases. A review of the current literature was conducted to examine functional and histomorphological effects of neuroprosthetic interfaces with a focus on end-organ, peripheral, and central nervous system interfaces. Innovations in bioelectric technologies are providing increasing selectivity in stimulating distinct nerve fiber populations in order to activate discrete muscles. Significant advances in electrode array design focus on increasing selectivity, stability, and functionality of implantable neuroprosthetics. The application of neuroprosthetics to paretic nerves or even directly stimulating or recording from the central nervous system holds great potential in advancing the field of nerve and tissue bioelectric engineering and contributing to clinical care. Although current physiotherapeutic and surgical treatments seek to restore function, structure, or comfort, they bear significant limitations in enabling cosmetic or functional recovery. Instead, the introduction of bioelectric technology may play a role in the restoration of function in patients with neurologic deficits.

THE EFFICACY OF INTERACTIVE IBOOKS IN EDUCATING OLDER PATIENTS ON TBI, CONCUSSION, AND NPH

tered treatment at homewith an 810 nm intranasal device (13 mW) or sham equivalent. Memory and cognition were assessed using MMSE and ADAS-cog at Baseline, at Week 12; and follow-up after 4 weeks of no treatment. Results:Mean(SD) baseline MMSE and ADAS-cog scores were 18.4(9.37) and 32.1(21.41) in the active group, (n1⁄413, 10M, 3F) compared with 25.8(4.36) and 14.8(7.91) in the sham group (n1⁄46, 5M, 1F). Since these were significantly different (p<0.1 for both), data were analyzed by baseline MMSE. In the baseline MMSE 0-24 subgroup, Week 12 scores were significantly improved for the 8 participants on active treatment: MMSE increased 2.00 points (p1⁄40.03, 2-tailed) and ADAS-cog decreased 5.00 points (p1⁄40.03). The only sham participant in this subgroup dropped out before post-baseline assessment. Slight declines in performance were noted at follow-up after 4 weeks of no treatment. In the baseline MMSE 25-30 subgroup, mean changes at Week 12 in MMSE and ADAS-cog were 1.80 and -2.27 in the active group (n1⁄45), versus 1.50 and -3.67 in the sham group (n1⁄45). None of the within-group or between-group comparisons were statistically significant for this milder group. Qualitative feedback from participants and caregivers in the active group reported better sleep, fewer angry outbursts and decreased anxiety, and wandering. No adverse events related to treatment were reported. Conclusions: The large significant improvements in cognitive functioning, QoL and lack of adverse events suggest that PBM therapy may show promise in treatment of individuals experiencing dementia/AD.