Andrew B. Baker

Malignant Otitis Externa: A Novel Stratification Protocol for Predicting Treatment Outcomes.

Objectives: 1) Stratify malignant otitis externa into severe and nonsevere disease categories. 2) Predict treatment courses and outcomes based on this stratification. Setting: Tertiary center. Patients: Retrospective review 2004 to 2014; 28 patients. Inclusion criteria are a diagnosis by senior authors, radiographic evidence of disease, admission for intravenous antibiotics/debridement, minimum 1 year of follow-up. Interventions: Severe group stratification if two or more of the following: cranial nerve VII palsy, fungal positive culture, relapse, surgery performed, major radiographic findings. All other patients stratified to nonsevere group. Main Outcome Measures: Cure, alive/refractory disease, death by disease, death by other cause. Secondary measures are antibiotic duration and number of disease-related admissions. Results: Forty-three percent (12 of 28) and 57% (16 of 28) of patients stratified into the severe and nonsevere groups. The severe group had significantly more adverse disease-specific outcomes than the nonsevere group (7 of 12 versus 0 of 16; p = 0.002). Disease-specific mortality was 42% and 0% in the severe and nonsevere groups, respectively. The severe group had longer antibiotic courses (12.8 versus 6.9 wk; p = 0.01) and more disease-related admissions/relapses (1.6 versus 1, p < 0.001). Only four of 12 severe group patients achieved cure. All but two nonsevere patients achieved cure, with those two dying of other causes. Conclusion: A subgroup of malignant otitis externa may exist that is not as susceptible to parenteral antibiotics and local debridement. A combination of clinical and radiographic findings may be useful for stratifying patients into severe/nonsevere categories. Patients with severe disease may be more likely to die of their disease and have worse treatment courses such that additional surgical intervention may be indicated.

Multi-institutional study of risk factors for perioperative morbidity following transnasal endoscopic pituitary adenoma surgery

The goal of this study was to identify preoperative risk factors associated with increased perioperative morbidity after endoscopic pituitary surgery.

Upper airway stimulation for obstructive sleep apnea: The surgical learning curve

To determine the effect of surgeon experience with an upper airway stimulation (UAS) system on surgical time and complication rates.

Predictors of 30-day morbidity and mortality in transnasal microscopic pituitary tumor excision.

There is a lack of population‐based, multi‐institutional analyses of factors associated with morbidity and mortality following pituitary tumor excision.

Factors impacting cerebrospinal fluid leak rates in endoscopic sellar surgery

In patients undergoing transnasal endoscopic sellar surgery, an analysis of risk factors and predictors of intraoperative and postoperative cerebrospinal fluid leak (CSF) would provide important prognostic information.

Ossiculoplasty With Titanium Prostheses in Patients With Intact Stapes: Comparison of TORP Versus PORP.

Objectives: Inferior rotation of the stapes or a small middle ear cleft can make placement of partial ossicular replacement prostheses (PORP) challenging. This study examines outcomes of total titanium prosthesis (TORP) ossiculoplasty in such patients and compares the results to PORPs. Study Design: Review of prospective database. Setting: Tertiary hospital. Patients: Patients with an intact/mobile stapes undergoing titanium ossicular chain reconstruction from 2002 to 2014. Intervention: Ossicular chain reconstruction. Outcomes: Hearing outcomes included ABG, closure of ABG(&Dgr;ABG), SRT, improvement in SRT(&Dgr;SRT), achievement of ABG ⩽20 dB, and stability over time. Results: Eighty-three patients were included; 56 were PORPs and 27 were TORPs. At initial follow-up (<6 mo), mean ABG and &Dgr;ABG in the TORP group were 20.6 and 11.7 dB, respectively. Postoperative ABG⩽20 dB was achieved in 60.0% of TORPs. At longer-term follow-up (mean 54.0 mo), hearing remained stable in TORPs. Specifically, the mean ABG and &Dgr;ABG were 17.7 and 13.3 dB, respectively. Sixty-three percent of TORPs achieved ABG ⩽20 dB at later follow-up. When compared PORPs at both short and longer-term follow-ups, no differences in hearing outcomes were noted. A small, but statistically significant, deterioration in both ABG and SRT was observed within the PORP group (p = 0.02 and <0.01, respectively). Conclusion: TORP reconstruction in patients with an intact stapes is associated with good short and longer-term hearing results. Furthermore, hearing outcomes within TORPs remain stable at follow-up >12 months postoperatively. Results did not differ when compared with traditional PORP reconstruction, suggesting that TORP through an intact stapes arch is an acceptable alternative to PORP reconstruction in patients with challenging anatomy.

Successful repair of intraoperative cerebrospinal fluid leaks improves outcomes in endoscopic skull base surgery

The impact of failed cerebrospinal fluid leak (CSF) leak repair in endoscopic skull base surgery has not been adequately studied.

Impact of resident involvement in outpatient otolaryngology procedures: An analysis of 17,647 cases

This study examines the impact of resident physician participation on postoperative outcomes in outpatient otolaryngologic surgery.

Uvulopalatopharyngoplasty Does Multilevel Surgery Increase Risk

Objectives (1) Determine the rate of postoperative complications, reoperation, readmission, and death after uvulopalatopharyngoplasty (UPPP) for sleep apnea through multi-institutional clinical data. (2) Compare outcomes of UPPP between multilevel and single-level procedures for the treatment of sleep apnea. Study Design Retrospective database analysis. Methods The American College of Surgeons National Surgical Quality Improvement Program—a nationally validated, prospective, multi-institutional database from 2005 to 2013—was analyzed for patients who underwent UPPP, per corresponding Current Procedural Terminology codes. Patients were categorized into 3 groups: UPPP alone, UPPP + nasal cavity (NC), and UPPP + base of tongue (BOT). Perioperative outcome measures of interest include surgical/medical complications, reoperation, readmission, and death. Comparisons were made among surgical groups through univariate cross-sectional analysis. Results A total of 1079 patients underwent UPPP; 413 patients had UPPP + NC; and 200 patients had UPPP + BOT procedures. One death was reported for the entire cohort of patients. Among all 3 groups (UPPP, UPPP + NC, and UPPP + BOT), no differences were noted in the rates of medical complications (P = .445), surgical complications (P = .396), reoperation (P = .332), and readmission (P = .447). However, the length of hospital stay in days was greatest for the UPPP + BOT group (UPPP, 0.81 ± 0.69; UPPP + NC, 0.87 ± 0.90; UPPP + BOT, 1.50 ± 2.70; P < .001). Conclusion These national data demonstrate no significant increase in risk when UPPP is performed as a single- or multilevel procedure. When indicated, UPPP with multilevel procedures may be safely performed for treatment of sleep apnea. These data set a benchmark for perioperative risk in UPPP surgery and will prove useful for counseling patients.OBJECTIVES (1) Determine the rate of postoperative complications, reoperation, readmission, and death after uvulopalatopharyngoplasty (UPPP) for sleep apnea through multi-institutional clinical data. (2) Compare outcomes of UPPP between multilevel and single-level procedures for the treatment of sleep apnea. STUDY DESIGN Retrospective database analysis. METHODS The American College of Surgeons National Surgical Quality Improvement Program-a nationally validated, prospective, multi-institutional database from 2005 to 2013-was analyzed for patients who underwent UPPP, per corresponding Current Procedural Terminology codes. Patients were categorized into 3 groups: UPPP alone, UPPP + nasal cavity (NC), and UPPP + base of tongue (BOT). Perioperative outcome measures of interest include surgical/medical complications, reoperation, readmission, and death. Comparisons were made among surgical groups through univariate cross-sectional analysis. RESULTS A total of 1079 patients underwent UPPP; 413 patients had UPPP + NC; and 200 patients had UPPP + BOT procedures. One death was reported for the entire cohort of patients. Among all 3 groups (UPPP, UPPP + NC, and UPPP + BOT), no differences were noted in the rates of medical complications (P = .445), surgical complications (P = .396), reoperation (P = .332), and readmission (P = .447). However, the length of hospital stay in days was greatest for the UPPP + BOT group (UPPP, 0.81 ± 0.69; UPPP + NC, 0.87 ± 0.90; UPPP + BOT, 1.50 ± 2.70; P < .001). CONCLUSION These national data demonstrate no significant increase in risk when UPPP is performed as a single- or multilevel procedure. When indicated, UPPP with multilevel procedures may be safely performed for treatment of sleep apnea. These data set a benchmark for perioperative risk in UPPP surgery and will prove useful for counseling patients.

Prognostic Factors in Myoepithelial Carcinoma of the Major Salivary Glands

Objectives (1) Identify all cases of myoepithelial carcinoma of the major salivary glands from the National Cancer Data Base (NCDB). (2) Analyze the effect of grade, stage, and regional nodal metastasis on survival in myoepithelial carcinoma of the major salivary glands. Study Design Retrospective review of NCDB. Setting Multicenter data pooled from 1998 to 2012 in the NCDB. Methods We identified all reported cases of myoepithelial carcinomas of the major salivary glands from the United States from 1998 to 2012 in the NCDB. Clinical parameters were then examined and analyzed for predictors of survival. Results A total of 473 cases of myoepithelial carcinoma were identified. Of the reported cases, 38.1% were low grade; 26.7%, intermediate grade; and 35.2%, high grade. When presenting stage was examined, 24.4% were stage I; 30.6%, stage II; 22.5%, stage III; 12.2%, stage IVa; 3.0%, stage IVb; and 4.1%, stage IVc. At presentation, 18.7% of patients had regional nodal disease, and 4.5% had distant metastases. The 3- and 5-year survival rates were 73% and 64%, respectively. The presence of nodal disease significantly reduced mean survival time versus those without (64 vs 108 months, P < .001), as did high-grade disease compared with low grade (67 vs 114 months, P < .001) and stage III/IV compared with stage I/II disease (61 vs 118 months, P < .001). Conclusions The presence of regional nodal disease, high-grade disease, and advanced stage are predictors of lower survival in myoepithelial carcinoma. Further studies based on types of treatment are warranted.