James K. Liu

The use of the h-index in academic otolaryngology†

The h‐index is an objective and easily calculable measure that can be used to evaluate both the relevance and amount of scientific contributions of an individual author. Our objective was to examine how the h‐index of academic otolaryngologists relates with academic rank.

Surgery for Pediatric Subglottic Stenosis: Disease-Specific Outcomes

To set the foundation to develop a disease-based, operation-specific model to predict the outcome of pediatric airway reconstruction surgery, we performed a retrospective database review of children operated on at a single, tertiary-care childrens hospital. Over the 12-year period 1988 to 2000, a total of 1,296 airway reconstruction procedures were performed. Out of these, charts were identified for 199 children who underwent laryngotracheal reconstruction for a sole diagnosis of subglottic stenosis. Children were excluded from the study if their disorder included supraglottic, glottic, or upper tracheal disease. The main outcome measures were Myer-Cotton grade-specific decannulation and extubation rates, including both operation-specific and overall results. There were 101 children who underwent double-stage laryngotracheal reconstruction. The operation-specific decannulation rates for Myer-Cotton grades 2, 3, and 4 were 85% (18/21), 37% (23/61), and 50% (7/14) (χ2 analysis, p =.0007). The overall decannulation rates were 95% (20/21), 74% (45/61), and 86% (12/14) (χ2 analysis, p =.04). There were 98 children who underwent single-stage laryngotracheal reconstruction. The operation-specific extubation rates for Myer-Cotton grades 2, 3, and 4 were 82% (37/45), 79% (34/43), and 67% (2/3) (χ2 analysis, p =.63). The overall extubation rates were 100% (45/45), 86% (37/43), and 100% (3/3) (χ2 analysis, p =.03). Logistic regression analysis showed no effect of age (less than or greater than 2 years of age) on operation-specific or overall outcome parameters. We conclude that laryngotracheal reconstruction for pediatric subglottic stenosis remains a challenging set of procedures in which multiple operations may be required to achieve eventual extubation or decannulation. Children with Myer-Cotton grade 3 or 4 disease continue to represent a significant challenge, and refinements of techniques are being examined to address this subset of children. Disease-based, operation-specific outcome statistics are the first step in the development of a meaningful predictive model.

A gender-based comparison of academic rank and scholarly productivity in academic neurological surgery

The number of women pursuing training opportunities in neurological surgery has increased, although they are still underrepresented at senior positions relative to junior academic ranks. Research productivity is an important component of the academic advancement process. We sought to use the h-index, a bibliometric previously analyzed among neurological surgeons, to evaluate whether there are gender differences in academic rank and research productivity among academic neurological surgeons. The h-index was calculated for 1052 academic neurological surgeons from 84 institutions, and organized by gender and academic rank. Overall men had statistically higher research productivity (mean 13.3) than their female colleagues (mean 9.5), as measured by the h-index, in the overall sample (p<0.0007). When separating by academic rank, there were no statistical differences (p>0.05) in h-index at the assistant professor (mean 7.2 male, 6.3 female), associate professor (11.2 male, 10.8 female), and professor (20.0 male, 18.0 female) levels based on gender. There was insufficient data to determine significance at the chairperson rank, as there was only one female chairperson. Although overall gender differences in scholarly productivity were detected, these differences did not reach statistical significance upon controlling for academic rank. Women were grossly underrepresented at the level of chairpersons in this sample of 1052 academic neurological surgeons, likely a result of the low proportion of females in this specialty. Future studies may be needed to investigate gender-specific research trends for neurosurgical residents, a cohort that in recent years has seen increased representation by women.

High-resolution computed tomography analysis of the prevalence of onodi cells†‡

Onodi cells are the posterior‐most ethmoid air cells that lie superior to the sphenoid sinus. Identification of these cells is essential prior to endoscopic sinus and skull base surgery due to their intricate relationship with the optic nerves and carotid arteries, which may lead to deleterious complications. In this study, high‐resolution computed tomography (HRCT) scans from 170 adult‐patients were analyzed by two independent observers for the presence of Onodi cells.

Sinonasal malignancies: A population-based analysis of site-specific incidence and survival

Sinonasal malignancies vary in behavior according to histology and anatomical location. Incidence, survival, and optimal treatment for these lesions are thus uncertain in various cases. Our objective was to utilize a national population‐based registry to identify the most common sinonasal histopathologies by anatomical site, and subsequently analyze the data by incidence trends, survival rates, patient demographics, and treatment modalities.

Endoscopic Versus Microsurgical Resection of Colloid Cysts: A Systematic Review and Meta-Analysis of 1278 Patients

OBJECTIVE Colloid cysts of the third ventricle have been successfully treated with transcranial microsurgical approaches. However, the endoscopic approach has recently been advocated as a lesser invasive technique. We conducted a systematic review and meta-analysis of published studies to compare the outcomes between the two approaches. METHODS A PubMED search of contemporary literature (1990-2014) was performed to identify surgical series of open and endoscopic treatment of colloid cysts. Relevant articles were identified and data were extracted concerning surgical treatment, extent of resection, and outcomes. RESULTS A meta-analysis was performed for recurrence rates based on treatment strategy. A total of 583 patients were included in the microsurgical group, and 695 patients in the endoscopic group. The microsurgical approach was found to have a significantly higher gross total resection rate (96.8% vs. 58.2%; P < 0.0001), lower recurrence rate (1.48% vs. 3.91%; P = 0.0003), and lower reoperation rate (0.38% vs. 3.0%; P = 0.0006) compared with the endoscopic group. There was no significant difference in mortality rate (1.4% vs. 0.6%) or shunt dependency (6.2% vs. 3.9%) between the two groups. The overall morbidity rate was lower in the endoscopic group (10.5%) than in the microsurgery group (16.3%). Within the microsurgery group, the transcallosal approach had a lower overall morbidity rate (14.4%) than the transcortical approach (24.5%). CONCLUSIONS Microsurgical resection of colloid cysts is associated with a higher rate of complete resection, lower rate of recurrence, and fewer reoperations than with endoscopic removal. However, the rate of morbidity is higher with microsurgery than with endoscopy.

Meningitis and legal liability: An otolaryngology perspective ☆ ☆☆

PURPOSE Meningitis is a potential complication in otolaryngologic procedures and conditions. Severe sequelae make understanding factors involved in relevant malpractice litigation critical. We analyze pertinent litigation for awards, outcomes, patient demographic factors, and other alleged causes of malpractice. METHODS Pertinent jury verdict and settlement reports were examined using the Westlaw legal database (Thomson Reuters, New York, NY). RESULTS Twenty-three cases (60.5%) involved non-iatrogenic injuries, including inadequate treatment or failure to diagnose sinusitis or otitis media, while 15 (39.5%) involved iatrogenic cases, mostly rhinologic procedures. 36.8% of cases were resolved for the defendant, 28.9% with juries awarding damages, and 34.2% with settlements. Although not statistically significant, mean damages awarded were higher than settlements (

Internal carotid artery injury in endoscopic endonasal surgery: A systematic review

2.1 vs. 1.5M, p=0.056), and cases involving pediatric patients were more likely to be resolved with payment than those with adult litigants (80.0% vs. 52.2%, p=0.08 respectively). Other frequent alleged factors included permanent deficits (63.2%), requiring additional surgery (41.1%), death (34.2%), cognitive deficits (21.2%), deafness (15.8%), and inadequate informed consent (33.0% of iatrogenic cases). CONCLUSIONS Practitioners facing litigation related to meningitis may wish to consider these findings, notably for cases involving death or permanent functional deficits, as cases with out of court settlements tended to be resolved with lower payments. Cases involving misdiagnosis may be more likely to be resolved with payment compared with iatrogenic cases. By understanding the issues detailed in this analysis and including them in the informed consent process for patients undergoing rhinologic and otologic procedures, otolaryngologists may potentially improve patient safety and decrease liability.

Update on prolactinomas. Part 2: Treatment and management strategies

Internal carotid artery (ICA) injury during endoscopic endonasal surgery (EES) is a known and feared complication of paranasal sinus and skull base procedures. These ICA injuries can result in stroke, cranial nerve palsies, and death. This review examines the setting of injury along with the treatment approaches, and patient outcomes.

Update on prolactinomas. Part 1: Clinical manifestations and diagnostic challenges

The authors present an update on the various treatment modalities and discuss management strategies for prolactinomas. Prolactinomas are the most common type of functional pituitary tumor. Effective hyperprolactinemia treatment is of great importance, due to its potential deleterious effects including infertility, gonadal dysfunction and osteoporosis. Dopamine agonist therapy is the first line of treatment for prolactinomas because of its effectiveness in normalizing serum prolactin levels and shrinking tumor size. Though withdrawal of dopamine agonist treatment is safe and may be implemented following certain recommendations, recurrence of disease after cessation of the drug occurs in a substantial proportion of patients. Concerns regarding the safety of dopamine agonists have been raised, but its safety profile remains high, allowing its use during pregnancy. Surgery is typically indicated for patients who are resistant to medical therapy or intolerant of its adverse side effects, or are experiencing progressive tumor growth. Surgical resection can also be considered as a primary treatment for those with smaller focal tumors where a biochemical cure can be expected as an alternative to lifelong dopamine agonist treatment. Stereotactic radiosurgery also serves as an option for those refractory to medical and surgical therapy.