Josh Meier

Mammary analogue secretory carcinoma: Update on a new diagnosis of salivary gland malignancy

To review the known histopathologic findings and clinical behavior of mammary analogue secretory carcinoma (MASC).

Incidence and survival patterns of cranial chordoma in the United States

To determine trends in survival patterns for cranial chordoma in the United States.

EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis.

Health utility value (HUV) is an index used to measure health‐related quality of life for the valuation and comparison of treatments. The Euroqol 5‐Dimension (EQ‐5D) questionnaire is a widely used method for determining HUV, but it has not been applied for this purpose in patients with chronic rhinosinusitis (CRS) who undergo sinus surgery.

Incidence and survival patterns of sinonasal undifferentiated carcinoma in the United States.

Objective To determine trends in sinonasal undifferentiated carcinoma (SNUC) survival patterns in the United States. Design Retrospective review of national database. Participants All cases of SNUC in the National Cancer Institutes Surveillance Epidemiology and End Results program from 1973 to 2010 were examined. Main Outcome Measures Age-adjusted incidence and survival rates were calculated and stratified by demographic information and treatment modality. Cohort analysis was performed to analyze survival patterns over time. Results A total of 318 SNUC cases were identified. Age-adjusted incidence rate (IR) was 0.02 per 100,000. Incidence was greater in males (IR: 0.03) than females (IR: 0.01; p = 0.03). Overall 5- and 10-year relative survival rate was 34.9% and 31.3%, respectively. Overall median survival was 22.1 months. Median survival following surgery combined with radiation was 41.9 months. Five-year relative survival rate following surgery, radiation, or surgery combined with radiation was 38.7%, 36.0%, and 39.1%, respectively. Median survival from 1973-1986 and 1987-2010 was 14.5 and 23.5 months, respectively. Conclusions This study provides new data regarding survival patterns of SNUC in the United States, confirming survival benefit with surgery and radiation as well as identifying a trend toward improved survival in recent decades.

A new model for collection of clinical outcomes data in patients with chronic rhinosinusitis

The need for objective assessment of patient outcomes is becoming an essential component of clinical practice for both private and academic otolaryngologists. The purpose of this study is to describe the implementation of an online model for collection of clinical outcomes data in patients with chronic rhinosinusitis (CRS).

A validated model for the 22-item Sino-Nasal Outcome Test subdomain structure in chronic rhinosinusitis

Previous studies have identified subdomains of the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), reflecting distinct and largely independent categories of chronic rhinosinusitis (CRS) symptoms. However, no study has validated the subdomain structure of the SNOT‐22. This study aims to validate the existence of underlying symptom subdomains of the SNOT‐22 using confirmatory factor analysis (CFA) and to develop a subdomain model that practitioners and researchers can use to describe CRS symptomatology.

The impact of surgical trainee participation on sinus surgery outcomes.

To determine the effect of otolaryngology trainee participation on clinical outcomes in patients who undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis.

Delayed Endovascular Coil Extrusion following Internal Carotid Artery Embolization

Internal carotid artery injury is a rare and devastating complication of endoscopic sinus and skull base surgery that has an associated mortality rate of 15%. This case describes a patient who developed massive epistaxis following routine sinus surgery and was eventually diagnosed with a pseudoaneurysm of the cavernous internal carotid artery. Endovascular coiling and Onyx (Covidien, Irvine, California, United States) liquid embolization were ultimately used to completely occlude the internal carotid artery with resolution of bleeding; however, the patient had an unexpected late complication of coil extrusion through the pseudoaneurysm sac into the sphenoid sinus and nasal cavity. The endoscopic skull base team safely excised the coils endoscopically without recurrent bleeding. We describe the multidisciplinary operative management of this case of endovascular coil extrusion to increase awareness of this potentially life-threatening complication.

Skull base erosion and associated complications in sphenoid sinus fungal balls

Background Sphenoid sinus fungal balls (SSFB) are rare entities that can result in serious orbital and intracranial complications. There are few published reports of complications that result from SSFB. Objective To review the incidence of skull base erosion and orbital or intracranial complications in patients who present with SSFB. Methods A retrospective review was performed of all the patients with SSFB who were treated at the Massachusetts Eye and Ear Infirmary from 2006 to 2014. Presenting clinical data, radiology, operative reports, pathology, and postoperative course were reviewed. Results Forty-three patients with SSFB were identified. Demographic data were compared between patients with (39.5%) and those without (61.5%) skull base erosion. Two patients underwent emergent surgery for acute complications of SSFB (one patient with blindness, one patient who had a seizure). Both patients with acute complications had evidence of skull base erosion, whereas no patients with an intact skull base developed an orbital or intracranial complication (p = 0.15). All the patients were surgically managed via an endoscopic approach. Conclusion SSFBs are rare but may cause significant skull base erosion and potentially severe orbital and intracranial complications if not treated appropriately. Endoscopic sphenoidotomy is effective in treating SSFB and should be performed emergently in patients who presented with associated complications.

Emerging Innovative Topical Therapies

Chronic rhinosinusitis (CRS) represents a spectrum of disease with a common end result of sinonasal mucosal inflammation. The cause of the inflammation can be multifactorial, including infections and allergies. Although defined recommendations for optimal treatment are lacking, typical therapeutics include antibiotics and steroids in systemic and topical forms. Endoscopic sinus surgery is recommended when medical management fails. The benefits of sinus surgery in creating enlarged sinus ostia are twofold: optimization of drainage and deposition of topical therapies. Once exposed surgically, the air-filled sinus cavities are ideal for topical therapies, providing a larger surface area for distribution. Topical therapies are ideal for providing increased local drug concentration while decreasing systemic side effects. However, local mucosal irritation, physically challenging delivery methods, higher costs, and unclear pharmacokinetics provide limitation to their use (Rudmik et al., Int Forum Allergy Rhinol 3:281–298, 2013). Besides saline irrigation, common topical therapies include steroids and antibiotics, but alternative topical therapies have been investigated as an adjunct to these more standard therapies. Manuka honey, xylitol, and surfactants are three frequently used topical therapies that reportedly exert an anti-inflammatory or antimicrobial effect. This chapter will focus on these three alternative topical therapies and provide current data supporting or refuting their benefit in the treatment of CRS.