Karam W. Badran

Vestibular Schwannoma Excision in Sporadic versus Neurofibromatosis Type 2 Populations

Objective To understand the differences in characteristics of neurofibromatosis type 2 (NF2) and sporadic patients with surgically excised vestibular schwannomas in the state of California. Study Design Cross-sectional. Setting, Subjects, and Methods The records of all patients who underwent vestibular schwannoma excision between 1997 and 2011 were extracted from the California Hospital Inpatient Discharge Databases (CHIDD). NF2 cases were identified using ICD-9-CM diagnosis code 237.72, neurofibromatosis, type 2. All other cases were recoded as sporadic. Trends in total number and population-adjusted rates (per 1 million California residents) of surgery, demographics, hospital case volume, state of residency, complications, length of stay, total charges, expected source of payment, and disposition were examined. Results Vestibular schwannoma (VS) excision was performed on 7017 patients, of which 464 patients (6.6%) had NF2. The population-adjusted surgery rate declined from 11.8 to 6.2 (P < .001) for sporadic cases and from 0.3 to 0.2 (P = .01) for NF2 cases over the study period. NF2 was associated with younger age (mean, 32.9 vs 51.3), higher rate of other complications (8.8% vs 4.4%) and facial nerve complications (32.3% vs 16.8%), higher total charges (median

Ex Vivo Electromechanical Reshaping of Costal Cartilage in the New Zealand White Rabbit Model

70,106 vs

Higher antineutrophil cytoplasmic antibody (C-ANCA) titers are associated with increased overall healthcare use in patients with sinonasal manifestations of granulomatosis with polyangiitis (GPA).

46,395), longer stay (median 5 vs 4), and high volume hospitals (80.4% vs 48.8%) (all P < .001). Conclusion The surgery rates for vestibular schwannoma excision for both sporadic and NF2 patients have declined, but the decline is more prominent for sporadic cases. NF2 patients tend to be younger and have a longer hospitalization and possibly higher corresponding hospital charges compared to patients with sporadic VS.

Epidemiology of Nasopharyngeal Lymphoma in the United States: A Population-Based Analysis of 1119 Cases

Determine the effective electromechanical reshaping (EMR) parameters for shape change and cell viability in the ex vivo rabbit costal cartilage model.

Improving applicant selection: Identifying qualities of the unsuccessful otolaryngology resident

Background Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous airway inflammation and vasculitis. Sinonasal involvement occurs in more than 80% cases, with antineutrophil cytoplasmic antibody (C-ANCA) titers used as a marker of disease severity. The purpose of this study was to determine whether C-ANCA levels impact radiographic findings and healthcare use in patients with sinonasal GPA. Methods A retrospective review was performed on GPA patients evaluated in a multidisciplinary rheumatologic/otolaryngologic clinic from 2008 to 2013. Data were collected with respect to age, gender, clinical presentation, C-ANCA titers, Lund-Mackay (LM) scores, surgical interventions, and healthcare use, the latter of which were determined by assessing the number of rheumatology/otolaryngology clinic visits, computed tomography (CT) scans, and email/telephone encounters. Results A total of 44 patients were identified, 11 male and 33 female. Sinonasal manifestations were evident in 70.4%, with chronic rhinosinusitis (CRS) (41.9%), septal perforation (38.7%), and crusting (32.2%) the most common findings. No significant differences in number of CT scans (p = 0.10) or mean LM scores (p = 0.47) were found between patients with more than or equal to 1:80 and less than 1:80 C-ANCA titers, respectively. However, overall healthcare use was increased in the more than or equal to 1:80 C-ANCA group (n = 28) compared with less than 1:80 (n = 16), with a significantly greater number of rheumatologic/otolaryngologic encounters (mean 121 versus 69.2, p = 0.03) noted. When otolaryngologic healthcare use was specifically examined, the average number of encounters was also higher in more than or equal to 1:80 C-ANCA patients (31.9 versus 22.9), but this difference was not statistically significant (p = 0.16). Conclusion Sinonasal GPA patients with presenting C-ANCA titers more than or equal to 1:80 demonstrated significantly greater overall healthcare use than their lower C-ANCA level counterparts (less than 1:80). However, no significant differences in otolaryngology resource use or LM scores were evident between the two titer groups.

Systematic Assessment of Noise Amplitude Generated by Toys Intended for Young Children

Objectives To describe the incidence and determinants of survival of patients with nasopharyngeal lymphoma (NPL) between 1973 and 2012 using the Surveillance, Epidemiology, and End Results (SEER) database. Study Design Retrospective cohort study using a national database. Methods The SEER registry was used to calculate survival trends for patients with NPL between 1973 and 2012. Patient data were then analyzed with respect to histopathology, age, sex, race, histologic subtype, Ann Arbor stage, and whether radiation therapy was given. Overall survival (OS) and disease-specific survival (DSS) were calculated. Results A total of 1119 cases of NPL were identified. The cohort was composed of 58.8% males. The mean age at diagnosis was 59.3 years. The median OS was 8.2 years. B-cell non-Hodgkin’s lymphomas (NHLs) accounted for most cases (77.5%), with natural killer (NK)/T-cell lymphomas comprising 6.0% of cases. A total of 41.5% patients received radiation therapy. OS at 2, 5, and 10 years was 70%, 57%, and 45%, respectively. On multivariate analysis, advanced age and NK/T-cell NHL histologic subtype were associated with worse OS and DSS, while radiation therapy was associated with improved OS and DSS (all P < .05). Conclusion With the exception of NK/T-cell NHL subtypes, NPL is associated with a fair prognosis, with younger age, low Ann Arbor stage, and radiation therapy being independent positive prognosticators for survival.

Long‐term in vivo electromechanical reshaping for auricular reconstruction in the New Zealand white rabbit model

To identify the prevalence and management of problematic residents. Additionally, we hope to identify the factors associated with successful remediation of unsuccessful otolaryngology residents.

The Rabbit Costal Cartilage Reconstructive Surgical Model

Objective To systematically evaluate the noise generated by toys targeted for children and to compare the results over the course of 4 consecutive holiday shopping seasons. Study Design Experimental study. Setting Academic medical center. Subjects and Methods During 2008-2011, more than 200 toys marketed for children older than 6 months were screened for loudness. The toys with sound output of more than 80 dBA at speaker level were retested in a soundproof audiometry booth. The generated sound amplitude of each toy was measured at speaker level and at 30 cm away from the speaker. Results Ninety different toys were analyzed. The mean (SD) noise amplitude was 100 (8) dBA (range, 80-121 dBA) at the speaker level and 80 (11) dBA (range, 60-109 dBA) at 30 cm away from the speaker. Eighty-eight (98%) had more than an 85-dBA noise amplitude at speaker level, whereas 19 (26%) had more than an 85-dBA noise amplitude at a 30-cm distance. Only the mean noise amplitude at 30 cm significantly declined during the studied period (P < .001). There was no significant difference in mean noise amplitude of different toys specified for different age groups. Conclusion Our findings demonstrate the persistence of extremely loud toys marketed for very young children. Acoustic trauma from toys remains a potential risk factor for noise-induced hearing loss in this age group, warranting promotion of public awareness and regulatory considerations for manufacture and marketing of toys.

Is multidisciplinary team care for head and neck cancer worth it

To demonstrate the dosimetry effect of electromechanical reshaping (EMR) on cartilage shape change, structural integrity, cellular viability, and remodeling of grafts in an in vivo long‐term animal model.

Minor Salivary Gland Carcinoma of the Oropharynx: A Population-Based Analysis of 1426 Patients.

Rib grafts in facial plastic surgery are becoming more frequently used. Small animal models, although not ideal may be used to emulate costal cartilage-based procedures. A surgical characterization of this tissue will assist future research in the selection of appropriate costal segments, based on quantitative and qualitative properties. The objective of this study is to assess the surgical anatomy of the rabbit costal margin and evaluate costal cartilage for use in either in vivo or ex vivo studies and to examine reconstructive procedures. Detailed thoracic dissections of 21 New Zealand white rabbits were performed post-mortem. Costal cartilage of true, false, and floating ribs were harvested. The length, thickness, and width at proximal, medial, and distal locations of the cartilage, with perichondrium intact were measured. Further qualitative observation and digital images of curvature, flexibility, and segmental cross-sectional shape were recorded. The main outcome measure(s) is to characterize, describe, and assess the consistency of dimensions, location, and shape of costal cartilage. In this study, 12 to 13 ribs encase the thoracic cavity. Cartilage from true ribs has an average length, width, and depth of 23.75 ± 0.662, 3.02 ± 0.025, and 2.18 ± 0.018 mm, respectively. The cartilage from false ribs has an average length, width, and depth of 41.97 ± 1.48, 2.00 ± 0.07, 1.19 ± 0.03 mm, and that of floating ribs are 7.66 ± 0.29, 1.98 ± 0.04, and 0.96 ± 0.03 mm. Rib 8 is found to be the longest costal cartilage (49.10 ± 0.64 mm), with the widest and thickest at ribs 1 (3.91 ± 0.08 mm) and 6 (2.41 ± 0.11 mm), respectively. Cross-sectional segments reveal the distal cartilage to maintain an hourglass shape that broadens to become circular and eventually ovoid at the costochondral junction. The New Zealand white rabbit is a practical source of costal cartilage that is of sufficient size and reproducibility to use in surgical research where the long-term effects of operations, therapies, devices, and pharmacologic on cartilage can be studied in vivo.