Kevin J. Choi

Characterizing Airflow Profile in the Postoperative Maxillary Sinus by Using Computational Fluid Dynamics Modeling: A Pilot Study:

Background Maxillary antrostomy is commonly performed during endoscopic sinus surgery. Little is known about the association surrounding recalcitrant maxillary sinusitis, antrostomy size, and intranasal airflow changes. Furthermore, the interaction between sinus mucosa and airflow is poorly understood. This study used computational fluid dynamics (CFD) modeling to investigate postoperative airflow characteristics between diseased and nondiseased maxillary sinuses in subjects with recurrent disease. Methods A retrospective review of patients from a tertiary-level academic rhinology practice was performed. Seven subjects with endoscopic evidence of postoperative maxillary sinus disease that presented as chronic unilateral crusting at least 1 year after bilateral maxillary antrostomies were selected. A three-dimensional model of each subjects sinonasal cavity was created from postoperative computed tomographies and used for CFD analysis. Results Although the variables investigated between diseased and nondiseased sides were not statistically significant, the diseased side in six subjects had a smaller antrostomy, and five of these subjects had both reduced nasal unilateral airflow and increased unilateral nasal resistance on the diseased side. The ratio of posterior wall shear stress (WSS) of the maxillary sinus to the total WSS was higher on the diseased side in six subjects. Results also showed strong correlations between antrostomy and CFD variables on the diseased side than on the nondiseased side. Conclusion This pilot study showed that the majority of the simulated sinonasal models exhibited common characteristics on the side with persistent disease, such as smaller antrostomy, reduced nasal airflow, increased nasal resistance, and increased posterior WSS. Although statistical significance was not established, this study provided preliminary insight into variables to consider in a larger cohort study.

Correlation between sinus and lung cultures in lung transplant patients with cystic fibrosis: Sinus and Lung Cultures in CF Transplant

Lung transplantation has revolutionized the treatment of end‐stage pulmonary disease due to cystic fibrosis. However, infection of the transplanted lungs can lead to serious complications, including graft failure and death. Although many of these patients have concurrent sinusitis, it is unclear whether bacteria from the sinuses can infect the allograft.

Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center

Importance The consultation patterns of an otolaryngology–head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown. Objective To assess trends in otolaryngology–head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services. Design, Setting, and Participants A retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014. Exposure Clinical evaluation and bedside and operative procedures performed by the otolaryngology–head and neck surgery service. Main Outcomes and Measures Demographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables. Results A total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization. Conclusions and Relevance The consultation volume of an otolaryngology–head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which the patient is evaluated. Cost savings may be realized by increasing health care access points for nonurgent concerns that can be evaluated in an outpatient setting.

Image-Guided Placement of Osseointegrated Implants for Challenging Auricular, Orbital, and Rhinectomy Defects

Objectives: Prosthetic reconstruction can restore the preoperative form and function after surgery for head and neck malignancies. We demonstrate the use of preoperative planning and intraoperative image guidance for placement of osseointegrated implants to restore craniofacial defects. Methods: A retrospective review of patients with craniofacial defects treated with image-guided placement of osseointegrated prosthetic implants was performed. Results: Case 1: 55-year-old male who underwent total auriculectomy with anterolateral thigh reconstruction. Case 2: 64-year-old male who required orbital exenteration and total auriculectomy with latissimus dorsi reconstruction. Case 3: 74-year-old male presented after a total rhinectomy. Cases 1 and 3 received adjuvant radiation prior to implantation. Case 2 underwent simultaneous placement of osseointegrated hearing and prosthetic implants. Computed tomography scans were used to perform preoperative planning to determine the optimal implant trajectories and sites. Complications included tissue overgrowth, delayed nonunion of implant, wound infection, and dehiscence. Conclusions: Defects following oncologic resection of head and neck malignancies can be difficult to achieve with native tissue alone. Osseointegrated implants offer an excellent means for reconstruction but can be challenging due to limited bone stock and anatomic landmarks. This can be overcome using intraoperative image guidance techniques for prosthetic reconstruction.

Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus.

Objective: To identify the incidence of retrocochlear pathology on MRI in patients with non-pulsatile tinnitus. Study Design: Retrospective review. Setting: Tertiary referral center. Patients: Adults with MRIs performed between March 1, 2008 and February 1, 2014 for non-pulsatile tinnitus with or without hearing loss. Intervention: MRI. Main Outcome Measure: Incidence of retrocochlear pathology. Results: Of the 218 patients who met inclusion criteria, 198 (91.3%) had unremarkable MRIs. Six patients (2.7%) had MRI findings that accounted for their tinnitus. Of these patients, five had unilateral tinnitus with asymmetric hearing loss because of acoustic neuroma found on MRI. One patient presented with bilateral tinnitus with asymmetric hearing loss and was found to have a right acoustic neuroma. Twenty (9.2%) patients had bilateral or unilateral tinnitus without hearing loss, all with unremarkable MRIs. Fourteen patients (6.4%) had incidental findings including two acoustic neuromas that were identified contralateral to the side of presenting tinnitus. Conclusions: Imaging should be used judiciously in the evaluation of tinnitus. Patients with unilateral tinnitus and asymmetric hearing loss were most likely to have abnormal findings. The majority of MRIs performed for tinnitus were normal in our study. Given the low incidence of MRI findings in the workup of tinnitus, every effort should be made to optimize screening protocols. Noncontrasted fast spin-echo T2-weighted MRI should be used to assess patients with tinnitus when there is low suspicion for retrocochlear pathology. Patients with unilateral non-pulsatile tinnitus with symmetric hearing may be observed, but clinical judgement should determine the need for further imaging.

Solar-powered hearing aids for children with impaired hearing in Vietnam: a pilot study

Abstract Background: Hearing loss is a barrier to speech and social and cognitive development. This can be especially pronounced in children living in low- and middle-income countries with limited resources. Aim: To determine the feasibility, durability and social impact of ComCare GLW solar-powered hearing aids provided for Vietnamese children with hearing impairment. Methods: A retrospective review of data from an international, multi-discipline humanitarian visit was performed. Hearing aids were given to 28 children enrolled at the Khoai Chau Functional Rehabilitation School, Hung Yen Province, Vietnam. Device inspection and observational assessments were performed by teachers using a modified Parents’ Evaluation of Aural/Oral Performance of Children and an Infant Hearing Program Amplification Benefit Questionnaire. Qualitative interviews were undertaken to assess the study aims. Results: Hearing aids were well tolerated for use during regular school hours. All units remained functional during the study period (12 months). Teachers noted increased student awareness and responsiveness to surrounding sounds, but the degree of response to amplification varied between children. There was no significant improvement in speech development as all subjects had prelingual deafness. Teachers felt confident in troubleshooting any potential device malfunction. Conclusions: A solar-powered hearing aid may be a viable option for children in low- and middle-income countries. This study demonstrates that device distribution, maintenance and function can be established in countries with limited resources, while providing feasibility data to support future studies investigating how similar devices may improve the quality of life of those with hearing loss.

What Is the Role of Preoperative Imaging for Cochlear Implants in Adults With Postlingual Deafness

BACKGROUND Computed tomographies (CTs) and magnetic resonance imagings (MRIs) have been traditionally used to evaluate cochlear implant (CI) candidates. The utility of preoperative imaging in pediatric CI candidates is well documented because anatomic abnormalities can alter surgical planning in up to 20% of cases. However, the utility of preoperative imaging is yet to be determined in adult CI candidates with postlingual deafness. Today, institutional protocols and surgeon preference determine the preoperative radiographic evaluation. But there is no consensus on when and which imaging modality should be employed to assess adult CI candidates with postlingual deafness.

Preoperative Imaging Findings and Cost in Adults With Postlingual Deafness Prior to Cochlear Implant

Objective: To assess the imaging findings of computed topography (CT) and magnetic resonance imaging (MRI) in adults with postlingual deafness and otherwise normal clinical history and physical exam. Additionally, determine the influence and implications of these findings with respect to surgical outcomes and cost. Study Design: Retrospective case review. Setting: Tertiary referral hospital. Patients: Adults with postlingual deafness with no history of prior ear surgery, chronic ear disease, meningitis, otosclerosis, or head trauma. Interventions: Cochlear implantation of 1 or both ears, with preoperative CT, MRI, or both. Main Outcome Measures: Imaging results were classified as normal, abnormal affecting surgery, incidental requiring follow-up, or incidental not requiring follow-up. Average cost of each imaging modality was determined. Results: A total of 128 patients met the inclusion criteria. Of these, 82 (64.1%) had both CT and MRI performed, 33 (25.8%) had CT, and 13 (10.2%) had MRI prior to cochlear implant (CI). Scans were normal in 125 (97.7%) of cases. Of the remaining 3 (2.3%) patients, there were incidental findings requiring follow-up. All implants were placed successfully, and in no instance did the results of the scan influence the surgery. The average cost of imaging per patient was

Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures

4707. Conclusion: In adults with postlingual deafness with an otherwise benign clinical history, CT and MRI are unlikely to affect or preclude surgery. With new MRI safe cochlear implants, imaging can be performed safely postoperatively if needed.

Recurrent post-tonsillectomy bleeding due to an iatrogenic facial artery pseudoaneurysm

The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on plastic surgeons and oral and maxillofacial surgeons is heretofore unknown. A cross-sectional survey was performed to assess the practice pattern variations in frontal sinus fracture management across multiple surgical disciplines. A total of 298 surveys were reviewed. 33.5% were facial plastic surgeons with otolaryngology training, 25.8% general otolaryngologists, 25.5% plastic surgeons, and 15.1% oral and maxillofacial surgeons. 74.8% of respondents practiced in an academic setting. 61.7% felt endoscopic sinus surgery changed their management of frontal sinus fractures. 91.8% of respondents favored observation for uncomplicated, nondisplaced frontal sinus outflow tract fractures. 36.4% favored observation and 35.9% favored endoscopic sinus surgery for uncomplicated, displaced frontal sinus outflow tract fractures. For complicated, displaced frontal sinus outflow tract fractures, obliteration was more frequently favored by plastic surgeons and oral and maxillofacial surgeons than those with otolaryngology training. The utility of FESS in managing frontal sinus fractures appears to be recognized across multiple surgical disciplines.