Thomas J. Willson

Rising Incidence of Oropharyngeal Cancer and the Role of Oncogenic Human Papilloma Virus

Objectives/Hypothesis: To document the increasing incidence of oropharyngeal (OP) cancer and to provide evidence that this increase is caused by oncogenic human papilloma virus (HPV).

Prevalence of Oncogenic Human Papillomavirus 16 and 18 in the Palatine Tonsils of the General Adult Population

OBJECTIVE To determine whether there has been a demonstrable increase in the prevalence of human papillomavirus (HPV)-infected palatine tonsils corresponding to the increase in incidence of HPV-positive oropharyngeal squamous cell carcinoma (SCC) over time. DESIGN Review of archived, paraffin-embedded, noncancerous palatine tonsils. SETTING A single institution in El Paso County, Colorado. PATIENTS Age- and sex-matched patients 21 years and older from 2 different periods: January 1, 1979, to December 31, 1982, (group A) and January 1, 1997, to December 31, 2001 (group B). MAIN OUTCOME MEASURES Prevalence of oncogenic HPV-16 and HPV-18 in noncancerous palatine tonsils in relation to the incidence of HPV-positive oropharyngeal SCC. RESULTS All specimens in both groups were negative for HPV-16 and HPV-18. Thus, the prevalence of HPV infection in the palatine tonsils of the general adult population was zero in both group A and group B. CONCLUSIONS This analysis shows a low prevalence of HPV infection in the palatine tonsils of the general adult population in a single county in Colorado known to have an increasing rate of HPV-positive oropharyngeal SCC. Analysis of oropharyngeal tissues from individuals at highest risk of developing HPV-positive oropharyngeal SCC (middle-aged men) is likely to provide a higher prevalence rate.

Fabrication and validation of a low-cost, medium-fidelity silicone injection molded endoscopic sinus surgery simulation model.

Develop a low‐cost, medium‐fidelity model for education in endoscopic sinus surgery techniques. Establish face and content validity of the model based on the feedback of otolaryngology faculty including fellowship‐trained rhinologists.

Correlating regional aeroallergen effects on internet search activity.

Objective To investigate the correlation between the change in regional aeroallergen levels and Internet search activity related to allergies. Study Design A retrospective time series analysis using a graphical analytical approach and statistical modeling was used. Setting Tertiary academic hospital setting. Subjects and Methods There were no specific enrolled subjects. Data from Google Trends were obtained (google.com/trends) for the following search terms: “allergy,” “allergies,” “pollen,” “runny nose,” “congestion,” and “post nasal drainage.” Daily pollen and mold spore count data were obtained for the same period from throughout Texas. Graphical analysis, correlation, and autoregressive integrated moving average (ARIMA) were employed to assess the relationship between aeroallergens on Google search activity. Results A strong positive correlation was observed between observed pollen counts and search activity for the terms “allergies” (r pollen = 0.798), “allergy” (r pollen = 0.781), and “pollen” (r pollen = 0.849). Symptom term searches were weakly correlated with pollen and mold counts. Also, ARIMA modeling supported the relationships indicated by the correlations. Conclusion Search activities for surrogate terms such as “allergy,” “allergies,” and “pollen” correlate strongly with observed pollen counts but not mold counts. These data demonstrate the usefulness of Google Trends search data in assessing regional disease burdens and offer insight into how the public seeks information about their own illness.

Quantifying Changes in Nasal Tip Support

IMPORTANCE Imparting surgical change to the nasal tip remains one of the most challenging aspects of rhinoplasty. The surgeon must assess the tip preoperatively and execute the necessary maneuvers to impart the desired change. OBJECTIVE To assess nasal tip resistance to compression in a cadaveric model before and after specific rhinoplasty maneuvers using a novel method. DESIGN, SETTING, AND MATERIALS Open rhinoplasty maneuvers were performed at an academic tertiary care center on 6 fresh-thawed cadaver heads. Assessment of tip support was performed with a motorized, computer-controlled test stand equipped with a digital load cell. Tip support was assessed by compression to a depth of 2.5 mm from contact both preoperatively and after each surgical maneuver. All force data were recorded in pound-force and converted to newtons (N) following analysis. MAIN OUTCOMES AND MEASURES Nasal tip support, measured as resistance to compression, before and after various rhinoplasty maneuvers. RESULTS Following the elevation of the skin-soft-tissue envelope with septoplasty, resistance to compression (1.82 N) was not significantly different from the preoperative assessment (1.60 N for all specimens). Tip support following placement of a caudal extension graft was significantly different from all other conditions (3.16 N; P < .01), showing support increased by more than 66% from preoperative assessment. Placement of columellar strut (1.28 N) did not show significant increase in tip support. Tip support was decreased slightly after placement of intradomal sutures, which was significant (1.22 N; P < .01). CONCLUSIONS AND RELEVANCE This study demonstrates the use of materials testing equipment to assess and quantify change in tip support after several rhinoplasty maneuvers. Minor supporting maneuvers that rely on healing and scar do not significantly alter tip support in a cadaveric model. Caudal extension graft is an important maneuver imparting significant effect on nasal tip support. LEVEL OF EVIDENCE NA.

Effect of environmental factors on Internet searches related to sinusitis.

Sinusitis significantly affects the population of the United States, exacting direct cost and lost productivity. Patients are likely to search the Internet for information related to their health before seeking care by a healthcare professional. Utilizing data generated from these searches may serve as an epidemiologic surrogate.

Searching for Cedar: Geographic Variation in Single Aeroallergen Shows Dose Response in Internet Search Activity

Objective To assess the effect of a single aeroallergen on Internet search activity in 3 distinct geographic regions over time. Study Design A retrospective time series analysis. Setting Tertiary academic medical center. Methods Mountain Cedar pollen counts spanning the periods from 2011 to 2014 were collected for San Antonio, Dallas–Ft Worth, and Houston metro regions (Texas). Google search data for the corresponding period and regions were also obtained for the search terms pollen and mountain cedar. Data were analyzed through time series plots and autoregressive integrated moving average. Results Seasonal maximum pollen counts were greatest in San Antonio, ranging from 5413 to 9982 grains per cubic centimeter. In San Antonio, there was a strong, positive, and statistically significant effect of mountain cedar pollen count on search activity for both pollen (P = .001) and mountain cedar (P < .001) when evaluated by autoregressive integrated moving average. Conclusions Environmental levels of a single allergen—mountain cedar pollen—show a geographic and temporal relationship between Internet searches and mountain cedar pollen, based on Google Trends. These data are useful to understand patients’ perceptions of the health risk presented by mountain cedar pollen. In turn, this information affords practitioners the opportunity to offer targeted patient education in a geographically unique region, as well as adjust surveillance of related pathologies.

The association of air pollutants and allergic and nonallergic rhinitis in chronic rhinosinusitis: Air pollutants in rhinitis disease expression

There has been little investigation regarding air quality and rhinitis in the pathophysiology of upper airway disease. In this study, we assessed the impact of inhalant pollutants (particulate matter 2.5 [PM2.5] and black carbon [BC]) on allergic rhinitis and chronic rhinosinusitis (CRS) disease severity.

Air pollutants may be environmental risk factors in chronic rhinosinusitis disease progression: Pollutant exposures in CRS

Little is known about the role of environmental exposures in the pathophysiology of chronic rhinosinusitis (CRS). In this study, we measured the impact of air pollutants (particulate matter 2.5 [PM2.5] and black carbon [BC]) on CRS with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP).

Air Travel with Known Pneumocephalus Following Outpatient Sinus Surgery

BACKGROUND Intracranial air is a common finding after many neurosurgical procedures and trauma to the head. In patients requiring transport via air to reach a destination there is risk of expansion of the intracranial air and development of neurological complications. Though relatively uncommon after functional endoscopic sinus surgery (FESS), pneumocephalus may be encountered. CASE REPORT We describe one of our patients in whom intracranial air was introduced during FESS. Following the procedure she required commercial air transportation from our center to her home. A 45-min commercial flight to the destination was safely completed without the patient experiencing any neurological sequellae. DISCUSSION This case highlights the controversy surrounding air travel with pneumocephalus and provides an example of safe commercial air travel after diagnosis of post-FESS pneumocephalus.