Factors predictive of an academic otolaryngologist's scholarly impact.

OBJECTIVES: Describe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one's choice of medical school, residency, or fellowship has any impact on one's scholarly output. Determine other factors predictive of an academic otolaryngologist's productivity. STUDY DESIGN: Analysis of bibliometric data of academic otolaryngologists. METHODS: Active grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database. RESULTS: Forty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments. CONCLUSIONS: H index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual's medical school, residency, or fellowship of origin is not correlative with one's scholarly impact, but current institutional affiliation and choice of subspecialty are.

Quality of life in obese patients after thyroidectomy for goiter.

BACKGROUND: Compressive symptoms are common in thyroid disease. Many studies have focused on the size of the gland and its effects on patients. However, few have taken into account the body mass of the patient. The aim of our study was to examine whether or not a patient's body mass index (BMI) influences symptomatic outcomes following thyroid surgery for benign disease. METHODS: We conducted a prospective analysis evaluating 60 patients that underwent thyroidectomy for benign goiter (single or multinodular) disease. Patients were classified as obese, overweight, or normal based on BMI. Pre- and post-operative surveys were administered including the MRC breathlessness scale, M.D. Anderson Dysphagia Inventory (MDADI), and the ThyPRO quality of life questionnaire to evaluate dysphagia, dyspnea, and quality of life respectively. RESULTS: Patients classified as obese (n=37) scored significantly worse pre-operatively on MRC, MDADI, and ThyPRO surveys when compared to overweight (n=13) or normal weight (n=10) counterparts. Subjects in the obese group, but not the other groups, showed post-surgical improvement on both the MRC and MDADI surveys (P<0.0001). Similarly, obese subjects showed significant improvement on all 11 domains of the ThyPRO survey following surgery (P<0.0001), and overall degree of improvement was highly correlated with BMI among all subjects (r=0.60; P=0.0005). CONCLUSIONS: Obesity, as determined by BMI, is a critical factor to consider in the alleviation of compressive symptoms before and after thyroidectomy for goiter. Our analysis of survey data indicates obese subjects have increased benefit of surgery compared to their lighter counterparts.

Contained hypopharyngeal and cervical esophageal perforation masquerading as retropharyngeal abscess.

It is possible to have a spontaneous hypopharyngeal and cervical esophageal perforation following yelling. We believe our case is the first study showing such an event, which can become catastrophic if not addressed in a timely manner.

The utility of intraoperative nerve monitoring in secondary and tertiary Hyperparathyroid surgery.

OBJECTIVES: Recurrent laryngeal nerve (RLN) injury is a well-known complication of parathyroid surgery. Despite ample data, there is still uncertainty about the role of intraoperative monitoring (IONM) in mitigating RLN damage. STUDY DESIGN: A retrospective review. METHODS: We included all patients presenting for total, subtotal, or completion parathyroidectomy at a tertiary referral hospital from 2013 to 2018. Information about demographics, previous neck surgery, perioperative data, pathology, and possible RLN injury was collected. Two groups were formed for analysis: IONM vs. nonmonitored (NM). RESULTS: 105 patients underwent 107 surgeries with IONM utilized in 71 cases. The groups were similar in demographics, but significantly differed (all P < 0.05) in preincision parathyroid hormone level (IONM = 2091.44 vs NM = 1334.87), surgery type (IONM = 62.9% vs NM = 27.8% subtotal), and surgery length in minutes (IONM = 155.21 vs NM = 182.22). We observed six cases (6/71 = 8.45%) of persistent RLN complaints (three or more weeks postoperatively) and four cases (4/71 = 5.63%) of temporary complaints with the use of IONM compared with only one temporary complaint (1/36 = 2.78%) in unmonitored procedures (P = 0.129). CONCLUSIONS: These results suggest that the use of IONM does not provide a protective effect on the RLN in patients with secondary or tertiary hyperparathyroidism undergoing total, subtotal, or completion parathyroidectomy. Prospective, randomized studies with pre- and postoperative flexible laryngoscopy are needed to explore the use of IONM in this patient population further.

Awake ECMO without anticoagulation for nearly completely obstructive squamous cell carcinoma of the trachea.

Awake veno-venous ECMO without anticoagulation is a safe and successful way to remove a significantly obstructive malignancy in the trachea.

Unusual cause of acute sinusitis and orbital abscess in COVID-19 positive patient: Case report.

BACKGROUND: Peptoniphilus indolicus is not usually seen in the eye or paranasal sinuses but is a commensal of the human vagina and gut. However, with COVID-19, eye infections and other unusual complications are possible with such unsuspected bacteria. CASE PRESENTATION: The patient is a 76-year-old white male from a nursing home tested positive for COVID-19 and was sent from a nursing facility for left eye drainage and psychiatric evaluation. Upon presentation, the patient was not fully oriented and could not provide a history of the eye drainage. CT scan showed sinusitis with left orbital and periorbital abscess formation, cellulitis, and extensive osteomyelitis. He underwent endoscopic transnasal drainage and orbiotomy. Cultures returned positive for methicillin-resistant Stapholococcus aureus (MRSA), Streptococcus constellatus, and Peptoniphilus indolicus. He was maintained on several days of IV antibiotics and returned to the nursing home. He then presented 2 months later and required enucleation of his globe, due to the presence of multiple scleral perforations in the setting of orbital abscess, as well as removal of necrotic orbital bone. CONCLUSIONS: Given the concomitant infection with COVID-19 and unusual presentation, the patient's sinus cultures support the notion that COVID-19 can affect the presence of bacteria within certain anatomical regions. Specifically, Peptoniphilus indolicus is not normally found outside of the vagina or gut biome. Avascular, pale mucosa and bone of the nasal cavity was noted during surgery of this COVID-19 infected patient, which is in contrast to the friable and edematous tissue typically found in acutely infected sinuses. Our patient's orbital abscess began to drain spontaneously through the skin, which is rare for orbital abscesses. Also uncommon with orbital abscesses is the need for enucleation, which in this case was deemed necessary given that the abscess had perforated the sclera in multiple locations.

The Unseen Global Burden of Disease.

Due to geographic-specific patient and institutional-related barriers to care, data extrapolation and expert opinion on global burden of disease in otolaryngology-head and neck surgery may under- or overestimate the presence and effect of common head and neck conditions. The group of conditions that fail to present to local physicians and/or missed in data extrapolation methods is the unseen burden of disease. This article presents opinions from otolaryngology-head and neck surgery physicians in high- and low/middle-income countries to help explain the contributing factors and ultimately how to use this unseen burden of disease.

Chyloma formation after anterior cervical disc fusion.

Chyle leak from iatrogenic thoracic duct injury is a rare but serious complication of head and neck surgery. The chyloma in this case took months to recognize and required open thoracic ligation. He fully recovered.

Global Disparities in Wilms Tumor.

BACKGROUND: Wilms tumor accounts for more than 90% of all malignant kidney neoplasms in children. Survival after diagnosis and treatment is excellent in most high-income countries. Low- and middle-income countries (LMICs) continue to struggle with Wilms tumor detection and treatment. The purpose of this study was to compare the global incidence and outcomes of Wilms tumor. MATERIAL AND METHODS: Wilms tumor incidence data from the World Health Organization (WHO), International Incidence of Childhood Cancer, Volume III, was analyzed according to world region and country socioeconomic status using descriptive statistics and independent-sample Kruskal-Wallis Test. A literature review was also performed to assess outcomes and identify common themes. RESULTS: Wilms tumor was most common in children aged 0-4 y (median incidence 15.1 [IQR 11.8-18.7] ASR/million). High-income countries reported significantly higher median incidence than middle-income countries (8.6 [7.4-9.3] versus 6.1 [4.9-8.7] ASR/million; P < 0.01), although low-income countries reported the highest median incidence overall (9.8 [6.2-16.4] ASR/million). Low-income countries had the fewest countries with registries (n = 6). Overall survival ranged from 70% to 97% in high-income countries, 61%-94% in upper-middle-income countries, 0%-85% in lower-middle-income countries, and 25%-53% in low-income countries. Delay in diagnosis, lack of available treatment, and inadequate follow up contributed to the large variations in outcomes. CONCLUSIONS: Reported Wilms tumor incidence is highest in low-income countries, and these are also the countries that have the lowest survival. Lack of significance may reflect incomplete and absent data reporting from lower income countries. Accurate and comprehensive registries are the first steps to appropriate resource allocation in order to improve outcomes for this highly curable childhood malignancy.