Michael Chang, MD

All Publications

• Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Daum, R., Grimm, D., Yong, M., Hosseinzadeh, F., Lee, C. K., Fernandez-Miranda, J. C., Nayak, J., Patel, Z. M., Hwang, P. H., Chang, M. T. 2024

  View details for DOI 10.1055/s-0044-1792078

  View details for Web of Science ID 001348085700001

• Comparative analysis of traditional machine learning and automated machine learning: advancing inverted papilloma versus associated squamous cell carcinoma diagnosis. International forum of allergy & rhinology Hosseinzadeh, F., Mohammadi, S. S., Palmer, J. N., Kohanski, M. A., Adappa, N. D., Chang, M. T., Hwang, P. H., Nayak, J. V., Patel, Z. M. 2024

  Abstract

  KEY POINTS: Inverted papilloma conversion to squamous cell carcinoma is not always easy to predict. AutoML requires much less technical knowledge and skill to use than traditional ML. AutoML surpassed the traditional ML algorithm in differentiating IP from IP-SCC.

  View details for DOI 10.1002/alr.23438

  View details for PubMedID 39186252

• Fluorescent guided surgery for sinonasal tumors MINI-INVASIVE SURGERY Chang, M., Baik, F. 2024; 8

  View details for DOI 10.20517/2574-1225.2023.137

  View details for Web of Science ID 001362625500003

• Oral Corticosteroids Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis Without Nasal Polyposis: A Randomized Clinical Trial. JAMA otolaryngology-- head & neck surgery Chang, M. T., Noel, J. n., Ayoub, N. F., Qian, Z. J., Dholakia, S. n., Nayak, J. V., Patel, Z. M., Hwang, P. H. 2021

  Abstract

  Although oral corticosteroids are commonly prescribed following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) without nasal polyposis, there are little data to suggest that this is a beneficial practice.To assess the efficacy of oral corticosteroids following ESS in CRS without polyps.This prospective double-blinded, placebo-controlled, randomized noninferiority clinical trial conducted in a single academic tertiary rhinology practice included adults with CRS without polyps undergoing ESS. Of 81 patients recruited, 72 completed the study.Patients were randomized into 2 treatment groups: a 12-day postoperative taper of oral prednisone vs matched placebo tablets. All study patients also received a uniform 2-week postoperative regimen of oral antibiotics, fluticasone nasal spray, and saline rinses.The primary outcome measures were Sinonasal Outcome Test-22 (SNOT-22) scores and Lund-Kennedy endoscopy scores, collected preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. Scores were compared between treatment groups at each time point using longitudinal difference between treatment groups and analyzed using 2-way, repeated measures analysis of variance. Secondary outcome measures included treatment-related adverse effects.Overall, 72 patients (mean [SD] age, 49.4 [14.9] years; 36 men, 36 women) completed the study, with 33 in the prednisone arm and 39 in the placebo arm. When comparing longitudinal differences between treatment groups, there was no clinically meaningful difference observed in SNOT-22 total (F[4254] = 1.71, η2 = 0.01 [95% CI, 0.00-0.05]) or Lund-Kennedy scores (F[4247] = 1.23, η2 = 0.02 [95% CI, 0.00-0.50]). In SNOT-22 subdomain analyses, there was no clinically meaningful difference between treatment groups for rhinologic, extranasal rhinologic, ear/facial, or sleep subdomains. However, the prednisone group had worse longitudinal scores for psychological dysfunction compared with the placebo group (F[4254] = 3.18, η2 = 0.05 [95% CI, 0.02-0.09]). Reported adverse effects were similar between the 2 treatment groups.In this randomized clinical trial of patients with CRS without polyps, oral prednisone following ESS conferred no additional benefit over placebo in terms of SNOT-22 total scores, SNOT-22 rhinologic subscores, or Lund-Kennedy endoscopy scores up to 6 months after surgery. Patients receiving prednisone, however, did demonstrate worse SNOT-22 psychologic subdomain scores. These results suggest that the risks of oral corticosteroids may outweigh the benefits; thus use of oral corticosteroids after ESS for CRS without polyps should be carefully considered.ClinicalTrials.gov Identifier: NCT02748070.

  View details for DOI 10.1001/jamaoto.2021.0011

  View details for PubMedID 33662124

• Hemodynamic changes in patients undergoing office-based sinus procedures under local anesthesia. International forum of allergy & rhinology Chang, M. T., Jitaroon, K. n., Nguyen, T. n., Yan, C. H., Overdevest, J. B., Nayak, J. V., Hwang, P. H., Patel, Z. M. 2020; 10 (1): 114–20

  Abstract

  The objective of this study is to characterize changes in hemodynamics, pain, and anxiety during office-based endoscopic sinus procedures performed under local anesthesia.We conducted a prospective study of adults undergoing in-office endoscopic sinus procedures under local anesthesia. Patients with American Society of Anesthesiologists (ASA) Physical Status Classification System class 1 or 2 were included. Anesthesia was administered by topical 4% lidocaine/oxymetazoline and submucosal injection of 1% lidocaine/1:200,000 epinephrine. Vital signs and pain were measured at baseline, postinjection, and 5-minute intervals throughout the procedure. Anxiety levels were scored using the State-Trait Anxiety Inventory (STAI). Univariate and multivariate regression analyses were performed to identify factors significantly associated with changes in each hemodynamic metric.Twenty-five patients were studied. This cohort was 52% male, mean age of 57.8 ± 14.4 years, and Charlson Comorbidity Index (CCI) median of 2. Mean procedure duration was 25.0 ± 10.3 minutes. Mean maximal increase in systolic blood pressure (SBP) was 24.6 ± 17.8 mmHg from baseline. Mean maximal heart rate increase was 22.8 ± 10.8 beats per minute (bpm) from baseline. In multivariate regression analysis, when accounting for patient age, cardiac comorbidity, CCI, and ASA, older age was significantly associated with an increase of >20 mmHg in SBP (p = 0.043). Mean pain score during procedures was 1.5 ± 1.3 with a mean maximum of 4.0 ± 2.6. STAI anxiety scores did not change significantly from preprocedure to postprocedure (32.8 ± 11.6 to 31.0 ± 12.6, p = 0.46). No medical complications occurred.Although patients appear to tolerate office procedures well, providers should recognize the potential for significant fluctuations in blood pressure during the procedure, especially in older patients.

  View details for DOI 10.1002/alr.22460

  View details for PubMedID 31899857

• The Effect of Endoscopic Sinus Surgery on Eustachian Tube Dysfunction Symptoms. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Chang, M. T., Hosseini, D. K., Song, S. H., Nayak, J. V., Patel, Z. M., Lee, J. Y., Hwang, P. H. 2020: 194599820917396

  Abstract

  We assessed how eustachian tube dysfunction (ETD) changed with endoscopic sinus surgery (ESS) and identified factors associated with improvement.Retrospective chart review.Academic center.Patients undergoing ESS for chronic rhinosinusitis with and without nasal polyposis (CRSwNP, CRSsNP) or recurrent acute rhinosinusitis (RARS) completed the Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. Included in analyses were demographics, comorbidities, Sinonasal Outcome Test 22 (SNOT-22), radiographic score, endoscopy score, procedure, and medication use. Regression analysis identified factors associated with improvement, defined as ΔETDQ-7 >3.5.In total, 302 patients were studied. ETD prevalence was 68% in CRSsNP, 48% in CRSwNP, and 88% in RARS. Patients with ETD had a mean baseline ETDQ-7 of 25.8 ± 8.0 and improved postoperatively at 2 weeks (19.9 ± 8.1, P < .001), 6 weeks (17.8 ± 9.3, P < .001), 3 months (16.8 ± 8.5, P < .001), and 6 months (16.4 ± 7.9, P < .001). At 6 months, ETD improved in 89% of patients with CRSsNP, 68% with CRSwNP, and 78% with RARS. On multivariate analysis, ETD improvement was associated with higher preoperative ETDQ-7 score (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.04-1.22; P = .030), higher preoperative SNOT-22 score (aOR, 1.02; 95% CI, 1.02-1.08; P = .001), higher preoperative SNOT-22 ear subscore (aOR, 1.27; 95% CI, 1.02-1.65; P = .034), posterior ethmoidectomy (aOR, 1.59; 95% CI, 1.22-4.92; P = .025), and postoperative corticosteroid spray use (aOR, 1.57; 95% CI, 1.17-1.66; P = .008).ETD symptoms often improve following ESS. Factors associated with improvement include higher preoperative disease burden, posterior ethmoidectomy, and postoperative corticosteroid spray.4.

  View details for DOI 10.1177/0194599820917396

  View details for PubMedID 32343633

• Update on long-term outcomes for chronic rhinosinusitis in cystic fibrosis. Current opinion in otolaryngology & head and neck surgery Chang, M. T., Patel, Z. M. 2019

  Abstract

  PURPOSE OF REVIEW: This article reviews the existing body of literature regarding long-term outcomes of various treatments for chronic rhinosinusitis (CRS) in the cystic fibrosis population.RECENT FINDINGS: The management of CRS in cystic fibrosis involves a multitude of medical and surgical therapies. Despite their high usage amongst clinicians, corticosteroids and antibiotics currently have little outcome data supporting their use. There is emerging evidence demonstrating beneficial outcomes for DNAse mucolytics and molecular modulators of cystic fibrosis transmembrane conductor regulator (CFTR). Endoscopic sinus surgery (ESS) improves sinonasal outcomes in cystic fibrosis CRS; however, the benefit on pulmonary outcomes remains unclear.SUMMARY: Successful management of CRS in cystic fibrosis requires multimodal and multidisciplinary care. The long-term outcome data is variable for different treatment modalities. There is recent evidence supporting the role of DNAse mucolytics, CFTR-targeting therapies, and ESS in management of cystic fibrosis CRS.

  View details for DOI 10.1097/MOO.0000000000000596

  View details for PubMedID 31815863

• Cryosurgical ablation for treatment of rhinitis: A prospective multicenter study. The Laryngoscope Chang, M. T., Song, S. n., Hwang, P. H. 2019

  Abstract

  To assess the efficacy and safety of cryoablation of the posterior nasal nerve (PNN) for treatment of chronic rhinitis.This was a prospective single-arm trial of 98 adult patients at six U.S. centers with chronic allergic and nonallergic rhinitis. PNN cryoablation was performed in-office under local anesthesia using a handheld device. Patients discontinued use of intranasal ipratropium 3 days prior to treatment and throughout the study period. Reflective Total Nasal Symptom Score (rTNSS) was measured at pretreatment baseline and posttreatment at 1 month, 3 months, 6 months, and 9 months. The Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was completed at pretreatment and 3 months posttreatment. Adverse effects and postprocedure medication usage were recorded.Ninety-eight procedures (100%) were successfully completed. rTNSS significantly improved over pretreatment baseline (6.1 ± 1.9) at 1 month (2.9 ± 1.9, P < 0.001), 3 months (3.0 ± 2.3, P < 0.001), 6 months (3.0 ± 2.1, P < 0.001), and 9 months (3.0 ± 2.4, P < 0.001) postprocedure. Nasal congestion and rhinorrhea subscores improved significantly at all time points (P < 0.001). Both allergic and nonallergic rhinitis subcohorts showed improvement (P < 0.001), with a comparable degree of improvement between groups. RQLQ significantly improved over pretreatment baseline (3.0 ± 1.0) at 3 months (1.5 ± 1.0, P < 0.001), and all RQLQ subdomains demonstrated improvement. Of 54 patients using intranasal medication at baseline, 19 (35.2%) were able to discontinue use. Twenty-nine adverse effects were reported, including headache, epistaxis, and sinusitis.Cryoablation of the PNN for chronic rhinitis is safe and can result in relief of nasal symptoms and improvements in quality of life.4 Laryngoscope, 2019.

  View details for DOI 10.1002/lary.28301

  View details for PubMedID 31566744

• Unilateral Versus Bilateral Endoscopic Resection of Olfactory Neuroblastoma: Pooled Analysis From Prospective and Retrospective Multicenter Data. International forum of allergy & rhinology Abiri, A., Nguyen, T. V., Chen, H., Krippaehne, E., Lerner, D. K., Rahman, A. S., Roozdar, P., Rosvall, B. R., Sabbaj, M., Workman, A. D., Wu, S., Adappa, N. D., Beswick, D. M., Chang, E. H., Chang, M. T., Choby, G., Eide, J. G., Douglas, J. E., Geltzeiler, M., Kohanski, M. A., Hwang, P. H., Le, C. H., Lee, J. T., Nayak, J. V., Palmer, J. N., Patel, Z. M., Pinheiro-Neto, C. D., Resnick, A. C., Smith, T. L., Snyderman, C. H., John, M. A., Storm, P. B., Suh, J. D., Wang, M. B., Wang, E. W., Kuan, E. C. 2025

  Abstract

  Olfactory neuroblastoma (ONB) is a rare sinonasal malignancy primarily treated with surgery. For tumors arising from the olfactory area, traditional treatment involves transcribriform resection of the anterior cranial fossa. Surgery can be performed with unilateral or bilateral resection depending on extent of involvement; however, there are currently no studies comparing outcomes between the two.Prospective and retrospective data on primary ONB patients were collected from a multicenter registry involving eight academic sites. Propensity score matching (PSM) was used to create patient cohorts with similar baseline characteristics. Cox proportional hazards and Kaplan Meier analyses assessed overall survival (OS). Logistic regression assessed associations between extent of resection (unilateral versus bilateral) and tumor recurrence or postoperative cerebrospinal fluid (CSF) leak.A total of 187 ONB patients (47.6% female) with an average age of 53.6 ± 15.1 years were analyzed. Most tumors were unilateral (81.3%) and predominantly Kadish C (58.3%) or Hyams II (55.8%). Overall, 56.7% of patients underwent bilateral resection. Fifty-four patients experienced tumor recurrence and nine had postoperative CSF leaks. Following PSM (n = 45/group), extent of resection was not associated with mortality (hazard ratio [HR] 1.73; p = 0.407) or OS (p = 0.400). There was no association between extent of resection and recurrence (odds ratio [OR] 0.90; p = 0.814) or postoperative CSF leak (OR 1.54; p = 0.647).For ONB tumors where unilateral resection may be feasible and oncologically sound, the decision for unilateral versus bilateral resection showed no significant effect on survival, recurrence, or postoperative CSF leak. Oncologic outcomes may be comparable when resection is tailored to individual patient and tumor characteristics.

  View details for DOI 10.1002/alr.23531

  View details for PubMedID 39811891

• Machine learning of endoscopy images to identify, classify, and segment sinonasal masses. International forum of allergy & rhinology Levi, L., Ye, K., Fieux, M., Renteria, A., Lin, S., Xing, L., Ayoub, N. F., Patel, Z. M., Nayak, J. V., Hwang, P. H., Chang, M. T. 2025

  Abstract

  We developed and assessed the performance of a machine learning model (MLM) to identify, classify, and segment sinonasal masses based on endoscopic appearance.A convolutional neural network-based model was constructed from nasal endoscopy images from patients evaluated at an otolaryngology center between 2013 and 2024. Images were classified into four groups: normal endoscopy, nasal polyps, benign, and malignant tumors. Polyps and tumors were confirmed with histopathological diagnosis. Images were annotated by an otolaryngologist and independently verified by two other otolaryngologists. We used high- and low-quality images to mirror real-world conditions. The models used for classification (EfficientNet-B2) and segmentation (nnUNet) were trained, validated, and tested at an 8:1:1 ratio. The performance accuracy was averaged across a 10-fold cross-validation assessment. Segmentation accuracy was assessed via Dice similarity coefficients.A total of 1242 images from 311 patients were used. The MLM was trained, validated, and tested on 663 normal, 276 polyps, 157 benign, and 146 malignant tumors images. Overall, the model performed at 84.1 ± 4.3% accuracy in the validation set and 80.4 ± 1.7% in the test set. The model correctly identified the presence of a sinonasal mass at 90.5 ± 1.2% accuracy rate. The MLM accuracy performance rates were 86.2 ± 1.0% for polyps and 84.1 ± 1.8% for tumors. Benign and malignant tumor subclassification achieved 87.8 ± 2.1% and 94.0 ± 2.4% accuracy, respectively. Segmentation accuracies for polyps were 72.3% and 72.8% for tumors.An MLM for nasal endoscopy images can perform with moderate to high accuracy in identifying, classifying, and segmenting sinonasal masses. Performance in future iterations may improve with larger and more diverse training datasets.

  View details for DOI 10.1002/alr.23525

  View details for PubMedID 39776302

• Comparing Efficacy of Steroid Irrigation + Steroid-eluting Sinus Stent Versus Steroid Irrigation Alone for Maintaining Frontal Sinus Patency After Sinus Surgery: A Randomized Controlled Trial. International forum of allergy & rhinology Fieux, M., Noel, J., Roozdar, P., Neves, C. A., Yan, C. H., Tyler, M., Rathor, A., Chang, M. T., Nayak, J. V., Hwang, P. H., Patel, Z. M. 2025

  Abstract

  Steroid rinses and steroid-eluting stents are both options for preventing postoperative stenosis after frontal sinus surgery. This study aimed to assess whether steroid-eluting stents offer added benefit over steroid rinses alone in postoperative healing and long-term frontal sinus patency.A randomized controlled trial enrolled patients with CRS with nasal polyps (CRSwNP) who underwent surgery for bilateral and equal frontal sinusitis after failing prior medical therapy. Each patient served as their own control, with each patient randomized to stent placement in either right or left frontal sinuses. Exclusion criteria included unequal frontal sinusitis, aspirin exacerbated respiratory disease, cystic fibrosis, primary ciliary dyskinesia, and immunocompromise. All patients used steroid rinses postoperatively. Scarring, edema, patency, and the need for additional treatments were assessed at 1, 3, 12, and 24 weeks postoperatively. Univariate and multivariate analyses were performed.Sixty-two patients were enrolled. Postoperatively, scarring, edema, patency, and the need for further treatment were similar in both groups at 24 weeks (p = 0.878, 0.688, 0.817, 1.00, and 1.00, respectively). Multivariable regression analysis identified time as an independent risk factor for scarring (OR = 1.32, [1.03‒1.71]) and patency (OR = 1.39, [1.10‒1.82]), while it was an independent protective factor for edema (OR = 0.40, [0.32‒0.49]). The steroid-eluting stent did not significantly affect this.For CRSwNP, with or without asthma, without other underlying systemic disease factors, steroid-eluting stents may not add benefit over steroid rinses in reducing postoperative scarring and edema, improving long-term frontal sinus patency, or reducing the need for additional treatments, as long as patients continue topical therapy and know how to rinse effectively.

  View details for DOI 10.1002/alr.23524

  View details for PubMedID 39778085

• Utilization of ChatGPT for Rhinology Patient Education: Limitations in a Surgical Sub-Specialty. OTO open Huang, A. E., Chang, M. T., Khanwalkar, A., Yan, C. H., Phillips, K. M., Yong, M. J., Nayak, J. V., Hwang, P. H., Patel, Z. M. 2025; 9 (1): e70065

  Abstract

  To analyze the accuracy of ChatGPT-generated responses to common rhinologic patient questions.Ten common questions from rhinology patients were compiled by a panel of 4 rhinology fellowship-trained surgeons based on clinical patient experience. This panel (Panel 1) developed consensus "expert" responses to each question. Questions were individually posed to ChatGPT (version 3.5) and its responses recorded. ChatGPT-generated responses were individually graded by Panel 1 on a scale of 0 (incorrect) to 3 (correct and exceeding the quality of expert responses). A 2nd panel was given the consensus and ChatGPT responses to each question and asked to guess which response corresponded to which source. They then graded ChatGPT responses using the same criteria as Panel 1. Question-specific and overall mean grades for ChatGPT responses, as well as interclass correlation coefficient (ICC) as a measure of interrater reliability, were calculated.The overall mean grade for ChatGPT responses was 1.65/3. For 2 out of 10 questions, ChatGPT responses were equal to or better than expert responses. However, for 8 out of 10 questions, ChatGPT provided responses that were incorrect, false, or incomplete based on mean rater grades. Overall ICC was 0.526, indicating moderate reliability among raters of ChatGPT responses. Reviewers were able to discern ChatGPT from human responses with 97.5% accuracy.This preliminary study demonstrates overall near-complete and variably accurate responses provided by ChatGPT to common rhinologic questions, demonstrating important limitations in nuanced subspecialty fields.

  View details for DOI 10.1002/oto2.70065

  View details for PubMedID 39776758

  View details for PubMedCentralID PMC11705442

• Evaluating the quality and readability of ChatGPT-generated patient-facing medical information in rhinology. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Fazilat, A. Z., Brenac, C., Kawamoto-Duran, D., Berry, C. E., Alyono, J., Chang, M. T., Liu, D. T., Patel, Z. M., Tringali, S., Wan, D. C., Fieux, M. 2024

  Abstract

  The artificial intelligence (AI) chatbot ChatGPT has become a major tool for generating responses in healthcare. This study assessed ChatGPT's ability to generate French preoperative patient-facing medical information (PFI) in rhinology at a comparable level to material provided by an academic source, the French Society of Otorhinolaryngology (Société Française d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, SFORL).ChatGPT and SFORL French preoperative PFI in rhinology were compared by analyzing responses to 16 questions regarding common rhinology procedures: ethmoidectomy, sphenoidotomy, septoplasty, and endonasal dacryocystorhinostomy. Twenty rhinologists assessed the clarity, comprehensiveness, accuracy, and overall quality of the information, while 24 nonmedical individuals analyzed the clarity and overall quality. Six readability formulas were used to compare readability scores.Among rhinologists, no significant difference was found between ChatGPT and SFORL regarding clarity (7.61 ± 0.36 vs. 7.53 ± 0.28; p = 0.485), comprehensiveness (7.32 ± 0.77 vs. 7.58 ± 0.50; p = 0.872), and accuracy (inaccuracies: 60% vs. 40%; p = 0.228), respectively. Non-medical individuals scored the clarity of ChatGPT significantly higher than that of the SFORL (8.16 ± 1.16 vs. 6.32 ± 1.33; p < 0.0001). The non-medical individuals chose ChatGPT as the most informative source significantly more often than rhinologists (62.8% vs. 39.7%, p < 0.001).ChatGPT-generated French preoperative PFI in rhinology was comparable to SFORL-provided PFI regarding clarity, comprehensiveness, accuracy, readability, and overall quality. This study highlights ChatGPT's potential to increase accessibility to high quality PFI and suggests its use by physicians as a complement to academic resources written by learned societies such as the SFORL.

  View details for DOI 10.1007/s00405-024-09180-0

  View details for PubMedID 39724239

  View details for PubMedCentralID 10315641

• Posterior nasal nerve surgical neurectomy versus ablation for chronic rhinitis. American journal of otolaryngology Maddineni, S., Hwang, P. H., Patel, Z. M., Nayak, J. V., Chang, M. T. 2024; 46 (1): 104553

  Abstract

  For chronic rhinitis (CR) refractory to medical management, several ablative procedures exist that target the posterior nasal nerve (PNN). Here we compare outcomes of PNN surgical neurectomy to in-office ablative procedures.We retrospectively reviewed patients with CR who trialed ipratropium at our center from 2013 to 2024 and received PNN ablation (cryoablation or radiofrequency) or neurectomy. We used the SNOT-22 questionnaire to assess outcomes, specifically evaluating the rhinologic subdomain: need to blow nose, sneezing, runny nose, nasal obstruction, loss of smell, cough, post-nasal discharge, and thick nasal discharge.Our cohort consisted of 55 patients, 34 receiving PNN ablation and 26 receiving surgical neurectomy (9 receiving both). Mean follow-up time was 243 ± 353 days. Surgical neurectomy (18.6 ± 5.5 to 14.9 ± 5.9, p = 0.02) were associated with significant SNOT-22 rhinologic domain improvements, and neurectomy was associated with significant rhinorrhea improvement (3.4 ± 1.6 to 2.4 ± 1.7, p = 0.04). Surgical neurectomy was associated with a greater decrease in sneezing (p = 0.04) scores than ablation, although there were no significant differences in total or rhinologic subdomain SNOT-22 scores between ablation and neurectomy. No clear improvements were observed in patients undergoing a neurectomy following ablation. Multivariable logistic regression analysis did not reveal any predictors of post-procedure improvement.Both surgical neurectomy and in-office ablation were associated with improvements in rhinologic symptoms for patients with CR, although neurectomy may have increased benefit for specific symptoms like sneezing. There is limited evidence that secondary procedure after an initial ablation is beneficial.

  View details for DOI 10.1016/j.amjoto.2024.104553

  View details for PubMedID 39657359

• Stepwise Empty Nose Syndrome Evaluation (SENSE) test-A modified cotton test for reduced bias in office diagnosis of empty nose syndrome. International forum of allergy & rhinology Levi, L., Yang, A., Tsai, E. F., Ma, Y., Ibrahim, N., Dholakia, S. S., Rao, V. K., Renteria, A., Cao, X., Chang, M. T., Nayak, J. V. 2024

  Abstract

  Diagnosis of empty nose syndrome (ENS) relies on the ENS six-item questionnaire (ENS6Q) with a score of ≥11, followed by a "positive" cotton test yielding seven-point reduction from baseline ENS6Q score via cotton placement to the inferior meatus (IM). Given the intricacies of diagnosing ENS and the propensity for false positives with the standard cotton test, we modified the classic single-step cotton test into a four-part Stepwise Empty Nose Syndrome Evaluation (SENSE) cotton test to reduce bias and evaluate the placebo effect.Individuals diagnosed with ENS underwent the SENSE test, a single-blinded, four-step, office-based cotton test, without topical anesthesia or decongestants. Conditions included: (1) placebo/no cotton placed; (2) complete cotton-blockade of nasal vestibule; (3) cotton placed medially against the nasal septum; and (4) cotton placed laterally in the IM (site of inferior turbinate tissue loss). With each condition, patients completed an ENS6Q.Forty-eight ENS patients were included. Twenty-nine percent demonstrated a placebo effect (p < 0.001), 40.4% had a positive response to complete cotton-blockade (p < 0.001), 64.4% to septum-placed cotton, and 79.1% to IM-placed cotton (p < 0.001), corresponding to a mean ENS6Q reduction of 11.9 points (p < 0.001). Notably, the mean difference in ENS6Q scores between septum and IM placement was 1.7 (p < 0.001).The SENSE test offers further insight into subtleties of nasal breathing experienced by ENS patients. The placebo effect can be prominent and important to consider with individual patients. While most ENS patients prefer any intranasal cotton placement over baseline, blinded testing reveals these patients can accurately discriminate minimal changes in nasal aerodynamics.

  View details for DOI 10.1002/alr.23442

  View details for PubMedID 39373717

• The Utility of a "Second-Look" Debridement Following Endonasal Skull Base Surgery in the Pediatric Population. Journal of neurological surgery. Part B, Skull base Chang, M. T., Huang, A. E., Quon, J. L., Fernandez-Miranda, J. C., Wen, C. Z., Eide, J. G., Kshirsagar, R. S., Qian, Z. J., Nayak, J. V., Hwang, P. H., Adappa, N. D., Patel, Z. M. 2024; 85 (3): 313-317

  Abstract

  Background  Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice. Methods  This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors. Results  We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2-18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications. Conclusion  Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure.

  View details for DOI 10.1055/a-2048-7564

  View details for PubMedID 38721369

  View details for PubMedCentralID PMC11076083

• Complications of Endonasal Odontoidectomy in Pediatric versus Adult Populations: A Systematic Review and Meta-Analysis JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Kosaraju, N., Lee, C. K., Qian, Z., Fernandez-Miranda, J. C., Nayak, J. V., Chang, M. T. 2024

  View details for DOI 10.1055/a-2257-5439

  View details for Web of Science ID 001178879200003

• Ipsilateral Nasoseptal Flaps in a Transpterygoid Approach: Technical Pearls and Reconstruction Outcomes JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Chang, M. T., Grimm, D., Asmaro, K., Yong, M., Low, C., Lee, C. K., Nayak, J. V., Hwang, P. H., Fernandez-Miranda, J. C., Patel, Z. M. 2024

  View details for DOI 10.1055/s-0043-1778662

  View details for Web of Science ID 001147729300003

• Surgical Correction of Nasal Obstruction and Its Effect on Eustachian Tube Dysfunction Symptoms. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Daum, R., Grimm, D., Castro Silva, B. R., Huang, A. E., Lee, J. Y., Nayak, J. V., Patel, Z. M., Hwang, P. H., Chang, M. T. 2023

  Abstract

  To investigate how eustachian tube dysfunction symptoms change following surgical treatment of nonsinusitis-related nasal obstruction.Retrospective chart review.Single academic center.We assessed patients who underwent septoplasty, turbinate reduction, or both for nasal obstruction. Chronic sinusitis patients were excluded. Eustachian tube dysfunction (ETD) symptoms were studied using the Eustachian Tube Dysfunction Questionnaire (ETDQ-7), collected preoperatively and postoperatively (1 week, 1 month, 3 months, 6 months postop). Patients with preoperative ETDQ-7 > 14.5 were considered to have clinically significant symptoms. Sinonasal outcomes test scores were also assessed. Pre- and postoperative ETDQ-7 scores were compared using t test. Multivariate linear regression analysis identified factors associated with ETDQ-7 change.We analyzed 259 patients. Preoperatively, 37.5% of patients with nasal obstruction had clinically significant ETD symptoms. These patients exhibited significant improvement in ETDQ-7 at all postoperative timepoints from 23.3 ± 7.6 at baseline to 19.1 ± 9.1 at 1 week, 16.5 ± 8.0 at 1 month, 16.2 ± 7.8 at 3 months, and 16.7 ± 10.4 at 6 months (all P < .01). In patients without baseline ETD symptoms, (baseline ETDQ-7: 9.1 ± 2.3) ETDQ-7 scores did not change significantly at postoperative timepoints, except for an acute worsening at 1 week postoperatively (10.7 ± 5.1, P < .001). Regression analysis showed that higher preoperative ETDQ-7 score (β = -0.84, 95% confidence interval [CI]: -1.10 to -0.59) and postoperative antihistamine spray usage (β = -8.70, 95% CI: -14.20 to -3.20) were associated with ETDQ-7 improvement, while comorbid GERD (β = 7.50, 95% CI: 3.42-11.58) and asthma (β = 5.62, 95% CI: 0.80-10.45) were negatively associated with improvement.Surgical correction of nasal obstruction may improve ETD symptoms.

  View details for DOI 10.1002/ohn.607

  View details for PubMedID 38037398

• An Exploratory Analysis of the Chronic Rhinosinusitis Online Support Community. OTO open Ulloa, R., Tam, B., Orozco, F. R., Castellanos, C. X., Chang, M. T., Hur, K. 2023; 7 (4): e88

  Abstract

  Objective: To characterize the users of the largest chronic rhinosinusitis (CRS) online support communities (OSCs), describe the perceived benefits of OSCs for their users, and understand how patient medical decision making is affected by membership in OSCs.Study Design: Cross-sectional online survey.Setting: Online.Methods: A cross-sectional online survey was adapted from the existing literature on patient support groups and modified for CRS patients. The survey was posted on multiple Facebook/Reddit groups aimed at providing support toward patients with CRS. Survey data was collected over 3months and analyzed thereafter.Results: There were 127 total participants. The majority were female (65.35%), white (76.98%), and the median age was 38 years. Just under half of patients had nasal polyps (48.67%) and 54.54% had undergone surgery. Many participants (69.42%) reported engaging in the OSC at least multiple times per month. The most common reason for joining an OSC was to learn tips on how to manage CRS (89.7%) and the most achieved goal from membership was hearing from others undergoing a similar experience (79.5%). Involvement in an OSC impacted knowledge of CRS in 87.41% of participants. Most users (81.1%) would recommend membership in an OSC and 54.33% reported the OSC influenced their medical decision-making.Conclusion: A majority of patients with CRS who frequently engage in an OSC for CRS have a positive experience. OSCs are a resource that CRS patients utilize to manage their disease.

  View details for DOI 10.1002/oto2.88

  View details for PubMedID 37941963

• Eustachian tube dysfunction symptoms after endonasal skull base surgery. International forum of allergy & rhinology Grimm, D., Daum, R., Castro Silva, B. R., Lee, C. K., Fernandez-Miranda, J. C., Nayak, J. V., Patel, Z. M., Hwang, P. H., Chang, M. T. 2023

  Abstract

  ETD symptoms are present in 16% patients with underlying skull base pathology. Preoperative ETD symptoms improve following surgical treatment of skull base pathology. ETD symptoms may worsen in patients with central, posterior, or malignant skull base pathology.

  View details for DOI 10.1002/alr.23266

  View details for PubMedID 37694445

• International consensus statement on allergy and rhinology: Sinonasal tumors. International forum of allergy & rhinology Kuan, E. C., Wang, E. W., Adappa, N. D., Beswick, D. M., London, N. R., Su, S. Y., Wang, M. B., Abuzeid, W. M., Alexiev, B., Alt, J. A., Antognoni, P., Alonso-Basanta, M., Batra, P. S., Bhayani, M., Bell, D., Bernal-Sprekelsen, M., Betz, C. S., Blay, J. Y., Bleier, B. S., Bonilla-Velez, J., Callejas, C., Carrau, R. L., Casiano, R. R., Castelnuovo, P., Chandra, R. K., Chatzinakis, V., Chen, S. B., Chiu, A. G., Choby, G., Chowdhury, N. I., Citardi, M. J., Cohen, M. A., Dagan, R., Dalfino, G., Dallan, I., Dassi, C. S., de Almeida, J., Tos, A. P., DelGaudio, J. M., Ebert, C. S., El-Sayed, I. H., Eloy, J. A., Evans, J. J., Fang, C. H., Farrell, N. F., Ferrari, M., Fischbein, N., Folbe, A., Fokkens, W. J., Fox, M. G., Lund, V. J., Gallia, G. L., Gardner, P. A., Geltzeiler, M., Georgalas, C., Getz, A. E., Govindaraj, S., Gray, S. T., Grayson, J. W., Gross, B. A., Grube, J. G., Guo, R., Ha, P. K., Halderman, A. A., Hanna, E. Y., Harvey, R. J., Hernandez, S. C., Holtzman, A. L., Hopkins, C., Huang, Z., Huang, Z., Humphreys, I. M., Hwang, P. H., Iloreta, A. M., Ishii, M., Ivan, M. E., Jafari, A., Kennedy, D. W., Khan, M., Kimple, A. J., Kingdom, T. T., Knisely, A., Kuo, Y. J., Lal, D., Lamarre, E. D., Lan, M. Y., Le, H., Lechner, M., Lee, N. Y., Lee, J. K., Lee, V. H., Levine, C. G., Lin, J. C., Lin, D. T., Lobo, B. C., Locke, T., Luong, A. U., Magliocca, K. R., Markovic, S. N., Matnjani, G., McKean, E. L., Meço, C., Mendenhall, W. M., Michel, L., Na'ara, S., Nicolai, P., Nuss, D. W., Nyquist, G. G., Oakley, G. M., Omura, K., Orlandi, R. R., Otori, N., Papagiannopoulos, P., Patel, Z. M., Pfister, D. G., Phan, J., Psaltis, A. J., Rabinowitz, M. R., Ramanathan, M., Rimmer, R., Rosen, M. R., Sanusi, O., Sargi, Z. B., Schafhausen, P., Schlosser, R. J., Sedaghat, A. R., Senior, B. A., Shrivastava, R., Sindwani, R., Smith, T. L., Smith, K. A., Snyderman, C. H., Solares, C. A., Sreenath, S. B., Stamm, A., Stölzel, K., Sumer, B., Surda, P., Tajudeen, B. A., Thompson, L. D., Thorp, B. D., Tong, C. C., Tsang, R. K., Turner, J. H., Turri-Zanoni, M., Udager, A. M., van Zele, T., VanKoevering, K., Welch, K. C., Wise, S. K., Witterick, I. J., Won, T. B., Wong, S. N., Woodworth, B. A., Wormald, P. J., Yao, W. C., Yeh, C. F., Zhou, B., Palmer, J. N., Abiri, A., Adams, C. D., Ayoub, N. F., Bitner, B. F., Boyd, J. T., Chang, M. T., Chapurin, N., Chaskes, M. B., Chua, A., Chung, S. Y., Contrera, K. J., Dilley, K. K., Dutra, A. Z., Eide, J. G., Fenberg, R., Godse, N. R., Jawad, B., Johnson, J., Johnson, B. J., Judd, R., Khalife, S., Khosravi, P., Kolarski, M. M., Kong, K. A., Kshirsagar, R. S., Lee, J. S., Lin, T. Y., McCormick, J. P., Melder, K., Morse, E., Nguyen, T. V., Norwood, T. G., Pang, J. C., Parsel, S. M., Patel, P. S., Ringel, B., Schneider, A. L., Spielman, D. B., Spock, T., Vasudev, M. 2023

  Abstract

  Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represents a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field.In accordance with prior ICAR documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication.The ICNST document consists of 4 major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention.As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/alr.23262

  View details for PubMedID 37658764

• Development of a shortwave infrared sinuscope for the detection of cerebrospinal fluid leaks. Journal of biomedical optics Klein, T. W., Yang, S., Tusty, M. A., Nayak, J. V., Chang, M. T., Bruns, O. T., Bischof, T. S., Valdez, T. A. 2023; 28 (9): 094803

  Abstract

  Cerebrospinal fluid (CSF) rhinorrhea (leakage of brain fluid from the nose) can be difficult to identify and currently requires invasive procedures, such as intrathecal fluorescein, which requires a lumbar drain placement. Fluorescein is also known to have rare but significant side effects including seizures and death. As the number of endonasal skull base cases increases, the number of CSF leaks has also increased for which an alternative diagnostic method would be highly advantageous to patients.We aim to develop an instrument to identify CSF leaks based on water absorption in the shortwave infrared (SWIR) without the need of intrathecal contrast agents. This device needed to be adapted to the anatomy of the human nasal cavity while maintaining low weight and ergonomic characteristics of current surgical instruments.Absorption spectra of CSF and artificial CSF were obtained to characterize the absorption peaks that could be targeted with SWIR light. Different illumination systems were tested and refined prior to adapting them into a portable endoscope for testing in 3D-printed models and cadavers for feasibility.We identified CSF to have an identical absorption profile as water. In our testing, a narrowband laser source at 1480 nm proved superior to using a broad 1450 nm LED. Using a SWIR enabling endoscope set up, we tested the ability to detect artificial CSF in a cadaver model.An endoscopic system based on SWIR narrowband imaging can provide an alternative in the future to invasive methods of CSF leak detection.

  View details for DOI 10.1117/1.JBO.28.9.094803

  View details for PubMedID 37188003

  View details for PubMedCentralID PMC10181794

• Environmental Risk Factors for Pediatric Epistaxis vary by Climate Zone. The Laryngoscope Wei, E. X., Green, A., Chang, M. T., Hwang, P. H., Sidell, D. R., Qian, Z. J. 2023

  Abstract

  Prior studies have provided variable results regarding environmental risk factors for epistaxis. These studies were conducted in varying climate zones, which may explain discrepancies in results. The objective of this study is to investigate correlations between season, temperature, and humidity on frequency of pediatric epistaxis across climate zones.Children seen in the outpatient setting for epistaxis were identified from the 2007-2010 IBM MarketScan database. Climate zones were assigned according to International Energy Conservation Code (IECC) classification, where temperature zones in the United States and territories were assigned on an ordinal scale from 1 (tropical) to 8 (subarctic), and humidity zones were categorized as moist, dry, or marine. The control population was a sample of all well-child visits matched by age and county.We identified 184,846 unique children seen for epistaxis and 1,897,012 matched controls. Moderate temperature zones were associated with lower odds of epistaxis compared with the hottest and coldest zones. Humidity was associated inversely with epistaxis rates in moderate temperature zones but was not a significant predictor of epistaxis in climates with extreme heat. Additionally, summer was associated with lower odds of epistaxis compared to winter. Interestingly, however, there were significantly higher rates of cautery procedures during summer months, driven largely by increased procedures performed in clinic, as opposed to the operating room or emergency room.Environmental risk factors for epistaxis vary by climate zone. The model presented reconciles prior reports and may allow for more personalized clinical management based on regional climate.Level 3 Laryngoscope, 2023.

  View details for DOI 10.1002/lary.30961

  View details for PubMedID 37589269

• In Response to Social Media Utilization in Otolaryngology: A Scoping Review. The Laryngoscope Huang, A. E., Chang, M. T. 2023

  View details for DOI 10.1002/lary.30846

  View details for PubMedID 37354054

• The Utility of a "Second-Look" Debridement Following Endonasal Skull Base Surgery in the Pediatric Population JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE Chang, M. T., Huang, A. E., Quon, J. L., Fernandez-Miranda, J. C., Wen, C. Z., Eide, J. G., Kshirsagar, R. S., Qian, Z., Nayak, J. V., Hwang, P. H., Adappa, N. D., Patel, Z. M. 2023

  View details for DOI 10.1055/a-2048-7564

  View details for Web of Science ID 000960953100002

• Social Media Utilization in Otolaryngology: A Scoping Review. The Laryngoscope Huang, A. E., Chan, E. P., Stave, C. M., Patel, Z. M., Hwang, P. H., Chang, M. T. 2023

  Abstract

  OBJECTIVE: Social media (SM) is an increasingly popular medium for the medical community to engage with patients, trainees, and colleagues. This review aimed to identify reported uses of SM in otolaryngology-head and neck surgery (OHNS), assess the quality of evidence supporting these uses, and identify gaps in the literature. With the relative lack of regulatory guidelines for the development of SM content, we hypothesized that the quality of content available on SM would be highly variable.DATA SOURCES AND METHODS: A scoping review was performed of English-language peer-reviewed studies published to date discussing SM use in any form within OHNS. Three reviewers independently screened all abstracts. Two reviewers independently extracted data of interest from the full text of articles identified from the preliminary abstract screen.RESULTS: 171 studies were included, with 94 (54.9%) studies published between 2020 and 2022. 104 (60.8%) studies were conducted in the US. 135 (78.9%) used cross-sectional or survey-based methodology; only 7 (4.1%) were controlled studies. SM was most commonly employed for professional networking (n=37 [21%]), and within subspecialties of otology (n=38 [22%]) and rhinology/allergy (n=25 [15%]). Facebook was most frequently used for study recruitment (n=23 [13.5%]), YouTube for patient education (n=15 [14.6%]), and Twitter for professional networking (n=16 [9.4%]).CONCLUSION: SM use within OHNS is increasing rapidly, with applications including patient education, professional networking, and study recruitment. Despite myriad articles, there remains a paucity of well-controlled studies. As SM becomes integrated into healthcare, particularly for applications directly impacting patient care, higher levels of evidence are needed to understand its true impact. Laryngoscope, 2023.

  View details for DOI 10.1002/lary.30619

  View details for PubMedID 36807152

• Rhinolithiasis misdiagnosed as intranasal osteoma: Diagnostic challenges in the telehealth era. SAGE open medical case reports Kiessling, P., Hwang, P., Chang, M. 2023; 11: 2050313X231207204

  Abstract

  Rhinolithiasis is a rare clinical presentation and may be a diagnostic challenge, often mimicking other intranasal pathologies and difficult to differentiate based on imaging alone. We present the case of a 50-year-old patient with rhinolithiasis who presented with chronic left nasal obstruction and unilateral cyclic pain with foul discharge. After review of her imaging, she was initially misdiagnosed with an intranasal osteoma via telehealth and scheduled for surgical resection. Her true pathology of rhinolithiasis was subsequently identified and treated during an in-person pre-operative clinic visit. In this case report, we review the key characteristic elements of rhinolithiasis presentation, and in doing so, we reveal the limitations inherent to telehealth evaluations, and the considerations needed to be taken into account by providers evaluating intranasal lesions. Specifically, in-person assessment with a detailed endoscopy is critical as part of the complete workup of nasal cavity lesions.

  View details for DOI 10.1177/2050313X231207204

  View details for PubMedID 37860281

• Effect of dupilumab on Eustachian tube dysfunction in patients with chronic rhinosinusitis with nasal polyposis. International forum of allergy & rhinology Chang, M., Roozdar, P., Lin, Y. T., Lee, J. Y., Nayak, J. V., Patel, Z. M., Hwang, P. H. 2022

  View details for DOI 10.1002/alr.23110

  View details for PubMedID 36399364

• Novel Therapies in Olfactory Disorders CURRENT OTORHINOLARYNGOLOGY REPORTS Chang, M. T., Patel, Z. M. 2022: 1-6

  Abstract

  To summarize and critically review the recent literature on novel treatments for olfactory disorders (OD).Emerging therapies in the management of OD include multiple vitamins and supplements, biologics, neuromodulators, and intranasal agents. There is also an active investigation into treatments that harness the neuroregenerative properties of the olfactory epithelium, such as platelet-rich plasma and stem cell transplantation.Successful management of OD is multimodal and tailored to the underlying etiology. As the findings of further investigations accrue, the management of OD will undoubtedly continue to be advanced and refined, and likely harness the intrinsic neuroregenerative properties of the olfactory system.

  View details for DOI 10.1007/s40136-022-00436-z

  View details for Web of Science ID 000870932400001

  View details for PubMedID 36312744

  View details for PubMedCentralID PMC9589531

• In Response to Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome. The Laryngoscope Chang, M. T., Nayak, J. V. 2022

  View details for DOI 10.1002/lary.30119

  View details for PubMedID 35366011

• Inferior Meatus Augmentation Procedure (IMAP) for Treatment of Empty Nose Syndrome. The Laryngoscope Chang, M. T., Bartho, M., Kim, D., Tsai, E. F., Yang, A., Dholakia, S. S., Khanwalkar, A., Rao, V. K., Thamboo, A., Lechner, M., Nayak, J. V. 1800

  View details for DOI 10.1002/lary.30001

  View details for PubMedID 35072280

• The Nasal Vestibular Body and Its Role in Nasal Obstruction CURRENT OTORHINOLARYNGOLOGY REPORTS Yang, A., Kim, D., Tsai, E., Chang, M. T., Low, C. M., Ibrahim, N. 2022

  View details for DOI 10.1007/s40136-021-00388-w

  View details for Web of Science ID 000745547700001

• Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Chang, M. T., Lalakea, M. L., Shepard, K., Saste, M., Munoz, A., Amoils, M. 1800: 1945998211071116

  Abstract

  OBJECTIVE: To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery.STUDY DESIGN: Retrospective cohort study.SETTING: County hospital otolaryngology practice.METHODS: A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use.RESULTS: We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 (P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased (P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased (P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids.CONCLUSION: Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

  View details for DOI 10.1177/01945998211071116

  View details for PubMedID 35015583

• Venous thromboembolism rates and risk factors following endoscopic skull base surgery. International forum of allergy & rhinology Chang, M. T., Jitaroon, K., Song, S., Roozdar, P., Wangworat, Y., Ibrahim, N., Ma, Y., Rao, V. K., Chang, S. D., Fernandez-Miranda, J. C., Patel, Z. M., Dodd, R. L., Hwang, P. H., Harsh, G. R., Nayak, J. V. 2021

  Abstract

  BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal perioperative complication. The objective of this study was to assess the rate and risk factors for VTE in endoscopic skull base surgery (ESBS).METHODS: This was a retrospective review of adults undergoing ESBS at a tertiary academic center. Incidence of VTE in the 30-day postoperative period was recorded. Logistic regression analyses identified factors associated with VTE.RESULTS: 1122 ESBS cases between 2009 and 2019 were studied. Almost no cases (96.1%) employed perioperative VTE chemoprophylaxis. The overall incidence of VTE was 2.3% (26/1122). Malignant pathologies had a higher rate of VTE compared to nonmalignant pathologies (4.5% vs 2.0%, OR 2.85, 95%CI 1.22-6.66). Factors associated with an increased risk of VTE included a Caprini score greater than 5 (OR 1.53, 95% CI 1.28-1.83); multiple preoperative endocrinopathies such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (OR 22.48, 95% CI 3.93-128.70), adrenal insufficiency (OR 5.24, 95% CI 1.82-15.03), hypercortisolism (OR 4.46, 95% CI 1.47-13.56), and hypothyroidism (OR 3.69, 95% CI 1.66-8.20), each 10-hour increment of lumbar drain duration (OR 1.16, 95%CI 1.08-1.25), and each 10-hour increment for duration of hospitalization (OR 1.05, 95% CI 1.03-1.06).CONCLUSIONS: The incidence of VTE following ESBS is relatively low. Factors with a higher association with VTE include malignancy, preoperative endocrinopathies, higher Caprini score, prolonged lumbar drain duration, and prolonged hospitalization. Further study is needed to validate these findings and to refine clinical decision making around perioperative VTE prophylaxis. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/alr.22943

  View details for PubMedID 34894093

• Challenging our assumptions: oral corticosteroids and chronic rhinosinusitis without nasal polyposis. International forum of allergy & rhinology Chang, M. T., Hwang, P. H. 2021

  View details for DOI 10.1002/alr.22817

  View details for PubMedID 34057289

• Long-Term Outcomes of Inferior Meatus Augmentation Procedure to Treat Empty Nose Syndrome. The Laryngoscope Dholakia, S. S., Yang, A., Kim, D., Borchard, N. A., Chang, M. T., Khanwalkar, A., Lechner, M., Nayak, J. V. 2021

  Abstract

  OBJECTIVES/HYPOTHESIS: We sought to report the long-term, symptom-focused, prospective outcomes in empty nose syndrome (ENS) patients after undergoing inferior meatus augmentation procedure (IMAP) through use of four validated questionnaires: Empty Nose Syndrome 6-Item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-Item Scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9).STUDY DESIGN: Prospective case series.METHODS: A single-center prospective case series was performed for patients diagnosed with ENS who underwent IMAP between July 2017 and February 2020. Diagnosis of ENS was based on the following criteria: 1) reported discomfort with nasal breathing and/or paradoxical nasal obstruction after inferior turbinate reduction, 2) a positive ENS6Q score of at least 11, and 3) a positive cotton test. Questionnaire responses were recorded prior to surgery as well as 1, 3, 6, and 12months postoperatively.RESULTS: Seventeen eligible patients were included. Mean ENS6Q scores were significantly reduced at all postoperative time points (p<.0001, p<.0001, p<.0001, p=.0003). Of the six ENS6Q subdomains, five (suffocation, dryness, sense of diminished airflow, nasal crusting, and nasal burning) were significantly reduced 1-year postoperatively (p<.0001, p=.0004, p=.0136, p=.0114, p=.0080, respectively). SNOT-22 scores were significantly reduced at all time points (p=.0021, p=.0227, p=.0004, and p=.0025). Of the SNOT-22 subdomains, the sleep subdomain was significantly reduced 1-year postoperatively (p=.0432). Low baseline GAD-7 and PHQ-9 scores were recorded at 7 and 9.4, respectively, and although scores at all postoperative time points were reduced, there was no statistical significance.CONCLUSION: IMAP via implant of cadaveric rib cartilage provides significant, long-term improvements in ENS-specific and general sinonasal symptoms.LEVEL OF EVIDENCE: IV Laryngoscope, 2021.

  View details for DOI 10.1002/lary.29593

  View details for PubMedID 33991117

• Sinonasal Ewing sarcoma misdiagnosed as recurrent glomangiopericytoma: Case report and literature review Otolaryngology Case Reports Huang, A. E., Hwang, P. H., Lin, J. H., Chang, M. T. 2021; 21: 100369

  View details for DOI 10.1016/j.xocr.2021.100369

• International Consensus Statement on Rhinology and Allergy: Rhinosinusitis. International forum of allergy & rhinology Orlandi, R. R., Kingdom, T. T., Smith, T. L., Bleier, B., DeConde, A., Luong, A., Poetker, D. M., Soler, Z., Welch, K. C., Wise, S. K., Adappa, N., Alt, J. A., Anselmo-Lima, W. T., Bachert, C., Baroody, F. M., Batra, P. S., Bernal-Sprekelsen, M., Beswick, D., Bhattacharyya, N., Chandra, R. K., Chang, E., Chiu, A., Chowdhury, N., Citardi, M. J., Cohen, N. A., Conley, D. B., DelGaudio, J., Desrosiers, M., Douglas, R., Eloy, J. A., Fokkens, W. J., Gray, S. T., Gudis, D. A., Hamilos, D. L., Han, J. K., Harvey, R., Hellings, P., Holbrook, E. H., Hopkins, C., Hwang, P., Javer, A. R., Jiang, R., Kennedy, D., Kern, R., Laidlaw, T., Lal, D., Lane, A., Lee, H., Lee, J. T., Levy, J. M., Lin, S. Y., Lund, V., McMains, K. C., Metson, R., Mullol, J., Naclerio, R., Oakley, G., Otori, N., Palmer, J. N., Parikh, S. R., Passali, D., Patel, Z., Peters, A., Philpott, C., Psaltis, A. J., Ramakrishnan, V. R., Ramanathan, M. J., Roh, H., Rudmik, L., Sacks, R., Schlosser, R. J., Sedaghat, A. R., Senior, B. A., Sindwani, R., Smith, K., Snidvongs, K., Stewart, M., Suh, J., Tan, B. K., Turner, J. H., van Drunen, C. M., Voegels, R., Wang, D. Y., Woodworth, B. A., Wormald, P., Wright, E. D., Yan, C., Zhang, L., Zhou, B. 2020

  Abstract

  BACKGROUND: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR-RS-2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence-based findings of the document.METHODS: ICAR-RS presents over 180 topics in the forms of evidence-based reviews with recommendations (EBRRs), evidence-based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary.RESULTS: ICAR-RS-2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence-based management algorithm is provided.CONCLUSION: This ICAR-RS-2021 executive summary provides a compilation of the evidence-based recommendations for medical and surgical treatment of the most common forms of RS. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/alr.22741

  View details for PubMedID 33236525

• Retrograde parotidectomy under local anesthesia for benign, malignant, and inflammatory lesions. American journal of otolaryngology Chang, M., Coughran, A., Lee, Y., Collins, J., Sirjani, D. 2019

  Abstract

  OBJECTIVE: To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).METHODS: A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center.RESULTS: Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free.CONCLUSION: In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.

  View details for PubMedID 30691973

• Operative Management of Vocal Fold Avulsion Following Pediatric Laryngotracheal Separation. Ear, nose, & throat journal Chang, M. T., Schoppy, D. W., Schoppy, K. K., Sidell, D. R. 2019: 145561319866821

  Abstract

  Laryngotracheal disruption in children is rare but life-threatening, and endolaryngeal injuries may go overlooked. We present the case of a 10-year-old boy who sustained near-complete laryngotracheal separation, multiple laryngeal fractures, and arytenoid and vocal fold avulsion following blunt cervical trauma. These injuries were not identified radiographically and only became apparent intraoperatively. Following surgical repair, the patient was successfully decannulated, eating a normal diet, and had a serviceable speaking voice within 2 months. In children, the diagnosis of severe endolaryngeal injuries may be elusive and therefore require high degree of clinical suspicion. Surgical success requires accurate diagnosis and prompt intervention.

  View details for DOI 10.1177/0145561319866821

  View details for PubMedID 31558058

• The 50 Most Cited Articles in Facial Plastic Surgery. Aesthetic plastic surgery Chang, M. T., Schwam, Z. G., Schutt, C. A., Kamen, E. M., Paskhover, B. 2017; 41 (5): 1202-1207

  Abstract

  Bibliometric analysis is a common method to determine the most influential articles in medical specialties, as it is an objective measure of peer recognition of scientific work. This study is the first bibliometric analysis of the literature in facial plastic surgery, to determine the most cited papers in the field. Bibliometric analysis was performed using the Science Citation Index from the Institute for Scientific Information, accessed through the Web of Science™. Filter terms relevant to the field of facial plastic surgery were used to identify the 50 most cited journal articles between 1900 and 2016. The median number of citations was 150 (range 116-1091). The articles spanned a wide range of topics in the field, with the most common topics being free flap reconstruction (n = 10), nasal surgery (n = 9), and rhytidectomy (n = 6). The majority of these articles (n = 29) presented findings supported by level IV or V evidence. This analysis provides an overview of the most cited articles in facial plastic surgery, many of which introduced some of the most fundamental principles and techniques in the field. These landmark articles represent important educational points that should be reviewed by all clinicians and trainees in this field. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  View details for DOI 10.1007/s00266-017-0908-x

  View details for PubMedID 28634701

• Clinical and molecular insights into adenoid cystic carcinoma: Neural crest-like stemness as a target. Laryngoscope investigative otolaryngology Yarbrough, W. G., Panaccione, A., Chang, M. T., Ivanov, S. V. 2016; 1 (4): 60-77

  Abstract

  This review surveys trialed therapies and molecular defects in adenoid cystic carcinoma (ACC), with an emphasis on neural crest-like stemness characteristics of newly discovered cancer stem cells (CSCs) and therapies that may target these CSCs.Articles available on Pubmed or OVID MEDLINE databases and unpublished data.Systematic review of articles pertaining to ACC and neural crest-like stem cells.Adenoid cystic carcinoma of the salivary gland is a slowly growing but relentless cancer that is prone to nerve invasion and metastases. A lack of understanding of molecular etiology and absence of targetable drivers has limited therapy for patients with ACC to surgery and radiation. Currently, no curative treatments are available for patients with metastatic disease, which highlights the need for effective new therapies. Research in this area has been inhibited by the lack of validated cell lines and a paucity of clinically useful markers. The ACC research environment has recently improved, thanks to the introduction of novel tools, technologies, approaches, and models. Improved understanding of ACC suggests that neural crest-like stemness is a major target in this rare tumor. New cell culture techniques and patient-derived xenografts provide tools for preclinical testing.Preclinical research has not identified effective targets in ACC, as confirmed by the large number of failed clinical trials. New molecular data suggest that drivers of neural crest-like stemness may be required for maintenance of ACC; as such, CSCs are a target for therapy of ACC.

  View details for DOI 10.1002/lio2.22

  View details for PubMedID 28894804

  View details for PubMedCentralID PMC5510248

• NOTCH1 and SOX10 are Essential for Proliferation and Radiation Resistance of Cancer Stem-Like Cells in Adenoid Cystic Carcinoma. Clinical cancer research : an official journal of the American Association for Cancer Research Panaccione, A., Chang, M. T., Carbone, B. E., Guo, Y., Moskaluk, C. A., Virk, R. K., Chiriboga, L., Prasad, M. L., Judson, B., Mehra, S., Yarbrough, W. G., Ivanov, S. V. 2016; 22 (8): 2083-95

  Abstract

  Although the existence of cancer stem cells (CSC) in adenoid cystic carcinoma (ACC) has been proposed, lack of assays for their propagation and uncertainty about molecular markers prevented their characterization. Our objective was to isolate CSC from ACC and provide insight into signaling pathways that support their propagation.To isolate CSC from ACC and characterize them, we used ROCK inhibitor-supplemented cell culture, immunomagnetic cell sorting, andin vitro/in vivoassays for CSC viability and tumorigenicity.We identified in ACC CD133-positive CSC that expressed NOTCH1 and SOX10, formed spheroids, and initiated tumors in nude mice. CD133(+)ACC cells produced activated NOTCH1 (N1ICD) and generated CD133(-)cells that expressed JAG1 as well as neural differentiation factors NR2F1, NR2F2, and p27Kip1. Knockdowns ofNOTCH1, SOX10, and their common effectorFABP7had negative effects on each other, inhibited spheroidogenesis, and induced cell death pointing at their essential roles in CSC maintenance. Downstream effects ofFABP7knockdown included suppression of a broad spectrum of genes involved in proliferation, ribosome biogenesis, and metabolism. Among proliferation-linked NOTCH1/FABP7 targets, we identified SKP2 and its substrate p27Kip1. A γ-secretase inhibitor, DAPT, selectively depleted CD133(+)cells, suppressed N1ICD and SKP2, induced p27Kip1, inhibited ACC growthin vivo, and sensitized CD133(+)cells to radiation.These results establish in the majority of ACC the presence of a previously uncharacterized population of CD133(+)cells with neural stem properties, which are driven by SOX10, NOTCH1, and FABP7. Sensitivity of these cells to Notch inhibition and their dependence on SKP2 offer new opportunities for targeted ACC therapies.

  View details for DOI 10.1158/1078-0432.CCR-15-2208

  View details for PubMedID 27084744

  View details for PubMedCentralID PMC4834904

• Severe epistaxis due to aberrant vasculature in a patient with STAT-1 mutation. Head & neck Chang, M. T., Schwam, Z. G., Hajek, M. A., Paskhover, B., Judson, B. L. 2016; 38 (3): E68-70

  Abstract

  Signal transducer and activator 1 (STAT-1) mutations are rare and have been implicated in combined immunodeficiency, enhanced tumorigenesis, and vascular defects.A 60-year-old woman with a novel STAT-1 mutation and resulting immunodeficiency, squamous cell carcinoma, and vascular disease presented with profuse epistaxis secondary to rupture of an aberrant artery that she developed in part because of this mutation. After unsuccessful posterior packing, embolization was initiated but subsequently aborted because of a bovine origin carotid artery and a history of multiple carotid dissections.After repeat posterior packing, hemostasis was achieved. No additional episodes of epistaxis occurred in the subsequent 13 months.Vascular anomalies can present challenges in epistaxis management. In patients with conditions known to cause vascular anomalies, it is critical to obtain vascular imaging before intervention.

  View details for DOI 10.1002/hed.24165

  View details for PubMedID 26445901

• Applications of 3-Dimensional Printing in Facial Plastic Surgery. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Schwam, Z. G., Chang, M. T., Barnes, M. A., Paskhover, B. 2016; 74 (3): 427-8

  View details for DOI 10.1016/j.joms.2015.10.016

  View details for PubMedID 26611375

• High rate of bilaterality in internal auditory canal metastases. American journal of otolaryngology Chang, M. T., Michaelides, E. M. 2015; 36 (6): 798-804

  Abstract

  Presentation of three cases of metastatic carcinoma to the internal auditory canal bilaterally, as well as a systematic review of the literature regarding the characteristics of these lesions.Using a MEDLINE Ovid search (1946-2015), we identified and reviewed 102 cases of metastatic carcinoma to the internal auditory canal. Metrics recorded include: patient age, sex, tumor type, laterality, past oncologic history, co-occurring metastatic sites, clinical findings, radiographic findings, therapy received, and outcome. Cases of unilateral versus bilateral IAC were compared.Remarkably, 52.9% reported cases of internal auditory canal metastases have bilateral occurrence. The most common primary tumor sites for internal auditory canal metastases were lung (21.2%), skin (18.6%), and breast (16.7%), with lung and skin cancers having the highest rates of bilateral metastasis. Meningeal metastasis occurred at a much higher rate in bilateral cases (47.2%) versus unilateral cases (8.5%). Brain parenchymal metastasis also occurred at a higher rate in bilateral cases (38.2%) versus unilateral cases (19.2%). Outcomes for cases of internal auditory canal metastases are generally poor, with 56.3% of unilateral cases and 86.1% of bilateral cases reporting patient death within 5 years from diagnosis.In cases of internal auditory canal metastasis, clinicians should carefully assess for not only contralateral disease but also additional metastatic disease of the central nervous system. Rapid-onset hearing loss, tinnitus, vertigo, or facial palsy should raise suspicion for internal auditory canal metastasis, particularly in patients with a known oncologic history.

  View details for DOI 10.1016/j.amjoto.2015.06.002

  View details for PubMedID 26545474

• Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infection control and hospital epidemiology Huang, S. S., Avery, T. R., Song, Y., Elkins, K. R., Nguyen, C. C., Nutter, S. K., Nafday, A. A., Condon, C. J., Chang, M. T., Chrest, D., Boos, J., Bobashev, G., Wheaton, W., Frank, S. A., Platt, R., Lipsitch, M., Bush, R. M., Eubank, S., Burke, D. S., Lee, B. Y. 2010; 31 (11): 1160-9

  Abstract

  Assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. This is particularly important for pathogens with prolonged incubation periods or carrier states.We quantified patient sharing among all 32 hospitals in Orange County (OC), California, using hospital discharge data. Same-day transfers between hospitals were considered "direct" transfers, and events in which patients were shared between hospitals after an intervening stay at home or elsewhere were considered "indirect" patient-sharing events. We assessed the frequency of readmissions to another OC hospital within various time points from discharge and examined interhospital sharing of patients with Clostridium difficile infection.In 2005, OC hospitals had 319,918 admissions. Twenty-nine percent of patients were admitted at least twice, with a median interval between discharge and readmission of 53 days. Of the patients with 2 or more admissions, 75% were admitted to more than 1 hospital. Ninety-four percent of interhospital patient sharing occurred indirectly. When we used 10 shared patients as a measure of potential interhospital exposure, 6 (19%) of 32 hospitals "exposed" more than 50% of all OC hospitals within 6 months, and 17 (53%) exposed more than 50% within 12 months. Hospitals shared 1 or more patient with a median of 28 other hospitals. When we evaluated patients with C. difficile infection, 25% were readmitted within 12 weeks; 41% were readmitted to different hospitals, and less than 30% of these readmissions were direct transfers.In a large metropolitan county, interhospital patient sharing was a potential avenue for transmission of infectious agents. Indirect sharing with an intervening stay at home or elsewhere composed the bulk of potential exposures and occurred unbeknownst to hospitals.

  View details for DOI 10.1086/656747

  View details for PubMedID 20874503

  View details for PubMedCentralID PMC3064463