Jennifer Y Lee, MD

All Publications

• Hearing Dysfunction After Treatment with Teprotumumab for Thyroid Eye Disease. American journal of ophthalmology Sears, C. M., Azad, A. D., Amarikwa, L., Pham, B. H., Men, C. J., Kaplan, D. N., Liu, J., Hoffman, A. R., Swanson, A., Alyono, J., Lee, J. Y., Dosiou, C., Kossler, A. L. 2022

  Abstract

  PURPOSE: To characterize the frequency, severity and resolution of hearing dysfunction in patients treated with teprotumumab for thyroid eye disease (TED).DESIGN: Prospective observational case series.METHODS: Ophthalmic examination and adverse event assessment, including otologic symptoms, were performed at baseline, after infusions 2, 4, and 8, and at 6-month follow-up in consecutive patients who received at least 4 teprotumumab infusions. Labs were collected at baseline and during treatment. Audiometry, patulous Eustachian tube (PET) testing and otolaryngology evaluation were obtained for patients with new or worsening otologic symptoms, with a subset obtaining baseline and post-treatment testing.RESULTS: Twenty-seven patients were analyzed (24 females, 3 males, average 56.3-years-old). Twenty-two patients (81.5%) developed new subjective otologic symptoms, after a mean of 3.8 infusions (SD 1.8). At 39.2 week average follow-up after the last infusion, most patients with tinnitus (100%), ear plugging/fullness (90.9%), and autophony (83.3%) experienced symptom resolution, while only 45.5% (5 of 11) of patients with subjective hearing loss/decreased word comprehension experienced resolution. Six patients underwent baseline and post-treatment audiometry, 5 of whom developed teprotumumab-related sensorineural hearing loss (SNHL) and one patient also developed PET. Three of the 5 patients with teprotumumab-related SNHL had persistent subjective hearing loss at last follow-up. A prior history of hearing loss was discovered as a risk factor for teprotumumab-related SNHL (p=0.008).CONCLUSIONS: Hearing loss is a concerning adverse event of teprotumumab and its mechanism and reversibility should be further studied. Until risk factors for hearing loss are better understood, we recommend baseline audiometry with PET testing and repeat testing if new otologic symptoms develop. Screening, monitoring and prevention guidelines are needed.

  View details for DOI 10.1016/j.ajo.2022.02.015

  View details for PubMedID 35227694

• Flexible Bronchoscopy Simulation as a Tool to Improve Surgical Skills in Otolaryngology Residency. OTO open Santa Maria, C., Sung, C., Lee, J. Y., Chhetri, D. K., Mendelsohn, A. H., Dewan, K. 2021; 5 (4): 2473974X211056530

  Abstract

  Objective: To evaluate the benefits of simulation to teach flexible bronchoscopy.Study Design: A prospective cohort study to assess the bronchoscopic skills of residents in an otolaryngology training program using a commercially available bronchoscopy simulator.Setting: Tertiary care otolaryngology residency program.Methods: Thirty-two otolaryngology residents and 4 expert faculty across 2 academic institutions were assessed on 3 flexible bronchoscopy tasks: diagnostic bronchoscopy, foreign body removal, and tracheal lesion biopsy. Performance was evaluated with a modified version of the validated Bronchoscopy Skills and Tasks Assessment Tool. At 1 of the 2 academic institutions, an additional tool was implemented to evaluate the simulator.Results: There was a correlation between postgraduate training year and time taken to complete tasks, including bronchoscopy, foreign body extraction, and passing through the glottis (P < .001, P = .04, and P < .01, respectively). There was a significant difference between residents and faculty laryngologists for a range of skills and tasks, including percentage of time in middle lumen, contact with bronchial walls, inadvertent esophagus entry, and biopsy of healthy tissue (P < .001, P = .003, P < .001, and P < .001). Additionally, increasing postgraduate level was correlated with a higher percentage of time in the center of the lumen and reduced time to task completion (P = .05 and P < .001). Of 32 residents, 20 evaluated the simulator on its realism, with an average score of 4.1 of 5.Conclusion: The commercially available flexible bronchoscopy simulator provides a valid assessment of bronchoscopic skill and is a useful tool for practicing bronchoscopy in a safe, controlled environment.Level of Evidence: Individual cohort study.

  View details for DOI 10.1177/2473974X211056530

  View details for PubMedID 34734157

• Ambient Pressure Tympanometry in the Workup of Patulous Eustachian Tube and Neurotologic Disorders. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery Thai, A. n., Lee, J. Y., Sayyid, Z. N., Hosseini, D. K., Swanson, A. n., Fitzgerald, M. B., Vaisbuch, Y. n. 2020

  Abstract

  In contrast to previous reports, respiration-synchronous APT wave patterns display low sensitivity (53.3%) in our retrospective cohort of 15 PET ears, as diagnosed by characteristic symptoms and otoscopy. In 327 non-PET ears, the largest cohort of non-PET ears evaluated to date, respiration-synchronous APT wave patterns demonstrate high specificity for PET (93.9%), consistent with previous literature. APT performed solely at rest and with ipsilateral nostril respiration displays similar sensitivity for PET as the full battery of respiratory maneuvers. Pulse-synchronous wave patterns at rest may suggest an alternative neurotologic diagnosis requiring further workup, such as superior semicircular canal dehiscence. Ambient pressure tympanometry is a rapid, simple and widely available tool that can be integrated into general otolaryngology clinics and warrants further study in the evaluation of PET and neurotologic disorders.

  View details for DOI 10.1111/coa.13686

  View details for PubMedID 33289958

• 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

• Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic AMERICAN JOURNAL OF OTOLARYNGOLOGY Saraswathula, A., Lee, J. Y., Megwalu, U. C. 2019; 40 (1): 83–88

  View details for DOI 10.1016/j.amjoto.2018.10.002

  View details for Web of Science ID 000453638400016

• Geriatric Otolaryngology Preface OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Mirza, N., Lee, J. Y. 2018; 51 (4): XVII-XVIII

  View details for PubMedID 30001794

• Patient preferences regarding the communication of biopsy results in the general otolaryngology clinic. American journal of otolaryngology Saraswathula, A. n., Lee, J. Y., Megwalu, U. C. 2018

  Abstract

  To determine the preferred methods of communicating biopsy results for patients in our comprehensive otolaryngology clinic, and to examine factors associated with preferring remote vs. in-person communication of results.Cross-sectional study.Academic comprehensive otolaryngology clinic.A survey instrument was administered to 107 consecutive adult otolaryngology patients undergoing head and neck fine needle aspiration biopsy from March 1, 2017 to April 30, 2018 assessing their health literacy using the Brief Health Literacy Score and their preferred method of notification of biopsy results (in-person vs. remote).69% of patients preferred remote notification of their biopsy results (either by telephone or via an online portal). 54% of patients prioritized clear explanation of the results as the most important factor when communicating a malignant result. Adequate health literacy was associated with lower odds of preferring in-person notification (adjusted odds ratio 0.11, 95% CI 0.03 to 0.39). Patients who prioritized clear explanation of the results were more likely to prefer in-person notification (adjusted OR 4.13, 95% CI 1.31 to 14.88).A significant proportion of patients in our comprehensive otolaryngology clinic undergoing fine needle aspiration biopsy preferred remote communication of their biopsy results. Patients most valued clear explanations from the provider and prompt receipt of the result when communicating malignant results. This highlights the need for individualized results communication plans, for patients undergoing biopsy.

  View details for PubMedID 30472134

• Health Literacy Assessment in an Otolaryngology Clinic Population OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Lee, J. Y. 2016; 155 (6): 969-973

  Abstract

  To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy.Cross-sectional study.Tertiary care otolaryngology clinic.The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen.Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy.Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes.

  View details for DOI 10.1177/0194599816664331

  View details for Web of Science ID 000389146500009

  View details for PubMedID 27554512

• Inflammatory Protein Expression in Human Subglottic Stenosis Tissue Mirrors That in a Murine Model ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Haft, S., Lee, J. Y., Ghosh, A., Philiponis, G., Malaisrie, N., Leahy, K. P., Singhal, S., Cohen, N. A., Mirza, N. 2014; 123 (1): 65-70

  Abstract

  We undertook to describe the genetic and protein composition of subglottic stenosis (SGS) by measuring an array of protein expression and messenger RNA levels within human SGS tissue. We also sought to compare this human array to cytokine expression from a murine model of SGS in order to confirm the effective translational nature of our animal model.Human granulation tissue from 10 patients with early symptomatic SGS was compared to control bronchus. The expression levels of 24 different cytokines were measured by a Luminex protein assay and real-time polymerase chain reaction.The protein expression in human SGS mirrors that seen in murine SGS. Transforming growth factor β1, interleukin 1β, and matrix metalloproteinase 9 were markedly elevated in both human and mouse SGS tissues. The protein array showed a statistically significant elevation in the proinflammatory cytokines tumor necrosis factor α, interleukin 1, granulocyte macrophage colony-stimulating factor, and interferon γ.This is the first study, to our knowledge, to measure an array of protein expression within human SGS tissue. The expression profile suggests that symptomatic tracheal granulation tissue is mostly within the early inflammatory phase of wound healing and has only begun fibrotic and angiogenic remodeling. This study validates our murine model of SGS, and also helps to define the exact pathways of tissue injury, in the hope of leading to new treatments for this difficult condition.

  View details for DOI 10.1177/0003489414521146

  View details for Web of Science ID 000330823300010

  View details for PubMedID 24574426

• Sphenoid sinus anatomy and suprasellar extension of pituitary tumors Clinical article JOURNAL OF NEUROSURGERY Ramakrishnan, V. R., Suh, J. D., Lee, J. Y., O'Malley, B. W., Grady, M. S., Palmer, J. N. 2013; 119 (3): 669-674

  View details for DOI 10.3171/2013.3.JNS122113

  View details for Web of Science ID 000323358700016

• Nasal Congestion, Postnasal Drip, and Aural Fullness Sinonasal schwannoma JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Lin, K. F., Lee, J. Y., Kennedy, D. W. 2013; 139 (8): 849-850

  View details for DOI 10.1001/jamaoto.2013.3843

  View details for Web of Science ID 000323545800016

• Pulse Steroid Therapy Inhibits Murine Subglottic Granulation 115th AAO-HNSF Annual Meeting and OTO EXPO Ghosh, A., Philiponis, G., Lee, J. Y., Leahy, K. P., Singhal, S., Cohen, N. A., Mirza, N. SAGE PUBLICATIONS LTD. 2013: 284–90

  Abstract

  Using a functional model of airway granulation tissue in subglottic stenosis, we investigated changes in inflammatory markers within granulation tissue in response to intraperitoneal dexamethasone injections. Changes in inflammatory markers will allow us to identify potential targets for immunological therapy.Institutional Animal Care and Use Committee-approved animal study.Philadelphia Veterans Administration Medical Center animal research facility.Laryngotracheal complexes of donor mice underwent direct airway injury and were transplanted into subcutaneous tissue of 19 recipient mice in 2 groups: steroid treated and untreated, with sample sizes of 10 and 9, respectively. The steroid-treated arm received intraperitoneal injection of dexamethasone for 3 weeks. Laryngotracheal complexes were then harvested, and granulation formation was measured. The messenger RNA (mRNA) expression of transforming growth factor (TGF)-β(1) and interleukin (IL)-1 was quantified.At 3 weeks posttransplantation, there were statistically significant differences in observable granulation formation as well as mRNA expression of TGF-β(1) and IL-1β in all groups within the steroid treated arm as compared with the untreated arm.Systemic steroids have been used to prevent formation of granulation tissue and subglottic stenosis. However, the study of the immunologic markers and the corresponding changes with steroid treatment has not been well studied in animal models. Using a previously described novel murine model, we begin to delineate inflammatory markers that can be applied for potential therapeutic targets.

  View details for DOI 10.1177/0194599812466533

  View details for Web of Science ID 000318361700017

  View details for PubMedID 23172907

• Bilateral silent sinus syndrome. Ear, nose, & throat journal Suh, J. D., Ramakrishnan, V., Lee, J. Y., Chiu, A. G. 2012; 91 (12): E19-21

  Abstract

  Silent sinus syndrome is a rare clinical entity associated with progressive enophthalmos, collapse of the maxillary sinus, and hypoglobus. We report a case of bilateral silent sinus syndrome in a 29-year-old man. Representative radiographic and intraoperative images are presented. The purpose of this article is to illustrate a new presentation of the disease and to review the current diagnostic and treatment modalities.

  View details for PubMedID 23288826

• Localization in stereocilia, plasma membrane, and mitochondria suggests diverse roles for NMHC-IIa within cochlear hair cells BRAIN RESEARCH Lalwani, A. K., Atkin, G., Li, Y., Lee, J. Y., Hillman, D. E., Mhatre, A. N. 2008; 1197: 13-22

  Abstract

  NMHC-IIa, a nonmuscle myosin heavy chain isoform encoded by MYH9, is expressed in sensory hair cells and its dysfunction is associated with syndromic and nonsyndromic hearing loss. In this study, we investigate the ultrastructural distribution of NMHC-IIa within murine hair cells to elucidate its potential role in hair cell function. Using previously characterized anti-mouse NMHC-IIa antibody detected with immunogold labelling, NMHC-IIa was observed in the stereocilia, in the cytosol along the plasma membrane, and within mitochondria. Within stereocilia, presence of NMHC-IIa is observed throughout its length along the actin core, from the center to the periphery and at its base in the cuticular plate, suggesting a potential role in structural support. Within the sensory hair cells, NMHC-IIa was distributed throughout the cytoplasm and along the plasma membrane. A novel finding of this study is the localization of NMHC-IIa within the mitochondria, with the majority of the label along its inner membrane folds. The presence of NMHC-IIa within heterogeneous areas of the hair cell suggests that it may play different functional roles in these distinct regions. Thus, mutant NMHC-IIa may cause hearing loss by affecting hair cell dysfunction through structural and or functional disruption of its stereocilia, plasma membrane, and/or mitochondria.

  View details for DOI 10.1016/j.brainres.2007.12.058

  View details for Web of Science ID 000254070900002

  View details for PubMedID 18241845

• The j-subunit of human translation initiation factor eIF3 is required for the stable binding of eIF3 and its subcomplexes to 40 S ribosomal subunits in vitro JOURNAL OF BIOLOGICAL CHEMISTRY Fraser, C. S., Lee, J. Y., Mayeur, G. L., Bushell, M., Doudna, J. A., Hershey, J. W. 2004; 279 (10): 8946-8956

  Abstract

  Eukaryotic initiation factor 3 (eIF3) is a 12-subunit protein complex that plays a central role in binding of initiator methionyl-tRNA and mRNA to the 40 S ribosomal subunit to form the 40 S initiation complex. The molecular mechanisms by which eIF3 exerts these functions are poorly understood. To learn more about the structure and function of eIF3 we have expressed and purified individual human eIF3 subunits or complexes of eIF3 subunits using baculovirus-infected Sf9 cells. The results indicate that the subunits of human eIF3 that have homologs in Saccharomyces cerevisiae form subcomplexes that reflect the subunit interactions seen in the yeast eIF3 core complex. In addition, we have used an in vitro 40 S ribosomal subunit binding assay to investigate subunit requirements for efficient association of the eIF3 subcomplexes to the 40 S ribosomal subunit. eIF3j alone binds to the 40 S ribosomal subunit, and its presence is required for stable 40 S binding of an eIF3bgi subcomplex. Furthermore, purified eIF3 lacking eIF3j binds 40 S ribosomal subunits weakly, but binds tightly when eIF3j is added. Cleavage of a 16-residue C-terminal peptide from eIF3j by caspase-3 significantly reduces the affinity of eIF3j for the 40 S ribosomal subunit, and the cleaved form provides substantially less stabilization of purified eIF3-40S complexes. These results indicate that eIF3j, and especially its C terminus, play an important role in the recruitment of eIF3 to the 40 S ribosomal subunit.

  View details for DOI 10.1074/jbc.M312745200

  View details for Web of Science ID 000189265900053

  View details for PubMedID 14688252