Alyssa Smith

All Publications

• Changes in Thyroglossal Duct Cyst Case Volume During the COVID-19 Pandemic LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY Fehrenbach, M. P., Masden, L. R., Ebelhar, A. J., Morris, D. H., Morris, L. B., Smith, A. J. 2025; 10 (4): e70205

  Abstract

  The purpose of this study is to identify trends in thyroglossal duct cyst (TGDC) presentation, management, and clinical characteristics in patients before and after the COVID-19 pandemic.A retrospective chart review was conducted at a tertiary referral center and community hospital. Patients were identified using TGDC diagnosis and surgical codes and organized into two cohorts: "Pre-COVID" (May 18th, 2016-March 10th, 2020) and "COVID" (March 11th, 2020-December 31st, 2023). Patient demographics, clinical characteristics, and surgical rates and outcomes were obtained.The case volume of patients presenting with TGDCs did not differ significantly between pre-COVID (n = 121, 52.6%) and COVID (n = 109, 47.4%) periods (p = 0.31). The proportion of pediatric cases increased (35.5% pre-COVID vs. 50.5% COVID, p = 0.03). Patients were more likely to present with an infected neck mass or sequelae of infection, such as fistula, in the COVID cohort (10.7% vs. 22.0%, p = 0.03). The percentage of patients that underwent surgery for their TGDC (62.8% vs. 69.7%, p = 0.33) did not significantly differ.The presentation or surgical rates of patients presenting with TGDC in the pre-COVID vs. COVID periods did not significantly change. However, COVID patients were more likely to present with an infected mass or sequelae of infection, suggesting delays in seeking care until infection occurred or greater infection rates in these cysts. Future studies with larger sample sizes may help clarify trends in TGDC case volume before and after the COVID-19 pandemic, explaining variances in referral and presentation patterns.Level III.

  View details for DOI 10.1002/lio2.70205

  View details for Web of Science ID 001529696400001

  View details for PubMedID 40677960

  View details for PubMedCentralID PMC12267105

• Toothbrush Oropharyngeal Impalement With Spinal Canal Compromise: 2-Dimensional Operative Video OPERATIVE NEUROSURGERY Mikula, A. L., Ransom, R. C., Nesvick, C. L., Douse, D. M., Smith, A. J., Maldonado, G., Clements, C. M., Kim, B. D., Driscoll, C. L., Elder, B. D. 2022; 23 (6): E377-E378

  View details for DOI 10.1227/ons.0000000000000403

  View details for Web of Science ID 000885380400008

  View details for PubMedID 36227199

• Telehealth as an effective method of follow-up for pediatric post tonsillectomy patients AMERICAN JOURNAL OF OTOLARYNGOLOGY Smith, A. J., Yoon, J. J., Cofer, S. A., Orvidas, L. J. 2022; 43 (6): 103639

  Abstract

  To determine if pediatric patients can be safely and effectively managed postoperatively with nurse led telehealth communication.This is a retrospective case series conducted at a tertiary academic medical center pediatric otolaryngology practice. Retrospective chart review was conducted on patients <18 years old who underwent tonsillectomy from January 2017 to December 2019. Patients were managed postoperatively with a telehealth communication on postoperative day (POD) 3-5 and again at 4-6 weeks. Patient demographics, satisfaction with follow-up, number of office visits, and postoperative complications were recorded.829 tonsillectomy patients were identified. Average patient age was 5.7 years (range 10 months-16 years). Successful contact was made with the patient's caregiver on POD 3-5 for 511 patients. 322 patients successfully completed 4-6 weeks telehealth follow-up. 292 patients (91 %) reported improvement in pre-operative symptoms at 4-6 weeks. Overall, 98 % of patients who completed telehealth follow-up were satisfied with this method and did not desire an additional office appointment. 62 patients (21 %) participated in an office follow-up in 2017, 54 patients in 2018 (19 %), and 36 patients (14 %) in 2019. Only 61 of these visits were routinely scheduled postoperative tonsillectomy office visits. 53 patients (6 %) had a postoperative tonsillectomy bleed and 31 patients (4 %) required return to the operating room for cauterization.Telehealth is successful in reducing the number of post-tonsillectomy office visits for pediatric patients without a subsequent increase in complications. Reduction in office visits can lead to cost reduction and increased availability of pediatric otolaryngology appointments.

  View details for DOI 10.1016/j.amjoto.2022.103639

  View details for Web of Science ID 000870429600001

  View details for PubMedID 36170768

• Prevalence of Surgical, Anesthetic, and Device-related Complications Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: Evidence for the Continued Expansion of Pediatric Cochlear Implant Candidacy Criteria OTOLOGY & NEUROTOLOGY Chweya, C. M., Smith, A. J., May, M. M., Lohse, C. M., Neff, B. A., Driscoll, C. L. W., Carlson, M. L. 2021; 42 (6): E666-E674

  Abstract

  To compare the prevalence of surgical, anesthetic, and device-related complications among infants and older children receiving cochlear implantation (CI).Retrospective chart review.Tertiary academic referral center.Pediatric patients who underwent CI from November 1990 to January 2020.CI.Surgical, anesthetic, and device-related complication rates were compared by age group (<12 versus 12-23 versus 24+ months with subset analysis of <9 versus 9-11 months).A total of 406 primary pediatric CI surgeries encompassing 482 ears were analyzed, including 45 ears in 23 patients implanted less than 9 months and 89 ears in 49 patients less than 12 months. No anesthetic complications occurred. Postoperative surgical and device-related complication rates were not significantly different among the less than 12, 12 to 23, and 24+ month groups (16% versus 16% versus 12%; p = 0.23) or between the less than 9 and 9 to 11 month groups (22% versus 9%; p = 0.09). Thirty-day readmission was significantly higher for patients less than 12 months compared with patients 24+ months (6% versus <1%; p = 0.011), but was not significantly higher compared with patients 12 to 23 months (6% versus 3%; p = 0.65). Reoperation rates did not differ significantly among the less than 12, 12 to 23, and 24+ month groups (10% versus 7% versus 6%; p = 0.31).The prevalence of surgical, anesthetic, and device related complications was not significantly different among infants implanted less than 9 or less than 12 months of age when compared with older children. These data provide evidence for the continued expansion of pediatric cochlear implant candidacy criteria to include appropriately selected infants less than 9 months of age.

  View details for DOI 10.1097/MAO.0000000000003060

  View details for Web of Science ID 000661951100005

  View details for PubMedID 33710142

• Aneurysmal Bone Cysts of the Paranasal Sinuses: The Mayo Clinic Experience and Review of the Literature LARYNGOSCOPE Smith, A. J., Choby, G., Van Gompel, J. J., Link, M. J., Van Abel, K. M. 2021; 131 (9): E2525-E2533

  Abstract

  Aneurysmal bone cysts (ABCs) are benign, lytic bone lesions, which rarely present in the paranasal sinuses. There is no published consensus on the appropriate diagnostic or treatment approach. Our objective was to elucidate the clinical behavior, treatment, and outcomes for patients with ABCs of the paranasal sinuses (psABCs).Retrospective case series and system review of the literature.A retrospective chart review was performed to identify patients evaluated at the authors' institution with psABC and consolidated with literature reports of psABC.Eighty-nine patients met inclusion criteria. The most common presenting symptom was painless facial swelling (n = 35, 39%). The ethmoid sinuses were the most common site involved (n = 55, 62%). Surgical approach was reported in 74 cases including 20 endoscopic and 54 with an open or combined approach. Fifty-nine patients (71%) underwent gross total resection. Follow up data was reported for 67 patients. Fifteen patients (22%) were found to have recurrence or progression at follow up; 10/15 (66%) patients within the first 12 months, 14/15 (93%) within the first 24 months, and 1/15 (7%) greater than 24 months after treatment. Patients were more likely to have recurrence/progression if they presented with nasal discharge (P = .05), proptosis (P = .01), or orbital involvement (P = .03).psABCs typically present with painless swelling or nasal obstruction. Orbital involvement is a negative prognostic indicator with these patients more likely to have recurrence after treatment. Recurrence or progression of disease is most likely to occur within 2 years after treatment. Therefore, patients should be monitored closely during this time.4 Laryngoscope, 131:E2525-E2533, 2021.

  View details for DOI 10.1002/lary.29478

  View details for Web of Science ID 000623500100001

  View details for PubMedID 33646602

• Postoperative dysphagia immediately following pediatric endoscopic laryngeal cleft repair. International journal of pediatric otorhinolaryngology Kiessling, P., Smith, A., Puccinelli, C., Balakrishnan, K. 2021; 142: 110625

  Abstract

  OBJECTIVES: In pediatric patients undergoing endoscopic laryngeal cleft repair, immediate postoperative dysphagia is not well-characterized. This study examined whether worsened dysphagia is present in the immediate postoperative period as detected by clinical swallow evaluation, and evaluated how this relates to postoperative change in presenting symptoms and findings on swallow studies.METHODS: A retrospective cohort was conducted at a tertiary academic medical center, evaluating all pediatric patients who underwent endoscopic laryngeal cleft repair by a single surgeon from October 2014 through December 2018. All patients underwent instrumental swallow evaluation preoperatively and clinical swallow evaluation within 24h following surgery.RESULTS: Thirty-nine patients met inclusion criteria. Based on clinical swallow evaluation performed within 24h after surgery, 4 patients (10%) were recommended to thicken their diet from preoperative baseline; all others were unchanged. All patients were admitted to the PICU for observation; 34 (87%) discharged on postoperative day 1. Thirty-seven patients attended 6-week follow-up, with 2 (5%) requiring thicker diet since discharge; all others were stable or improved. Prevalence of recurrent respiratory infections, subjective dysphagia, chronic cough, and wheezing significantly decreased after surgery. No statistically significant change occurred in prevalence of aspiration or penetration on instrumental swallow studies postoperatively.CONCLUSION: Endoscopic laryngeal cleft repair is well-tolerated in pediatric patients, and most do not have obviously worsened dysphagia at immediate postoperative evaluation. Improvement in symptoms postoperatively may be a more useful indicator of surgical outcomes beyond instrumental swallow studies alone. The relative stability of these patients provides further evidence that they can likely be managed on the floor or as outpatients rather than in the ICU postoperatively.

  View details for DOI 10.1016/j.ijporl.2021.110625

  View details for PubMedID 33454453

• Association of bone mineral density of the anterior cranial base, obesity, and spontaneous cerebrospinal fluid rhinorrhea INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY Low, C. M., Kim, D., Smith, A. J., Yin, L. X., Smith, B. M., Stokken, J. K., O'Brien, E. K., Link, M. J., Van Gompel, J. J., Choby, G. 2021; 11 (4): 804-806

  View details for DOI 10.1002/alr.22717

  View details for Web of Science ID 000585450800001

  View details for PubMedID 33151644

• Creation of a New Educational Podcast: "Headmirror's ENT in a Nutshell". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Barnes, J. H., Choby, G., Smith, A. J., Kiessling, P., Marinelli, J. P., Bowe, S., Carlson, M. L. 2020; 163 (4): 623-625

  Abstract

  Podcasts are online digital audio programs that are disseminated via online subscription that are easily accessible through computers or smartphones. Increasingly, residents and medical students are prioritizing podcasts for asynchronous medical education due to ease of use, convenience (eg, use while exercising or commuting), and repeatability. Some trainees have found podcasts more useful than traditional didactic lectures. Given the increasing requirements of social distancing and the need for distance medical education platforms, podcast production can serve as a useful tool to complement resident and medical student education and is a resource that will remain accessible in perpetuity. An otolaryngology specialty podcast, "Headmirror's ENT in a Nutshell," was created to augment asynchronous learning and address the acute need for distance learning opportunities. Over the first 7 weeks of production, 50 episodes were created. Episodes were posted on www.headmirror.com, with subscription services available through Apple Podcast, Spotify, and other platforms.

  View details for DOI 10.1177/0194599820930662

  View details for PubMedID 32513092

• Elevated Urine LeukotrieneE4Is Associated With Worse Objective Markers in Nasal Polyposis Patients LARYNGOSCOPE Choby, G., O'Brien, E. K., Smith, A., Barnes, J., Hagan, J., Stokken, J. K., Strumpf, A., Mattos, J. L., Payne, S. C., Divekar, R. 2021; 131 (5): 961-966

  Abstract

  Urine leukotriene E4 (uLTE4) is a biomarker of leukotriene synthesis and is elevated in patients with aspirin-exacerbated respiratory disease (AERD). It can also be useful to help delineate aspirin-tolerant chronic rhinosinusitis with nasal polyposis (CRSwNP) patients from AERD patients. The purpose of this study is to determine if uLTE4 biomarker levels are associated with objective and subjective markers of disease severity in patients with CRSwNP.A retrospective analysis of CRSwNP patients who underwent uLTE4 testing was completed to determine the association of uLTE4 levels to markers of disease severity. uLTE4 levels, as well as presenting subjective (Sinonasal Outcome Test 22 [SNOT22] scores, asthma control test [ACT] scores) and objective data (Lund-Mackay CT score, spirometry and lab values) were collected.Among the 157 CRSwNP patients who met inclusion criteria, uLTE4 levels were associated with history of asthma (P < .001), aspirin sensitivity (P < .001), worse Lund-Mackay CT scores (P = .002) and other objective markers of disease severity including serum IgE (P = .05), presenting blood eosinophil level (P < .001), and the highest recorded eosinophil level (P < .001). In subgroup analysis, associations of uLTE4 to disease markers had stronger correlations in the aspirin sensitive CRSwNP group (R range 0.31-0.52) than the aspirin tolerant CRSwNP group (R range -0.30-0.24). uLTE4 levels were not associated with subjective symptom scores (SNOT22 and ACT scores).Elevated uLTE4 biomarker levels are associated with worsened objective markers of disease severity in CRSwNP patients but not patient-reported symptom measures.3 Laryngoscope, 131:961-966, 2021.

  View details for DOI 10.1002/lary.29137

  View details for Web of Science ID 000573938400001

  View details for PubMedID 33001452

• Determining the utility of standard hospital microbiology testing: Comparing standard microbiology cultures with DNA sequence analysis in patients with chronic sinusitis. World journal of otorhinolaryngology - head and neck surgery Rapoport, S. K., Smith, A. J., Bergman, M., Scriven, K. A., Brook, I., Mikula, S. K. 2019; 5 (2): 82-87

  Abstract

  OBJECTIVE: To demonstrate DNA sequencing analysis (DNAsa) of sinus cultures in patients with CRS is a reliable method of detecting pathogens in polymicrobial CRS infections.METHODS: After obtaining Institutional Review Board approval for this prospective cohort study, we selected a random sample of 50 patients with CRS at Medstar Georgetown University Hospital between September 2016 and March 2017. We defined CRS as a history of rhinosinusitis refractory to maximal medical therapy and prior endoscopic sinus surgery. Patients demonstrating active purulence in a sinus cavity were prospectively selected to undergo standard hospital cultures (SHC) and DNAsa cultures. Organisms identified in both methods were compared for each patient.RESULTS: Specimens were obtained from 29 female and 16 male patients with a mean age of 50 years. A total of 45 cultures were included in our final analysis; five cultures were excluded after inappropriate laboratory processing. Results from these patients were compared and analyzed. Cohen's weighted kappa analysis showed agreement between the two testing methods in identifying predominant microorganisms. DNAsa detected 31.9% more microorganisms compared to SHC (P<0.05). When multiple microorganisms were detected, DNAsa yielded more positive results compared to SHC (P<0.05).CONCLUSIONS: DNAsa detects all microorganisms identified by SHC as well as predominant microorganisms not detected by SHC. Thus molecular pathogen identification may be more reliable for identifying multiple microorganisms as compared to standard culture techniques that identify only one or two microorganisms. In recalcitrant cases of CRS, DNAsa may provide better guidance in selection of appropriate antimicrobial treatment.

  View details for DOI 10.1016/j.wjorl.2018.11.001

  View details for PubMedID 31334486