All Publications

  • Effectiveness of Hyperbaric Oxygen Treatment in Facial Plastic and Reconstructive Surgery: A Systematic Review. Facial plastic surgery & aesthetic medicine Rossi Meyer, M. K., Kandathil, C. K., Saltychev, M., Wei, E. X., Most, S. P. 2024

    View details for DOI 10.1089/fpsam.2024.0012

    View details for PubMedID 38648530

  • Does Recent COVID-19 Infection Impact Safety of Nasal Surgery? Facial plastic surgery & aesthetic medicine Wei, E. X., Green, A., Kandathil, C. K., Most, S. P. 2024

    View details for DOI 10.1089/fpsam.2023.0352

    View details for PubMedID 38530097

  • Healthcare Utilization Among Adults With Vestibular Vertigo in the United States. Ear and hearing Matthews, J. C., Agrawal, Y., Qian, Z. J., Wei, E. X. 2024


    OBJECTIVES: Vestibular vertigo has been shown to have a high lifetime prevalence. Previous studies have described the increased morbidities associated with vestibular vertigo.DESIGN: In this cross-sectional study of the 2016 National Health Interview Study, we sought to explore whether individuals with vestibular vertigo were more likely to utilize healthcare resources compared with those without vestibular vertigo. We characterized utilization of specific healthcare resources including general doctors, specialist doctors, emergency departments, mental health professionals, and others among individuals with vestibular vertigo to better understand how individuals with vertigo interact with the US healthcare system.RESULTS: In multivariable analyses, participants with vestibular vertigo had an increased number of nights in the hospital in the last 12 months (mean difference = 0.67 days, 95% confidence interval [CI] = 0.37 to 0.97), increased odds of receiving healthcare 10 or more times in the last 12 months (odds ratio = 2.22, 95% CI = 1.99 to 2.48) and increased number of visits to a healthcare professional in the last 2 weeks (mean difference = 0.17 visits, 95% CI = 0.14 to 0.21). In addition, participants with vestibular vertigo had increased odds of visiting both general doctors, specialist doctors, and other healthcare professionals.CONCLUSIONS: These findings characterize how individuals with vestibular vertigo utilize and interact with healthcare resources compared with those without vestibular vertigo.

    View details for DOI 10.1097/AUD.0000000000001487

    View details for PubMedID 38503724

  • Rhinoplasty Outcomes in Patients with Symptoms of Body Dysmorphia. Aesthetic surgery journal Losorelli, S., Kimura, K. S., Wei, E. X., Abdelhamid, A. S., El Abany, A., Green, A., Karki, S., Stephanian, B. A., Kandathil, C. K., Most, S. P. 2024


    Patients with symptoms of body dysmorphia often seek consultation for aesthetic rhinoplasty. While body dysmorphic disorder is a formal psychiatric diagnosis, recent evidence indicates that patients with symptoms of this condition who seek rhinoplasty may experience increased satisfaction with their appearance following surgery.To determine the psychological impact of rhinoplasty in patients screened pre-/postoperatively with a body dysmorphia screening questionnaire.Retrospective chart review of patients who underwent aesthetic and/or functional rhinoplasty by a single surgeon (S.P.M.) from 6/2021- 4/2023. Adult patients with a complete pre- and postoperative body dysmorphic disorder-aesthetic surgery questionnaire (BDDQ-AS), Standardized Cosmesis and Health Nasal Outcomes Survey-Obstruction and Cosmesis (SCHNOS), and Visual Analog Scale (VAS) were included. Patient characteristics and outcomes were analyzed stratifying by BDDQ-AS screen.One-hundred fifteen patients (88% female) met criteria for inclusion. There was an 83% resolution rate in BDDQ-AS positive screening following rhinoplasty. Positive BDDQ-AS screening status pre- and postoperatively correlated with worse aesthetic satisfaction (all p<0.002). No patient reported outcome measures were indicative of which patients with a BDDQ-AS positive screen preoperatively would experience 'resolution' postoperatively.Body dysmorphia screening resolution following surgical intervention correlated with improved patient aesthetic satisfaction, pointing to a potential positive psychological impact of undergoing rhinoplasty.

    View details for DOI 10.1093/asj/sjae045

    View details for PubMedID 38452148

  • Telehealth Usage in Otolaryngology: A Comparative Study Pre- and Post-COVID-19. OTO open Lee, M. L., Wei, E. X., Kandathil, C., Most, S. P. 2024; 8 (1): e109


    The COVID-19 pandemic led to increased telehealth utilization in outpatient otolaryngology settings. While other studies on telehealth usage in otolaryngology settings have focused on demographic disparities during the pandemic, none have yet assessed how these demographic disparities have evolved from before versus after the pandemic. This study examines 4 recent consecutive years of demographic and clinical data from a large hospital system to investigate how the COVID-19 pandemic has changed demographic patterns in telehealth utilization. We demonstrate substantial increases in the number of otolaryngology patients participating in telehealth since the beginning of the COVID-19 pandemic but with no differences in patient distributions by race or ethnicity over time. We also found that telehealth patients, on average, were younger, more likely to be English-speaking, and more likely to be female. While these disparities widened slightly after the start of the pandemic, they were also present prior to the pandemic.

    View details for DOI 10.1002/oto2.109

    View details for PubMedID 38282795

  • Increased Prevalence of Positive Body Dysmorphic Disorder Screening Among Rhinoplasty Consultations During the COVID-19 Era. Facial plastic surgery & aesthetic medicine Wei, E. X., Green, A., Kandathil, C. K., Most, S. P. 2023

    View details for DOI 10.1089/fpsam.2023.0262

    View details for PubMedID 38150506

  • Foreign Body Reaction Requiring Re-Exploration After Tympanoplasty With Porcine Small Intestinal Submucosa Reconstruction. The Annals of otology, rhinology, and laryngology Fullerton, Z. H., Wei, E. X., Green, A., Sajjadi, H. 2023: 34894231218900


    OBJECTIVE: We present the first published case of large foreign body reaction to Biodesign (Cook Medical, Bloomington, IN), an acellular otologic graft matrix derived from porcine small intestinal submucosa, after use in tympanoplasty surgery in a patient without previous exposure to meat products.METHODS: A single case report of a 39-year-old female who developed tinnitus, ear drainage, and large fibrotic mass in external auditory canal and extending into middle ear after Type I medial graft tympanoplasty with Biodesign Graft. Left endoscopic microdissection and resection of the tympanic membrane and middle ear fibrotic mass were performed.MAIN FINDINGS: Surgical excision of the fibrous mass required extensive microdissection to ensure preservation of the ossicles and chorda tympani. Postoperatively, hearing improved and otalgia and otorrhea resolved.CONCLUSIONS: We report the first case of post-tympanoplasty reaction with the use of Biodesign acellular porcine graft in a patient with no previous known exposure to meat products. Although this presentation appears to be rare, it reinforces the need for careful patient selection and counseling around the use of porcine or other foreign grafts.

    View details for DOI 10.1177/00034894231218900

    View details for PubMedID 38098236

  • Parosteal Lipoma Overlying an Osteochondroma of the Hyoid Bone: A Case Report and Literature Review. The Laryngoscope Green, A., Wei, E. X., Chang-Graham, A., Holmes, B., Smith, A., Sung, C. K. 2023


    Parosteal lipomas and osteochondromas of the head and neck are uncommon benign tumors, constituting a small fraction of lipoma and bone tumor cases. We present a unique case of a 66-year-old male with a parosteal lipoma overlying an osteochondroma in the anterior midline neck, causing dysphagia. Surgical excision confirmed the diagnosis, and a literature review revealed similar cases predominantly adjacent to the mandible or calvaria. This case emphasizes the need to have parosteal lipoma and osteochondroma on the differential diagnosis for patients presenting with a firm mass of the central neck, especially with a history of trauma. Laryngoscope, 2023.

    View details for DOI 10.1002/lary.31192

    View details for PubMedID 37965970

  • Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery. Facial plastic surgery & aesthetic medicine Wei, E. X., Kimura, K. S., Abdelhamid, A. S., Abany, A. E., Losorelli, S., Green, A., Kandathil, C. K., Most, S. P. 2023


    Background: Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized. Methods: We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire-Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables. Results: Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger (p = 0.02), and those who had a positive self-reported psychiatric history (p = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score (SCHNOS-O) (p = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score-Nasal Cosmesis Score (SCHNOS-C) (p < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening (p < 0.0001). Conclusions: Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.

    View details for DOI 10.1089/fpsam.2023.0212

    View details for PubMedID 37930999

  • Evaluating the Effectiveness of Septoplasty for Nasal Valve Collapse: A Retrospective Study. Facial plastic surgery & aesthetic medicine Green, A., Wei, E. X., Kandathil, C. K., Youn, G. M., Shah, J. P., Most, S. P. 2023

    View details for DOI 10.1089/fpsam.2023.0218

    View details for PubMedID 37862050

  • Nonopioid Versus Opioid Analgesics After Thyroid and Parathyroid Surgery: A Systematic Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Moon, P. K., Wei, E. X., Hamid, M. S., Borghi, J. A., Megwalu, U. C. 2023


    To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid analgesic regimens. Secondarily, we sought to determine if nonopioid analgesic regimens decrease the number of opioid medications taken after thyroid and parathyroid surgery, and to assess adverse events associated with opioid versus nonopioid regimens.PubMed, Embase, Cochrane.A comprehensive search of the literature was performed according to the PRISMA guidelines, and identified 1299 nonduplicate articles for initial review of which 2 randomized controlled trials (RCTs) were identified as meeting all eligibility criteria. Meta-analysis was not conducted due to heterogeneity in the data and statistical analyses.Both RCTs included in this systematic review found no significant differences in postoperative pain scores between individuals discharged with a nonopioid only analgesic regimen compared to analgesic regimen that included oral opioid medications. One study reported significantly increased number of postoperative calls related specifically to pain in the nonopioid arm compared to the opioid arm (15.6% vs. 3.2%, P = .045).This systematic review of RCTs revealed a limited number of studies examining nonopioid versus opioid postoperative pain medications among adults who undergo thyroid and parathyroid surgery. Among the 2 RCTs on this topic, there is a shared finding that nonopioid analgesic regimens are noninferior to opioid analgesic regimens in managing postoperative pain after thyroid and parathyroid surgery, supporting the use of nonopioid pain regimens given the risk of opioid dependence associated with prescription opioid medications.

    View details for DOI 10.1002/ohn.503

    View details for PubMedID 37595107

  • 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


    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

  • Disparities in Access to Healthcare in Adults with Sinusitis in the United States. International forum of allergy & rhinology Shah, J. P., Youn, G. M., Wei, E. X., Patel, Z. M. 2023


    Sinusitis can significantly decrease quality of life, is costly in both healthcare expenditure and lost productivity, and can lead to complications if treatment is delayed. Our objective was to explore disparities in healthcare access among adults with sinusitis based on sociodemographic factors.32,994 participants (representing 244,838,261 U.S. adults) who completed the 2016 National Health Interview Survey were analyzed, of which 12.17% were diagnosed with sinusitis at least once in the prior 12 months. Multivariate regression analyses were performed.In regression analyses, female sex (OR = 2.00; [95% CI, 1.79-2.24]; p<0.001) and older age groups were associated with increased odds of having sinusitis. Within the sinusitis cohort, Asian race (OR = 5.97; [1.61-22.12]; p = 0.008) and Hispanic ethnicity (OR = 6.97; [3.22-15.06]; p<0.001) were associated with increased odds of obtaining foreign medications. Individuals with Medicaid had decreased odds of delaying care (OR = 0.37; [0.25-0.56]; p<0.001) or not receiving care due to cost (OR = 0.40; [0.24-0.65]; p<0.001), but increased odds of delaying care due to transportation barriers (OR = 4.64; [2.52-8.55]; p<0.001). Uninsured individuals had higher odds for delaying care (OR = 4.97; [3.35-7.38]; p<0.001) and not receiving care (OR = 5.46; [3.56-8.38]; p<0.001) due to cost. Income > $100,000 was associated with a nearly 90% reduction in inability to obtain care due to cost (OR = 0.11; [0.05-0.21]; p-value<0.001) and an over 99% reduction in inability to obtain care due to transportation issues compared to income < $35,000 (OR = 0.01; [0.00-0.04]; p-value<0.001).Significant disparities in healthcare access based on race, health insurance status, and income exist among adults with sinusitis in the United States. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/alr.23167

    View details for PubMedID 37029607

  • Factors related to wellness and burnout in academic otolaryngology: A pre- and Post-COVID-19 analysis. Laryngoscope investigative otolaryngology Yesantharao, L. V., Joo, H., Wei, E. X., Lin, S. Y., Vohra, V., Agrawal, Y., Galaiya, D. 2023; 8 (2): 409-416


    Describe demographic and professional factors predictive of burnout in academic otolaryngology before and during the COVID-19 pandemic.In 2018 and 2020, cross-sectional surveys on physician wellness and burnout were distributed to faculty members of a single academic institution's otolaryngology department. Faculty were dichotomized into low and high burnout groups for 2018 (n = 8 high burnout, 19%) and 2020 (n = 11 high burnout, 37%). To identify protective factors against burnout, three semi-structured interviews were conducted with faculty that reported no burnout.Forty-two participants (59%) in 2018 and 30 out of 49 participants (62%) in 2020 completed the survey. In multivariate analysis of 2018 survey data, full and associate professors had significantly lower odds of high burnout (OR 0.06, 95% CI 0.00-0.53; p = .03). Female gender was associated with increased in odds of high burnout (OR 15.55, 95% CI 1.86-231.74; p = .02). However, academic rank and gender did not remain independent predictors of high burnout in the 2020 survey. We identified significant differences in drivers of burnout brought on by the pandemic, including a shift from a myriad of work-related stressors in 2018 to a focus on patientcare and family obligations in 2020. Interview analysis identified three themes in faculty who reported no burnout: (1) focus on helping others, (2) happiness over compensation as currency, and (3) gratitude for the ability to have an impact.Approximately 20% of faculty reported high burnout before the pandemic, and this proportion nearly doubled during the pandemic. The risk factors and themes identified in this study may help academic otolaryngologists prevent burnout.Factors driving burnout among academic otolaryngologists during the COVID-19 pandemic transitioned away from research, conferences, and work outside business hours toward family and patient responsibilities. Females report higher burnout and full professors report lower burnout.III.

    View details for DOI 10.1002/lio2.1033

    View details for PubMedID 37090875

    View details for PubMedCentralID PMC10116971

  • Perceptions of Respect Among Patients With Hearing Loss in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Youn, G. M., Shah, J. P., Wei, E. X., Alyono, J. C. 2023


    Hearing loss is a common condition that can lead to disability and significantly impact the quality of life. However, as the literature investigating the relationship between hearing loss and patients' perception of respect within the clinical setting is lacking, we performed a retrospective, cross-sectional analysis of the 2017 National Health Interview Survey to elucidate this interaction. After weights were applied, 16,295,495 patients (mean age: 63.79, standard error: 0.28) with hearing loss were identified. Multivariable logistic regression analyses found that those with self-reported hearing loss were less likely to report being treated with respect by their healthcare providers (odds ratio [OR], 0.766; [95% confidence interval, CI: 0.691-0.848]) and less likely to be asked about their beliefs/opinions about the care that they received (OR, 0.842; [95% CI: 0.774-0.916]), indicating a possible disparity in care. Further investigation is needed to examine how this patient population is treated and how providers can create a more inclusive environment.

    View details for DOI 10.1002/ohn.330

    View details for PubMedID 36994933

  • Ankyloglossia: Clinical and Sociodemographic Predictors of Diagnosis and Management in the United States, 2004 to 2019. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Wei, E. X., Meister, K. D., Balakrishnan, K., Cheng, A. G., Qian, Z. J. 2023


    OBJECTIVE: The past 2 decades have seen a rapid increase in the diagnosis of ankyloglossia. Patients are often managed by lingual frenotomy. The objective is to define the clinical and socioeconomic factors that determine which patients receive frenotomy.STUDY DESIGN: A retrospective analysis of commercially insured children.SETTING: Optum Data Mart database.METHODS: Trends in frenotomy including provider and setting were described. Multiple logistic regression was used to determine predictors of frenotomy.RESULTS: Diagnosis of ankyloglossia increased from 2004 to 2019 (from 3377 in 2004 to 13,200 in 2019), while lingual frenotomy similarly increased from 1483 in 2004 to 6213 in 2019. The proportion of inpatient frenotomy procedures increased from 6.2% to 16.6% from 2004 to 2019, with pediatricians having the highest odds of performing inpatient frenotomies (odds ratio:4.32, 95% confidence interval:4.08, 4.57). Additionally, during the study period, the proportion of frenotomies performed by pediatricians increased from 13.01% in 2004 to 28.38% in 2019. In multivariate regression analyses, frenotomy was significantly associated with the male sex, white non-Hispanic ethnicity, higher parental income and education, and a greater number of siblings.CONCLUSION: Ankyloglossia has been increasingly diagnosed in the past 2 decades, and amongpatients with ankyloglossia, frenotomy is increasingly performed. This trend was driven at least in part due to increasing rates of pediatricians as proceduralists. After accounting for maternal and patient-level clinical factors, socioeconomic differences in the management of ankyloglossia were observed.

    View details for DOI 10.1002/ohn.332

    View details for PubMedID 36994937

  • Vestibular Vertigo and Disparities in Healthcare Access Among Adults in the United States. Ear and hearing Min Youn, G., Shah, J. P., Agrawal, Y., Wei, E. X. 2023


    OBJECTIVE: Vertigo and dizziness have a high lifetime prevalence with significant impacts on daily life. We sought to explore differences in access to and ability to afford care among adults with vestibular vertigo by race/ethnicity, income, and insurance type.DESIGN: This is a cross-sectional study using the 2016 National Health Interview Survey. A total of 32,047 adults who completed the 2016 National Health Interview Survey Balance Supplement were analyzed. We used a previously validated definition of vertigo defined as (1) positional vertigo, (2) rotational vertigo, or (3) recurrent dizziness with nausea and either oscillopsia or imbalance. We examined several self-reported measures of healthcare utilization and access.RESULTS: Among adults with vestibular vertigo, African Americans had significantly increased odds of delayed care due to lack of transportation; Hispanic ethnicity was associated with decreased odds of skipping medication doses and asking a doctor for a lower-cost medication. Adults with public insurance had significantly lower odds of reporting delayed care due to worry about cost, not receiving medical care due to cost, and delayed filling of a prescription, but had greater odds of reporting delayed care due to lack of transportation. Lack of insurance and lower income were associated with increased odds of delaying and not receiving care due to cost.CONCLUSION: These findings demonstrate significant differences in access to care among adults with vestibular vertigo in the United States based on race, income, and health insurance status.

    View details for DOI 10.1097/AUD.0000000000001344

    View details for PubMedID 36920251

  • Difference in Perception of Nasal Aesthetic Appearance Between Surgeons and Rhinoplasty Patients: A Single-Center Perspective. Aesthetic surgery journal Kim, C. H., Kandathil, C. K., Saltychev, M., Youn, G. M., Shah, J. P., Khan, S. I., Buba, C. M., Okland, T. S., Wei, E. X., Fullerton, Z., Most, S. P. 2022


    Patient satisfaction is an essential outcome measure after a rhinoplasty. Yet differences of opinions between rhinoplasty patients and surgeons on nasal aesthetic appearance are unknown.To determine the differences between patients and surgeons in the perception of nasal aesthetic appearance.A retrospective cohort of 300 patients seen in consultation for cosmetic, functional, or combined cosmetic and functional rhinoplasty at a single tertiary care center from June 2017 to June 2020 were studied. Based on preoperative patient images, six surgeons with varying levels of expertise assessed nasal aesthetics utilizing a modified Standardized Cosmesis and Health Nasal Outcomes Survey for nasal cosmesis (SCHNOS-C). These scores were then compared to the patient reported SCHNOS-C scores.The cosmetic, functional, and combined subgroups consisted of 100 patients each. The mean age (SD) was 35.4 (13.7) years and 64% were women. The modified SCHNOS-C scores were well-correlated among the six surgeons but showed only weak correlations of 0.07 to 0.20 between patient reported scores and scores assessed by the surgeons. Compared to the surgeon's scores, patients in the cosmetic subgroup perceived their nasal aesthetic problems to be more severe whereas the those in the functional subgroup perceived their nasal aesthetic problems to be milder compared to the surgeons.'Our findings suggest that patients and surgeons perceive nasal cosmesis differently. This difference should be considered carefully when planning rhinoplasty or assessing its outcome.

    View details for DOI 10.1093/asj/sjac317

    View details for PubMedID 36478029

  • Septoplasty Revision Rates in Pediatric vs Adult Populations. JAMA otolaryngology-- head & neck surgery Shah, J. P., Youn, G. M., Wei, E. X., Kandathil, C., Most, S. P. 2022


    Importance: Although septal deviations are highly prevalent in the pediatric population and pediatric septoplasties are garnering more discussion, to date, there are no large-scale studies characterizing pediatric septoplasty revision rates.Objective: To identify rates of pediatric septoplasty revision in the US.Design, Setting, and Participants: This retrospective, observational cohort study used administrative claims data from the IBM MarketScan Commercial Database (which contains inpatient and outpatient data for millions of patients and dependents covered by employer-sponsored private health insurance in the US) to identify patients undergoing septoplasty between January 1, 2007, and December 31, 2016. Patients 18 years or younger were included in the study as the pediatric cohort, and patients aged 19 to 65 years were included as the adult cohort for comparison. Patients were excluded if the initial surgery included rhinoplasty, nasal vestibular stenosis, or costal cartilage grafts or if the second surgery did not have nasal vestibular stenosis, septoplasty, rhinoplasty, and/or cartilage grafts.Main Outcomes and Measures: Outcomes included septoplasty revision rate, septoplasty-to-rhinoplasty conversion rate, and associated risks for revision surgery. Collected data were analyzed between January 1 and July 30, 2022.Results: A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%]) who underwent an initial septoplasty were identified, of whom 704 (2.9%) received a revision. In the adult cohort of 286 218 patients (mean [SD] age, 41.4 [12.2] years; 162 893 [56.9%] men), 3081 individuals (1.1%) received a revision. Within the pediatric revision group, 66 patients (9.4%) received a rhinoplasty vs 162 (5.3%) in the adult revision group. All pediatric age groups had higher revision rates than the adult population, with the 9- to 13-year-old group having the highest rates of revision (118 of 2763 [4.3%]). Patients in the West and Northeast, along with those with point of service and health maintenance organization health plans, were more likely to receive a revision.Conclusion and Relevance: The findings of this cohort study suggest that pediatric patients are more likely to receive a revision surgery than their adult counterparts. Furthermore, pediatric patients are more likely than adults to receive a rhinoplasty as their revision surgery. These findings provide valuable information that may be used to inform clinical decision-making, although further research is needed to better identify the causes for pediatric septoplasty revision.

    View details for DOI 10.1001/jamaoto.2022.3041

    View details for PubMedID 36201221

  • Revision Rates of Septoplasty in the United States. Facial plastic surgery & aesthetic medicine Youn, G. M., Shah, J. P., Wei, E. X., Kandathil, C., Most, S. P. 2022


    Background: Large-scale studies characterizing septoplasty revision rates are lacking. Objectives: To identify rates of septoplasty revision in the United States. Methods: Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM MarketScan Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery. Results: 295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds. Conclusion: Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.

    View details for DOI 10.1089/fpsam.2022.0009

    View details for PubMedID 35394347

  • Performance in Real World- and Virtual Reality-Based Spatial Navigation Tasks in Patients With Vestibular Dysfunction. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Biju, K., Wei, E. X., Rebello, E., Matthews, J., He, Q., McNamara, T. P., Agrawal, Y. 2021; 42 (10): e1524-e1531


    OBJECTIVE: This study evaluated whether vestibular dysfunction is associated with reduced spatial navigation performance.STUDY DESIGN: Cross-sectional study.SETTING: Otolaryngology Clinic in the Johns Hopkins Outpatient Center and an analogous virtual reality (VR) environment.PATIENTS: Eligible patients had diagnosis of unilateral or bilateral vestibular loss. Matched healthy controls were recruited at 1:1 ratio.INTERVENTIONS: The navigation task involved a route-based or place-based strategy in both real world and VR environments.MAIN OUTCOME MEASURES: Navigation performance was measured by distance travelled relative to optimal distance (i.e., path ratio) and the Judgments of Relative Direction (JRD) task, whereby participants had to recall relative angular distances between landmarks.RESULTS: The study sample included 20 patients with vestibular loss (mean age: 61 yrs, SD: 10.2 yrs) and 20 matched controls (mean age: 60 yrs, SD: 10.4 yrs). Patients with vestibular loss travelled significantly greater distance using both route-based (path ratio 1.3 vs. 1.0, p = 0.02) and place-based (path ratio 2.6 vs. 2.0, p = 0.03) strategies in the real world. Overall, participants performed worse in virtual reality compared to real world in both path ratio (2.2 vs. 1.7; p = 0.04) and JRD error (78° vs. 67°; p < 0.01). Furthermore, while controls exhibited significant positive correlations between real world and VR performance in place-based (beta = 0.75; p < 0.001) and JRD tasks (beta = 0.70; p < 0.001), patients with vestibular loss exhibited no similar correlations.CONCLUSIONS: The vestibular system appears to play a role in navigation ability during both actual and virtual navigation, suggesting a role for static vestibular signals in navigation performance.

    View details for DOI 10.1097/MAO.0000000000003289

    View details for PubMedID 34766948

  • Detection of Wandering Behaviors Using a Body-Worn Inertial Sensor in Patients With Cognitive Impairment: A Feasibility Study. Frontiers in neurology Kamil, R. J., Bakar, D., Ehrenburg, M., Wei, E. X., Pletnikova, A., Xiao, G., Oh, E. S., Mancini, M., Agrawal, Y. 2021; 12: 529661


    Patients with Alzheimer's disease (AD) and AD related dementias (ADRD) often experience spatial disorientation that can lead to wandering behavior, characterized by aimless or purposeless movement. Wandering behavior has been associated with falls, caregiver burden, and nursing home placement. Despite the substantial clinical consequences of wandering, there is currently no standardized approach to objectively quantify wandering behavior. In this pilot feasibility study, we used a lightweight inertial sensor to examine mobility characteristics of a small group of 12 older adults with ADRD and mild cognitive impairment in their homes. Specifically, we evaluated their compliance with wearing a sensor for a minimum of 4 days. We also examined the ability of the sensor to measure turning frequency and direction changes, given that frequent turns and direction changes during walking have been observed in patients who wander. We found that all patients were able to wear the sensor yielding quantitative turn data including number of turns over time, mean turn duration, mean peak turn speed, and mean turn angle. We found that wanderers make more frequent, quicker turns compared to non-wanderers, which is consistent with pacing or lapping behavior. This study provides preliminary evidence that continuous monitoring in patients with dementia is feasible using a wearable sensor. More studies are needed to explore if objective measures of turning behaviors collected using inertial sensors can be used to identify wandering behavior.

    View details for DOI 10.3389/fneur.2021.529661

    View details for PubMedID 33776875

    View details for PubMedCentralID PMC7991404

  • Ankyloglossia: Update on Trends in Diagnosis and Management in the United States, 2012-2016. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Wei, E. X., Tunkel, D., Boss, E., Walsh, J. 2020; 163 (5): 1029-1031


    Ankyloglossia, or "tongue-tie," refers to limited tongue mobility caused by a restrictive lingual frenulum. Previous studies have demonstrated rapid increases in diagnosis and treatment of ankyloglossia in the United States up to 2012. We performed an updated retrospective review of data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ) to evaluate trends in diagnosis of ankyloglossia and use of lingual frenotomy in the hospital setting. From 2012 to 2016, there was an 110.4% increase in reported diagnosis of ankyloglossia in the inpatient setting with similar increases in lingual frenotomy procedures. As seen previously, sex, type of insurance, median income ZIP code, and geographic region were associated with diagnosis of ankyloglossia. The observed trends from prior to 2012 have continued to increase, while unanswered questions about diagnostic criteria and about which infants should undergo frenotomy remain.

    View details for DOI 10.1177/0194599820925415

    View details for PubMedID 32427523

  • Vestibular function and cortical and sub-cortical alterations in an aging population HELIYON Jacob, A., Tward, D. J., Resnick, S., Smith, P. F., Lopez, C., Rebello, E., Wei, E. X., Ratnanather, J., Agrawal, Y. 2020; 6 (8): e04728


    While it is well known that the vestibular system is responsible for maintaining balance, posture and coordination, there is increasing evidence that it also plays an important role in cognition. Moreover, a growing number of epidemiological studies are demonstrating a link between vestibular dysfunction and cognitive deficits in older adults; however, the exact pathways through which vestibular loss may affect cognition are unknown. In this cross-sectional study, we sought to identify relationships between vestibular function and variation in morphometry in brain structures from structural neuroimaging. We used a subset of 80 participants from the Baltimore Longitudinal Study of Aging, who had both brain MRI and vestibular physiological data acquired during the same visit. Vestibular function was evaluated through the cervical vestibular-evoked myogenic potential (cVEMP). The brain structures of interest that we analyzed were the hippocampus, amygdala, thalamus, caudate nucleus, putamen, insula, entorhinal cortex (ERC), trans-entorhinal cortex (TEC) and perirhinal cortex, as these structures comprise or are connected with the putative "vestibular cortex." We modeled the volume and shape of these structures as a function of the presence/absence of cVEMP and the cVEMP amplitude, adjusting for age and sex. We observed reduced overall volumes of the hippocampus and the ERC associated with poorer vestibular function. In addition, we also found significant relationships between the shape of the hippocampus (p = 0.0008), amygdala (p = 0.01), thalamus (p = 0.008), caudate nucleus (p = 0.002), putamen (p = 0.02), and ERC-TEC complex (p = 0.008) and vestibular function. These findings provide novel insight into the multiple pathways through which vestibular loss may impact brain structures that are critically involved in spatial memory, navigation and orientation.

    View details for DOI 10.1016/j.heliyon.2020.e04728

    View details for Web of Science ID 000568517600027

    View details for PubMedID 32904672

    View details for PubMedCentralID PMC7457317

  • Psychometric Tests and Spatial Navigation: Data From the Baltimore Longitudinal Study of Aging FRONTIERS IN NEUROLOGY Wei, E. X., Anson, E. R., Resnick, S. M., Agrawal, Y. 2020; 11: 484


    Spatial cognition is the process by which individuals interact with their spatial environment. Spatial cognition encompasses the specific skills of spatial memory, spatial orientation, and spatial navigation. Prior studies have shown an association between psychometric tests of spatial ability and self-reported or virtual measures of spatial navigation. In this study, we examined whether psychometric spatial cognitive tests predict performance on a dynamic spatial navigation task that involves movement through an environment. We recruited 151 community-dwelling adult participants [mean (SD) age 69.7 (13.6), range 24.6-93.2] from the Baltimore Longitudinal Study of Aging (BLSA). Spatial navigation ability was assessed using the triangle completion task (TCT), and two quantities, the angle and distance of deviation, were computed. Visuospatial cognitive ability was assessed primarily using the Card Rotations Test. Additional tests of executive function, memory, and attention were also administered. In multiple linear regression analyses adjusting for age, sex, race, and education, cognitive tests of visuospatial ability, executive function, and perceptual motor speed and integration were significantly associated with spatial navigation, as determined by performance on the TCT. These findings suggest that dynamic spatial navigation ability is related to spatial memory, executive function, and motor processing speed.

    View details for DOI 10.3389/fneur.2020.00484

    View details for Web of Science ID 000543906900001

    View details for PubMedID 32595588

    View details for PubMedCentralID PMC7300262

  • Saccular function is associated with both angular and distance errors on the triangle completion test. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology Anson, E. R., Ehrenburg, M. R., Wei, E. X., Bakar, D., Simonsick, E., Agrawal, Y. 2019; 130 (11): 2137-2143


    The present study was designed to determine whether healthy older adults with age-related vestibular loss have deficits in spatial navigation.154 adults participating in the Baltimore Longitudinal Study of Aging were tested for semicircular canal, saccular, and utricular function and spatial navigation ability using the blindfolded Triangle Completion Test (TCT). Multiple linear regression was used to investigate the relationships between each measure of vestibular function and performance on the TCT (angular error, end point error, and distance walked) while controlling for age and sex.Individuals with abnormal saccular function made larger angular errors (β = 4.2°, p < 0.05) and larger end point errors (β = 13.6 cm, p < 0.05). Independent of vestibular function, older age was associated with larger angular (β's = 2.2-2.8°, p's < 0.005) and end point errors (β's = 7.5-9.0 cm, p's < 0.005) for each decade increment in age.Saccular function appears to play a prominent role in accurate spatial navigation during a blindfolded navigation task.We hypothesize that gravitational cues detected by the saccule may be integrated into estimation of place as well as heading direction.

    View details for DOI 10.1016/j.clinph.2019.08.027

    View details for PubMedID 31569041

    View details for PubMedCentralID PMC6874399

  • Association Between Saccule and Semicircular Canal Impairments and Cognitive Performance Among Vestibular Patients. Ear and hearing Pineault, K., Pearson, D., Wei, E., Kamil, R., Klatt, B., Agrawal, Y. 2019; 41 (3): 686-692


    Growing evidence suggests that vestibular function impacts higher-order cognitive ability such as visuospatial processing and executive functioning. Despite evidence demonstrating vestibular functional impairment impacting cognitive performance, it is unknown whether cognitive ability is differentially affected according to the type of vestibular impairment (semicircular canal [SCC] versus saccule) among patients with diagnosed vestibular disease.Fifty-four patients who presented to an academic neurotologic clinic were recruited into the study. All patients received a specific vestibular diagnosis. Forty-one patients had saccule function measured with the cervical vestibular-evoked myogenic potential, and 43 had SCC function measured using caloric irrigation. Cognitive tests were administered to assess cognitive performance among patients. One hundred twenty-five matched controls were recruited from the Baltimore Longitudinal Study of Aging to compare cognitive performance in patients relative to age-matched healthy controls.Using multivariate linear regression analyses, patients with bilaterally absent cervical vestibular-evoked myogenic potential responses (i.e., bilateral saccular impairments) were found to take longer in completing the Trail-Making test (β = 25.7 sec, 95% confidence interval = 0.3 to 51.6) and to make significantly more errors on the Benton Visual Retention test part-C (β = 4.5 errors, 95% confidence interval [CI] = 1.2 to 7.8). Patients with bilateral SCC impairment were found to make significantly more errors on the Benton Visual Retention test part-C (β = 9.8 errors, 95% CI = 0.2 to 19.4). From case-control analysis, for each SD difference in Trail-Making test part-B time, there was a corresponding 142% increase in odds of having vestibular impairment (odds ratio = 2.42, 95% CI = 1.44 to 4.07).These data suggest that bilateral saccule and SCC vestibular impairments may significantly affect various domains of cognitive performance. Notably, the cognitive performance in patients in this study was significantly poorer relative to age-matched healthy adults. Cognitive assessment may be considered in patients with saccule and SCC impairments, and cognitive deficits in vestibular patients may represent an important target for intervention.

    View details for DOI 10.1097/AUD.0000000000000795

    View details for PubMedID 31567562

    View details for PubMedCentralID PMC7080562

  • Increased Prevalence of Vestibular Loss in Mild Cognitive Impairment and Alzheimer's Disease. Current Alzheimer research Wei, E. X., Oh, E. S., Harun, A., Ehrenburg, M., Xue, Q. L., Simonsick, E., Agrawal, Y. 2019; 16 (12): 1143-1150


    Recent evidence has shown that Alzheimer's Disease (AD) patients have reduced vestibular function relative to healthy controls. In this study, we evaluated whether patients with Mild Cognitive Impairment (MCI) also have reduced vestibular function relative to controls, and compared the level of vestibular impairment between MCI and AD patients.Vestibular physiologic function was assessed in 77 patients (26 MCI, 51 AD) and 295 matched controls using 3 clinical vestibular tests. The association between vestibular loss and cognitive impairment was evaluated using conditional logistic regression models.Individuals with vestibular impairment had a 3 to 4-fold increased odds of being in the MCI vs. control group (p-values < 0.05). MCI patients had a level of vestibular impairment that was intermediate between controls and AD.These findings suggest a dose-response relationship between vestibular loss and cognitive status, and support the hypothesis that vestibular loss contributes to cognitive decline.

    View details for DOI 10.2174/1567205016666190816114838

    View details for PubMedID 31418661

  • Vestibular Loss Predicts Poorer Spatial Cognition in Patients with Alzheimer's Disease. Journal of Alzheimer's disease : JAD Wei, E. X., Oh, E. S., Harun, A., Ehrenburg, M., Agrawal, Y. 2018; 61 (3): 995-1003


    The vestibular system is an important contributor to balance control, spatial orientation, and falls risk. Recent evidence has shown that Alzheimer's disease (AD) patients have a higher prevalence of vestibular impairment relative to healthy controls. We sought to evaluate whether vestibular loss is specifically associated with poor spatial cognitive skills among patients with mild cognitive impairment (MCI) and AD. We enrolled 50 patients (22 MCI and 28 AD) from an interdisciplinary Memory Clinic and measured vestibular physiologic function in all patients. Spatial cognitive function was assessed using the Money Road Map Test (MRMT) and the Trail Making Test Part B (TMT-B). General cognitive function was assessed with the Mini-Mental Status Examination (MMSE). In multivariable linear regression analyses adjusted for age, gender, education level, and MMSE, MCI and AD patients with vestibular loss made significantly more errors on the MRMT relative to patients with normal vestibular function (β= 7.3, 95% CI 2.4, 12.1 for unilateral vestibular loss and β= 6.4, 95% CI 1.9, 10.9 for bilateral vestibular loss). We further stratified AD patients into "spatially normal" and "spatially impaired" groups based on MRMT performance, and found that the prevalence of vestibular loss was significantly higher in the spatially impaired AD group relative to the spatially normal AD group. These findings support the hypothesis that vestibular loss contributes specifically to a decline in spatial cognitive ability in MCI and AD patients, independently of general cognitive decline, and may predict a "spatially impaired" subtype of AD.

    View details for DOI 10.3233/JAD-170751

    View details for PubMedID 29254098

  • Association Between Vestibular Vertigo and Motor Vehicle Accidents: Data From the 2016 National Health Interview Survey EAR AND HEARING Wei, E. X., Agrawal, Y. 2018; 39 (6): 1232-1235


    Recent evidence has shown that individuals with vestibular impairment have higher rates of self-reported driving difficulty compared with individuals without vestibular impairment. However, it is unknown whether individuals with vestibular impairment are more likely to be involved in motor vehicle accidents. We used data from the 2016 National Health Interview Survey of U.S. adults to evaluate whether individuals with vestibular vertigo are more likely to experience motor vehicle accidents relative to individuals without vestibular vertigo. In multivariate analysis, vestibular vertigo was associated with an over threefold increased odds of motor vehicle accidents (odds ratio, 3.5; 95% confidence interval, 1.7-7.3). This study supports an association between vestibular dysfunction and driving impairment, and provides a relative risk of motor vehicle accidents associated with vestibular vertigo that clinicians may utilize in counseling patients on the potential safety hazards of driving.

    View details for DOI 10.1097/AUD.0000000000000602

    View details for Web of Science ID 000457578500017

    View details for PubMedID 29782443

  • "Text It" program to track falls in patients with Alzheimer's disease and dementia. Alzheimer's & dementia (New York, N. Y.) Kamil, R. J., Bakar, D., Ehrenburg, M., Frankenthaler, S., Wei, E. X., Anson, E., Oh, E., Agrawal, Y. 2018; 4: 137-140


    Falls are a significant problem among older adults with Alzheimer's disease, leading to high rates of fracture, hospitalization, and death. Tracking falls in older adults, particularly those with cognitive impairment, is a clinical and research challenge.This prospective pilot study evaluated the feasibility of a text message program to track falls among patients with dementia. We also compared this technique with the calendar method of fall data collection.There was a 96% completion rate of text messaging and 100% of calendars; however, the text-gathered data were more accurate.A text-messaging platform to track falls shows promise in cognitively impaired individuals.

    View details for DOI 10.1016/j.trci.2018.03.001

    View details for PubMedID 29955657

    View details for PubMedCentralID PMC6021553

  • Vestibular Dysfunction and Difficulty with Driving: Data from the 2001-2004 National Health and Nutrition Examination Surveys. Frontiers in neurology Wei, E. X., Agrawal, Y. 2017; 8: 557


    There is growing understanding of the role of vestibular function in spatial navigation and orientation. Individuals with vestibular dysfunction demonstrate impaired performance on static and dynamic tests of spatial cognition, but there is sparse literature characterizing how these impairments might affect individuals in the real-world. Given the important role of visuospatial ability in driving a motor vehicle, we sought to evaluate whether individuals with vestibular dysfunction might have increased driving difficulty.We used data from the 2001-2004 National Health and Nutrition Examination Surveys to evaluate the influence of vestibular dysfunction in driving difficulty in a nationally representative sample of U.S. adults aged ≥50 years (n = 3,071). Vestibular function was measured with the modified Romberg test. Furthermore, since vestibular dysfunction is a known contributor to falls risk, we assessed whether individuals with vestibular dysfunction and concomitant driving difficulty were at an increased risk of falls.In multivariate analyses, vestibular dysfunction was associated with a twofold increased odd of driving difficulty (odds ratio 2.16, 95% CI 1.57, 2.98). Among participants with vestibular dysfunction, concomitant driving difficulty predicted an increased risk of falls that was significantly higher than in participants with vestibular dysfunction only (odds ratio 13.01 vs. 2.91, p < 0.0001).This study suggests that difficulty driving may be a real-world manifestation of impaired spatial cognition associated with vestibular loss. Moreover, driving difficulty may be a marker of more severe vestibular dysfunction.

    View details for DOI 10.3389/fneur.2017.00557

    View details for PubMedID 29089924

    View details for PubMedCentralID PMC5650982

  • Saccular Impairment in Alzheimer's Disease Is Associated with Driving Difficulty. Dementia and geriatric cognitive disorders Wei, E. X., Oh, E. S., Harun, A., Ehrenburg, M., Agrawal, Y. 2017; 44 (5-6): 294-302


    Patients with Alzheimer's disease (AD) experience increased rates of vestibular loss. Recent studies suggest that saccular impairment in mild cognitive impairment (MCI) and AD patients is associated with impaired spatial cognitive function. However, the impact of saccular impairment on everyday behaviors that rely on spatial cognitive function is unknown.We recruited 60 patients (21 MCI and 39 AD) from an interdisciplinary Memory Clinic. Saccular function was measured, and a visuospatial questionnaire was administered to assess whether participants experienced impairments in terms of driving difficulty, losing objects, falls, and fear of falling.In multiple logistic regression analyses, MCI and AD patients with bilateral saccular impairment had a significant, greater than 12-fold odds of driving difficulty (OR 12.1, 95% CI 1.2, 117.7) compared to MCI and AD patients with normal saccular function, and the association appears to be mediated by spatial cognition as measured by the Money Road Map Test.This study suggests a novel link between saccular impairment and driving difficulty in MCI and AD patients and demonstrates that driving difficulty may be a real-world manifestation of impaired spatial cognition associated with saccular impairment.

    View details for DOI 10.1159/000485123

    View details for PubMedID 29393172

    View details for PubMedCentralID PMC5906193