All Publications

  • 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

  • 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

  • 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

  • Influence of Age, Gender, and Wait-Times On Public Online Ratings of Glaucoma Physicians in the United States. Journal of glaucoma Kim, J. Y., Francisco, R., Wang, J., Liu, J. J., Stephenson, N. J., Khalil, C. B., Kim, D. H., Nguyen, A. X., Youn, G. M., Sun, Y., Wu, A. Y. 2023


    PRCIS: Glaucoma surgeons are highly rated by the general public. Physicians with shorter wait times and who are younger are more likely to have higher ratings. Women glaucoma physicians are less likely to have higher ratings.PURPOSE: Find what characteristics of glaucoma physicians are associated with higher online ratings.PATENTS AND METHODS: All American members of the American Glaucoma Society (AGS) were queried on Healthgrades, Vitals, and Yelp. Ratings, medical school ranking, region of practice, gender, age, and wait times were recorded.RESULTS: 1106 (78.2%) of AGS members had at least one review across the three platforms. The average score among glaucoma surgeons was 4.160 (0.898 standard deviation, SD). Women physicians were associated with lower online ratings (adjusted odds ratio [aOR] 0.536 [95% CI 0.354-0.808). Physicians with less than 30 minutes of wait time had higher ratings: 15-30 minutes wait time (aOR 2.273 [95% CI 1.430-3.636]) and <15-minute wait time (aOR 3.102 [95% CI 1.888-5.146]). Older physicians had lower ratings (aOR 0.384 [95% CI 0.255-0.572]).CONCLUSIONS: Public online ratings of glaucoma specialists in the United States appear to favour those of younger age, men, and those with shorter wait times.

    View details for DOI 10.1097/IJG.0000000000002189

    View details for PubMedID 36795534

  • 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

  • The Use of Panitumumab-IRDye800CW in a Novel Murine Model for Conjunctival Squamous Cell Carcinoma. Translational vision science & technology Youn, G. M., Case, A. G., Jarin, T., Li, B., Swarup, A., Naranjo, A., Bou-Khalil, C., Yao, J., Zhou, Q., Hom, M. E., Rosenthal, E. L., Wu, A. Y. 2022; 11 (7): 23


    Purpose: Conjunctival squamous cell carcinoma (SCC) is a sight-threatening ocular surface malignancy with the primary treatment modality being surgical resection. To evaluate surgical imaging modalities to improve surgical resection, we established a novel murine model for conjunctival SCC to demonstrate the utility of panitumumab-IRDye800, a fluorescently labeled anti-epidermal growth factor receptor (EGFR) antibody.Methods: NOD-scid IL2Rgammanull (NSG) mice received subconjunctival injection of UM-SCC-1 or SCC-9, head and neck SCC cell lines. On tumor growth, mice were injected with Panitumumab-IRDye800CW, and imaged with a small animal imaging system and optical coherence tomography (OCT). Immunohistochemistry for SCC markers were used to confirm tumor origin.Results: Seventy-five percent (N = 4) of the UM-SCC-1 group developed aggressive, rapidly growing tumors that were P40 and EGFR positive within two weeks of inoculation. The SCC-9 tumors failed to demonstrate any growth (N = 4). Ocular tumors demonstrated high fluorescence levels with a tumor to background ratio of 3.8.Conclusions: Subconjunctival injections are an appropriate technique to create in vivo models for assessing treatment modalities and novel therapies in conjunctival SCC.Translational Relevance: This model demonstrates Panitumumab-IRDye800CW's utility in the ophthalmic setting and suggests that clinical trials may be warranted.

    View details for DOI 10.1167/tvst.11.7.23

    View details for PubMedID 35895055

  • 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

  • Acromioclavicular Joint Repair Using a Suture Cerclage Tensioning System ARTHROSCOPY TECHNIQUES Youn, G., Chakrabarti, M. O., McGahan, P. J., Chen, J. L. 2019; 8 (12): E1555-E1560


    Injuries to the acromioclavicular (AC) joint are common among adults in their twenties and account for 8% of all joint dislocations. Although there are numerous operative approaches to treating AC joint separations, a gold standard does not exist because of lack of conclusive evidence supporting the use of 1 standard technique. In this Technical Note and accompanying video, we describe an anatomic AC joint repair using a suture cerclage tensioning system to accurately control the reduction and improve the precision and outcomes of the repair.

    View details for DOI 10.1016/j.eats.2019.08.006

    View details for Web of Science ID 000503877200019

    View details for PubMedID 31890537

    View details for PubMedCentralID PMC6928360

  • Arthroscopic-Assisted Osteochondral Allograft Transplantation for Posterolateral Lesions of the Talus Without Fibular Osteotomy. Arthroscopy techniques Youn, G. M., Rosinski, A., Gwosdz, J., Chakrabarti, M., Elena, N., Woodall, B. M., Shimizu, M., McGahan, P. J., Chen, J. L. 2019; 8 (3): e311-e316


    Osteochondral lesions of the talus are chondral defects often caused by acute trauma to the ankle such as sprains and fractures. If operative treatment is necessary, microfracture, cartilage replacement, and autologous chondrocyte implantation can be used. We describe a single-step osteochondral allograft transfer to access the posterolateral talar dome that avoids the need for a fibular osteotomy and therefore eliminates morbidity while reducing operative time.

    View details for DOI 10.1016/j.eats.2018.11.009

    View details for PubMedID 31016127

    View details for PubMedCentralID PMC6475624

  • Arthroscopic Bone Marrow Aspirate Concentrate Harvesting From the Intercondylar Notch of the Knee ARTHROSCOPY TECHNIQUES Youn, G., Woodall, B. M., Elena, N., Shin, E. C., Pathare, N., McGahan, P. J., Chen, J. L. 2018; 7 (11): E1173-E1176


    Bone marrow aspirate concentrate is commonly harvested to obtain mesenchymal stem cells, progenitor cells, and growth factors. The iliac crest is the most common donor site for bone marrow harvesting and is associated with donor site morbidity of an additional incision and pain from the harvest. Iliac crest harvesting can be cumbersome because it often requires different patient positioning from the surgical procedure and additional sedation or anesthesia for the harvest prior to repositioning. The purpose of this Technical Note and accompanying video is to describe a technique to arthroscopically aspirate bone marrow from the intercondylar femoral notch, reducing the need for iliac crest harvesting.

    View details for DOI 10.1016/j.eats.2018.07.016

    View details for Web of Science ID 000451394100016

    View details for PubMedID 30533365

    View details for PubMedCentralID PMC6261716