Hong-Ho Yang

All Publications

• Biodiversity of the Bacterial and Fungal Microbiome and Associated Inflammatory Cytokine Profile in Chronic Rhinosinusitis. International forum of allergy & rhinology Yang, H. H., Simpson, C. A., Srivastava, M., Bera, A., Cappelletti, M., Suh, J. D., Wang, M., Beswick, D. M., Maxim, T., Basak, S. K., Srivatsan, E. S., Fischer, J. L., Jacobs, J. P., Lee, J. T. 2025

  Abstract

  Dysbiosis of the bacterial and fungal microbiome has been increasingly implicated in the pathogenesis of chronic rhinosinusitis (CRS). This study explores the relationship between microbiome and mycobiome biodiversity and type 2 (T2) versus non-type 2 (NT2) inflammation.Mucosal tissues from the ethmoid sinus were collected during endoscopic sinus (CRS) and skull base (controls) surgery between January 2020 and July 2021. Specimens underwent 16S rRNA (bacterial) and internal transcribed spacer (fungal) gene sequencing, along with cytokine analysis using the Luminex assay. Based on cytokine (IL-4, IL-5, IL-13) concentrations and the presence of eosinophils, CRS cases were classified into T2 or NT2 inflammatory profiles. The relationships between CRS endotype and the biodiversity of the microbiome and mycobiome were assessed.Specimens from 92 patients (30 control, 31 CRSwNP, 31 CRSsNP) were included in the analyses. Among 62 CRS cases, 20 exhibited T2 inflammation and 42 exhibited NT2 inflammation. Compared with control specimens, NT2 specimens exhibited significantly lower amplicon sequence variants (mean difference -149, 95% CI [-261, -37], p = 0.007), Shannon index (-0.48 [-0.79, -0.16], p = 0.002), and Simpson index (-0.003 [-0.005, -0.001], p = 0.002) for bacterial alpha diversity. However, no significant differences in bacterial alpha diversity were observed between T2 specimens and controls, or between T2 and NT2 specimens. Fungal biodiversity did not differ significantly across endotype and control groups.Dysbiosis of the sinus bacterial microbiome is more strongly associated with a NT2-mediated inflammatory profile than with a T2-mediated inflammatory profile.

  View details for DOI 10.1002/alr.23519

  View details for PubMedID 39776217

• Arcuate eminence distance to temporal bone outer table in the middle fossa repair of superior canal dehiscence. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery Yang, H. H., Yang, I., Gopen, Q. S. 2024

  Abstract

  To investigate the influence of arcuate eminence's distance to temporal bone outer table (AE-OT) on surgical outcomes following the middle fossa repair of superior canal dehiscence (SCD).We conducted a cohort study of consecutive repairs at a center between 2011 and 2022. AE-OT was measured on temporal bone CT imaging. Surgical outcomes were assessed with established metrics including Symptom Resolution Score (SRS), rate of Overall Symptom Improvement (OSI), and change in low-frequency air-bone gap (ΔLF-ABG) from pre- to post-surgery. Multivariable regression models assessing surgical outcomes were constructed with AE-OT as the primary predictor. Models adjusted for patient demographics, medical and surgical history, and follow-up duration.A total of 402 repairs were included. Mean AE-OT was 27.1 mm (SD 2.1, range 20.8-33.9). Every mm increase in AE-OT was independently associated with a 14% reduction in odds of OSI (aOR 0.86, 95% C.I. [0.75, 0.98]) and a 4-point decrease in SRS (adj. β - 4.0 [- 6.9, - 1.1]) among frank dehiscences. AE-OT was also not associated with operative duration and ΔLF-ABG among both frank dehiscences and near dehiscences.Longer AE-OT predicted poorer symptomatic response but similar operative duration and audiometric improvement among frank SCD cases.

  View details for DOI 10.1007/s00405-024-09067-0

  View details for PubMedID 39643813

  View details for PubMedCentralID 7492198

• Ambient particulate matter and frequency of outpatient visits for chronic rhinosinusitis in the United States. International forum of allergy & rhinology Yang, H. H., Grimm, D., Velasquez, E., Hwang, P. H. 2024

  Abstract

  Emerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).We conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core-based statistical area [CBSA]), we calculated the annual rate of CRS-related outpatient visits per 1000 well-patient checkup visits (CRS-OV). Using data from the Environmental Protection Agency's Air Quality System, we mapped the rolling statistical average of daily PM2.5 and PM10 over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS-OV.Across 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS-OV was 164 (interquartile range 110-267). The mean PM2.5 level was 8.9 µg/m3 (SD 2.6) and the mean PM10 level was 20.2 µg/m3 (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS-OV was observed with increasing PM levels. Each µg/m3 rise in PM2.5 independently predicted a 10% increase in CRS-OV (adjusted incidence rate ratio [aIRR]) 1.10, 95% confidence interval [CI] 1.08-1.13) and each µg/m3 rise in PM10 independently predicted a 3% increase in CRS-OV (aIRR 1.03, 95% CI 1.02-1.04).Elevated ambient PM2.5 and PM10 levels are associated with a subsequent compounded increase in the frequency of CRS-OV, with PM2.5 predicting a more pronounced rise compared to PM10.

  View details for DOI 10.1002/alr.23477

  View details for PubMedID 39476332

• Radiographic Estimation of Superior Canal Dehiscence Area in a Prediction Model of Surgical Outcome. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Yang, I., Gopen, Q. S. 2024

  Abstract

  Computed tomography (CT) imaging of the temporal bone constitutes an integral element in the diagnostic workup of superior canal dehiscence (SCD). This study explores the utility of a clinically efficient method of manually estimating SCD size on CT imaging in predicting surgical outcomes.Cohort study.Tertiary center.Consecutive middle fossa repairs of SCD between 2011 and 2022 were included. Measurements of approximate dehiscence area (ADA), a previously established estimation method, on temporal bone CT imaging were performed by trained raters blind to clinical information. Surgical outcomes, evaluated with symptom resolution and audiometric improvement following repair, were assessed in multivariable regression models with ADA as the primary predictor and patient demographics and other history factors as covariates.Among 311 cases included, mean ADA was 2.68 mm2, and 71% of cases achieved overall symptom improvement (OSI). Every 1 mm2 rise in ADA predicted on average 3 dB greater narrowing of low-frequency air-bone gap (β 95% confidence interval, CI [-5.4, -0.7]) but 50% lower odds of OSI (adjusted odds ratio: 95% CI [0.32, 0.78]) among unilateral SCD cases. A model incorporating ADA, patient demographics, and history factors predicted OSI with a sensitivity, specificity combination as high as 85%, 73% and a positive predictive value, negative predictive value combination as high as 85%, 82% (area under the curve: 95% CI: 0.76-0.93).Increased ADA predicts more pronounced audiometric improvement but poorer symptomatic response among unilateral SCD cases. ADA is an efficient and practical method of estimating SCD size and demonstrated clinical utility in accurately predicting surgical outcomes.

  View details for DOI 10.1002/ohn.970

  View details for PubMedID 39369435

• Gender, Racial, and Academic Authorship Diversity in the Otolaryngology Clinical Trial Literature. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Huynh, J. D., Moffatt, C., Evans, L. K., Bommakanti, K., Wong, E., John, M. S. 2024

  Abstract

  To investigate the state and trajectory of gender, racial, and academic authorship diversity in the otolaryngology clinical trial literature over the past 2 decades.Bibliometric analysis.Otolaryngology clinical trial literature.Clinical trials published in the 9 major otolaryngology journals between 2000 and 2020 were included. The gender, race, and academic seniority of the first, senior, and corresponding authors were recorded for each trial. Multivariable regression models assessed the temporal trajectory of authorship diversity over time and the disparity in citations across author characteristics. Models adjusted for relevant confounders pertaining to publication environment and study design.Among 2117 trials, first, senior, and corresponding authors have been predominantly White (60%-64%), male (76%-80%), and attending physicians (63%-69%). Trials led by Black (<1%) and Hispanic (<5%) authors were severely underrepresented. Over time, the representation of female (adj. β 0.8%, 95% CI [0.5%, 1.1%] per year), Asian (1.0% [0.7%, 1.3%] per year), and MD resident (0.4% [0.1%, 0.7%] per year) first authorship increased, but representation of female (0.2% [-0.1%, 0.5%] per year), Black (0% [-0.03%, 0.02%] per year), Hispanic (-0.2% [-0.33%, -0.02%] per year) senior authorship remained persistently low. Asian-led trials were cited significantly less compared to White-led trials even after adjusting for study design and publication year (aIRR 0.82 [0.73, 0.92]).Despite promising signs of improving authorship diversity over time, persistent underrepresentation of female, Black, Hispanic senior authorship underscore the need for additional efforts to diversify the otolaryngology clinical science workforce.

  View details for DOI 10.1002/ohn.994

  View details for PubMedID 39369433

• Regular Physician Access and Obesity Status Among Underserved Asian and Pacific Islander American Immigrants in Los Angeles. Asia-Pacific journal of public health Yang, H. H., Dhanjani, S. A., Chwa, W. J., Wells, C. R., Huynh, J. D., Vo, L. N., Chou, H. N., Cowgill, B. 2024; 36 (6-7): 610-618

  Abstract

  According to prior research, Asian and Pacific Islander American (APIA) immigrants often refrain from seeking health care unless necessitated by medical conditions. Utilizing data from health screenings conducted in APIA immigrant enclaves in Los Angeles, we hypothesize that poorer obesity status would predict higher rates of regular physician access. Analyses involved objectively measured percent body fat (%BF) and survey responses collected between 2011 and 2019. We assessed the association between obesity status and regular physician access, adjusting for insurance status, demographic, and socioeconomic factors. The study population (n = 4102) primarily consisted low-income, low English proficiency APIAs. Participants with a regular physician were significantly more likely to be obese compared to participants without (adjusted odds ratio [aOR] = 1.28). This association may suggest that care was sought reactively rather than proactively within this community. Interventions with emphasis on cultural competency and language services may encourage preventative care utilization among this understudied community.

  View details for DOI 10.1177/10105395241260970

  View details for PubMedID 38880968

• Patient Sex Mediates the Influence of Patient Age on Superior Canal Dehiscence Repair Outcome. The Laryngoscope Yang, H. H., Yang, I., Gopen, Q. S. 2024; 134 (7): 3363-3370

  Abstract

  To investigate the independent and interactive effects of patient age and sex on superior canal dehiscence (SCD) repair outcomes.This was a cohort study of consecutive SCD repairs via the middle fossa approach at an institution between 2011 and 2022. We constructed multivariable regression models assessing surgical outcomes with age and sex as the primary predictors. Models controlled for surgery duration, follow-up duration, and relevant surgical and medical history. Subsequently, we repeated each model with the incorporation of an interaction term between patient age and sex.Among 402 repairs, average age was 50 years, and 63% of cases were females. There was a significant interaction between patient age and sex with respect to symptom resolution score (SRS) (adj. β 0.80, 95% C.I. 0.04-1.56). Older age was associated with lower SRS among females (-0.84, -1.29 to -0.39 point per year) but not significantly associated with SRS among males (0.04, -0.65 to 0.56 point per year). Furthermore, older age independently predicted a greater magnitude of increase in air conduction at 8000 Hz following surgery regardless of sex (adj. β 2.1, 0.2-4.0 dB per 10-year increase).This is the first study on the interactive effect between patient age and sex with respect to SCD repair outcomes. Older age predicted poorer symptomatic response among female patients but did not predict symptomatic response among male patients. Furthermore, older age predicted more severe high-frequency hearing loss following SCD repairs among both female and male patients.3 Laryngoscope, 134:3363-3370, 2024.

  View details for DOI 10.1002/lary.31356

  View details for PubMedID 38381092

• Narrowing of Low-Frequency Air-Bone Gap and Its Association with Symptom Resolution Following Superior Canal Dehiscence Repair. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Yang, I., Gopen, Q. S. 2024; 170 (4): 1133-1139

  Abstract

  Low-frequency air-bone gap (LABG) on pure tone audiometry is an expected clinical finding of superior canal dehiscence (SCD) syndrome. We investigate how narrowing of LABG following SCD repairs translates to symptom resolution.Cohort study.Tertiary Care Center.We analyzed consecutive SCD repairs at an institution between 2012 and 2022. Pure tone audiometry and symptom questionnaires were administered pre- and post-operatively. The independent variable assessed whether the LABG narrowed (≥5 dB) following surgery. Outcome measures were rates of Overall Symptom Improvement (OSI, net resolution of ≥1 symptom) and Symptom Resolution Score (SRS, % symptoms resolved). We conducted multivariable regression analyses with LABG narrowing as the primary predictor. All models controlled for demographics, bilateral disease, prior ear surgery, and follow-up.Among total of 217 repairs analyzed, 161 (74%) reached OSI, and mean SRS was 39 (out of 100). LABG narrowing at 250 Hz (65%), 500 Hz (52%), and 1000 Hz (47%) was associated with a 41-point (β 95% confidence interval [CI] 5-77) increase in auditory, 15-point (β 95% CI 1-30) increase in auditory, and 23-point (β 95% CI 2-45) increase in vestibular SRS, respectively. However, LABG narrowing was not significantly associated with the rates of auditory and vestibular OSI at all frequencies assessed.Lack of LABG narrowing following repair was associated with the persistence of a greater proportion of preoperative symptoms but similar likelihood of OSI. This relationship was more prominent for auditory symptoms at 250 to 500 Hz and for vestibular symptoms at 1000 Hz. Additional research is warranted to elucidate the mechanism through which symptoms resolve despite LABG persistence.

  View details for DOI 10.1002/ohn.588

  View details for PubMedID 38149698

• First-Side and Second-Side Repair of Bilateral Superior Canal Dehiscence. The Laryngoscope Yang, H. H., Yang, I., Gopen, Q. S. 2024; 134 (4): 1882-1888

  Abstract

  Bilateral superior canal dehiscence (SCD) may warrant surgeries on both sides. With repairs of unilateral SCD as reference, we investigate the comparative effectiveness of first-side and second-side repairs, in hopes of establishing knowledge that can guide clinical decision-making pertaining the appropriateness of second-side surgeries.Middle fossa SCD repairs at an institution between 2011 and 2022 were analyzed. Multivariable regression models assessed symptom resolution and audiometric improvement with surgery cohort (unilateral SCD repair vs. first-side repair vs. second-side repair) as the primary predictor. All models controlled for patient age, sex, surgery duration, prior ear surgery, and follow-up.A total of 407 repairs (180 unilateral SCD, 172 first-side, and 55 second-side repairs) were analyzed. The rates of overall symptom improvement for auditory and vestibular symptoms were as follows: 81% and 67% for unilateral SCD repairs; 73% and 54% for first-side repairs; and 43% and 51% for second-side repairs, respectively. Compared with first-side repairs, which resolved auditory symptoms at similar rates (aOR 95% C.I. 0.36-1.07) but resolved vestibular symptoms at significantly lower rates (aOR 95% C.I. 0.35-0.93) compared with unilateral SCD repairs, second-side repairs resolved auditory symptoms at significantly lower rates (aOR 95% C.I. 0.10-0.51) but resolved vestibular symptoms at similar rates (aOR 95% C.I. 0.45-2.01).Careful consideration of perioperative symptomatology may inform the appropriateness of second-side surgeries. If auditory symptoms persisted following first-side surgeries, second-side surgeries are less likely to yield resolution. If vestibular symptoms persisted following first-side repairs, second-side repairs may lead to resolution at similar rates as first-side repairs.3 Laryngoscope, 134:1882-1888, 2024.

  View details for DOI 10.1002/lary.31118

  View details for PubMedID 37937741

• Positive Outcome Bias in the Influential Otolaryngology Clinical Trial Literature. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Tsai, M., Mukdad, L., St John, M. 2024; 170 (3): 812-820

  Abstract

  To assess for the presence of positive outcome bias in the otolaryngology clinical trial literature. Specifically, we investigate the prevalence of clinical trials with positive findings (CTP) and clinical trials with negative findings (CTN), as well as their quality of evidence and subsequent impact.Retrospective analysis.Clinical Trials in the Influential Otolaryngology Literature.We reviewed all clinical trials published in 4 major otolaryngology journals between 2000 and 2020. We constructed several multivariable regression models to investigate the relationship of finding direction with randomization status and citation count. Subsequently, we incorporated an interaction term between year and the primary covariate of each model to assess the temporal trajectory of these relationships. All models accounted for sample size, journal, subspecialty, and the affiliated program prestige.Of the 1367 trials analyzed, 1143 (84%) were CTPs, a rate that persisted throughout the study period (aOR 1.00, 95% CI 0.98-1.03). CTPs were significantly less likely to be randomized compared to CTNs (aOR 0.25, 0.17-0.37), a relationship that persisted over time (aOR 1.05, 0.99-1.03). CTPs received significantly more citations compared to CTNs (aIRR 1.41, 1.25-1.60), a disparity that also persisted over time (aIRR 0.99, 0.97-1.01).The otolaryngology clinical trial literature has been heavily dominated by positive findings. CTPs were more frequently cited and published even with a lower level of evidence compared to CTNs. This bias may influence the objectivity of evidence used to guide clinical practice and warrants attention when reviewing findings and changing practices.

  View details for DOI 10.1002/ohn.562

  View details for PubMedID 37822124

• Low-Lying Tegmen and Surgical Outcomes Following the Middle Cranial Fossa Repair of Superior Canal Dehiscence. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Patel, V. S., Yang, I., Gopen, Q. S. 2024; 170 (1): 195-203

  Abstract

  To compare treatment response from the middle cranial fossa repair of superior canal dehiscence (SCD) between cases with and cases without low-lying tegmen (LLT).Cohort study.Single tertiary care institution.Two investigators independently reviewed preoperative high-resolution temporal bone computed tomography images and classified the ipsilateral tegmen as either "low-lying" or "control." Patients completed a symptom questionnaire and underwent audiometric testing pre- and post-operatively. Multivariable regression models assessed for symptomatic resolution and audiometric improvement following surgery with tegmen status as the primary predictor. Models controlled for patient age, sex, bilateral SCD disease, dehiscence location, prior ear surgery status, surgery duration, and follow-up duration.Among a total of 410 cases included, we identified 121 (29.5%) LLT cases. Accounting for all control measures, patients with LLT were significantly less likely to experience overall symptom improvement (adjusted odds ratio: 0.32, 95% confidence interval [CI]: 0.18-0.57, p < .001) and reported a significantly lower proportion of preoperative symptoms that resolved following surgery (adjusted β: -25.6%, 95% CI: -37.0% to -14.3%, p < .001). However, audiometric outcomes following surgery did not differ significantly between patients with and patients without LLT.This is the first investigation on the relationship between LLT and surgical outcomes following the middle fossa repair of SCD. Patients with LLT reported less favorable symptomatic response but exhibited a similar degree of audiometric improvement.

  View details for DOI 10.1002/ohn.480

  View details for PubMedID 37598319

• Residential Proximity to a Commercial Pesticide Application Site and Risk of Chronic Rhinosinusitis. JAMA otolaryngology-- head & neck surgery Yang, H. H., Paul, K. C., Cockburn, M. G., Thompson, L. K., Cheng, M. Y., Suh, J. D., Wang, M. B., Lee, J. T. 2023; 149 (9): 773-780

  Abstract

  Environmental and occupational toxicants have been shown to be associated with an increased prevalence of chronic rhinosinusitis (CRS). However, few to no studies have evaluated patients for CRS using objective testing and workup protocols that fulfill guidelines for CRS diagnostic criteria. Furthermore, no study, to our knowledge, has investigated the risks of CRS in the context of residential exposure through proximity to a commercial pesticide application site.To evaluate associations of residential proximity to a commercial pesticide application site and the prevalence of CRS with nasal polyps (CRSwNP) and without nasal polyps (CRSwoNP).This was a retrospective cohort study of patients who presented to a tertiary care institution for rhinology evaluation between March 1, 2018, and December 31, 2022.The outcome variable was the clinical diagnosis of CRS (CRSwNP, CRSwoNP, or non-CRS control). Patients' residential addresses were utilized to determine pesticide exposure status based on a validated computational geographic information algorithm based on data from the California Pesticide Use Report System. The dichotomous independent variable of exposure status (exposed or non-exposed) was determined by assessing reports of any pesticide applications within 2000 m of each participant's residence in 2017. Multivariable logistic regressions assessing CRS status and CRS subtypes were conducted with pesticide exposure as the primary covariate of interest. The primary study outcome and measurements as well as study hypothesis were all formulated before data collection.Among a total of 310 patients (90 CRSwNP, 90 CRSwoNP, and 130 control), the mean (SD) age was 50 (17) years; 164 (53%) were female. Race and ethnicity information was not considered. Controlling for patient demographic information, smoking history, county of residence, and medical comorbidities, pesticide exposure was associated with an approximately 2.5-fold increase in odds of CRS (adjusted odds ratio, 2.41; 95% CI, 1.49-3.90). Pesticide exposure was associated with similar risks for CRSwNP (adjusted relative risk ratio [aRRR], 2.34; 95% CI, 1.31-4.18) and CRSwoNP (aRRR, 2.42; 95% CI, 1.37-4.30).The findings of this retrospective cohort study and analysis revealed that residential exposure to commercial pesticide application within a 2000-m buffer was independently associated with an approximately 2.5-fold increase in odds of being diagnosed with CRS. If validated by additional research, this association would have substantial implications for public health.

  View details for DOI 10.1001/jamaoto.2023.1499

  View details for PubMedID 37440215

  View details for PubMedCentralID PMC10346512

• Clinical Predictors of Symptom Improvement Following Eustachian Tube Balloon Dilation. The Annals of otology, rhinology, and laryngology Yang, H. H., Alonso, J., Ishiyama, A., Gopen, Q. S., Suh, J. D., Wang, M. B., Wells, C., Wung, V., Lee, J. T. 2023; 132 (9): 1032-1039

  Abstract

  This study aims to identify clinical predictors of treatment response to Eustachian Tube Balloon Dilation (ETBD) as measured by changes in Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores.One hundred thirteen patients who underwent ETBD at an institution from 2017 to 2021 completed ETDQ-7 pre- and post-operatively. We conducted multivariable regression analyses with ETDQ-7 normalization (<2.1 post-op), minimum clinically important difference (MCID) (>0.5 pre-op - post-op), and quantitative improvement in ETDQ-7 score as outcome variables. Pre-operative ETDQ-7 score, tympanogram type, chronic otitis media, chronic rhinosinusitis (CRS), inferior turbinate hypertrophy, deviated septum, allergic rhinitis, and rhinorrhea were included as covariates. Models controlled for age, sex, ethnicity, prior ear or sinus surgery, and follow-up duration.The mean age was 49 years old. 51% were females, and all patients had pre-operative ETDQ-7 above 2.1. After a mean follow-up period of 13 months, 77% achieved MCID and 37% had normalized. Higher pre-operative ETDQ-7 score was associated with greater ETDQ-7 score improvement (B = 0.60, 95% CI = [0.37, 0.83]) and greater odds of achieving MCID (aOR = 1.65; 95% CI = [1.06, 2.59]). A history of CRS improved chances of achieving MCID (aOR = 4.53; 95% CI = [1.11, 18.55]) and a history of chronic otitis media predicted increased odds of ETDQ-7 normalization (aOR = 2.88; 95% CI = [1.09, 7.58]).Our findings suggest that ETBD was highly effective among patients with pre-operative ETDQ-7 above 2.1. Furthermore, higher pre-operative ETDQ-7 score, CRS, and chronic otitis media predicted more favorable symptomatic benefit from ETBD. These factors may be important to consider when counseling potential candidates for this procedure.

  View details for DOI 10.1177/00034894221129912

  View details for PubMedID 36226334

  View details for PubMedCentralID PMC10359951

• Audiometric Outcomes After the Middle Cranial Fossa Repair of Superior Semicircular Canal Dehiscence. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Yang, H. H., Yang, I., Gopen, Q. S. 2023; 44 (6): 593-599

  Abstract

  To evaluate the audiometric outcomes after the middle cranial fossa approach (MCF) for superior canal dehiscence (SCD) repair.Retrospective review.Tertiary referral center.SCD cases presented to a single institution between 2012 and 2022.The MCF repair of SCD.Air conduction (AC) threshold (250-8,000 Hz), bone conduction threshold (BC) (250-4,000 Hz), and air bone gap (ABG) (250-4,000 Hz) at each frequency, pure tone average (PTA) (500, 1,000, 2,000, 3,000 Hz).Among 202 repairs, 57% were bilateral SCD disease and 9% had previous surgery on the affected ear. The approach significantly narrowed ABG at 250, 500, and 1,000 Hz. The narrowing of ABG was achieved by both decreased AC and increased BC at 250 Hz, but mediated primarily by increased BC at 500 Hz and 1,000 Hz. Among cases without previous ear surgery, mean PTA remained in the normal hearing range (mean: preop, 21 dB; postop, 24 dB) and clinically important hearing loss (PTA increased by ≥10 dB) after the approach was noted in 15% of cases. Among cases with previous ear surgery, mean PTA remained in the mild hearing loss range (mean: preop, 33 dB; postop, 35 dB) and clinically important hearing loss after the approach was noted in 5% of cases.This is the largest study to date examining the audiometric outcomes after the middle cranial fossa approach for SCD repair. Findings of this investigation support that the approach is effective and safe with long-term hearing preservation for most.

  View details for DOI 10.1097/MAO.0000000000003905

  View details for PubMedID 37231537

• Computed tomography approximated superior semicircular canal dehiscence size and location and their association with clinical presentation. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Yang, H. H., Patel, V. S., Yang, I., Gopen, Q. S. 2023; 112: 30-37

  Abstract

  This study investigates the relationship of superior semicircular canal dehiscence (SSCD) size and location with patient symptomatology and audiometry.We retrospectively reviewed SSCD cases presented to a tertiary institution between 2011 and 2022. Dehiscence length and width measured on high-resolution temporal bone computed tomography imaging were used to calculate an approximate dehiscence area (ADA). Dehiscence location was classified employing a six-grade system. Multivariable regression analyses were performed with symptomatology and audiogram metrics as outcome variables and ADA and dehiscence location as the primary covariates of interest.A total of 402 SSCD were included in the analysis. Controlling for patient age, sex, dehiscence laterality, and location, greater ADA was independently associated higher rates of autophony (aOR 1.39; 95% C.I. 1.14-1.71; P = 0.004) and hyper-amplification (aOR 1.39; 1.14-1.70; P = 0.004). Additionally, dehiscences with greater ADA exhibited significantly lower bone conduction threshold at 500 Hz (adjusted β -1.75, P = 0.006) and 1000 Hz (adjusted β -1.61, P = 0.018) and significantly wider air-bone gap at 500 Hz (adjusted β 2.22, P < 0.001) and 1000 Hz (adjusted β 1.00, P = 0.039). Dehiscence location was not independently associated with any outcome variable examined when accounting for dehiscence size.The size of dehiscence is more independently related to clinical presentations than the anatomical location of the dehiscence in the superior semicircular canal. Greater dehiscence size is associated with symptomatology and audiometry consistent with more severe bone conduction hyperacusis.

  View details for DOI 10.1016/j.jocn.2023.04.002

  View details for PubMedID 37037168

• Disparity in Obesity and Hypertension Risks Observed Between Pacific Islander and Asian American Health Fair Attendees in Los Angeles, 2011-2019. Journal of racial and ethnic health disparities Yang, H. H., Dhanjani, S. A., Chwa, W. J., Cowgill, B., Gee, G. 2023; 10 (3): 1127-1137

  Abstract

  The Pacific Islander American population is understudied due to being aggregated with Asian Americans. In this study, we conduct a comparative analysis of directly measured body mass index (BMI), body fat percentage (%BF), and blood pressure (BP) between Pacific Islander Americans and Asian Americans from health screenings in Los Angeles, California. We hope to reveal intra-APIA health disparities masked by this data aggregation.We analyzed BMI, %BF, and BP that were objectively measured by trained personnel at health screenings in Los Angeles between January 2011 and December 2019. We performed multivariable multinomial logistic regression models with obesity and hypertensive categories as outcome variables and ethnicity as the primary independent variable of interest. Models controlled for year of visit, participant age, sex, income, education level, years living in the USA, employment status, English proficiency, regular doctor access, and health insurance status.A total of 4,832 individuals were included in the analysis. Multivariable analyses revealed that Pacific Islander participants were at significantly higher risks for being classified as obese compared with all Asian American subgroups studied, including Chinese, Korean, Thai, Vietnamese, Filipino, and Japanese. Pacific Islanders also exhibited significantly lower predicted probability of having a normal blood pressure compared with Chinese and Thai participants. Some variation between Asian subgroups were also observed.Pacific Islander participants had higher risk of several sentinel health problems compared to Asian American participants. Disaggregation of PI Americans from the APIA umbrella category in future studies is necessary to unmask the critical needs of this important community.

  View details for DOI 10.1007/s40615-022-01300-y

  View details for PubMedID 35426057

  View details for PubMedCentralID PMC9009494

• Predictors of Death, Survival, Need for Intubation, and Need for Oxygen Support Among Admitted COVID-19 Patients of the Veterans Affairs Greater Los Angeles Healthcare System. Military medicine Yang, H. H., Wu, T. J., Yu, A. C., Wells, C., Orshansky, G., Lee, J. T. 2023; 188 (5-6): 1276-1284

  Abstract

  While risk factors for severe COVID-19 infections have been well explored among the public, population-specific studies for the U.S. Veteran community are limited in the literature. By performing a comprehensive analysis of the demographics, comorbidities, and symptomatology of a population of COVID-19 positive Veterans Affairs (VA) patients, we aim to uncover predictors of death, survival, need for intubation, and need for nasal cannula oxygen support among this understudied community.A retrospective review was conducted of 124 COVID-19 Veteran patients who were admitted from March to October 2020 to the VA Greater Los Angeles Healthcare System (IRB#2020-000272). Chi-square and Fisher's exact tests were employed to assess differences in baseline demographic and clinical variables between Veterans who survived COVID-19 versus those who succumbed to COVID-19 illness. Multivariate logistic regression and Cox regression analyses were employed to assess predictors of outcome variables, including death, survival, need for intubation, and need for oxygen support (via nasal cannula). Covariates included a wide range of demographic, comorbidity-related, symptom-related, and summary index variables.Our study population consisted of primarily senior (average age was 73) Caucasian and African American (52.5% and 40.7%, respectively) Veterans. Bivariate analyses indicated that need for intubation was significantly associated with mortality (P = 0.002). Multivariate analyses revealed that age (P < 0.001, adjusted odds ratio (OR) = 1.16), dyspnea (P = 0.015, OR = 7.73), anorexia (P = 0.022, OR = 16.55), initial disease severity as classified by WHO (P = 0.031, OR = 4.55), and having more than one of the three most common comorbidities (hypertension, diabetes, and cardiac disease) and symptoms (cough, fever, and dyspnea) among our sample (P = 0.009; OR = 19.07) were independent predictors of death. Furthermore, age (P < 0.001, hazard ratio (HR) = 1.14), cerebrovascular disease (P = 0.022, HR = 3.76), dyspnea (P < 0.001, HR = 7.71), anorexia (P < 0.001, HR = 16.75), and initial disease severity as classified by WHO (P = 0.025, HR = 3.30) were independent predictors of poor survival. Finally, dyspnea reliably predicted need for intubation (P = 0.019; OR = 29.65).Several independent predictors of death, survival, and need for intubation were identified. These risk factors may provide guidelines for risk-stratifying Veterans upon admission to VA hospitals. Additional investigations of COVID-19 prognosis should be conducted on the larger U.S. Veteran population to confirm our findings and add to the current body of literature.

  View details for DOI 10.1093/milmed/usab550

  View details for PubMedID 35134214

  View details for PubMedCentralID PMC9383386

• Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery. The Laryngoscope Yang, H. H., Wu, T. J., Suh, J. D., Wang, M. B., Holliday, M. A., Beswick, D. M., Zhang, H., Wells, C., McCormick, J., Maxim, T., Regev, A., Chandy, Z. K., Lee, J. T. 2023; 133 (5): 1065-1072

  Abstract

  This study investigates the impact of postoperative gabapentin on opioid consumption and pain control following endoscopic sinus surgery (ESS) and/or septoplasty.Patients who underwent ESS and/or septoplasty at a single institution from 2021 to 2022 were enrolled. All patients received postoperative hydrocodone-acetaminophen for pain control. Half of the patients were also prescribed gabapentin for the first postoperative day in addition to hydrocodone-acetaminophen. Subjects completed the Revised American Pain Society Patient Outcome Questionnaire 24 h and 7 days after surgery. We conducted a multivariable regression analysis to assess opioid consumption and improvement in pain scores in the first week between gabapentin and non-gabapentin groups.A total of 102 subjects, 51 in each arm, were enrolled. The mean age was 52 years and 53% of participants were female. Controlling for important baseline demographic, clinical, and surgically related variables, the addition of postoperative gabapentin was associated with a 44% (9.5 mg from 21.6 mg) reduction in opioids consumed in the first postoperative week (B = -9.54, 95% C.I. = [-17.84, -1.24], p = 0.025). In addition, patients in both arms exhibited similar improvement in pain severity and sleep interference in the first 7 days (B = -1.59, 95% C.I. = [-5.03, 1.84], p = 0.36).To the best of our knowledge, this is the first study to investigate the impact of postoperative gabapentin on opioid consumption and pain control following ESS and/or septoplasty. Our analysis demonstrated that postoperative gabapentin effectively reduced opioid use during the first postoperative week without compromising pain control.3 Laryngoscope, 133:1065-1072, 2023.

  View details for DOI 10.1002/lary.30282

  View details for PubMedID 35833722

• Postoperative Pneumolabyrinth Following the Middle Cranial Fossa Approach for Superior Semicircular Canal Dehiscence Repair, 2014-2020. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Lum, M., Kaur, T., Yang, I., Gopen, Q. S. 2023; 168 (3): 453-461

  Abstract

  The present study investigates risk factors and clinical outcomes of postoperative pneumolabyrinth following the middle cranial fossa approach for superior semicircular canal dehiscence repair, a complication that has not been documented previously.Retrospective cohort study.Tertiary/quaternary care referral center.We conducted a retrospective review of 332 middle cranial fossa procedures from 2014 to 2020 at a tertiary/quaternary care institution. Upon identifying pneumolabyrinth cases from postoperative computed tomography temporal bone scans, we conducted multivariable logistic regression analysis to explore demographic and clinical factors that were independently linked to this complication. We also compared the rates of postoperative symptoms among patients with different grades of pneumolabyrinth.We identified 41 (12.3%) pneumolabyrinth cases. Patients with older age, higher preoperative pure tone average, and frank dehiscence were at higher risk for pneumolabyrinth. Furthermore, patients with pneumolabyrinth reported significantly higher rates of postoperative dizziness and exhibited significantly greater pure tone average and air-bone gap postoperatively as compared with patients without pneumolabyrinth. Finally, higher-grade pneumolabyrinth was associated with increased rates of postoperative hearing loss, and grade III pneumolabyrinth was associated with higher rates of postoperative tinnitus vs grade I and II cases.Pneumolabyrinth following the middle cranial fossa approach was associated with poor clinical outcomes, including dizziness and auditory impairment. Old age, high preoperative pure tone average, and frank dehiscence were risk factors for this complication. The highlighted parameters may be important to note when considering this approach as a treatment option and while monitoring postoperative recovery.

  View details for DOI 10.1177/01945998221106688

  View details for PubMedID 35727631

• Image-derived Metrics Quantifying Hemodynamic Instability Predicted Growth of Unruptured Intracranial Aneurysms. Stroke (Hoboken, N.J.) Yang, H. H., Sayre, J., Dinh, H., Nael, K., Colby, G., Wang, A., Villablanca, P., Salamon, N., Chien, A. 2023; 3 (1)

  Abstract

  While image-derived predictors of intracranial aneurysm (IA) rupture have been well-explored, current understanding of IA growth is limited. Pulsatility index (PI) and wall shear stress pulsatility index (WSSPI) are important metrics measuring temporal hemodynamic instability. However, they have not been investigated in IA growth research. The present study seeks to verify reliable predictors of IA growth with comparative analyses of several important morphological and hemodynamic metrics between stable and growing cases among a group of unruptured IAs.Using 3D images, vascular models of 16 stable and 20 growing cases were constructed and verified using Geodesic techniques. With an overall mean follow-up period of 25 months, cases exhibiting a 10% or higher increase in diameter were considered growing. Patient-specific, pulsatile simulations were performed, and hemodynamic calculations were computed at 5 important regions of each aneurysm (inflow artery, aneurysm neck, body, dome, and outflow artery). Index values were compared between growing and stable IAs using ANCOVA controlling for aneurysm diameter. Stepwise multiple logistic regression and ROC analyses were conducted to investigate predictive models of IA growth.Compared to stable IAs, growing IAs exhibited significantly higher intrasaccular PI, intrasaccular WSSPI, intrasaccular spatial flow rate deviation, and intrasaccular spatial wall shear stress (WSS) deviation. Stepwise logistic regression analysis revealed a significant predictive model involving PI at aneurysm body, WSSPI at inflow artery, and WSSPI at aneurysm body.Our results showed that high degree of hemodynamic variations within IAs is linked to growth, even after controlling for morphological parameters. Further, evaluation of PI in conjunction with WSSPI yielded a highly accurate predictive model of IA growth. Upon validation in future cohorts, these metrics may aid in early identification of IA growth and current understanding of IA remodeling mechanism.

  View details for DOI 10.1161/svin.122.000426

  View details for PubMedID 37090136

  View details for PubMedCentralID PMC10118203

• APA Health CARE: A Student-Led Initiative Addressing Health Care Barriers Faced by the Asian and Pacific Islander American Immigrant Population in Los Angeles. Journal of community health Yang, H. H., Chwa, W. J., Yuen, S. B., Huynh, J. D., Chan, J. S., Kumar, A., Dhanjani, S. A., Gee, G. C., Cowgill, B. O. 2021; 46 (2): 367-379

  Abstract

  Asian and Pacific Islander Americans face cultural, linguistic, and financial barriers to accessing health care. APA Health CARE (APAHC), a UCLA student-led organization, attempts to bridge these disparities through free community health screenings, health education seminars, and follow-up procedures. From 2011 to 2018, participants' demographic and health-related information were recorded during health fairs and follow-up phone calls. Trends in participant characteristics were analyzed over time. Health fair data were compared to data from follow-up phone calls to assess the effectiveness of health fair education and referral practices. 5635 participants from 69 health fairs were screened over the 8-year period. Follow-up contact was attempted for 2258 participants, of which 555 responded. Over time, a greater proportion of participants reported higher income, health insurance, and access to a regular doctor. Of those contacted at follow-up, 32.3% reported visiting a doctor, 50.2% reported making lifestyle changes, and 68.0% of those who were uninsured at health fairs reported obtaining health insurance within 1 month of attendance. Despite an observed increase in the proportion of participants having insurance and a regular doctor, health fair attendance remained consistent, possibly due to Asian American immigrants' preference for services that are convenient and linguistically and culturally accessible. Attendees reported visiting a physician, making lifestyle changes, and obtaining health insurance based on health fair referrals, suggesting measurable success with referral uptake and follow through. Student-led initiatives similar to APAHC can serve as catalysts to increase health literacy and motivate communities to seek health insurance and care.

  View details for DOI 10.1007/s10900-020-00915-8

  View details for PubMedID 32909155

  View details for PubMedCentralID 4533853

• Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer? American journal of surgery Asmai, R., Huy, T., Baker, J. L., Yang, H. H., Thompson, C. K., Kapoor, N. S. 2025; 239: 115986

  Abstract

  This study compares positive margin rates in breast conserving surgery (BCS) for early breast cancer using two localization techniques: surgeon-performed intraoperative ultrasound-guided wire localization (IOWL) versus radiologist-performed preoperative wire localization (POWL).Patients with unifocal breast cancer undergoing BCS with follow-up at a single institution were retrospectively identified. Factors associated with positive margins were identified.177 patients underwent IOWL (N ​= ​85) or POWL (N ​= ​92). There was a significantly lower rate of positive margins for IOWL vs. POWL (7.1 ​% vs. 23.9 ​%, p ​= ​0.002) and a corresponding lower rate of re-excision for IOWL vs. POWL (5.9 ​% vs. 18.5 ​%, p ​= ​0.011). Presence of DCIS was associated with positive margins (p ​= ​0.015). After adjusting for presence of DCIS, tumor size, and volume of tissue removed, the positive margin rate was significantly lower in the IOWL group compared to the POWL group (aOR 0.34, 95 ​% CI 0.13-0.93).In this study, adjusted analysis favored IOWL in achieving negative tumor margins. Prospective studies are needed to further explore the impact of IOWL on quality, cost-effectiveness, and patient experience.

  View details for DOI 10.1016/j.amjsurg.2024.115986

  View details for PubMedID 39327165

• Risk Analysis Index Frailty Score as a Predictor of Otolaryngology Surgical Outcomes. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Evans, L. K., Moffatt, C., Niknejad, K., Yang, H. H., Kodaverdian, L., Soliman, S., Reyes Orozco, F., Chhetri, D. K. 2024; 171 (6): 1728-1735

  Abstract

  The Risk Analysis Index (RAI) score is a screening tool to assess patient frailty. It has been shown to be predictive of postoperative outcomes and mortality in orthopedic, urologic, and neurosurgical patient populations. We sought to evaluate the predictive ability of RAI score for surgical outcomes in an otolaryngology patient population.Retrospective study.Academic tertiary medical center.A retrospective study was conducted of adult patients undergoing otolaryngology surgery at a tertiary medical care center over 21 months. Patients were sent electronic RAI survey questionnaires via direct messaging, which was completed prior to surgery. Endpoint data were analyzed, including demographics, RAI score, and patient outcome data. Univariate analysis, ROC curves, and predictive modeling were utilized.A total of 517 patients responded to the RAI questionnaire, resulting in a 59.6% response rate. Mean RAI score was 21.38 ± 11.83. Higher RAI scores were associated with increased 30-day readmissions (P < .0015), postoperative complications (P < .001), hospital length of stay (P < .001), and discharge with home health (P < .001). Predictive models for RAI score and postoperative outcomes were created, and a cutoff score of RAI = 30 was established to identify frail patients.We evaluated if RAI scoring predicted postoperative complications in an otolaryngology patient population. Increased RAI score is significantly associated with poorer surgical outcomes, including increased hospital length of stay, 30-day readmissions, and postoperative complications. We propose a predictive model with suggested RAI cutoff scoring for use in the otolaryngology surgical population.

  View details for DOI 10.1002/ohn.899

  View details for PubMedID 38988306

  View details for PubMedCentralID PMC11605035

• Reply to "To the editor: Ambient particulate matter and frequency of outpatient visits for chronic rhinosinusitis in the United States". International forum of allergy & rhinology Yang, H. H., Grimm, D., Velasquez, E., Hwang, P. H. 2024

  View details for DOI 10.1002/alr.23490

  View details for PubMedID 39614595

• Fungal and Bacterial Microbiome in Sinus Mucosa of Patients with and without Chronic Rhinosinusitis. The Laryngoscope Lee, J. T., Simpson, C. A., Yang, H. H., Suh, J. D., Wang, M. B., Lagishetty, V., Liang, F., Jacobs, J. P. 2024; 134 (3): 1054-1062

  Abstract

  Dysbiosis of the sinonasal microbiome has been implicated in the pathogenesis of chronic rhinosinusitis (CRS). However, the mycobiome remains largely understudied, and microbial alterations associated with specific CRS subtypes have yet to be delineated. The objective of this study is to investigate the fungal and bacterial microbiome of sinus mucosa in CRS patients with and without nasal polyposis (CRSwNP and CRSsNP) versus healthy controls.Sinus mucosa was obtained from 92 patients (31 CRSsNP, 31 CRSwNP, and 30 controls) undergoing endoscopic sinus/skull base surgery. Data regarding demographics, Lund-MacKay scores, and histopathology were collected. Fungal and bacterial microbiome analysis was performed utilizing internal transcribed spacer amplicon and 16S rRNA sequencing.Beta diversity of the sinonasal mycobiome differed significantly between CRS and controls (p = 0.001) and between CRSwNP and controls (p = 0.049), but not between CRSwNP and CRSsNP (p = 0.32) nor between CRSsNP and controls (p = 0.06). With respect to the bacterial microbiome, significantly lower alpha diversity was observed between CRS and controls (p < 0.001), CRSwNP versus controls (p < 0.001), and CRSsNP versus controls (p < 0.001). Beta diversity was also significantly different at the genus level between CRSwNP and CRSsNP (p = 0.019), CRSwNP and controls (p = 0.002)), and CRSsNP and controls (p < 0.001). However, alpha and beta diversity did not differ significantly between CRS patients with/without eosinophils or correlate with Lund-MacKay scores.Differences in mycobiota diversity in CRS patients in comparison with controls suggest that alterations in the mycobiome may contribute to disease pathogenesis. Our findings also confirmed that diminished diversity among bacterial communities is associated with CRS and that significant differences are present in microbial composition between CRSwNP and CRSsNP.3 Laryngoscope, 134:1054-1062, 2024.

  View details for DOI 10.1002/lary.30941

  View details for PubMedID 37606305

• Response to "Underwater Plugging of Superior Canal Dehiscence via the Middle Cranial Fossa is Possible". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Yang, H. H., Yang, I., Gopen, Q. S. 2023; 169 (6): 1703-1704

  View details for DOI 10.1002/ohn.426

  View details for PubMedID 37493515

• In Response to Regarding: Postoperative Gabapentin's Effect on Opioid Consumption and Pain Control Following Sinonasal Surgery. The Laryngoscope Yang, H. H., Wu, T. J., Suh, J. D., Wang, M. B., Holliday, M., Beswick, D., Zhang, H., Wells, C., McCormick, J., Maxim, T., Regev, A., Chandy, Z. K., Lee, J. T. 2023; 133 (8): E50-E51

  View details for DOI 10.1002/lary.30609

  View details for PubMedID 36810837

• An analysis of the inclusion of ear and hearing care in national health policies, strategies and plans. Health policy and planning Canick, J., Petrucci, B., Patterson, R., Saunders, J., Htoo Thaw, M., Omosule, I., Denton, A., Xu, M. J., Chadha, S., Young, G., Siafa, L., Mortel, O., Shamshad, A., Reddy, A., McCalla, M., Prasad, K., Yang, H. H., Pan, D. R., Shah, J., Smith, E., Alkire, B., Ibekwe, T., Waterworth, C. 2023; 38 (6): 719-725

  Abstract

  Ear- and hearing-related conditions pose a significant global health burden, yet public health policy surrounding ear and hearing care (EHC) in low- and middle-income countries is poorly understood. The present study aims to characterize the inclusion of EHC in national health policy by analysing national health policies, strategies and plans in English, French, Spanish, Portuguese and Arabic. Three EHC keywords were searched, including ear*, hear* and deaf*. The terms 'human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)', 'tuberculosis' and 'malaria' were included as comparison keywords as these conditions have historically garnered political priority in global health. Of the 194 World Health Organization Member States, there were 100 national policies that met the inclusion criteria of document availability, searchable format, language and absence of an associated national EHC strategy. These documents mentioned EHC keywords significantly less than comparison terms, with mention of hearing in 15 documents, ears in 11 documents and deafness in 3 documents. There was a mention of HIV/AIDS in 92 documents, tuberculosis in 88 documents and malaria in 70 documents. Documents in low- and middle-income countries included significantly fewer mentions of EHC terms than those of high-income countries. We conclude that ear and hearing conditions pose a significant burden of disease but are severely underrepresented in national health policy, especially in low- and middle-income countries.

  View details for DOI 10.1093/heapol/czad026

  View details for PubMedID 37130061

  View details for PubMedCentralID PMC10274565

• Trends in Health Care Access Disparities Among Asian and Pacific Islander Health Fair Participants in Los Angeles, 2011-2019. Public health reports (Washington, D.C. : 1974) Dhanjani, S. A., Yang, H. H., Goyal, S., Zhang, K., Gee, G., Cowgill, B. 2023; 138 (1): 97-106

  Abstract

  Given several efforts to improve health care access in California and nationally, we studied whether linguistic and socioeconomic disparities in health care access changed from 2011 to 2019 among Asian and Pacific Islander American (APIA) people in Los Angeles, California.We analyzed survey responses from APIA health fair participants (n = 5032) in the Greater Los Angeles area from May 15, 2011, through October 20, 2019. To assess the effect of socioeconomic factors on and shifts in health care access (ie, health insurance status/regular doctor), we used a logistic regression model. Covariates included English proficiency, year, age, sex, ethnicity, income, employment, and education. We also ran an interaction analysis between English proficiency and year.Health insurance access increased and doctor access remained stable throughout the study period; however, disparities in health insurance status widened by a factor of 1.08 per year between participants with high English proficiency (HEP) and participants with low English proficiency (LEP) (P = .01). People with HEP were 2.02 times more likely to have a regular doctor than people with LEP (P < .001), and this disparity persisted from 2011 to 2019 (P = .58). Participants who were young (P < .001) and male (P = .005) were significantly less likely to have health insurance and a regular doctor (P < .001) than participants who were older and female. Chinese participants were significantly more likely than Thai (P = .002) and Korean (P < .001) participants to be insured but not more likely to have a regular doctor, when controlling for health insurance.Policy changes targeting language and cultural barriers to care for APIA people with LEP may address the disparities observed.

  View details for DOI 10.1177/00333549211061328

  View details for PubMedID 35067110

  View details for PubMedCentralID PMC9730186

• Modified Endoscopic Denker's Approach for Management of Anterior Maxillary Sinus Tumors: Multicenter Series of 58 Cases. American journal of rhinology & allergy McCormick, J. P., Suh, J. D., Wang, E. W., DeConde, A. S., Wang, M. B., Yang, H. H., Carle, T. R., Wung, V., Lee, J. T. 2022; 36 (6): 763-772

  Abstract

  Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications.A multi-institution retrospective chart review was performed on patients who underwent the MED approach for the management of tumors involving the anterior maxillary sinus from 2009 to 2020. Demographic data, pathology, surgical outcomes, and complications were reviewed.Fifty-eight patients were identified, including 34 (58.6%) male and 24 (41.4%) female patients. The most common pathologies included: inverted papilloma (n = 27; 46.6%), adenoid cystic carcinoma (n = 9; 15.5%), and squamous cell carcinoma (n = 8; 13.8%). Thirty-eight patients (65.5%) underwent MED alone, while 20 (34.5%) had combined expanded endonasal approaches for lesions extending beyond the maxillary sinus. All maxillary sinus lesions were successfully accessed with the MED procedure without the need for an additional approach. After a mean follow-up of 30 months (range, 1-127), 8 of 58 (13.8%) patients developed complications related to the MED, including epiphora requiring an additional procedure (n = 4; 6.9%), prolonged facial/palatal numbness (n = 3; 5.2%), severe epistaxis (n = 1; 1.7%), and vestibular stenosis (n = 1; 1.7%), the latter of which occurred following postoperative radiation.The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.

  View details for DOI 10.1177/19458924221110652

  View details for PubMedID 35791572

• Triamcinolone-impregnated bioabsorbable middle meatus packing following endoscopic sinus surgery: A prospective randomized controlled trial. International forum of allergy & rhinology McCormick, J. P., Suh, J. D., Yang, H. H., Lee, J. T., Wang, M. B. 2022; 12 (9): 1131-1136

  Abstract

  Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone-impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS).This is a prospective, randomized, double-blind, placebo-controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone-impregnated packing in one sinus cavity and normal saline-soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund-Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit.The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59).The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone-treated and non-triamcinolone-treated sinuses. There were no adverse effects from the use of triamcinolone-impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone-impregnated absorbable packing following ESS.

  View details for DOI 10.1002/alr.22970

  View details for PubMedID 35019237

• In Vitro Effects of Permethrin on Sinonasal Epithelia. OTO open Lee, J. T., Yang, H. H., Sanghoon Shin, D., Srivatsan, E., Basak, S. 2022; 6 (3): 2473974X221109838

  Abstract

  Inhalant toxicants are postulated to contribute to the pathogenesis of chronic rhinosinusitis. Permethrin is a pesticide widely used in agricultural, industrial, and residential settings. The objective of this pilot study is to investigate the in vitro effects of permethrin on sinonasal epithelial cells (SNECs). Sinus mucosa was collected from 4 patients undergoing transsphenoidal pituitary surgery without a history of chronic rhinosinusitis. Cultured SNECs were exposed to varied concentrations of permethrin (0-156 µM) for 6 days. Cell viability and proliferation were determined via the MTT colorimetric assay and the Incucyte Live Cell Imaging System. Cellular reactive oxygen species (ROS) activity was measured by the DCFDA ROS detection assay. A statistically significant reduction in cell viability and proliferation was observed between the exposure and control groups at certain concentrations, and a dose-dependent increase in ROS activity was also observed. These findings indicate that permethrin may have deleterious effects on SNECs in a dose-dependent manner.

  View details for DOI 10.1177/2473974X221109838

  View details for PubMedID 35860617

  View details for PubMedCentralID PMC9289904