Jennifer Alyono, MD, MS

All Publications

• Recidivism and Recurrence. Otolaryngologic clinics of North America Cooperman, S. P., Wong, K., Hwa, T. P., Alyono, J. 2024

  Abstract

  Recidivistic cholesteatoma encompasses residual as well as recurrent disease, and can occur in up to 61% of cases. Pediatric disease may have a higher propensity for recidivism. Serial physical examination and MRI including non-EPI DWI sequences are useful in surveillance. Canal wall down approaches with mastoid obliteration may be an approach to reduce recidivism while minimizing the need for mastoid cavity maintenance. Modern techniques of Eustachian tube dilation and endoscopic ear surgery may yet prove particularly helpful in reducing re-retraction and residual disease in the retrotympanum, respectively; however, they require further study.

  View details for DOI 10.1016/j.otc.2024.07.010

  View details for PubMedID 39244459

• Utility of MRI in the Outpatient Evaluation of Patients With Chronic Continuous or Recurrent Dizziness. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Gupta, A., Thai, A., Steenerson, K. K., Alyono, J. 2024; 45 (8): 919-924

  Abstract

  This study aimed to assess the utility of magnetic resonance imaging (MRI) in outpatient evaluation of patients with chronic continuous or recurrent dizziness (CCRD) and determine whether certain patient characteristics, symptoms, or examination findings are associated with diagnostic MRI findings.Retrospective cohort study.Ambulatory center.304 patients who received an MRI for CCRD.Diagnostic utility of MRI in patients with CCRD.MRI diagnostic findings in patients with CCRD and associated patient characteristics, symptoms, or examination findings.In this retrospective analysis, 304 patients who visited an outpatient clinic between 1998 and 2023 and underwent MRI for CCRD, without previously diagnosed neurological abnormalities, were examined. The study investigated the relationship between demographic characteristics, comorbidities, clinical symptoms, and examination findings with diagnostic MRI findings. Univariate analysis was used to identify factors predictive of diagnostic MRI findings.Out of 304 patients, 11 (3.6%; 95% confidence interval [CI], 1.5-5.72%) had diagnostic MRI findings. The most common diagnostic finding (36.4%) was brain metastasis, seen only in patients with previously diagnosed metastatic cancer. Univariate analysis revealed that hypertension (p = 0.004, likelihood ratio [LR] = 2.51), hyperlipidemia (p = 0.004, LR = 2.91), and cancer (p = 0.021, LR = 2.96) were significantly associated with diagnostic MRI findings. Incidental findings were observed in 73 patients (24%; 95% CI, 19.2-28.8%). Outside of cancer patients, six (2.3%; 95% CI, 1.1-5.0%) had diagnostic MRI findings.In our study, MRI rarely displayed diagnostic findings in patients with CCRD and normal neurologic examination. However, individuals with hypertension, hyperlipidemia, or cancer were significantly more likely to display positive MRI findings. It is essential to carefully consider the need for MRI when assessing patients with CCRD.

  View details for DOI 10.1097/MAO.0000000000004269

  View details for PubMedID 39142313

• The effect of climate changes on incidence of benign paroxysmal positional vertigo; a systematic review with meta-analysis of 16144 patients. Environmental research Sharifi, A., Steenerson, K. K., Alyono, J. C., Ghaffari, M. E., Zojaji, M., Ghaedsharaf, S., Salmani, M. H., Kouhi, A. 2024: 119551

  Abstract

  There were controversial findings in terms of the association between the incidence of Benign Paroxysmal Positional Vertigo (BPPV) and climate changes, so the current systematic review plus meta-analysis is designed to discover this possible relationship.Web of science, PubMed, Scopus, Google Scholar, Embase, and Cochrane library were systematically searched up to August 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Two authors independently reviewed the eligible articles and assessed the quality of them.In total, 15 studies including 16144 patients met the inclusion criteria. Ten studies reported the relation of BPPV to monthly mean temperature, 7 to monthly average humidity, 4 to monthly average rainfall, 6 to monthly sunlight time, and 2 to average solar radiation. The incidence of BPPV was associated significantly with atmospheric pressure (P: 0.003) and rainfall (P: 0.017). However, there was not any statistically significant correlation between incidence of BPPV and humidity, sunlight time, temperature, and solar radiation level (P > 0.05).The incidence of BPPV was higher in cold months of a year in both northern hemisphere and southern hemisphere countries. Although it can be because of negative correlation with temperature, the current meta-analysis did not find any statistically significant negative correlation with temperature. In addition, the incidence of BPPV was associated significantly with atmospheric pressure (positive correlation) and rainfall (negative correlation).

  View details for DOI 10.1016/j.envres.2024.119551

  View details for PubMedID 38977157

• Single-cell transcriptomic atlas reveals increased regeneration in diseased human inner ear balance organs. Nature communications Wang, T., Ling, A. H., Billings, S. E., Hosseini, D. K., Vaisbuch, Y., Kim, G. S., Atkinson, P. J., Sayyid, Z. N., Aaron, K. A., Wagh, D., Pham, N., Scheibinger, M., Zhou, R., Ishiyama, A., Moore, L. S., Maria, P. S., Blevins, N. H., Jackler, R. K., Alyono, J. C., Kveton, J., Navaratnam, D., Heller, S., Lopez, I. A., Grillet, N., Jan, T. A., Cheng, A. G. 2024; 15 (1): 4833

  Abstract

  Mammalian inner ear hair cell loss leads to permanent hearing and balance dysfunction. In contrast to the cochlea, vestibular hair cells of the murine utricle have some regenerative capacity. Whether human utricular hair cells regenerate in vivo remains unknown. Here we procured live, mature utricles from organ donors and vestibular schwannoma patients, and present a validated single-cell transcriptomic atlas at unprecedented resolution. We describe markers of 13 sensory and non-sensory cell types, with partial overlap and correlation between transcriptomes of human and mouse hair cells and supporting cells. We further uncover transcriptomes unique to hair cell precursors, which are unexpectedly 14-fold more abundant in vestibular schwannoma utricles, demonstrating the existence of ongoing regeneration in humans. Lastly, supporting cell-to-hair cell trajectory analysis revealed 5 distinct patterns of dynamic gene expression and associated pathways, including Wnt and IGF-1 signaling. Our dataset constitutes a foundational resource, accessible via a web-based interface, serving to advance knowledge of the normal and diseased human inner ear.

  View details for DOI 10.1038/s41467-024-48491-y

  View details for PubMedID 38844821

• The Effect of Surgeon Vocal Pitch and Gender on Patient Satisfaction Nuyen, B., Wang, A., Ayoub, N. F., Rakkar, M., Kearney, A., Alyono, J. LIPPINCOTT WILLIAMS & WILKINS. 2023: S264

  View details for Web of Science ID 001094086300555

• External Ear Disease: Keratinaceous Lesions of the External Auditory Canal. Otolaryngologic clinics of North America Munjal, T., Kullar, P. J., Alyono, J. 2023

  Abstract

  Keratosis obturans (KO) and external auditory canal cholesteatoma (EACC) are two distinct keratinaceous lesions of the external ear. This article reviews the signs, symptoms, pathophysiology, workup, and treatment of each. Patients with either pathology can often be managed in the clinic with debridement; however, EACC is more likely to involve osteonecrosis and require more extensive operative management if disease is not confined to the canal on account of the bony erosion characteristic of cholesteatoma. If required for extensive disease, surgical approaches to both pathologies are similar.

  View details for DOI 10.1016/j.otc.2023.06.013

  View details for PubMedID 37550109

• 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

  Abstract

  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

• Reduction of Teprotumumab-Induced Hearing Loss With Comparable Efficacy Using Half-Dose Therapy. Ophthalmic plastic and reconstructive surgery Phansalkar, R., Lu, T., Alyono, J., Lee, J., Dosiou, C., Kossler, A. L. 2023

  Abstract

  Teprotumumab has been shown to be effective in the treatment of thyroid eye disease, a potentially vision-threatening condition. Adverse events, including sensorineural hearing loss, have been associated with teprotumumab. The authors present the case of a 64-year-old female who discontinued teprotumumab due to significant sensorineural hearing loss after 4 infusions, along with other adverse events. The patient was unresponsive to a subsequent course of intravenous methylprednisolone and orbital radiation, during which she experienced worsening thyroid eye disease symptoms. Teprotumumab was restarted 1 year later, at a half dose of 10mg/kg for 8 infusions. Three months post-treatment, she retains resolution of double vision and orbital inflammatory signs, and significant improvement in proptosis. She tolerated all infusions with an overall reduction in the severity of her adverse events and without return of significant sensorineural hearing loss. The authors conclude that a lower dose of teprotumumab can be effective for patients with active moderate-severe thyroid eye disease who experience significant or intolerable adverse events.

  View details for DOI 10.1097/IOP.0000000000002355

  View details for PubMedID 36877549

• Abnormal Subjective and Audiometric Auditory Function in Migraine. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Wang, A. R., Steenerson, K. K., Alyono, J. C. 2023

  Abstract

  To identify if migraine is associated with auditory deficits and if the auditory profile of migraine is distinct from other pain syndromes, such as chronic pain.Cross-sectional, retrospective.A total of 5273 respondents of the 1999 to 2004 National Health and Nutrition Examination Survey.Regression analyses assessed the association between migraine (n = 1245) and chronic pain (n = 430) status with subjectively endorsed hearing loss, tinnitus, pure-tone average (PTA) at 500, 1000, 2000, and 4000 Hz, and subjective-audiometric hearing mismatch (endorsed hearing loss but with a PTA ≤ 25 dB), correcting for confounding factors.Migraine was associated with increased tinnitus (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI]: 1.47-2.13, p < .001) and subjective hearing loss (aOR = 1.58, 95% CI: 1.29-1.94, p < .001). Migraine was associated with higher PTA (β = .89, p = .023). Migraine decreased the PTA threshold at which individuals endorsed subjective hearing loss (β = -1.94, p = .013) and was associated with a more subjective-audiometric hearing mismatch (aOR = 1.50, 95% CI: 1.18-1.89, p < .001). Chronic pain was not associated with tinnitus (aOR = 1.26, 95% CI: 0.97-1.63, p = 0.079), subjective hearing loss (aOR = 0.94, 95% CI: 0.71-1.23, p = .64), changes in PTA (β = -.22, p = .69), altered PTA threshold for endorsing hearing loss (β = 1.40, p = .19), or subjective-audiometric hearing mismatch (aOR = 0.98, 95% CI: 0.70-1.34, p = .88).Migraine is associated with both worse pure-tone audiometry and higher sensitivity to changes in hearing ability, suggesting both peripheral and central auditory function abnormalities. In contrast, patients with chronic pain did not demonstrate these abnormalities. The etiology of abnormal auditory processing in migraine may be different from that of other pain syndromes.

  View details for DOI 10.1002/ohn.201

  View details for PubMedID 36939529

• Abnormal Subjective and Audiometric Auditory Function in Migraine OTOLARYNGOLOGY-HEAD AND NECK SURGERY Wang, A. R., Steenerson, K. K., Alyono, J. C. 2023

  View details for DOI 10.1002/ohn.201

  View details for Web of Science ID 000921423900001

• Matched Cohort Study of Radiographic Superior Semicircular Canal Dehiscence and Tegmen Dehiscence and Obstructive Sleep Apnea. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Kaufman, A. C., Cooperman, S., Ali, N., Alyono, J. C. 2022

  Abstract

  OBJECTIVE: To report the frequency of radiographic superior semicircular canal dehiscence (SSCD) and tegmen dehiscence in patients with and without obstructive sleep apnea (OSA).STUDY DESIGN: Retrospective matched cohort study.SETTING: Tertiary care center.PATIENTS: Adults with OSA and fine-cut computed tomographic scans including the temporal bone were matched to patients without OSA by age, sex, and type of computed tomography (protocol, scanner type, slice thickness). Ears with otologic surgery or temporal bone tumors were excluded.MAIN OUTCOME MEASURES: Prevalence of SSCD and tegmen dehiscence assessed by two independent reviewers.RESULTS: The average body mass index of the OSA patients was 29.2 kg/m2 with an average apnea-hypopnea index of 36.8. The control group had an average body mass index of 26.2 kg/m2. Of the 352 temporal bones, 34 (9.7%) had SSCD in the OSA cohort versus 37 (10.5%) in the control group (p > 0.05). Seven OSA patients (25.6% of those with SSCD) had bilateral SSCD versus 8 controls (27.6% of those with SSCD; p > 0.05). The majority (87.3%) of dehiscences involved the temporal lobe, with the remaining involving the superior petrosal sinus or both. Of the 352 OSA ears, 90 (25.6%) had a tegmen dehiscence versus 95 (27.0%) in the control group (p > 0.05). Neither group had a laterality preference for SSCD or tegmen dehiscence.CONCLUSION: The prevalence of radiographic SSCD and tegmen dehiscences in OSA patients does not significantly differ from age- and sex-matched controls. This is in contrast to a previous case-control study finding patients with symptomatic SSCD to have higher rates of OSA. This may suggest that the effect size of OSA on SSCD prevalence may be limited despite OSA being a risk factor for elevated intracranial pressure.

  View details for DOI 10.1097/MAO.0000000000003712

  View details for PubMedID 36214499

• Natural History of Cystic Vestibular Schwannomas. The Annals of otology, rhinology, and laryngology Ali, N., Sayyid, Z. N., Alyono, J. C. 2022: 34894221119613

  Abstract

  OBJECTIVE: To determine the natural history of cystic vestibular schwannomas (VS).STUDY DESIGN: Retrospective cohort.SETTING: Single tertiary academic hospital.PATIENTS: Adults diagnosed with cystic VS who had at least 2 MRIs performed at least 6months apart between 2008 and 2016 with no intervening treatment.MAIN OUTCOME MEASURES: Volumetric growth rates of both the entire tumor and individual cystic and solid components were measured. Linear growth rate of the entire tumor was assessed using the largest diameter parallel to the petrous face at the cerebellopontine angle (CPA).RESULTS: Twenty-one patients met inclusion criteria. The average volumetric growth rate of the tumor was 1.1±2 (range: -1.2 to 7.8), while the average growth rate of the cystic component was 0.8±1.6 (range: -0.5 to 5.3)cm3/year. The CPA diameter of the tumor demonstrated an average linear growth rate of was 1.2±4.4 (range: -8to 13.5)mm/year. With regards to tumor diameter, 9/21 (42.9%) remained stable, 3/21 (14.2%) decreased in size, while 9/21 (42.9%) increased in size.CONCLUSIONS: Cystic tumors demonstrate a wide variability in growth rate. Larger, multi-center studies will be required to further compare this relationship to solid tumors.

  View details for DOI 10.1177/00034894221119613

  View details for PubMedID 35993287

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

  Abstract

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

  View details for DOI 10.1016/j.ajo.2022.02.015

  View details for PubMedID 35227694

• Imaging of the Postoperative Temporal Bone. Neuroimaging clinics of North America Bhatt, P. R., Alyono, J. C., Fischbein, N. J., Penta, M. 2022; 32 (1): 175-192

  Abstract

  Evaluation of the postoperative temporal bone can be difficult given the complex anatomy of this region and the myriad surgical approaches for management of a variety of conditions. This article provides an understanding of common postsurgical changes of the temporal bone and their typical imaging appearances. Ultimately, greater radiologist knowledge of postoperative temporal bone imaging findings will help to serve patients and referring clinicians with prompt diagnosis and recognition of expected postintervention changes compared with postoperative complications and/or disease recurrence.

  View details for DOI 10.1016/j.nic.2021.08.006

  View details for PubMedID 34809837

• Outcomes in Patients Meeting Cochlear Implant Criteria in Noise but Not in Quiet. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Thai, A., Tran, E., Swanson, A., Fitzgerald, M. B., Blevins, N. H., Ma, Y., Smith, M. L., Larky, J. B., Alyono, J. C. 2022; 43 (1): 56-63

  Abstract

  OBJECTIVE: Evaluate outcomes in cochlear implant (CI) recipients qualifying in AzBio noise but not quiet, and identify factors associated with postimplantation improvement.STUDY DESIGN: Retrospective cohort study.SETTING: Tertiary otology/neurotology clinic.PATIENTS: This study included 212 implanted ears. The noise group comprised 23 ears with preoperative AzBio more than or equal to 40% in quiet and less than or equal to 40% in +10 signal-to-noise ratio (SNR). The quiet group included 189 ears with preoperative AzBio less than 40% in quiet. The two groups displayed similar demographics and device characteristics.INTERVENTIONS: Cochlear implantation.MAIN OUTCOME MEASURES: AzBio in quiet and noise.RESULTS: Mean AzBio quiet scores improved in both the quiet group (pre-implant: 12.7%, postimplant: 67.2%, p < 0.001) and noise group (pre-implant: 61.6%, postimplant: 73.8%, p = 0.04). Mean AzBio +10 SNR also improved in the quiet group (pre-implant: 15.8%, postimplant: 59.3%, p = 0.001) and noise group (pre-implant: 30.5%, postimplant: 49.1%, p = 0.01). However, compared with the quiet group, fewer ears in the noise group achieved within-subject improvement in AzBio quiet (≥15% improvement; quiet group: 90.3%, noise group: 43.8%, p < 0.001) and AzBio +10 SNR (quiet group: 100.0%, noise group: 45.5%, p < 0.001). Baseline AzBio quiet (p < 0.001) and Consonant-Nucleus-Consonant (CNC) scores (p = 0.004) were associated with within-subject improvement in AzBio quiet and displayed a higher area under the curve than either aided or unaided pure-tone average (PTA) (both p = 0.01).CONCLUSIONS: CI patients qualifying in noise display significant mean benefit in speech recognition scores but are less likely to benefit compared with those qualifying in quiet. Patients with lower baseline AzBio quiet scores are more likely to display postimplant improvement.

  View details for DOI 10.1097/MAO.0000000000003351

  View details for PubMedID 34889839

• Cochlear Implantation and Risk of Falls in Older Adults. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Grimm, D. R., Fakurnejad, S., Alyono, J. C. 1800: 1945998211064981

  Abstract

  OBJECTIVE: To examine whether cochlear implantation (CI) increases the risk of clinically significant falls in older adults.STUDY DESIGN: Retrospective analysis of deidentified administrative claims from a US commercial insurance database.SETTING: Nationwide deidentified private insurance claims database (Clinformatics Data Mart; Optum).METHODS: Patients undergoing CI were identified through Current Procedural Terminology codes. Number of days with falls resulting in health care expenditure were counted 1 year pre- and post-CI. Generalized estimating equation Poisson regression was used to determine medical and sociodemographic predictors for fall days, including age, sex, race, and income, with pre- vs post-CI status.RESULTS: Between 2003 and 2019, 3773 patients aged >50 years underwent CI. An overall 139 (3.68%) patients recorded at least 1 fall diagnosis a year pre-CI, and 142 (3.76%) recorded at least 1 fall diagnosis post-CI. The average number of days with fall diagnoses per patient with a recorded fall was 3.12 pre-CI and 2.04 post-CI. In bivariate analysis, age (P < .0001) and Charlson Comorbidity Index (P < .0001) were predictive of falls, but sex (P < .10), race (P < .72), and income (P < .51) were not. Poisson regression demonstrated a statistically significant association between Charlson Comorbidity Index and days with fall diagnoses (risk ratio, 1.39 [95% CI, 1.30-1.49]; P < .0001]). No statistically significant difference in falls was seen pre- vs post-CI (risk ratio, 0.67 [95% CI, 0.34-1.33]; P < .25]). Age also was not predictive of falls in multivariate analysis.CONCLUSIONS: CI does not appear to increase the risk of falls in older adults. Patient comorbidities correlate most strongly with fall risk and should be considered in patient selection for CI.

  View details for DOI 10.1177/01945998211064981

  View details for PubMedID 34905438

• Pulmonary Embolism and Sigmoid Sinus Thrombosis After Translabyrinthine Vestibular Schwannoma Resection: A Retrospective Case Series. The Annals of otology, rhinology, and laryngology Song, Y., Ayoub, N., Chen, J. X., Alyono, J. C., Welling, D. B. 2021: 34894211036864

  Abstract

  OBJECTIVE: To describe the presentation and treatment of patients developing pulmonary embolism following translabyrinthine approach for vestibular schwannoma resection.METHODS: This was a retrospective case series of patients at 2 academic tertiary medical centers who developed symptomatic pulmonary embolism post-operatively following translabyrinthine approach for vestibular schwannoma resection and were found to have evidence of sigmoid sinus thrombosis.RESULTS: Three patients were identified to have post-operative pulmonary emboli after translabyrinthine approach for vestibular schwannoma resection with sigmoid sinus or internal jugular vein clots in the absence of lower extremity deep vein thrombosis. Caprini scores for these patients were 5 or lower. All patients underwent CT pulmonary angiography and were confirmed to have pulmonary emboli. Two were promptly anticoagulated with heparin drips and transitioned to long-term oral anticoagulation therapy and 1 had delayed anticoagulation. None of these patients suffered from intracranial hemorrhage post-operatively.CONCLUSIONS: Patients undergoing translabyrinthine approach for vestibular schwannoma can develop pulmonary embolism from sigmoid sinus entry or thrombosis. No clear guidelines exist for the management of this complication in the setting of recent craniotomy and the risk of intracranial hemorrhage must be considered prior to initiating anticoagulation.

  View details for DOI 10.1177/00034894211036864

  View details for PubMedID 34353140

• Trends and Healthcare Use Following Different Cholesteatoma Surgery Types in a National Cohort, 2003-2019. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Qian, Z. J., Tran, E. D., Alyono, J. C., Cheng, A. G., Ahmad, I. N., Chang, K. W. 2021

  Abstract

  OBJECTIVE: To describe national trends in cholesteatoma management.STUDY DESIGN AND SETTING: Retrospective analysis Optum Clinformatics Database from 2003 to 2019.PATIENTS: 16,179 unique adult and pediatric patients who received cholesteatoma surgery.INTERVENTIONS AND MAIN OUTCOME MEASURES: Patients were categorized into three groups by initial surgical modality: canal wall down (CWD), canal wall up (CWU), and tympanoplasty without mastoidectomy (TnoM). Three major comparisons between groups were performed: 1) temporal trends, 2) clinical and sociodemographic determinants, and 3) healthcare use in terms of total costs and incidence of postoperative imaging and subsequent surgery.RESULTS: Overall, 23.2% received initial CWD surgery, 44.3% CWU, and 32.5% TnoM. 1) The incidence of initial CWD surgery decreased (odds ratios [OR] = 0.98, 95% confidence intervals [CI] [0.97,0.99]), while CWU increased (OR = 1.02, 95% CI [1.01,1.03]), and TnoM remained stable over the study period (OR = 0.99, 95% CI [0.98,1.00]). 2) Relative to CWU, TnoM surgery was less likely in adults, patients with prior complications, and non-White patients, while being more likely in patients with higher household income. CWD was more likely than CWU in adults, patients with prior complications, and non-White patients, while income had no effect. 3) Postoperative costs for CWU and CWD were similar. In 2 years following initial surgery, postoperative imaging and/or subsequent surgery was performed in 45.48% of CWD, 57.42% of CWU, and 41.62% of TnoM patients.CONCLUSIONS: Incidence of initial CWD surgery decreased and social disparities in cholesteatoma management were observed. Postoperative imaging or second-look surgery were performed in less than 60% of patients with initial CWU surgery and over 40% of patients with initial CWD.

  View details for DOI 10.1097/MAO.0000000000003284

  View details for PubMedID 34310551

• Acute Vestibular Syndrome and ER Presentations of Dizziness. Otolaryngologic clinics of North America Baron, R., Steenerson, K. K., Alyono, J. 2021

  Abstract

  Acute vestibular syndrome (AVS) describes sudden onset, severe, continuous dizziness that persists for more than 24 hours. Its wide differential presents a diagnostic challenge. Vestibular neuritis is the most common cause, but stroke, trauma, medication effects, infectious, and inflammatory causes all present similarly. The TiTrATE model (Timing, Triggers, And Targeted Exam) is systematic way to evaluate these patients, and the HINTS Plus exam (Head Impulse, Nystagmus, Test of Skew, plus hearing loss) is critical in differentiating central and peripheral causes. The importance of recognizing risk factors for stroke and the role of imaging is also discussed.

  View details for DOI 10.1016/j.otc.2021.05.013

  View details for PubMedID 34294435

• Hearing Loss Due to Otosyphilis: Imaging Case of the Month. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Hosseini, D. K., Aaron, K. A., Alyono, J. C. 2021

  View details for DOI 10.1097/MAO.0000000000003244

  View details for PubMedID 34172666

• Postoperative Venous Thromboembolism after Neurotologic Surgery. Journal of neurological surgery. Part B, Skull base Ali, N., Alyono, J. C., Song, Y., Kouhi, A., Blevins, N. H. 2021; 82 (3): 378-382

  Abstract

  Objective This study aimed to determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing neurotologic surgery at a single center. Methods The records of adults undergoing neurotologic surgery from August 2009 to December 2016 at a tertiary care hospital were reviewed for VTE within 30 postoperative days. Particular attention was focused on postoperative diagnosis codes, imaging, and a keyword search of postoperative notes. Caprini risk scores were calculated. Results Among 387 patients, 5 experienced postoperative VTE including 3 cases of pulmonary embolism (PE) and 2 cases of isolated deep vein thrombosis (DVT). All patients were given sequential compression devices perioperatively, and none received preoperative chemoprophylaxis. Patients with Caprini score>8 had a significantly higher rate of VTE compared with those<8 (12.5 vs. 1%, p =0.004). Receiver operating characteristic analysis revealed the Caprini risk assessment model to be a fair predictor of VTE, with a C-statistic of 0.70 (95% confidence interval [CI]: 0.49-0.92). Conclusion While no specific validated VTE risk stratification scheme has been widely accepted for patients undergoing neurotologic surgery, the Caprini score appears to be a useful predictor of risk. The benefits of chemoprophylaxis should be balanced with the risks of intraoperative bleeding, as well as the potential for postoperative intracranial hemorrhage.

  View details for DOI 10.1055/s-0039-3400223

  View details for PubMedID 34026416

• National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005-2017. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Cooperman, S. P., Jin, M. C., Qian, Z. J., Alyono, J. C. 2021: 194599821994755

  Abstract

  OBJECTIVE: To describe opioid stewardship in ambulatory otologic surgery from 2005 to 2017.STUDY DESIGN: Descriptive study of US private insurance claims.SETTING: Nationwide deidentified private insurance claims database (Clinformatics DataMart; Optum).METHODS: A total of 17,431 adult opioid-naive outpatients were included in the study. Patients were identified from CPT-4 codes (Current Procedural Terminology, Fourth Edition) as having undergone middle ear or mastoid surgery. Multiple regression was used to determine sociodemographic and geographic predictors of postoperative morphine milligram equivalents (MMEs) prescribed, including procedure type, year of procedure, age, sex, education, income level, and geographic region of the United States.RESULTS: The mean prescribed perioperative dose over the examined period was 203.03 MMEs (95% CI, 200.27-205.79; 5-mg hydrocodone pill equivalents, 40.61). In multivariate analysis, patients undergoing mastoid surgery were prescribed more opioids than those undergoing middle ear surgery (mean difference, 39.89 MME [95% CI, 34.37-45.41], P < .01; 5-mg hydrocodone pill equivalents, 8.0). Men were prescribed higher doses than women (mean difference, 15.39 [95% CI, 9.87-20.90], P < .01; 5-mg hydrocodone pill equivalents, 3.1). Overall MMEs prescribed by year demonstrates a sharp drop in MMEs from 2015 to 2017.CONCLUSION: While the amount of opioids prescribed perioperatively has declined in recent years, otologists should continue to be cognizant of potential overprescribing in light of previous studies of patients' relatively low opioid intake.

  View details for DOI 10.1177/0194599821994755

  View details for PubMedID 33618561

• Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery Nuyen, B., Altamirano, J., Fassiotto, M., Alyono, J. 2021

  Abstract

  BACKGROUND: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.METHODS: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. chi2 tests and generalized estimating equation regression models were run to assess correlation.RESULTS: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making.CONCLUSION: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.

  View details for DOI 10.1016/j.surg.2020.12.006

  View details for PubMedID 33531133

• Stereotactic Radiosurgery for Vestibular Schwannoma Outcomes in Patients With Perfect Word Recognition-A Retrospective Cohort Study. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Fouad, A. n., Tran, E. D., Feng, A. Y., Alyono, J. C., Ma, Y. n., Blevins, N. H., Jackler, R. K., Santa Maria, P. L. 2021

  Abstract

  To investigate tumor control rate and hearing outcomes following stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) cases with perfect (100%) word recognition score (WRS).A retrospective cohort study.Tertiary referral center.Inclusion criteria were receiving primary SRS, a pretreatment WRS of 100%, and availability of both pre- and posttreatment audiometric data for evaluation.SRS delivered by Cyberknife.Tumor growth rates and audiological outcomes after SRS.The cohort consisted of 139 patients, with more than 1-year follow-up (mean 6.1 yrs). SRS tumor control rate was 87% for the whole cohort. Growth before SRS was documented in 24% (n = 34 of 139). The proportion of sporadic VS cases who maintained hearing (decline <10 dB of pure-tone audiometry or <20% of WRS) at 3 years was 50%, at 5 years was 45%, and at 10 years was 42%. In multivariate analysis, increased age was found to be predictive of increased hearing loss (p = 0.03), while the following factors were shown not to be significant: sex (p = 0.5), tumor size (p = 0.2), pre-SRS tumor growth (p = 0.5), and target volume (p = 0.42).Among patients with VS who had perfect WRS and underwent SRS, the overall tumor control rate was 87% comparable to observation. Hearing maintenance and preservation of "serviceable" hearing rates after 5 years in VS patients with perfect WRS treated by SRS is less than that when comparing to similar observation cohorts. Given this finding we do not advocate using SRS to preserve hearing, over observation, in tumors with perfect WRS.

  View details for DOI 10.1097/MAO.0000000000003039

  View details for PubMedID 33443977

• Trends in Use and Timing of Intratympanic Corticosteroid Injections for Sudden Sensorineural Hearing Loss. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Jin, M. C., Qian, Z. J., Cooperman, S. P., Alyono, J. C. 2020: 194599820976177

  Abstract

  OBJECTIVE: Oral corticosteroids are treatment mainstays for idiopathic sudden sensorineural hearing loss (SSNHL). Recent studies suggest that intratympanic (IT) steroid injections may be effective as an alternate or adjunctive therapy. We sought to investigate nationwide trends in treatment patterns for SSNHL.STUDY DESIGN: Retrospective cross-sectional study.SETTING: A large nationwide health care claims database spanning 2007 to 2016.METHODS: Patients with SSNHL were identified from the IBM Watson Health MarketScan Database. Multivariable logistic, linear, and Cox regression were used for demographic- and comorbidity-adjusted analyses.RESULTS: Overall, 19,670 patients were included. Between 2007 and 2016, use of oral corticosteroids alone decreased (83.6% to 64.6%, P < .001), while use of IT corticosteroids alone and combination IT-oral corticosteroids increased (IT only, 7.9% to 15.1%, P = .002; IT-oral, 8.5% to 20.4%, P < .001). During the study period, time to treatment initiation decreased for both administration modalities, though more dramatically for IT corticosteroids (IT, 124.0 to 10.6 days, P < .001; oral, 42.6 to 12.7 days, P < .001). In patients receiving both IT and oral corticosteroids, concurrent first-line use increased (25.2% to 52.8%, P < .001). Repeat injections have also become more common but may raise risk of persistent tympanic membrane perforations (vs no injection; hazard ratio [first injection] = 7.95, 95% CI = 5.54-11.42; hazard ratio [fifth or higher injection] = 17.47, 95% CI = 6.93-44.05).CONCLUSION: SSNHL management increasingly involves early IT steroids as an alternative or adjunctive option to oral steroids. Use of repeat IT corticosteroid injections has also increased but may raise risk of persistent tympanic membrane perforations and subsequent tympanoplasty. Future decision analysis and cost-effectiveness studies are necessary to identify an optimal care pattern for SSNHL.

  View details for DOI 10.1177/0194599820976177

  View details for PubMedID 33287664

• Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009-2017. The Laryngoscope Qian, Z. J., Alyono, J. C., Jin, M. C., Cooperman, S. P., Cheng, A. G., Balakrishnan, K. 2020

  Abstract

  OBJECTIVES: Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009-2017, and 3) determinants of prescription patterns.METHODS: Cross-sectional analysis using 2009-2017 Optum claims data to identify opioid-naive children aged 1-18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses.RESULTS: In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all-cause readmissions and post-tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009-2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids.CONCLUSION: While the percentage of children receiving post-tonsillectomy opioids decreased during 2009-2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy.LEVEL OF EVIDENCE: N/A Laryngoscope, 2020.

  View details for DOI 10.1002/lary.29159

  View details for PubMedID 33026683

• Effect of Surgeon Sociodemographics on Patient-Reported Satisfaction Nuyen, B. A., Altamirano, J., Fassiotto, M., Alyono, J. ELSEVIER SCIENCE INC. 2020: S138

  View details for Web of Science ID 000582792300243

• Sleep surgery in syndromic and neurologically impaired children. American journal of otolaryngology Ali, N., Alyono, J. C., Kumar, A. R., Cheng, H., Koltai, P. J. 2020; 41 (4): 102566

  Abstract

  PURPOSE: To examine surgery performed for obstructive sleep apnea (OSA) in children with syndromic or neurologic comorbidities.MATERIAL AND METHODS: Medical records of 375 children with OSA were retrospectively reviewed, including 142 patients with trisomy 21, 105 with cerebral palsy, 53 with muscular dystrophy, 32 with spinal muscular atrophy, 18 with mucopolysaccharidoses, 14 with achondroplasia, and 11 with Prader-Willi.OUTCOME MEASURES: Apnea-hypopnea index (AHI), complications, length of postoperative stay, and endoscopic findings.RESULTS: 228 patients received 297 surgical interventions, with the remainder undergoing observation or positive pressure ventilation. Adenoidectomy was the most common procedure performed (92.1% of patients), followed by tonsillectomy (91.6%). Average AHI decreased following tonsillectomy, from 12.4 to 5.7 (p=0.002). The most common DISE finding was the tongue base causing epiglottic retroflexion. Lingual tonsillectomy also resulted in an insignificant decrease in the AHI.CONCLUSIONS: Adenotonsillectomy, when there is hypertrophy, remains the mainstay of management of syndromic and neurologically-impaired children with OSA. However, additional interventions are often required, due to incomplete resolution of the OSA. DISE is valuable in identifying remaining sites of obstruction and guiding future management.

  View details for DOI 10.1016/j.amjoto.2020.102566

  View details for PubMedID 32504854

• Trends in Age of Cochlear Implant Recipients, and the Impact on Perioperative Complication Rates. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Fakurnejad, S., Vail, D., Song, Y., Alyono, J., Blevins, N. H. 2020; 41 (4): 438-443

  Abstract

  The aim of the study is to examine trends in the age of patients receiving cochlear implants and to determine the effect of age on the rate of perioperative complications.Retrospective analysis of deidentified administrative claims data from a US commercial insurance database (Optum).Individuals undergoing cochlear implantation between 2003 and 2016.US hospital and outpatient facilities serving commercially insured patients.Cochlear implantation.Age at implantation, incidence of perioperative complications within 30 days identified by ICD9/10 codes including device problems, myocardial infarction, stroke, venous thromboembolism, local infection, meningitis, stroke, cerebrospinal fluid leak, and facial weakness.Between 2003 and 2016, 3420 patients underwent a total of 4154 cochlear implants. The number of implants per year increased annually from 171 in 2003 to 531 in 2016, with the greatest growth demonstrated in those aged 60 and older.The age of patients undergoing implantation increased annually from an average of 26.6-57.2 years (p < 0.001). The implantation rates from 2003 to 2016, per 100,000 enrollees, increased from 1.64 to 6.82 for patients 60-79 years of age, and 0 to 11.57 for patients greater than 80 years of age (p < 0.001). No significant differences in 30-day complication rates were found between patients when grouped by age in decades, except for device related problems, which was significantly higher in younger patients (<18 years).Over the past decade and a half, cochlear implantation is more frequently being performed, and in an increasingly aging population. This trend does not seem to alter the risk of perioperative complications.

  View details for DOI 10.1097/MAO.0000000000002558

  View details for PubMedID 32176121

• Prevalence and significance of cranial nerve imaging abnormalities in patients with hereditary neuropathies: Clinical implications at the skull base. Laryngoscope investigative otolaryngology Bartholomew, R. A., Zamani, A. A., Kim, G. S., Alyono, J. C., Steinert, H., Fridman, V., Sadjadi, R., Jackler, R. K., Corrales, C. E. 2020; 5 (1): 11-18

  Abstract

  To estimate the prevalence and significance of cranial nerve (CN) imaging abnormalities in patients with hereditary neuropathy and discuss clinical implications.We retrospectively analyzed data from patients at four tertiary academic medical centers with hereditary neuropathy diagnoses who had undergone gadolinium-enhanced magnetic resonance imaging (MRI) of the brain or skull base between 2004 and 2018. MRI scans, as well as computed tomography imaging when available, were reviewed and bivariable analysis was performed to identify predictors of CN abnormalities on imaging.Among 39 patients meeting study criteria, 11 had clinical CN deficits (28%) and 8 had CN abnormalities on imaging (21%). Of the patients with CN abnormalities on imaging, half had CN deficits (4/8) and only a quarter had imaging abnormalities of the CNs with the deficits (2/8). Imaging abnormalities were found in varied CNs, including CNs III, V, VII, and the VII/VIII complex in the internal auditory canal. MRI obtained for the purpose of evaluating CN deficits had a statistically significant increased likelihood of containing CN imaging abnormalities. However, CN deficits themselves were not predictive of imaging abnormalities.Thickening and enhancement of CNs on MRI may be found in approximately 1/5 of patients with hereditary neuropathies and are inconsistently associated with clinical deficits. These imaging findings should not be mistaken for neoplastic and infectious processes as they may be manifestations of the patients' underlying genetic neuropathy.4.

  View details for DOI 10.1002/lio2.343

  View details for PubMedID 32128425

  View details for PubMedCentralID PMC7042653

• Prevalence and significance of cranial nerve imaging abnormalities in patients with hereditary neuropathies: Clinical implications at the skull base LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY Bartholomew, R. A., Zamani, A. A., Kim, G. S., Alyono, J. C., Steinert, H., Fridman, V., Sadjadi, R., Jackler, R. K., Corrales, C. 2020

  View details for DOI 10.1002/lio2.343

  View details for Web of Science ID 000506466700001

• Effects of Pregnancy on Otosclerosis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Qian, Z. J., Alyono, J. C. 2020: 194599820907093

  Abstract

  The effect of pregnancy on otosclerosis is controversial. If pregnancy physiologically increases the risk of progression, females with children would be expected to receive stapedectomy earlier than childless females and males. Here, we seek to determine whether sex moderates the relationship between number of children and age at stapedectomy.Retrospective observational study of national health care claims.2003 to 2016 Optum Clinformatics Data Mart.In total, 6025 privately insured US adults (3553 females, 2472 males) who received stapedectomy for otosclerosis were queried for age and number of children at the time of initial surgery.The average age at stapedectomy was significantly lower in females than males (46.8 vs 48.1 years; t test, P < .0001). Females with children had a significantly lower age at surgery compared to childless females (39.3 vs 49.9 years; t test, P < .0001). Males with children similarly had a significantly lower age at surgery compared to childless males (40.5 vs 51.3 years; t test, P < .0001). A higher number of children was correlated with lower age for both females (Pearson, r = -0.3817, P < .0001) and males (Pearson, r = -0. 3675, P < .0001). Linear regression showed that younger age of surgery could be predicted by female sex and number of children (F(3, 6021) = 336.93, P < .001, R2 = 0.1437) with no significant interaction between sex and number of children (P = .186).Sex does not moderate the effect of increasing number of children on decreasing age at stapedectomy. Social, rather than biological, factors surrounding parenthood such as increased overall health care utilization may explain prior associations between pregnancy and otosclerosis.

  View details for DOI 10.1177/0194599820907093

  View details for PubMedID 32093549

• Mastoid Obliteration Using Autologous Bone Dust Following Canal Wall Down Mastoidectomy. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Sioshansi, P. C., Alyono, J. C., Blevins, N. H. 2020

  Abstract

  To describe a technique for mastoid obliteration following canal wall down (CWD) mastoidectomy for chronic otitis media with cholesteatoma, and review its early results in producing a dry, safe ear, and a small mastoid cavity.Retrospective review.Tertiary referral center.Forty-three consecutive CWD procedures using bone dust obliteration for chronic otitis media.All patients underwent CWD mastoidectomy and, if indicated, concurrent tympanoplasty and ossicular chain reconstruction. Bone dust harvested from healthy mastoid cortex was used to obliterate selected portions of the tympanomastoid defect. Temporalis fascia and/or an inferiorly-based periosteal flap were used for coverage of the bone dust.Postoperative infection, need for mastoid bowl cleaning, incidence of recurrent cholesteatoma, need for revision surgical intervention.At mean follow-up of 29 months, 95% of ears have remained dry and safe since mastoid obliteration, with a lack of symptoms and no evidence of recurrent disease. Cholesteatoma recurrence rate was 5%. Postoperative otorrhea, while rare, was managed successfully with topical medication in all affected patients. Clinical, radiographic, and surgical appearance of grafted bone dust suggests good take with long-term viability.The described technique used for mastoid obliteration using autologous bone dust and cartilage is simple, effective, and safe to reduce the size of the mastoid cavity in patients undergoing CWD mastoidectomy. It might help to reduce morbidity by improving the surgeon's control over mastoid bowl size and shape.

  View details for DOI 10.1097/MAO.0000000000002839

  View details for PubMedID 32976343

• Neonatal retropharyngeal abscess with complications: Apnea and cervical osteomyelitis. International journal of pediatric otorhinolaryngology Ali, N., Alyono, J. C., Koltai, P. J. 2019; 126: 109613

  Abstract

  OBJECTIVE: To evaluate the clinical presentation and management strategies for neonatal retropharyngeal abscess (RPA).METHODS: Retrospective chart review was performed, and literature reviewed.RESULTS: We report two cases of neonatal RPA, with one complicated by cervical osteomyelitis, and the other presenting with apparent life-threatening events (ALTEs). A 6-week-old female underwent transoral drainage of an RPA, which grew methicillin sensitive Staphylococcus aureus. She had a prolonged recovery course and was found to have developed osteomyelitis of the dens and atlas. She was treated with 14 weeks of IV antibiotics and rigid collar fixation for spinal cord instability. A 2-month-old female was admitted after multiple ALTEs with episodes of apnea and pallor. Direct laryngoscopy revealed a bulging RPA, which was drained transorally. This grew multiple organisms including methicillin resistant Staphylococcus aureus, Streptococcal oralis and Prevotella species.CONCLUSIONS: Uncommon in neonates, RPA can present in this age group without fever, and are is likely to have airway complications than in older children. In cases with prolonged recovery, additional diagnostic intervention is recommended to rule out rare complications such as osteomyelitis. Emphasis in such complex cases is placed on a multidisciplinary approach to patient care, coordinating neonatologists, infectious disease specialists, neurosurgeons, and otolaryngologists.

  View details for DOI 10.1016/j.ijporl.2019.109613

  View details for PubMedID 31382216

• Postoperative Venous Thromboembolism after Extracranial Otologic Surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Song, Y., Alyono, J. C., Ali, N., Blevins, N. H. 2019: 194599819835743

  Abstract

  OBJECTIVE: To determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing otologic surgery.STUDY DESIGN: Cross-sectional retrospective study.SETTING: Single tertiary academic center.SUBJECTS AND METHODS: Adults undergoing nononcologic, extracranial otologic surgery from August 2009 to December 2016. Patients with postoperative diagnosis VTE codes were identified. Imaging and clinical documents were searched for VTE evidence within the first 30 postoperative days. Methods of thromboprophylaxis were documented, and Caprini risk scores were calculated.RESULTS: In total, 1213 otologic surgeries were evaluated. No postoperative VTE events were identified (0/1268). Mean age was 51.0 ± 17.3 years (range, 18.1-93.4 years). Average length of surgery was 136.0 ± 79.0 minutes (range, 5-768 minutes). The average Caprini score in all patients was 4.0 ± 1.7 (range, 1-15). Eighty-five percent of patients had a Caprini score ≥3, the threshold at which chemoprophylaxis has been recommended in general surgery patients by the American College of Chest Physicians 2012 guidelines. Six patients had documented preoperative chemoprophylaxis and a Caprini score of 4.8 ± 1.7. This was not significantly different from that of patients who did not receive preoperative chemoprophylaxis ( t test, P = .3). The literature would estimate a rate of 3.7% VTE in adults with similar Caprini scores undergoing general surgery procedures with no VTE prophylaxis.CONCLUSION: The Caprini risk assessment model may overestimate VTE risk in patients undergoing extracranial otologic surgery. Postoperative VTE following otologic surgery is rare, even in patients traditionally considered moderate or high risk. Chemoprophylaxis guidelines in this group should be balanced against the potential risk of increased intraoperative bleeding and its associated effects on surgical visualization and morbidity.

  View details for PubMedID 30857484

• Aberrant Venous Drainage in a Case of Spontaneous Cerebrospinal Fluid Leak. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Ali, N. E., Alyono, J. C., Blevins, N. H. 2019; 40 (7): e755–e757

  View details for DOI 10.1097/MAO.0000000000002327

  View details for PubMedID 31295212

• An association between marijuana use and tinnitus. American journal of otolaryngology Qian, Z. J., Alyono, J. C. 2019: 102314

  Abstract

  While some advocates have argued for marijuana as a treatment for tinnitus, the relationship between marijuana use and tinnitus is unknown. The objective of this study was to evaluate associations between marijuana use and the prevalence, severity, and rate of occurrence of tinnitus.Cross-sectional analysis of nationally representative data.National Health and Nutrition Examination Survey 2011-2012.Statistical analysis was performed on data collected from 2705 non-institutionalized adults aged 20-69 who underwent audiometric testing and were administered questionnaires about hearing, drug use, current health status, and medical history.The use of marijuana at least once per month for the previous 12 months was significantly associated with experiencing tinnitus during that 12-month month (X2(1) = 19.41, p < 0.001). Subjects who used marijuana were more likely to experience tinnitus after accounting for covariables including age, gender, audiometric hearing loss, noise exposure history, depression, anxiety, smoking, salicylate use, cardiovascular disease, hypertension, and diabetes (OR = 1.75, 95% CI 1.02-3.01, p = 0.043). There were no associations between the severity or frequency of tinnitus occurrence and the quantity or frequency of marijuana use. Use of other substances such as alcohol, cocaine, methamphetamine, and heroin was not associated with tinnitus.Regular marijuana use is associated with prevalent tinnitus. However, no dose response between marijuana use and tinnitus was observed. The relationship between marijuana use and tinnitus is complex and is likely modulated by psychosocial factors.

  View details for DOI 10.1016/j.amjoto.2019.102314

  View details for PubMedID 31732310

• A Prospective Evaluation of Postoperative Opioid Use in Otologic Surgery. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Qian, Z. J., Alyono, J. C., Woods, O. D., Ali, N. n., Blevins, N. H. 2019

  Abstract

  To prospectively evaluate opioid consumption following adult outpatient otologic surgery.Prospective observational.Single-tertiary referral center.Patients scheduled for otologic surgery who did not have a history of chronic opioid use were recruited between February 2018 and February 2019.Opioid consumption was queried using telephone or in-person surveys administered between postoperative days 5 and 15. Patient demographics, surgical details, and opioid prescription patterns were abstracted from medical records. Opioid distribution was determined by querying records maintained by the California Department of Justice through a state-wide prescription drug monitoring program mandated since 2016.Seventy patients were prescribed an average of 68.9 ± 31.8 mg of morphine equivalents (MME) and consumed 47.3 ± 42.9 MME over 2.4 ± 2.3 days postoperatively. Patients who received a postauricular incision were prescribed significantly more than those who underwent transcanal procedures (86.2 vs 55.9 MME; t test, p < 0.001), consumed significantly more (72.2 vs 28.6 MME; t test, p < 0.001), and for a significantly longer duration (3.4 vs 1.6 days; t test, p = 0.001). In the postauricular group, there was no significant difference in consumption between mastoidectomy and nonmastoidectomy subgroups (64.9 vs 89.2 MME; t test, p = 0.151). Eighty percent of transcanal patients consumed 50 MME (10 pills) or less, while 80% of postauricular patients consumed 80 MME (16 pills) or less.Patients in our cohort consumed approximately 3/4 of the prescribed opioids. Those with postauricular incisions used significantly more than those with transcanal incisions. Postoperative opioid prescription recommendations should be tailored according to the extent of surgery.

  View details for DOI 10.1097/MAO.0000000000002364

  View details for PubMedID 31469798

• Prevalence of Radiographic Cochlear-Facial Nerve Dehiscence. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Song, Y., Alyono, J. C., Bartholomew, R. A., Vaisbuch, Y., Corrales, C. E., Blevins, N. H. 2018

  Abstract

  OBJECTIVE: To determine the prevalence of radiographic cochlear-facial nerve dehiscence (CFD).STUDY DESIGN: Retrospective radiological study.SETTING: Two tertiary-referral centers.PATIENTS: Two hundred six temporal-bone computed tomography (CT) scans (405 total ears) of otology/neurotology patients from two academic institutions between the years 2014 and 2017.INTERVENTION: Diagnostic.MAIN OUTCOME MEASURES: The cochlear-facial nerve partition width (CFPW) was measured on coronal CT sections and defined as the shortest distance between the cochlear basal turn and facial nerve (FN) labyrinthine segment. We used logistics regression analyses to determine positive predictors for radiographic evidence of CFD.RESULTS: The overall prevalence of radiographic CFD was 5.4% (22/406 ears). 9.2% of patients (19/206) had CFD. Of these 19 patients, only one patient had mixed hearing loss that could not be explained by any other vestibular or auditory etiology. Three out of 206 patients had dehiscence in both ears (1.4%). The average CFPW was 0.6 ± 0.2 mm, and fallopian canal width was 1.1 ± 0.02 mm (n = 405). Older age, use of traditional CT scans, and thinner CT slice thickness were significant predictors for radiographic CFD.CONCLUSIONS: The radiographic prevalence of CFD is higher than what is reported in histologic studies, and may over-estimate the true prevalence of CFD. The clinician should keep this in mind when considering this as potential cause for third-window symptoms.

  View details for PubMedID 30289844

• Occupational Noise Exposure and Risk for Noise-Induced Hearing Loss Due to Temporal Bone Drilling. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vaisbuch, Y., Alyono, J. C., Kandathil, C., Wu, S. H., Fitzgerald, M. B., Jackler, R. K. 2018; 39 (6): 693–99

  Abstract

  BACKGROUND: Noise-induced hearing loss is one of the most common occupational hazards in the United States. Several studies have described noise-induced hearing loss in patients following mastoidectomy. Although otolaryngologists care for patients with noise-induced hearing loss, few studies in the English literature have examined surgeons' occupational risk.METHODS: Noise dosimeters and sound level meters with octave band analyzers were used to assess noise exposure during drilling of temporal bones intraoperatively and in a lab setting. Frequency specific sound intensities were recorded. Sound produced using burrs of varying size and type were compared. Differences while drilling varying anatomic structures were assessed using drills from two manufacturers. Pure tone audiometry was performed on 7 to 10 otolaryngology residents before and after a temporal bone practicum to assess for threshold shifts.RESULTS: Noise exposure during otologic drilling can exceed over 100 dB for short periods of time, and is especially loud using large diameter burrs > 4 mm, with cutting as compared with diamond burrs, and while drilling denser bone such as the cortex. Intensity peaks were found at 2.5, 5, and 6.3 kHz. Drilling on the tegmen and sigmoid sinus revealed peaks at 10 and 12.5 kHz. No temporary threshold shifts were found at 3 to 6 kHz, but were found at 8 to 16 kHz, though this did not reach statistical significance.CONCLUSION: This article examines noise exposure and threshold shifts during temporal bone drilling. We were unable to find previous descriptions in the literature of measurements done while multiple people drilling simultaneously, during tranlabyrinthine surgery and a specific frequency characterization of the change in peach that appears while drilling on the tegmen. Hearing protection should be considered, which would still allow the surgeon to appreciate pitch changes associated with drilling on sensitive structures and communication with surgical team members. As professionals who specialize in promoting the restoration and preservation of hearing for others, otologic surgeons should not neglect hearing protection for themselves.

  View details for PubMedID 29889779

• Vertigo and Dizziness: Understanding and Managing Fall Risk. Otolaryngologic clinics of North America Alyono, J. C. 2018

  Abstract

  Vertigo and dizziness are common conditions among older adults. They are closely associated with fall risk and portend major implications for geriatric injury and disability. Management can be particularly challenging, because symptoms are often nonspecific and may reflect multiple etiologies. Chronic dizziness can reflect dysfunction in the vestibular, somatosensory, or visual systems or in their central integration. Systemic processes, such as postural hypotension, arrhythmias, heart failure, medication use, and lower extremity weakness or frailty, also contribute. Management of acute vestibular syndrome requires ruling out dangerous causes, such as stroke. This article reviews relevant definitions, epidemiology, pathophysiology, diagnosis, and clinical management.

  View details for PubMedID 29803531

• Temporal Bone CT Scan for Malleal Ligaments Assessment. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Vaisbuch, Y. n., Hosseini, D. K., Lanzman, B. n., Marcott, S. C., Ma, Y. n., Song, Y. n., Alyono, J. C., Blevins, N. H. 2018; 39 (10): e1054–e1059

  Abstract

  To determine the feasibility of using temporal bone computed tomography (CT) scans to identify malleal ligaments and the prevalence of calcification in malleal ligaments.Retrospective case review. CT scans were blindly and retrospectively reviewed by two physicians (a radiologist and a nonradiologist). Scans differed by slice thickness, and included both conventional CT and cone beam CT (CBCT).Ambulatory tertiary referral center.One hundred fifty-one temporal bone CT scans, obtained between the years 2014 and 2017, were initially screened, which included 302 ears. Patients with previous tympanomastoid surgery or middle ear opacification were excluded, leaving 187 ears in the study.Diagnostic.Percentage of visible normal and calcified malleal ligaments.Scans with submillimeter slice thickness were more likely to demonstrate all three malleal ligaments than those with 1 ml and larger slices (83.7% versus 50.0% for nonradiologist, p < 0.0001; 59.6 versus 34.8% for radiologist, p < 0.0001). Calcification was seen in 11.8% of ears reviewed. The ability to detect malleal ligaments with cone beam CT was 86.2%, while the rate with conventional CT was 71.1%, a difference that persisted when controlling for slice thickness. Interobserver agreement for the detection of malleal ligaments was 65% with a Cohen's kappa coefficient of κ = 0.27.Visualization of the malleal ligaments using CT scans is feasible in a majority of aerated ears. Detection of malleal ligaments improves with thinner slice thickness and cone-beam technique. Low interobserver agreement suggests the importance of experience and a need for standardized review.

  View details for PubMedID 30239436

• The American Otological Society at its Sesquicentennial: Insights Into the Society's Formative Years. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Jackler, R. K., Alyono, J. C., Mudry, A. C. 2018; 39 (4S Suppl 1): S1–S9

  Abstract

  To elucidate the sequence of events which led to the formation of the American Otological Society (AOS) in 1868 and to examine the lives and contributions of the nine founding members of the Society.Study of primary historical documents, biographical material, and previous histories of the AOS.Earlier treatments of the history of the AOS minimally covered the events and personalities from the Society's formative period. The founders of the AOS were much influenced by recent advances in European Otology and the success of the nascent American Ophthalmological Society which had been founded in 1864. The AOS has long credited Elkanah Williams as its first president of the AOS, although he never actually served in this role and was not a contributor to otological literature. Documents suggest that 30 years old New York physician Daniel Bennett St John Roosa, recently returned from a grand tour of the leading European otological centers, was the principal advocate for the creation of the AOS.The 1860s were a pivotal period in the maturation of American Otology. Previously, most "aurists" were widely considered to be charlatans who practiced unscientifically and often unscrupulously. The AOS founder generation were a group of Ophthalmologists who strove to elevate otology from being a lesser appendage of the mother field to becoming a respected and scientifically based medical specialty in its own right.

  View details for PubMedID 29342043

• Women of the American Otological Society. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Alyono, J. C., Jackler, R. K., Chandrasekhar, S. S. 2018; 39 (4S Suppl 1): S69–S80

  Abstract

  To describe the history of women in the American Otological Society (AOS).Biographies of the early women of the AOS were compiled through review of the AOS transactions, their published scholarship, newspaper articles, and memorials. Interviews were conducted with the only two women to have led the society and also with former colleagues and family members of pioneering AOS women members who are no longer with us. The evolving gender composition of the society over time was researched from AOS membership lists and compared with data on surgical workforce composition from multiple sources such as the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, American Medical Association, and the American Academy of Otolaryngology-Head and Neck Surgery.Although American women specialized in otology as far back as 1895, the first woman to be invited to join the AOS as Associate member in 1961 was Dorothy Wolff, PhD. The first female full member was otologic surgeon LaVonne Bergstrom, M.D., who was elected in 1977, 109 years after the foundation of the Society. As of 2017, only two women have served as AOS President. The first was Aina Julianna Gulya, M.D., who took office during the 133rd year in 2001. At the time of the sesquicentennial (2017), 7.5% of AOS members are women including three of eight who serve on the AOS Council. This compares with 15.8% of women among the otolaryngology workforce and a growing 10.9% representation among those who have earned subcertification in neurotology.Gender disparities remain in the AOS, but both participation and scholarly contributions by women in otology have grown substantially since the society's inception 150 years ago, and particularly in the 21st century. Increasing the presence of women in leadership provides role models and mentorship for the future.

  View details for PubMedID 29533377

• Practice of Otology During the First Quarter Century of the American Otological Society (1868-1893). Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Sioshansi, P. C., Jackler, R. K., Alyono, J. C. 2018; 39 (4S Suppl 1): S10–S29

  Abstract

  To describe the practice of otology in America during the first quarter century of the American Otological Society (AOS).Two sources were used to determine the most prevalent disease conditions cared for and surgical procedures undertaken during this era. All articles published in the AOS transactions between 1868 and 1893 were studied as were the otology textbooks published by 6 of the first 10 Presidents of the Society.The primary emphasis of late 19th century American otological scholarship was on chronic ear infection with numerous articles focusing on complications of otitis including frequent descriptions of fatalities. Much emphasis was placed upon the Eustachian tube with catheterization and insufflation a major part of otological practice. Due to limitations in technology, the overwhelming focus was on diseases of the ear canal and middle ear. Understanding of temporal bone anatomy was much superior to that of physiology. Erroneous speculations on the function of the middle and inner ear were common. Surgical interventions were largely limited to myringotomy and mastoidectomy, the latter of which was sometimes life saving during the preantibiotic era.The latter half of the 19th century saw the emergence of otology as a specialty in America and many emerging diagnostic and therapeutic advances were adopted. While capabilities were notably limited during this era, the efforts of a small band of pioneer otologists in the founder generation of the AOS contributed greatly to the progress of the emerging specialty.

  View details for PubMedID 29533373

• Electrode Array Displacement into the Fallopian Canal in Revisions of Long-standing Cochlear Implants OTOLOGY & NEUROTOLOGY Alyono, J., Locketz, G., Corrales, C. E., Blevins, N. H. 2017; 38 (5): 667-671

  Abstract

  To describe extracochlear extension of revision cochlear implant arrays into the Fallopian canal.Two adult patients with extension of revision cochlear implant arrays into the Fallopian canal.Computed tomography (CT), selective deactivation of non-functional electrodes.Facial nerve function, facial nerve stimulation, cochlear implant electrode position, radiography, functional hearing.Two patients presented with failure of their long-standing cochlear implants (CIs). One patient with presumed postviral hearing loss presented with declining function and increasing facial stimulation from an implant placed 30 years previous. A second with postmeningitic hearing loss presented with a draining mastoid fistula from an implant placed 7 years before. Both patients were reimplanted with minimal insertion resistance via the established electrode tract, yet demonstrated facial nerve stimulation during intraoperative telemetry and on device activation. Postoperative CTs of each patient showed exit of the electrode from the cochlea into the tympanic or labyrinthine Fallopian canal. Both patients can use their devices effectively with selective electrode deactivation.Our cases illustrate the potential association of long-standing electrodes with otic capsule changes, allowing extracochlear malposition of subsequent arrays. This can occur despite apparently uneventful reinsertion of a flexible array without undue force. Previously reported histopathology confirms the potential for a reactive osteitis from arrays that may contribute to this phenomenon. Intraoperative facial stimulation with neural telemetry testing can raise suspicion of a malpositioned array involving the Fallopian canal. Such cases can be effectively managed with selective deactivation of malpositioned electrode contacts.

  View details for DOI 10.1097/MAO.0000000000001376

  View details for PubMedID 28353620

• Mandibular Distraction in a Patient With Type II Collagenopathy. journal of craniofacial surgery Garza, R. M., Alyono, J. C., Dorfman, D. W., Wan, D. C. 2016: -?

  Abstract

  Kniest dysplasia is an extremely rare form of type II collagenopathy associated with cleft palate, micrognathia, shortened trunk, arms and legs, and club foot. The authors present a case of an infant with this disorder who also had micrognathia and respiratory distress for which mandibular distraction was performed. Although abnormal collagen and impaired endochondral ossification is noted with Kniest dysplasia, adequate bone formation was observed across the distraction gap. Nonetheless, despite stable mandibular advancement, failure to consider concomitant restrictive lung disease resulted in tracheostomy dependence. The authors demonstrate that while successful bone regeneration can be achieved through distraction of intramembranous facial bones, discretion must still be employed in patients with collagenopathies.

  View details for PubMedID 27152560

• Inflammatory Pseudotumors of the Skull Base: Meta-Analysis OTOLOGY & NEUROTOLOGY Alyono, J. C., Shi, Y., Berry, G. J., Recht, L. D., Harsh, G. R., Jackler, R. K., Corrales, C. E. 2015; 36 (8): 1432-1438

  Abstract

  To describe the presentation, treatment, and outcome of inflammatory pseudotumors (IPs) of the skull base.English-language articles in PubMed, Web of Science, and EMBASE from earliest available through April 2014.Articles were identified using a keyword search for "inflammatory pseudotumor," "inflammatory myofibroblastoma," or "plasma cell granuloma," including a keyword localizing to the skull base.One hundred papers with 157 cases met inclusion criteria. History, tumor site, initial and subsequent treatment, outcomes, and complications were extracted. Student t test, z test, and analysis of variance were used to analyze demographics, symptoms, sites involved, and outcomes. Odds ratios for site versus initial treatment were calculated.At diagnosis, average patient age was 41 years. Approximately 70% of lesions primarily involved the anterior skull base, 29% the lateral skull base, and 1.2% the occiput. The most common initial treatments were steroids (44%), surgery (28%), and surgery with steroids (16%). Anterior lesions were 55.8 times more likely than lateral lesions to be treated initially with steroids (CI, 14.7-212). Seventy-six percent of patients had stable or resolved symptoms after a single course of treatment.Diagnosis of skull base IP requires ruling out other aggressive pathologies, such as malignancy and infection, and maintaining a high index of suspicion. Surgery is favored for lesions that can be removed in toto with minimal morbidity, as well as steroids for those sites where anatomy limits complete resection, such as within the orbit, cavernous sinus, or brain. An option for larger lesions involving vital anatomy is debulking, followed by postoperative steroids.

  View details for DOI 10.1097/MAO.0000000000000818

  View details for Web of Science ID 000360488000023

• Inflammatory Pseudotumors of the Skull Base: Meta-Analysis. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology Alyono, J. C., Shi, Y., Berry, G. J., Recht, L. D., Harsh, G. R., Jackler, R. K., Corrales, C. E. 2015; 36 (8): 1432-8

  Abstract

  To describe the presentation, treatment, and outcome of inflammatory pseudotumors (IPs) of the skull base.English-language articles in PubMed, Web of Science, and EMBASE from earliest available through April 2014.Articles were identified using a keyword search for "inflammatory pseudotumor," "inflammatory myofibroblastoma," or "plasma cell granuloma," including a keyword localizing to the skull base.One hundred papers with 157 cases met inclusion criteria. History, tumor site, initial and subsequent treatment, outcomes, and complications were extracted. Student t test, z test, and analysis of variance were used to analyze demographics, symptoms, sites involved, and outcomes. Odds ratios for site versus initial treatment were calculated.At diagnosis, average patient age was 41 years. Approximately 70% of lesions primarily involved the anterior skull base, 29% the lateral skull base, and 1.2% the occiput. The most common initial treatments were steroids (44%), surgery (28%), and surgery with steroids (16%). Anterior lesions were 55.8 times more likely than lateral lesions to be treated initially with steroids (CI, 14.7-212). Seventy-six percent of patients had stable or resolved symptoms after a single course of treatment.Diagnosis of skull base IP requires ruling out other aggressive pathologies, such as malignancy and infection, and maintaining a high index of suspicion. Surgery is favored for lesions that can be removed in toto with minimal morbidity, as well as steroids for those sites where anatomy limits complete resection, such as within the orbit, cavernous sinus, or brain. An option for larger lesions involving vital anatomy is debulking, followed by postoperative steroids.

  View details for DOI 10.1097/MAO.0000000000000818

  View details for PubMedID 26164448

• Development and Characterization of Chemical Cochleostomy in the Guinea Pig OTOLARYNGOLOGY-HEAD AND NECK SURGERY Alyono, J. C., Corrales, C. E., Huth, M. E., Blevins, N. H., Ricci, A. J. 2015; 152 (6): 1113-1118

  Abstract

  Creation of an atraumatic, hearing-preservation cochleostomy is integral to the future of minimally invasive inner ear surgery. The goal of this study was to develop and characterize a novel chemical approach to cochleostomy.Prospective animal study.Laboratory.Experimental animal study in which phosphoric acid gel (PAG) was used to decalcify the otic capsule in 25 Hartley guinea pigs. Five animals in each of 5 surgical groups were studied: (1) mechanically opening the auditory bulla alone, (2) PAG thinning of the basal turn otic capsule, leaving endosteum covered by a layer of bone, (3) micro-pick manual cochleostomy, (4) PAG chemical cochleostomy, exposing the endosteum, and (5) combined PAG/micro-pick cochleostomy, with initial chemical thinning and subsequent manual removal of the last osseous layer. Preoperative and postoperative auditory brainstem responses and otoacoustic emissions were obtained at 2, 6, 10, and 16 kHz. Hematoxylin and eosin-stained paraffin sections were compared.Surgical and histologic findings confirmed that application of PAG provided reproducible local bone removal, and cochlear access was enabled. Statistically significant auditory threshold shifts were observed at 10 kHz (P = .048) and 16 kHz (P = .0013) following cochleostomy using PAG alone (group 4) and at 16 kHz using manual cochleostomy (group 3) (P = .028). No statistically significant, postoperative auditory threshold shifts were observed in the other groups, including PAG thinning with manual completion cochleostomy (group 5).Hearing preservation cochleostomy can be performed in an animal model using a novel technique of thinning cochlear bone with PAG and manually completing cochleostomy.

  View details for DOI 10.1177/0194599815573703

  View details for PubMedID 25779472

• Should Pediatric Tympanomastoidectomy and Cochlear Implantation Routinely Be Performed as Outpatient Surgery? LARYNGOSCOPE Alyono, J. C., Oghalai, J. S. 2015; 125 (5): 1041-1042

  View details for DOI 10.1002/lary.25013

  View details for PubMedID 25387840

• Second branchial cleft anomaly with an ectopic tooth: a case report. Ear, nose, & throat journal Alyono, J. C., Hong, P., Page, N. C., Malicki, D., Bothwell, M. R. 2014; 93 (9): E1-3

  Abstract

  Branchial cleft cysts, sinuses, and fistulas are the most common congenital lateral neck lesions in children. They arise as a result of an abnormal development of the branchial arches and their corresponding ectoderm-lined branchial clefts. Of these diverse anomalies, second branchial cleft lesions are the most common, accounting for approximately 95% of all branchial arch pathologies. We describe what is to the best of our knowledge the first reported case of an ectopic tooth in a branchial cleft anomaly. The patient was a young girl who had other congenital abnormalities and syndromic features and who was eventually diagnosed with Townes-Brocks syndrome. We describe the clinical presentation, management, pathologic analysis, and postoperative outcomes of this case, and we present a brief review of Townes-Brocks syndrome.

  View details for PubMedID 25255350

• Facial nerve schwannomas presenting as occluding external auditory canal masses: a therapeutic dilemma. Otology & neurotology Alyono, J. C., Corrales, C. E., Gurgel, R. K., Blevins, N., Jackler, R. K. 2014; 35 (7): 1284-1289

  Abstract

  To present a series of patients with facial nerve schwannomas (FNSs) presenting as occluding external auditory canal (EAC) masses.Retrospective case series.Four patients were identified with mastoid segment FNSs occluding the EAC. Three patients presented with conductive hearing loss (CHL), and the fourth presented with facial paralysis, later developing CHL.One patient underwent conservative debulking, removing the EAC component only. Two patients were managed nonoperatively with periodic cleaning of entrapped keratin. The fourth patient received radiation therapy.Facial nerve function, canal cholesteatoma formation, and hearing.Among the patients managed with serial cleaning of entrapped keratin, one maintained normal facial function and one worsened to House-Brackmann II/VI. Facial function worsened to House-Brackmann II/VI in the patient who underwent surgical debulking. The fourth patient, who received radiation, developed complete facial paralysis. All patients accumulated keratin medial to the tumor, and all had CHL.When evaluating an EAC tumor, it is important to obtain imaging before biopsy because biopsy of a schwannoma can result in paralysis. EAC occlusion by a schwannoma presents a challenging management issue, particularly when cholesteatoma forms between the tumor and the tympanic membrane. The primary goal is maintaining normal facial function as long as possible and avoiding secondary ear canal complications. The presence of canal occlusion limits the choice of stereotactic radiation because this leads to a month-long period of tumor swelling and cutaneous sloughing. Resection and grafting are indicated when substantial facial weakness or twitch develops.

  View details for DOI 10.1097/MAO.0000000000000398

  View details for PubMedID 24853246

• Otalgia, Facial Nerve Paralysis, and Hearing Loss JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Alyono, J. C., Corrales, C., Oghalai, J. S. 2014; 140 (6): 575–76

  View details for PubMedID 24810396

• PHYS 488-DCDHF photophysics: Designing new single-molecule fluorophores for cellular imaging Lord, S. J., Lu, Z., Wang, H., Alyono, J., Liu, N., Weber, R., Twieg, R. J., Moerner, W. E. AMER CHEMICAL SOC. 2006

  View details for Web of Science ID 000207781609088

• ORGN 54-Synthesis and properties of DCDHF chromophore dimers Liu, N., Bertke, J. A., Bunge, S. D., Twieg, R. J., Lord, S. J., Alyono, J., Moerner, W. E. AMER CHEMICAL SOC. 2006

  View details for Web of Science ID 000207781608613