Bio


Kara D. Meister, MD, FAAP, FACS is a pediatric otolaryngologist and head & neck surgeon. She received her medical degree from Medical University of South Carolina and completed her otolaryngology residency at University of Pittsburgh. She completed a NIH-funded fellowship in head and neck research at the University of Pittsburgh. Dr. Meister then went on to complete a pediatric otolaryngology fellowship at Lucile Packard Children’s Hospital Stanford.

She is currently a Clinical Assistant Professor in the Department Otolaryngology, Division of Pediatric Otolaryngology, at Stanford University. Dr. Meister’s research interest involves understanding the use of technology to diagnose and treat pediatric patients, specifically the use of point-of-care ultrasound. She currently serves as the Associate Clinical Chief of Pediatric Otolaryngology. Notable projects include serving as the physician lead for the development and introduction of the Epic Care Companion for surgical patients and improving access for surgical services. Dr. Meister completed additional training in innovation through the Stanford Biodesign Faculty Fellowship.

Her clinical interests include airway evaluation and reconstruction, voice and swallowing problems, and treatment of patients with head and neck masses including thyroid nodules and cancer. She is Co-Director, Surgical, of the Children's Thyroid Center at Lucile Packard Children’s Hospital Stanford and is a participating surgeon in the Aerodigestive and Airway Reconstruction Center at Stanford Children’s Health. She is co-editor of the textbook "Pediatric Bronchoscopy for Clinicians" and enjoys advocacy work with the American Academy of Pediatrics Button Battery Taskforce.

Dr. Meister is a member of the American Thyroid Association (ATA) where she serves on the Diversity, Equity, and Inclusion committee and is a member of the ATA Guidelines Writing Group for Thyroid Disease & Pregnancy. She is a member of the pediatric committee of the American Head and Neck Society. She is an author and speaker on masses and tumors of the head and neck, thyroid disease, and thyroid cancer in children and adolescents. In collaboration with SHC, she offers novel treatment for thyroid problems in children and adolescents including radiofrequency ablation of thyroid nodules and transoral, transvestibular thyroid surgery.

Dr. Meister lives in Woodside with her husband and 3 children.

Clinical Expertise:
Children's Thyroid Center, Co-Director, Surgical
Aerodigestive and Airway Reconstruction Center
Thyroid nodules
Thyroid cancer - papillary, follicular, and medullary
Surgical management of hyperthyroidism and Grave's disease
Head and Neck masses
Congenital neck masses
Pediatric Head and Neck cancer
Fetal Airway and Exit Team

Commonly treated diagnoses: Pediatric thyroid cancer, pediatric thyroid masses, Pediatric Head and Neck masses, subglottic stenosis, airway reconstruction, laryngeal reconstruction, tracheal stenosis, noisy breathing, tracheostomy, stridor, complete tracheal rings, vocal fold paralysis, bronchoscopy, Aerodigestive and Airway Reconstruction Center, pediatric voice disorders, Fetal Airway and Exit Surgery

Clinical Focus


  • Otolaryngology

Academic Appointments


Administrative Appointments


  • Associate Clinical Chief, SMCH (2021 - Present)

Honors & Awards


  • “Mixed Reality Tool to Improve Shared Decision Making” Grant, Lucile Packard Foundation Auxiliaries Endowment (2022)
  • “Preventing Unplanned Extubation in Neonates” Grant, Stanford Biodesign (2022)
  • Honor Award, American Academy of Otolaryngology—Head & Neck Surgery (2021)
  • Clinician Educator Grant, "Next Generation Sequencing for HN Infections", PI: K. Meister, $20,000, Maternal and Child Health Research Institute (MCHRI), Stanford University (2019-2020)
  • Adam T. Ross, MD, Leadership Excellence Grant, American Academy of Otolaryngology—Head & Neck Surgery (2017)
  • Women in Otolaryngology Section Exemplary Senior Trainee Award, American Academy of Otolaryngology—Head & Neck Surgery (2016)
  • “Co-targeting HER3 and PI3K in Squamous Cell Carcinoma”, AAO-HNSF Resident Research Award CORE Grant ($10,000) (2015)
  • Research Training in Otolaryngology, NIH T32 DC000066 ($107,140) (2014)

Boards, Advisory Committees, Professional Organizations


  • Faculty Practice Organization Nominating Committee, Lucile Packard Children’s Hospital (2022 - Present)
  • Stanford WellMD & WellPhD Lactation Council, Stanford University School of Medicine (2022 - Present)
  • Committee Member, Pediatric Otolaryngology Education Committee, AAO-HNS, Chair elect 2022 (2018 - Present)
  • MCHRI Education Committee, Lucile Packard Children’s Hospital (2021 - Present)
  • Taskforce Member, Content Curation Working Group, American Academy of Otolaryngology--Head & Neck Surgery (2019 - Present)
  • Committee Member, Media & Public Relations Committee, American Academy of Otolaryngology—Head & Neck Surgery (2018 - Present)

Professional Education


  • Board Certification: American Osteopathic Board of Ophthalmology and Otolaryngology, Complex Pediatric Otolaryngology (2021)
  • Fellowship: Stanford University Pediatric Otolaryngology Fellowship (2018) CA
  • Board Certification: American Board of Otolaryngology, Otolaryngology (2018)
  • Residency: University of Pittsburgh Otolaryngology Residency (2017) PA
  • BS, Clemson University (2006)
  • Medical Education: Medical University of South Carolina Registrar (2011) SC
  • MD, Medical University of South Carolina (2011)

All Publications


  • Use of temporary tracheostomy occlusion to reduce the risk of sternal wound infection after sternotomy in congenital cardiac surgery. Cardiology in the young Azimzadeh, J. B., Sidell, D. R., Balakrishnan, K., Mathew, R., Asija, R., Rutter, M. J., Meister, K. D. 2024: 1-6

    Abstract

    OBJECTIVE: To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023.METHODS: We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children's hospital. Clinical variables were extracted from the hospital medical records. The rates of antibiotic use and minor and major complications during the period when the stoma plug was in place were recorded.RESULTS: Totally, 19 patients underwent tracheal stoma plugging prior to sternotomy and were included in our analysis. There were two cases of sternal wound infection; one case occurred while the stoma plug was in place, and one developed four days following plug removal. There was one minor complication, with one patient requiring stoma revision via serial dilation at bedside at the time of recannulation. There were no deaths.CONCLUSION: Temporary occlusion of the tracheal stoma with an impermeable plug is a viable option for reducing the risk of sternal wound infection in children with a pre-existing tracheostomy who are undergoing sternotomy.

    View details for DOI 10.1017/S1047951124000106

    View details for PubMedID 38410052

  • The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series. Laryngoscope investigative otolaryngology Kim, G. S., Seeley, H., Noel, J., Ahmad, I., Meister, K. 2024; 9 (1): e1198

    Abstract

    To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population.Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology.Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat.RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population.4.

    View details for DOI 10.1002/lio2.1198

    View details for PubMedID 38362180

    View details for PubMedCentralID PMC10866600

  • The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY Kim, G. S., Seeley, H., Noel, J., Ahmad, I., Meister, K. 2024

    View details for DOI 10.1002/lio2.1198

    View details for Web of Science ID 001139414300001

  • Use of Neoadjuvant Vandetanib in Aggressive Pediatric Medullary Thyroid Carcinoma. JCO precision oncology Kothari, R., Kreimer, S., Nadel, H., Seeley, H., Hartman, G., Meister, K. D. 2024; 8: e2300257

    Abstract

    Novel use of vandetanib in a child with aggressive MTC with prolonged response to treatment.

    View details for DOI 10.1200/PO.23.00257

    View details for PubMedID 38207224

  • Cough Sounds in Screening and Diagnostics: A Scoping Review. The Laryngoscope Hegde, S., Sreeram, S., Alter, I. L., Shor, C., Valdez, T. A., Meister, K. D., Rameau, A. 2023

    Abstract

    The aim of the study was to examine applications of cough sounds towards screening tools and diagnostics in the biomedical and engineering literature, with particular focus on disease types, acoustic data collection protocols, data processing and analytics, accuracy, and limitations.PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, IEEE Xplore, Engineering Village, and ACM Digital Library were searched from inception to August 2021.A scoping review was conducted on screening and diagnostic uses of cough sounds in adults, children, and animals, in English peer-reviewed and gray literature of any design.From a total of 438 abstracts screened, 108 articles met inclusion criteria. Human studies were most common (77.8%); the majority focused on adults (57.3%). Single-modality acoustic data collection was most common (71.2%), with few multimodal studies, including plethysmography (15.7%) and clinico-demographic data (7.4%). Data analytics methods were highly variable, with 61.1% using machine learning, the majority of which (78.8%) were published after 2010. Studies commonly focused on cough detection (41.7%) and screening of COVID-19 (11.1%); among pediatric studies, the most common focus was diagnosis of asthma (52.6%).Though the use of cough sounds in diagnostics is not new, academic interest has accelerated in the past decade. Cough sound offers the possibility of an accessible, noninvasive, and low-cost disease biomarker, particularly in the era of rapid development of machine learning capabilities in combination with the ubiquity of cellular technology with high-quality recording capability. However, most cough sound literature hinges on nonstandardized data collection protocols and small, nondiverse, single-modality datasets, with limited external validity. Laryngoscope, 2023.

    View details for DOI 10.1002/lary.31042

    View details for PubMedID 37672667

  • Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. The Laryngoscope Schiff, E., Propst, E. J., Balakrishnan, K., Johnson, K., Lounsbury, D. W., Brenner, M. J., Tawfik, M. M., Yang, C. J. 2023

    Abstract

    To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps.A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments.The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively.The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives.Level 5 Laryngoscope, 2023.

    View details for DOI 10.1002/lary.30674

    View details for PubMedID 37114735

  • Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age. International journal of pediatric otorhinolaryngology Ayoub, N., Balakrishnan, K., Meister, K., Grimm, D., Johnson, A., Maida, K., Sidell, D. R. 2023; 168: 111542

    Abstract

    Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL.This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected.49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing.IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.

    View details for DOI 10.1016/j.ijporl.2023.111542

    View details for PubMedID 37058865

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

    Abstract

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

    View details for DOI 10.1002/ohn.332

    View details for PubMedID 36994937

  • Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Su-Velez, B. M., Hartman, G. E., Seeley, H., Orloff, L. A., Noel, J. E., Meister, K. D. 2023

    Abstract

    Devices for near-infrared light stimulation of autofluorescence (NIRAF) allow for intraoperative identification of parathyroid glands with high sensitivity in adults. However, their performance in the pediatric population is unknown. In this case series with chart review at a tertiary academic children's hospital, we investigated pediatric patients undergoing thyroid surgery and concurrent use of a probe-based NIRAF device. Thirteen patients (ages 6-18 years) underwent thyroid and/or neck dissection procedures, and 2 patients had revision procedures for a total of 15 cases with the NIRAF device. Eight cases had NIRAF values that matched surgeon opinion of parathyroid tissue or histology when available. Six cases had false positive NIRAF readings (40.0%) and 1 case had false negative readings (6.7%). Compared with surgeon opinion or histology, the NIRAF device confirmed 26 of 34 parathyroid gland candidates (76.5%). These devices need further investigation in pediatric patients, whose tissues may have different autofluorescence characteristics.

    View details for DOI 10.1002/ohn.272

    View details for PubMedID 36939554

  • Parathyroid Autofluorescence in Pediatric Thyroid Surgery: Experience With False Positive and False Negative Results OTOLARYNGOLOGY-HEAD AND NECK SURGERY Su-Velez, B. M., Hartman, G. E., Seeley, H., Orloff, L. A., Noel, J. E., Meister, K. D. 2023

    View details for DOI 10.1002/ohn.272

    View details for Web of Science ID 000921354900001

  • Sociodemographic Disparities in the Diagnostic Management of Pediatric Thyroid Nodules. JAMA otolaryngology-- head & neck surgery Moon, P. K., Qian, Z. J., Noel, J. E., Orloff, L. A., Seeley, H., Hartman, G. E., Josephs, S., Meister, K. D. 2022

    Abstract

    Importance: Thyroid cancer is the most common pediatric endocrine malignant neoplasm. Disparities in the workup of thyroid nodules may be significantly associated with thyroid cancer outcomes.Objective: To determine the association of sociodemographic factors with the odds of receiving a biopsy, timeliness of the procedure, and risk of nodule malignancy.Design, Setting, and Participants: This was a retrospective cross-sectional study using insurance claims data from the Optum Clinformatics Data Mart database. The study cohort comprised pediatric patients diagnosed with single thyroid nodules between 2003 and 2020. Data analysis was performed from January 1, 2003, to June 30, 2020.Main Outcomes and Measures: Multivariable logistic regression models were used to identify demographic variables associated with biopsy and nodule malignant neoplasm. A multivariable linear regression model was used to assess the time between thyroid nodule diagnosis and biopsy.Results: Of 11 643 children (median [IQR] age at diagnosis or procedure, 15 [12-17] years; 8549 [73.2%] were female and 3126 [26.8%] were male) diagnosed with single thyroid nodules, 2117 (18.2%) received a biopsy. Among the patients who received a biopsy, 304 (14.4%) were found to have a malignant nodule. Greater parental education was associated with a shorter diagnosis-to-biopsy interval (mean difference, -7.24 days; 95% CI, -13.75 to -0.73). Older age at nodule diagnosis (odds ratio [OR], 1.11; 95% CI, 1.09-1.13) and female gender (OR, 1.25; 95% CI, 1.11-1.40) were associated with increased odds of receiving a biopsy, while Black/African American (OR, 0.80; 95% CI, 0.65-0.99) and Hispanic (OR, 0.84; 95% CI, 0.72-0.99) patients had lower odds of receiving a biopsy compared with White patients. Finally, female gender (OR, 1.08; 95% CI, 0.80-1.47) was not associated with lower odds of nodule malignant neoplasm.Conclusions and Relevance: Findings of this cross-sectional study highlight disparities in the diagnostic management of pediatric thyroid nodules. These results call for future work to ensure equitable access to thyroid care for all children.

    View details for DOI 10.1001/jamaoto.2022.3167

    View details for PubMedID 36227590

  • International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Evaluation and management of congenital tracheal stenosis. International journal of pediatric otorhinolaryngology Sidell, D. R., Meister, K. D., de Alarcon, A., Boudewyns, A., Brigger, M., Chun, R., Fayoux, P., Goudy, S., Hart, C. K., Hewitt, R., Hsu, W., Javia, L. R., Johnson, R. F., Messner, A. H., Moreddu, E., Nicollas, R., Prager, J. D., Rahbar, R., Rickert, S., Rossi, M., Russell, J., Rutter, M., Sandu, K., Smith, R. J., Soma, M., Thierry, B., Trozzi, M., White, D. R., Balakrishnan, K. 2022; 161: 111251

    Abstract

    OBJECTIVES: To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis.METHODS: Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature.RESULTS: Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis.CONCLUSION: These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.

    View details for DOI 10.1016/j.ijporl.2022.111251

    View details for PubMedID 35988373

  • Airway Characteristics of Patients With 22q11 Deletion Undergoing Pulmonary Artery Reconstruction Surgery: Retrospective Cohort Study. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Sganga, D., Meister, K., Sidell, D. R., Wise-Faberowski, L., Shek, J., Ma, M., Martin, E., Hanley, F. L., McElhinney, D., Asija, R. 2022

    Abstract

    OBJECTIVES: We have previously shown that patients with a chromosome 22q11 microdeletion are at risk for prolonged respiratory failure after pulmonary artery reconstruction surgery compared with those with normal genotype. We sought to describe preexisting airway abnormalities in this patient population and examine relationships between airway abnormalities and outcomes.DESIGN: Single-center retrospective chart review from Society of Thoracic Surgery and Pediatric Cardiac Critical Care Consortium databases and the electronic medical record.SETTING: Lucile Packard Children's Hospital at Stanford from September 2017 to February 2019.PATIENTS: All patients undergoing pulmonary artery reconstruction surgery were considered for inclusion.INTERVENTIONS: We identified 127 patients meeting study inclusion criteria. Thirty-nine patients met specific criteria and underwent screening preoperative bronchoscopy including microdirect laryngoscopy and lower airway examination. Postoperative bronchoscopy was performed at the discretion of the intensive care team.MEASUREMENTS AND MAIN RESULTS: Airway abnormalities were detected in 25/26 of children (96%) with a chromosome 22q11 deletion who underwent preoperative bronchoscopy. Upper and lower airway pathologies were found in 19/25 (73%) and 21/25 (81%) patients, respectively, and it was common for patients to have more than one abnormality. Presence of 22q11 deletion was associated with longer duration of mechanical ventilation (9.1 vs 4.3 d; p = 0.001), use of noninvasive positive pressure support (13 vs 6 d; p = 0.001), and longer hospital stays (30 vs 14 d; p = 0.002). These outcomes were worse when compared with patients with known airway abnormalities who did not have 22q11 deletion.CONCLUSIONS: Preexisting upper and lower airway pathologies are common in patients with a chromosome 22q11 deletion who undergo pulmonary artery reconstruction surgery. Despite similar postoperative hemodynamics and outcomes as their counterparts without 22q11 deletion, 22q11 deletion is associated with more postoperative respiratory complications not entirely explained by preexisting airway abnormalities.

    View details for DOI 10.1097/PCC.0000000000002921

    View details for PubMedID 35213412

  • Next-Generation Sequencing as an Auxiliary Tool in Pediatric Laryngeal Lymphoma Diagnosis. Pediatrics Munjal, T., Vukkadala, N., Hazard, F. K., Meister, K. D. 2021

    Abstract

    Lymphomatous involvement of the larynx is a rare entity. We present a case of atypical laryngotracheitis as the initial manifestation of non-Hodgkin's lymphoma in a pediatric patient. The diagnosis was aided through the use of microbial cell-free DNA (mcfDNA) testing, which detected the presence of Epstein-Barr virus in the patient's plasma. This enabled the consideration of an Epstein-Barr virus-related lymphoproliferative process, leading to additional workup and the final diagnosis of lymphoma. To our knowledge, this is the first case of mcfDNA testing leading not simply to an infectious organism, but further to a new oncologic diagnosis. Plasma mcfDNA testing has the potential to inform clinical practice beyond classic infectious disease manifestations. In this article, we review both the possible future applications and the areas of further investigation that remain.

    View details for DOI 10.1542/peds.2020-047662

    View details for PubMedID 34716219

  • Challenges and Opportunities in Deploying COVID-19 Cough AI Systems. Journal of voice : official journal of the Voice Foundation Khanzada, A., Hegde, S., Sreeram, S., Bower, G., Wang, W., Mediratta, R. P., Meister, K. D., Rameau, A. 2021

    View details for DOI 10.1016/j.jvoice.2021.08.009

    View details for PubMedID 34610883

  • Opioid-Free Postoperative Pain Management After Adenotonsillectomy With Nasal Turbinate Reduction Using Bilateral Suprazygomatic Infratemporal-Pterygopalatine Fossa Injections: A Case Report. A&A practice Lin, C., Pan, S., Barros, V. R., Meister, K., Tsui, B. C. 2021; 15 (8): e01502

    Abstract

    Adenotonsillectomies are one of the most common otolaryngologic surgeries performed to alleviate obstructive sleep-disordered breathing and apnea in children. The pain management following adenotonsillectomy continues to be a challenge for both pediatric anesthesiologists and otolaryngologists due to the mortality that stems from the use of opioid pain medications in children who have an increased baseline risk airway obstruction and apnea that is exacerbated by any exposure to opioids. We present a case utilizing bilateral suprazygomatic maxillary nerve (SZMN) blocks or, more accurately, suprazygomatic infratemporal-pterygopalatine fossa injections to achieve opioid-free perioperative analgesia for pediatric adenotonsillectomy with nasal turbinate reduction.

    View details for DOI 10.1213/XAA.0000000000001502

    View details for PubMedID 34403375

  • Effects of Social Determinants of Health Care on Pediatric Thyroid Cancer Outcomes in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Gruszczynski, N. R., Low, C. M., Choby, G., Meister, K. D., Smith, B. H., Balakrishnan, K. 2021: 1945998211032901

    Abstract

    OBJECTIVE: To identify social determinants of health care that are associated with poorer pediatric well-differentiated thyroid cancer (WDTC) outcomes and increased stage at presentation.STUDY DESIGN: Using the SEER database (Surveillance, Epidemiology, and End Results), we retrospectively gathered data on pediatric WDTC across the United States between 1973 and 2015.SETTING: All patients between 0 and 19 years old with a diagnosis of WDTC were included.METHODS: Patient variables were analyzed for relationships to AJCC stage at presentation (American Joint Committee on Cancer), overall survival, and disease-specific survival.RESULTS: Among 3913 patients with pediatric thyroid cancer, 3185 were female (81.4%), 3366 had papillary thyroid cancer (85.3%), and 367 had follicular thyroid cancer (9.4%). Two- and 5-year overall and disease-specific survival approached 100%. However, when outcomes were analyzed by specific populations, male sex, non-Caucasian race, poverty, and language isolation were linked to worse overall survival. Male sex and poverty were associated with poorer disease-specific survival. Regarding overall AJCC stage at presentation, male sex and Black race were related to higher overall presenting AJCC stage. Later AJCC T stage at presentation was seen in male, Hispanic, Asian, and Black patients. There were no variables significantly related to following through with recommended surgery.CONCLUSION: Pediatric WDTC continues to carry an excellent prognosis in the United States. However, when we consider specific populations, the social determinants of health care affect survival and disease burden at presentation: male sex, poverty, language isolation, and race affected survival and/or AJCC stage at presentation in pediatric WDTC.

    View details for DOI 10.1177/01945998211032901

    View details for PubMedID 34311618

  • Nonsurgical Orthodontic Airway Plate Treatment for Newborns With Robin Sequence. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association Choo, H., Khosla, R. K., Meister, K. D., Wan, D. C., Lin, H. C., Feczko, R., Bruckman, K., Hopkins, E., Truong, M. T., Lorenz, H. P. 2021: 10556656211007689

    Abstract

    Despite promising outcomes for >50 years, nonsurgical orthodontic airway plates (OAP) are only infrequently offered for babies with Robin sequence in a few parts of the world. This article demonstrates possibility of providing functional improvement using an OAP to help these babies overcome their functional and structural difficulties on their own. Two consecutively treated cases are presented exemplifying that OAP treatment that had originated from Europe is reproducible and effective in an institution in the United States.

    View details for DOI 10.1177/10556656211007689

    View details for PubMedID 33845627

  • Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement. The Laryngoscope Sidell, D. R., Balakrishnan, K., Best, S. R., Zur, K., Buckingham, J., De Alarcon, A., Baroody, F. M., Bock, J. M., Boss, E. F., Bower, C. M., Campisi, P., Chen, S. F., Clarke, J. M., Clarke, K. D., Cocciaglia, A., Cotton, R. T., Cuestas, G., Davis, K. L., DeFago, V. H., Dikkers, F. G., Dossans, I., Florez, W., Fox, E., Friedman, A. D., Grant, N., Hamdi, O., Hogikyan, N. D., Johnson, K., Johnson, L. B., Johnson, R. F., Kelly, P., Klein, A. M., Lawlor, C. M., Leboulanger, N., Levy, A. G., Lam, D., Licameli, G. R., Long, S., Lott, D. G., Manrique, D., McMurray, J. S., Meister, K. D., Messner, A. H., Mohr, M., Mudd, P., Mortelliti, A. J., Novakovic, D., Ongkasuwan, J., Peer, S., Piersiala, K., Prager, J. D., Pransky, S. M., Preciado, D., Raynor, T., Rinkel, R. N., Rodriguez, H., Rodriguez, V. P., Russell, J., Scatolini, M. L., Scheffler, P., Smith, D. F., Smith, L. P., Smith, M. E., Smith, R. J., Sorom, A., Steinberg, A., Stith, J. A., Thompson, D., Thompson, J. W., Varela, P., White, D. R., Wineland, A. M., Yang, C. J., Zdanski, C. J., Derkay, C. S. 2021

    Abstract

    OBJECTIVES/HYPOTHESIS: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.STUDY DESIGN: Delphi method-based survey series.METHODS: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up.RESULTS: The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18).CONCLUSION: This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes.LEVEL OF EVIDENCE: 5. Laryngoscope, 2021.

    View details for DOI 10.1002/lary.29343

    View details for PubMedID 33405268

  • Modeling human adaptive immune responses with tonsil organoids. Nature medicine Wagar, L. E., Salahudeen, A. n., Constantz, C. M., Wendel, B. S., Lyons, M. M., Mallajosyula, V. n., Jatt, L. P., Adamska, J. Z., Blum, L. K., Gupta, N. n., Jackson, K. J., Yang, F. n., Röltgen, K. n., Roskin, K. M., Blaine, K. M., Meister, K. D., Ahmad, I. N., Cortese, M. n., Dora, E. G., Tucker, S. N., Sperling, A. I., Jain, A. n., Davies, D. H., Felgner, P. L., Hammer, G. B., Kim, P. S., Robinson, W. H., Boyd, S. D., Kuo, C. J., Davis, M. M. 2021

    Abstract

    Most of what we know about adaptive immunity has come from inbred mouse studies, using methods that are often difficult or impossible to confirm in humans. In addition, vaccine responses in mice are often poorly predictive of responses to those same vaccines in humans. Here we use human tonsils, readily available lymphoid organs, to develop a functional organotypic system that recapitulates key germinal center features in vitro, including the production of antigen-specific antibodies, somatic hypermutation and affinity maturation, plasmablast differentiation and class-switch recombination. We use this system to define the essential cellular components necessary to produce an influenza vaccine response. We also show that it can be used to evaluate humoral immune responses to two priming antigens, rabies vaccine and an adenovirus-based severe acute respiratory syndrome coronavirus 2 vaccine, and to assess the effects of different adjuvants. This system should prove useful for studying critical mechanisms underlying adaptive immunity in much greater depth than previously possible and to rapidly test vaccine candidates and adjuvants in an entirely human system.

    View details for DOI 10.1038/s41591-020-01145-0

    View details for PubMedID 33432170

  • Pediatric Subspecialty Adoption of Telemedicine Amidst the COVID-19 Pandemic: An Early Descriptive Analysis. Frontiers in pediatrics Xie, J., Prahalad, P., Lee, T. C., Stevens, L. A., Meister, K. D. 2021; 9: 648631

    Abstract

    Telemedicine has rapidly expanded in many aspects of pediatric care as a result of the COVID-19 pandemic. However, little is known about what factors may make pediatric subspeciality care more apt to long-term adoption of telemedicine. To better delineate the potential patient, provider, and subspecialty factors which may influence subspecialty adoption of telemedicine, we reviewed our institutional experience. The top 36 pediatric subspecialties at Stanford Children's Health were classified into high telemedicine adopters, low telemedicine adopters, and telemedicine reverters. Distance from the patient's home, primary language, insurance type, institutional factors such as wait times, and subspecialty-specific clinical differences correlated with differing patterns of telemedicine adoption. With greater awareness of these factors, institutions and providers can better guide patients in determining which care may be best suited for telemedicine and develop sustainable long-term telemedicine programming.

    View details for DOI 10.3389/fped.2021.648631

    View details for PubMedID 33928058

  • Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Meister, K. D., Pandian, V., Hillel, A. T., Walsh, B. K., Brodsky, M. B., Balakrishnan, K., Best, S. R., Chinn, S. B., Cramer, J. D., Graboyes, E. M., McGrath, B. A., Rassekh, C. H., Bedwell, J. R., Brenner, M. J. 2020: 194599820961990

    Abstract

    OBJECTIVE: In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy.DATA SOURCES: PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents.REVIEW METHODS: Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations.CONCLUSIONS: Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel.IMPLICATIONS FOR PRACTICE: Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.

    View details for DOI 10.1177/0194599820961990

    View details for PubMedID 32960148

  • Management of Swallowing and Feeding Disorders in Schools (Book Review) INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Book Review Authored by: Meister, K. D. 2020; 135
  • Using Augmented Reality to Reduce Fear and Promote Cooperation During Pediatric Otolaryngologic Procedures. The Laryngoscope Caruso, T. J., Madill, M. n., Sidell, D. n., Meister, K. n., Wang, E. n., Menendez, M. n., Kist, M. N., Rodriguez, S. n. 2020

    Abstract

    This case series examines interactive AR during minor otolaryngologic procedures. Although VR has been successfully used for pediatric vascular access, removing children from comforting people in the real world has resulted in patient anxiety. AR offers a potential advantage, utilizing distracting holographic images when patients maintain eye contact with parents. The primary objective was to determine the effect of AR on fear during pediatric otolaryngologic procedures. Secondary objectives included evaluating pain; procedure compliance; and patient, parent and physician attitudes toward AR, as well as assessing the feasibility of adding AR to a busy outpatient otolaryngologic clinic. Laryngoscope, 2020.

    View details for DOI 10.1002/lary.29098

    View details for PubMedID 32886794

  • Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study. The Laryngoscope Sioshansi, P. C., Byrne, E. n., Freccero, A. n., Meister, K. D., Sidell, D. R. 2020

    Abstract

    To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study.Multi-institutional survey and prospective cohort study.Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted.Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events.Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team.4 Laryngoscope, 2020.

    View details for DOI 10.1002/lary.28748

    View details for PubMedID 32438519

  • Static endoscopic swallow evaluation in children. The Laryngoscope Meister, K. D., Okland, T., Johnson, A., Galera, R., Ayoub, N., Sidell, D. R. 2019

    Abstract

    OBJECTIVES: Static Endoscopic Evaluation of Swallowing (SEES) has been demonstrated to have a strong correlation with the Videofluoroscopic Swallow Study (VFSS) in adults. In children, Fiberoptic Endoscopic Evaluations of Swallow (FEES) are frequently performed to avoid repeated VFSS; however, a subset of the population does not tolerate FEES. The purpose of this study was to evaluate the utility of a modified SEES in children.METHODS: Charts of 50 consecutive patients who underwent FEES evaluations were reviewed. Patients age 3 months to 12years undergoing SEES, FEES, and VFSS were extracted. We compared a binary assessment of outcome on SEES versus VFSS as the diagnostic standard to report characteristics, including sensitivity, specificity, and positive and negative predicted value.RESULTS: A total of 36 patients met all inclusion criteria (mean age 2.8years). Using the VFSS as the diagnostic standard, residue seen on SEES had a sensitivity of 80.0%, specificity of 85.7%, a positive predictive value of 88.9%, and a negative predictive value of 75.0% for predicting deep penetration or aspiration.CONCLUSION: SEES may be helpful for developing an initial diagnostic impression and may serve as a platform for patient and caregiver counseling. In children who are unable to cooperate with FEES, SEES may provide clinical insight in predicting an abnormal swallow study; however, a normal SEES was less reliable in predicting a safe swallow on subsequent VFSS in this patient population.LEVEL OF EVIDENCE: 4 Laryngoscope, 2019.

    View details for DOI 10.1002/lary.28263

    View details for PubMedID 31448817

  • Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes OTOLARYNGOLOGY-HEAD AND NECK SURGERY Meister, K. D., Johnson, A., Sidell, D. R. 2019; 160 (3): 540–45
  • Current Experience of Ultrasound Training in Otolaryngology Residency Programs JOURNAL OF ULTRASOUND IN MEDICINE Meister, K. D., Vila, P. M., Bonilla-Velez, J., Sebelik, M., Orloff, L. A. 2019; 38 (2): 393–97

    View details for DOI 10.1002/jum.14700

    View details for Web of Science ID 000456851600014

  • The Runaway Croup Train: Off the Pathway and Through the Woods. Hospital pediatrics Weatherly, J. n., Song, Y. n., Meister, K. n., Berg, M. n. 2019

    View details for DOI 10.1542/hpeds.2019-0030

    View details for PubMedID 31492686

  • Application-Based Translaryngeal Ultrasound for the Assessment of Vocal Fold Mobility in Children. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Sayyid, Z. n., Vendra, V. n., Meister, K. D., Krawczeski, C. D., Speiser, N. J., Sidell, D. R. 2019: 194599819877650

    Abstract

    To compare the evaluation of vocal fold mobility between flexible nasal laryngoscopy (FNL) and a handheld application-based translaryngeal ultrasound (TLUS) platform.Prospective analysis included patients with unknown vocal fold mobility status who underwent FNL and TLUS.Tertiary referral center.TLUS was performed on 23 consecutive children (<18 years old) presenting for laryngoscopy due to unknown vocal fold mobility status. After the recording of three 10-second TLUS videos as well as FNL, the study was divided into 2 parts: parental assessment of laryngeal ultrasound at the time of patient evaluation and random practitioner assessment of ultrasound videos.We describe 23 patients who underwent TLUS and FNL. Ten patients (43.5%) had normal vocal fold function bilaterally, and 13 (56.5%) had either left or right vocal fold immobility. Family members and physicians correctly identified the presence and laterality of impaired vocal fold mobility in 22 of 23 cases (κ = 0.96). The sensitivity, specificity, positive predictive value, and negative predictive value of FLUS in diagnosing vocal fold immobility were 92.3%, 100%, 100%, and 90.9%, respectively. Random practitioners accurately identified the presence and laterality of vocal fold immobility under all circumstances.A handheld application-based ultrasound platform is both sensitive and specific in its ability to identify vocal fold motion impairment. Portable handheld TLUS has the potential to serve as a validated screening examination, even by inexperienced providers, and in specific cases may obviate the need for an invasive transnasal laryngoscopy.

    View details for DOI 10.1177/0194599819877650

    View details for PubMedID 31547773

  • Pediatric Thyroid Cancer Incidence and Mortality Trends in the United States, 1973-2013. JAMA otolaryngology-- head & neck surgery Qian, Z. J., Jin, M. C., Meister, K. D., Megwalu, U. C. 2019

    Abstract

    The incidence of thyroid cancer is increasing by 3% annually. This increase is often thought to be attributable to overdiagnosis in adults. A previous study reported a 1.1% annual increase in the incidence of pediatric thyroid cancer. However, the analysis was limited to the period from 1973 to 2004 and was performed in a linear fashion, which does not account for changes in incidence trends over time.To analyze trends in pediatric thyroid cancer incidence based on demographic and tumor characteristics at diagnosis.This cross-sectional study included individuals younger than 20 years who had a diagnosis of thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1973 to 2013. Cases of thyroid cancer were identified using the International Classification of Diseases for Oncology, Third Edition and were categorized by histologic type, stage, and tumor size.Annual percent change (APC) in the incidence rates was calculated using joinpoint regression analysis.Among 1806 patients included in the analysis, 1454 (80.5%) were female and 1503 (83.2%) were white; most patients were aged 15 to 19 years. The overall incidence rates of thyroid cancer increased annually from 0.48 per 100 000 person-years in 1973 to 1.14 per 100 000 person-years in 2013. Incidence rates gradually increased from 1973 to 2006 (APC, 1.11%; 95% CI, 0.56%-1.67%) and then markedly increased from 2006 to 2013 (APC, 9.56%; 95% CI, 5.09%-14.22%). The incidence rates of large tumors (>20 mm) gradually increased from 1983 to 2006 (APC, 2.23%; 95% CI, 0.93%-3.54%) and then markedly increased from 2006 to 2013 (APC, 8.84%; 95% CI, 3.20%-14.79%); these rates were not significantly different from incidence rates of small (1-20 mm) tumors. The incidence rates of regionally extended thyroid cancer gradually increased from 1973 to 2006 (APC, 1.44%; 95% CI, 0.68%-2.21%) and then markedly increased from 2006 to 2013 (APC, 11.16%; 95% CI, 5.26%-17.40%); these rates were not significantly different from the incidence rates of localized disease.The incidence rates of pediatric thyroid cancer increased more rapidly from 2006 to 2013 than from 1973 to 2006. The findings suggest that there may be a co-occurring increase in thyroid cancer in the pediatric population in addition to enhanced detection.

    View details for DOI 10.1001/jamaoto.2019.0898

    View details for PubMedID 31120475

  • Injection Laryngoplasty for Children with Unilateral Vocal Fold Paralysis: Procedural Limitations and Swallow Outcomes. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Meister, K. D., Johnson, A., Sidell, D. R. 2018: 194599818813002

    Abstract

    OBJECTIVE: Vocal fold immobility with resultant dysphagia is a known cause of morbidity in the pediatric population. Herein we evaluate the efficacy and adverse events of injection laryngoplasty in children.STUDY DESIGN: Case series with chart review.SETTING: Tertiary academic children's hospital.SUBJECTS AND METHODS: Patients <12 years of age with unilateral vocal fold immobility, dysphagia, and objective swallow study data were included. Primary outcome measures included perioperative adverse events and the ability to advance the diet, as defined by initiation of oral feeds or reduction in thickener following postoperative swallow study.RESULTS: The mean age of the cohort (N = 41) was 43.83 months (range, 0.5-144 months), and 46.3% of patients were <18 months old. Perioperative adverse events included increased oxygen requirement (n = 3), prolonged operating room time secondary to tenuous cardiopulmonary status (n = 2), and postoperative readmission within 30 days (n = 1). A total of 63.63% (n = 21 of 33) of patients safely advanced their diet following objective improvement on swallow study. Patients undergoing injection laryngoplasty ≤6 months of the onset of vocal fold immobility were more likely to advance their diet following surgery.CONCLUSION: Injection laryngoplasty has the potential to advance or initiate an oral diet for children with vocal fold immobility, including those in the first months of life. It is relatively free of adverse events, but certain limitations in the pediatric population must be considered. Preoperative characteristics, including timing of injection and premorbidity diet, may guide clinicians in predicting those patients most likely to advance their diet following injection laryngoplasty.

    View details for PubMedID 30453837

  • Current Experience of Ultrasound Training in Otolaryngology Residency Programs. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Meister, K. D., Vila, P. M., Bonilla-Velez, J., Sebelik, M., Orloff, L. A. 2018

    Abstract

    OBJECTIVES: The applications of using ultrasound for the evaluation and management of otolaryngologic diagnoses are expanding. The purpose of this study was to evaluate the current experience of ultrasound training in otolaryngology residency programs.METHODS: All allopathic and osteopathic otolaryngology residency programs in the United States were surveyed online via an e-mailed survey link to the resident representatives of the Section for Residents and Fellows in Training of the American Academy of Otolaryngology-Head and Neck Surgery. We present a descriptive analysis of the survey results.RESULTS: A total of 110 responses were obtained from resident representatives at MD and DO otolaryngology residency programs, representing a response rate of 94.8%. Forty-four percent of residents reported that they would not feel comfortable with performing ultrasound-guided procedures after residency; 43% reported that they do not perform ultrasound procedures as a part of their residency training; and 60% of those trainees performing ultrasound procedures do not log the procedures. Twenty-three percent of residents did not have access to an ultrasound machine. Most respondents (71%) desired more exposure to diagnostic and/or interventional ultrasound training during residency.CONCLUSIONS: Although current experience is variable, there is a strong interest in increasing resident skill acquisition in ultrasound training among otolaryngology residents. Some barriers to these goals may be a lack of trained faculty members using ultrasound and insufficient recording mechanisms for residents performing ultrasound procedures.

    View details for PubMedID 30099758

  • What parents are reading about laryngomalacia: quality and readability of internet resources on laryngomalacia. Int J Pediatr Otorhinolaryngol Carredera , E., Meister, K. D., Simons, J. P., Jabbour, N. 2018
  • TMEM16A/ANO1 suppression improves response to antibody-mediated targeted therapy of EGFR and HER2/ERBB2. Genes, chromosomes & cancer Kulkarni, S., Bill, A., Godse, N. R., Khan, N. I., Kass, J. I., Steehler, K., Kemp, C., Davis, K., Bertrand, C. A., Vyas, A. R., Holt, D. E., Grandis, J. R., Gaither, L. A., Duvvuri, U. 2017; 56 (6): 460-471

    Abstract

    TMEM16A, a Ca2+ -activated Cl- channel, contributes to tumor growth in breast cancer and head and neck squamous cell carcinoma (HNSCC). Here, we investigated whether TMEM16A influences the response to EGFR/HER family-targeting biological therapies. Inhibition of TMEM16A Cl- channel activity in breast cancer cells with HER2 amplification induced a loss of viability. Cells resistant to trastuzumab, a monoclonal antibody targeting HER2, showed an increase in TMEM16A expression and heightened sensitivity to Cl- channel inhibition. Treatment of HNSCC cells with cetuximab, a monoclonal antibody targeting EGFR, and simultaneous TMEM16A suppression led to a pronounced loss of viability. Biochemical analyses of cells subjected to TMEM16A inhibitors or expressing chloride-deficient forms of TMEM16A provide further evidence that TMEM16A channel function may play a role in regulating EGFR/HER2 signaling. These data demonstrate that TMEM16A regulates EGFR and HER2 in growth and survival pathways. Furthermore, in the absence of TMEM16A cotargeting, tumor cells may acquire resistance to EGFR/HER inhibitors. Finally, targeting TMEM16A improves response to biological therapies targeting EGFR/HER family members.

    View details for DOI 10.1002/gcc.22450

    View details for PubMedID 28177558

    View details for PubMedCentralID PMC5469289

  • Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Ishii, L. E., Tollefson, T. T., Basura, G. J., Rosenfeld, R. M., Abramson, P. J., Chaiet, S. R., Davis, K. S., Doghramji, K., Farrior, E. H., Finestone, S. A., Ishman, S. L., Murphy, R. X., Park, J. G., Setzen, M., Strike, D. J., Walsh, S. A., Warner, J. P., Nnacheta, L. C. 2017; 156 (2): 205-219

    Abstract

    Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline executive summary is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patient satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The guideline development group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.

    View details for DOI 10.1177/0194599816683156

    View details for PubMedID 28145848

  • What might parents read: Sorting webs of online information on vascular anomalies. International journal of pediatric otorhinolaryngology Davis, K. S., McCormick, A. A., Jabbour, N. 2017; 93: 63-67

    Abstract

    The internet is increasingly a source of healthcare information utilized by parents, especially in rarer pathologies such as vascular malformations. The quality, validity and thoroughness of these websites is variable and unregulated. The goal of this study was to evaluate the quality and understandability of websites related to vascular malformations.The terms "hemangioma", "vascular malformation", and "vascular anomalies" were searched in Google. The first 30 websites meeting inclusion and exclusion criteria were evaluated. Quality and readability were assessed using the DISCERN criteria and the Flesh-Kincaid Reading Grade Level (FKGL), respectively. Date of last update, HONcode accreditation, and the website category were recorded.Most websites were owned by academic institutions (n = 19, 63.3%). The mean DISCERN score for all websites was 2.97, or a partially valid source of information on a 1-5 scale. The average reading level estimated by FKGL was grade 12; only one website was scored at less than a grade 9 level. Two websites were HONcode accredited. Of the 18 sites giving an explicit date of last update, 12 (67.7%) had been updated in the previous 12 months.Websites relating information about vascular anomalies may not be understandable to the general public, including parents. Health care providers should be cognizant of the quality and availability of such information as it may impact parent perspectives and bias toward treatment options.

    View details for DOI 10.1016/j.ijporl.2016.12.004

    View details for PubMedID 28109499

  • Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Ishii, L. E., Tollefson, T. T., Basura, G. J., Rosenfeld, R. M., Abramson, P. J., Chaiet, S. R., Davis, K. S., Doghramji, K., Farrior, E. H., Finestone, S. A., Ishman, S. L., Murphy, R. X., Park, J. G., Setzen, M., Strike, D. J., Walsh, S. A., Warner, J. P., Nnacheta, L. C. 2017; 156 (2_suppl): S1-S30

    Abstract

    Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.

    View details for DOI 10.1177/0194599816683153

    View details for PubMedID 28145823

  • TMEM16A/ANO1 suppression improves response to antibody-mediated targeted therapy of EGFR and HER2/ERBB2. Genes, chromosomes & cancer Kulkarni, S., Bill, A., Godse, N. R., Khan, N. I., Kass, J. I., Steehler, K., Kemp, C., Davis, K., Vertrand, C. A., Vyas, A. R., Holt, D. E., Grandis, J. R., Gaither, L. A., Duvvuri, U. 2017
  • Association of pretreatment body mass index and survival in human papillomavirus positive oropharyngeal squamous cell carcinoma. Oral oncology Albergotti, W. G., Davis, K. S., Abberbock, S., Bauman, J. E., Ohr, J., Clump, D. A., Heron, D. E., Duvvuri, U., Kim, S., Johnson, J. T., Ferris, R. L. 2016; 60: 55-60

    Abstract

    Pretreatment body mass index (BMI) >25kg/m(2) is a positive prognostic factor in patients with head and neck cancer. Previous studies have not been adequately stratified by human papilloma virus (HPV) status or subsite. Our objective is to determine prognostic significance of pretreatment BMI on overall survival in HPV+ oropharyngeal squamous cell carcinoma (OPSCC).This is a retrospective review of patients with HPV+ OPSCC treated between 8/1/2006 and 8/31/2014. Patients were stratified by BMI status (>/<25kg/m(2)). Univariate and multivariate analyses of survival were performed.300 patients met our inclusion/exclusion criteria. Patients with a BMI >25kg/m(2) had a longer overall survival (HR=0.49, P=0.01) as well as a longer disease-specific survival (HR=0.43, P=0.02). Overall survival remained significantly associated with high BMI on multivariate analysis (HR=0.54, P=0.04).Pre-treatment normal or underweight BMI status is associated with worse overall survival in HPV+ OPSCC.

    View details for DOI 10.1016/j.oraloncology.2016.07.003

    View details for PubMedID 27531873

    View details for PubMedCentralID PMC4991628

  • Intraoperative Image Guidance Improves Outcomes in Complex Orbital Reconstruction by Novice Surgeons. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Davis, K. S., Vosler, P. S., Yu, J., Wang, E. W. 2016; 74 (7): 1410-5

    Abstract

    This study aims to describe the utility of surgical navigation in improving operative outcomes in complex orbital reconstruction by novice compared with experienced surgical trainees.A randomized, controlled cadaveric study was conducted at the University of Pittsburgh School of Medicine with otolaryngology and ophthalmology residents and fellows. Participants were divided into novice (postgraduate year 2-4 residents) and experienced (postgraduate year 5 residents and fellows) groups. Ten cadaveric specimens with pre-dissection computed tomography images underwent endoscopic resection of the orbital floor and lamina papyracea bilaterally. Participants performed reconstruction with or without the use of surgical navigation, randomized by laterality and order of the use of navigation. Post-dissection imaging was obtained after reconstruction and compared with pre-dissection imaging. The primary outcome was orbital volume; secondary outcomes included the participant's operative time and National Aeronautics and Space Administration Task Load Index score, a subjective workload assessment measure. Matched-pair t tests and 2-way analysis of variance were used for statistical analysis.Novice participants (n = 6) had improved outcomes with respect to orbital volume when using surgical navigation compared with experienced participants (n = 4). There were no differences in operative times or National Aeronautics and Space Administration Task Load Index scores when using surgical navigation.In a cadaveric setting, use of surgical navigation by novice surgeons improves post-dissection orbital volume in complex orbital reconstruction. Surgical navigation should be considered as an adjunct to surgical training and simulation curricula.

    View details for DOI 10.1016/j.joms.2016.02.023

    View details for PubMedID 27019413

  • The Pursuit of Otolaryngology Subspecialty Fellowships. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Wilson, M. N., Vila, P. M., Cohen, D. S., Carter, J. M., Lawlor, C. M., Davis, K. S., Raol, N. P. 2016; 154 (6): 1027-33

    Abstract

    To examine otolaryngology resident interest in subspecialty fellowship training and factors affecting interest over time and over the course of residency trainingCross-sectional study of anonymous online survey data.Residents and fellows registered as members-in-training through the American Academy of Otolaryngology-Head and Neck Surgery.Data regarding fellowship interest and influencing factors, including demographics, were extracted from the Section for Residents and Fellows Annual Survey response database from 2008 to 2014.Over 6 years, there were 2422 resident and fellow responses to the survey. Senior residents showed a statistically significant decrease in fellowship interest compared with junior residents, with 79% of those in postgraduate year (PGY) 1, 73% in PGY-2 and PGY-3, and 64% in PGY-4 and PGY-5 planning to pursue subspecialty training (P < .0001). Educational debt, age, and intended practice setting significantly predicted interest in fellowship training. Sex was not predictive. The most important factors cited by residents in choosing a subspecialty were consistently type of surgical cases and nature of clinical problems.In this study, interest in pursuing fellowship training decreased with increased residency training. This decision is multifactorial in nature and also influenced by age, educational debt, and intended practice setting.

    View details for DOI 10.1177/0194599816639038

    View details for PubMedID 27026739

  • Tumor volume as a predictor of survival in human papillomavirus-positive oropharyngeal cancer. Head & neck Davis, K. S., Lim, C. M., Clump, D. A., Heron, D. E., Ohr, J. P., Kim, S., Duvvuri, U., Johnson, J. T., Ferris, R. L. 2016; 38 Suppl 1: E1613-7

    Abstract

    Increasing evidence exists that tumor volume may be a superior prognostic model than traditional TNM staging. It has been observed that oropharyngeal squamous cell carcinoma (oropharyngeal SCC) in the setting of human papillomavirus (HPV) positivity have a greater propensity for cystic nodal metastases, and, thus, presumably larger volume with relatively smaller primary tumors. The influence of HPV status on the predictive value of tumor volume is unknown.Fifty-three patients with HPV-positive oropharyngeal SCC were treated with definitive chemotherapy and intensity-modulated radiotherapy (IMRT).The estimated 2-year overall survival (OS) and disease-free survival (DFS) was 92.2% and 83.6%, respectively. Nodal classification did not predict OS (p = .096) or DFS (p = .170). Similarly, T classification did not predict OS (p = .057) or DFS (p = .309). Lower nodal volume was associated with greater DFS (p = .001).Nodal tumor volume was found to be predictive of DFS. DFS was best predicted by nodal gross tumor volume (GTV) at 24 months. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1613-E1617, 2016.

    View details for DOI 10.1002/hed.24287

    View details for PubMedID 26681273

    View details for PubMedCentralID PMC4844840

  • A prospective phase 2 trial of reirradiation with stereotactic body radiation therapy plus cetuximab in patients with previously irradiated recurrent squamous cell carcinoma of the head and neck. International journal of radiation oncology, biology, physics Vargo, J. A., Ferris, R. L., Ohr, J., Clump, D. A., Davis, K. S., Duvvuri, U., Kim, S., Johnson, J. T., Bauman, J. E., Gibson, M. K., Branstetter, B. F., Heron, D. E. 2015; 91 (3): 480-8

    Abstract

    Salvage options for unresectable locally recurrent, previously irradiated squamous cell carcinoma of the head and neck (rSCCHN) are limited. Although the addition of reirradiation may improve outcomes compared to chemotherapy alone, significant toxicities limit salvage reirradiation strategies, leading to suboptimal outcomes. We therefore designed a phase 2 protocol to evaluate the efficacy of stereotactic body radiation therapy (SBRT) plus cetuximab for rSCCHN.From July 2007 to March 2013, 50 patients >18 years of age with inoperable locoregionally confined rSCCHN within a previously irradiated field receiving ≥60 Gy, with a Zubrod performance status of 0 to 2, and normal hepatic and renal function were enrolled. Patients received concurrent cetuximab (400 mg/m(2) on day -7 and then 250 mg/m(2) on days 0 and +8) plus SBRT (40-44 Gy in 5 fractions on alternating days over 1-2 weeks). Primary endpoints were 1-year locoregional progression-free survival and National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 graded toxicity.Median follow-up for surviving patients was 18 months (range: 10-70). The 1-year local PFS rate was 60% (95% confidence interval [CI]: 44%-75%), locoregional PFS was 37% (95% CI: 23%-53%), distant PFS was 71% (95% CI: 54%-85%), and PFS was 33% (95% CI: 20%-49%). The median overall survival was 10 months (95% CI: 7-16), with a 1-year overall survival of 40% (95% CI: 26%-54%). At last follow-up, 69% died of disease, 4% died with disease, 15% died without progression, 10% were alive without progression, and 2% were alive with progression. Acute and late grade 3 toxicity was observed in 6% of patients respectively.SBRT with concurrent cetuximab appears to be a safe salvage treatment for rSCCHN of short overall treatment time.

    View details for DOI 10.1016/j.ijrobp.2014.11.023

    View details for PubMedID 25680594

  • Stereotactic body radiotherapy for recurrent oropharyngeal cancer - influence of HPV status and smoking history. Oral oncology Davis, K. S., Vargo, J. A., Ferris, R. L., Burton, S. A., Ohr, J. P., Clump, D. A., Heron, D. E. 2014; 50 (11): 1104-8

    Abstract

    HPV status and smoking history stratifies patients into 3 distinct risk groups for survival following definitive chemoradiotherapy. Local-regional recurrences are common patterns of failure across all 3 risk-groups. SBRT±cetuximab has emerged as a promising salvage strategy for unresectable locally-recurrent, previously-irradiated head-and-neck cancer (rHNC) relative to conventional re-irradiation±chemotherapy. However the influence of HPV and smoking remains unknown in the setting of re-irradiation.Patients (n=30) with rHNC of the oropharynx salvaged with SBRT±cetuximab from August 2002 through August 2013 were retrospectively reviewed; HPV status was determined based on p16 staining of primary pathology.At a median follow-up of 10months for surviving patients, the mean overall survival for all patients was 12.6 months. HPV positivity was a significant predictor of overall survival (13.6 vs. 6.88 months, p=0.024), while smoking status did not significantly impact overall survival (p=0.707).HPV status remains a significant predictor of overall survival in the re-irradiation setting with HPV positive rHNC demonstrating superior overall survival following salvage SBRT±cetuximab.

    View details for DOI 10.1016/j.oraloncology.2014.08.004

    View details for PubMedID 25175942

    View details for PubMedCentralID PMC4505797

  • Multi-institutional investigation of the prognostic value of lymph nodel yield in advanced-stage oral cavity squamous cell carcinoma. Head & neck Jaber, J. J., Zender, C. A., Mehta, V., Davis, K., Ferris, R. L., Lavertu, P., Rezaee, R., Feustel, P. J., Johnson, J. T. 2014; 36 (10): 1446-52

    Abstract

    Although existing literature provides surgical recommendations for treating occult disease (cN0) in early-stage oral cavity squamous cell carcinoma (SCC), a focus on late-stage oral cavity SCC is less pervasive.The medical records of 162 patients with late-stage oral cavity SCC pN0 who underwent primary neck dissections were reviewed. Lymph node yield as a prognosticator was examined.Despite being staged pN0, patients that had a higher lymph node yield had an improved regional/distant control rates, disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). Lymph node yield consistently outperformed all other standard variables as being the single best prognostic factor with a tight risk ratio range (RR = 0.95-0.98) even when correcting for the number of lymph nodes examined.The results of this study showed that lower regional recurrence rates and improved survival outcomes were seen as lymph node yield increased for advanced T classification oral cavity SCC pN0. This suggests that increasing lymph node yield with an extended cervical lymphadenectomy may result in lower recurrence rates and improved survival outcomes for this advanced stage group.

    View details for DOI 10.1002/hed.23475

    View details for PubMedID 24038739

    View details for PubMedCentralID PMC4136977

  • Occult Primary Head and Neck Squamous Cell Carcinoma: Utility of Discovering Primary Lesions. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Davis, K. S., Byrd, J. K., Mehta, V., Chiosea, S. I., Kim, S., Ferris, R. L., Johnson, J. T., Duvvuri, U. 2014; 151 (2): 272-8

    Abstract

    Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status.Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion.Tertiary teaching hospital.Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan-Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age.Discovered lesions were more likely to exhibit HPV positivity (P < .001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03).HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.

    View details for DOI 10.1177/0194599814533494

    View details for PubMedID 24812081

    View details for PubMedCentralID PMC4604041

  • Transoral Robotic Surgery and the Unknown Primary: A Cost-Effectiveness Analysis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Byrd, J. K., Smith, K. J., de Almeida, J. R., Albergotti, W. G., Davis, K. S., Kim, S. W., Johnson, J. T., Ferris, R. L., Duvvuri, U. 2014; 150 (6): 976-82

    Abstract

    To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP).Case series with chart review.Tertiary academic hospital.A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in 3 strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio.In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively.Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of $8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.

    View details for DOI 10.1177/0194599814525746

    View details for PubMedID 24618502

    View details for PubMedCentralID PMC4167971

  • External validity reporting in behavioral treatment of childhood obesity: a systematic review. American journal of preventive medicine Klesges, L. M., Williams, N. A., Davis, K. S., Buscemi, J., Kitzmann, K. M. 2012; 42 (2): 185-92

    Abstract

    To aid translation of childhood obesity interventions evidence into practice, research studies must report results in a way that better supports pragmatic decision making. The current review evaluated the extent to which information on key external validity dimensions, participants, settings, interventions, outcomes, and maintenance of effects, was included in research studies on behavioral treatments for childhood obesity.Peer-reviewed studies of behavioral childhood obesity treatments published between 1980 and 2008 were identified from (1) electronic searches of social science and medical databases; (2) research reviews of childhood obesity interventions; and (3) reference lists cited in these reviews. Included studies reported on a controlled obesity intervention trial, targeted overweight or obese children aged 2-18 years, included a primary or secondary anthropometric outcome, and targeted change in dietary intake or physical activity behaviors.1071 publications were identified and 77 met selection criteria. Studies were coded on established review criteria for external validity elements. All studies lacked full reporting of generalizability elements. Across criteria, the average reporting was 23.9% (range=0%-100%). Infrequently reported were setting-level selection criteria and representativeness, characteristics regarding intervention staff, implementation of the intervention content, costs, and program sustainability.Enhanced reporting of relevant and pragmatic information in behavioral investigations of childhood obesity interventions is needed to improve the ability to evaluate the applicability of results to practice implementation. Such evidence would improve translation of research to practice, provide additional explanation for variability in intervention outcomes, and provide insights into successful adaptations of interventions to local conditions.

    View details for DOI 10.1016/j.amepre.2011.10.014

    View details for PubMedID 22261216

    View details for PubMedCentralID PMC4573550

  • Pathology quiz case 3. Heterotopic gastric mucosa (inlet patch). Archives of otolaryngology--head & neck surgery Davis, K. S., Welsh, C. T., Hawes, R. H., Gillespie, M. B. 2011; 137 (8): 831; author reply 834-5

    View details for DOI 10.1001/archoto.2011.128-a

    View details for PubMedID 21844423