Patrick Timothy Kiessling

All Publications

• Analysis of Pediatric Acute Upper Airway Pathology During Local Wildfires and Increased PM 2.5 Burden. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Kiessling, P., Meister, K., Sidell, D., O'Bryan, M., Erickson-DiRenzo, E., Balakrishnan, K. 2025

  Abstract

  OBJECTIVE: As wildfires worldwide increase in severity and frequency, fine particulate matter (PM 2.5), generated as a component of wildfire smoke, increasingly impacts air quality. Children are particularly vulnerable to poor air quality in numerous ways, including inhalation of more air in proportion to their body size than adults. Though its adverse impacts on the lower airway are well demonstrated, the clinical effects of PM 2.5 on the pediatric upper airway are poorly understood and warrant investigation.STUDY DESIGN: Retrospective cohort study.SETTING: Tertiary academic medical center.METHODS: From 2014 to 2023, patient presentations to a pediatric emergency department in Northern California during exposure periods of elevated PM 2.5 burden associated with nearby wildfires were identified. Patient diagnoses, presenting symptoms, and management were analyzed. Comparison group patients were evaluated during date-matched control periods with confirmed normal air quality. Chi-squared analyses determined significance.RESULTS: During periods of increased wildfire-generated PM 2.5 burden, a significantly greater proportion of pediatric patients presented to the emergency department with upper airway pathology compared to matched control periods of healthy air quality. Further, a significantly greater proportion of patients were diagnosed with croup during wildfires. Of patients presenting with upper airway pathology, a significantly greater proportion experienced dysphonia during wildfires and had a negative strep test.CONCLUSION: Wildfire-generated PM 2.5 may contribute to increased rates of croup presentations, and PM 2.5 may disproportionately affect the larynx in the pediatric upper airway. Larger population-based studies and preclinical models may clarify these clinical manifestations of a growing public health threat.

  View details for DOI 10.1002/ohn.1191

  View details for PubMedID 40062612

• Pediatric tracheal mucoepidermoid carcinoma treated with cricotracheal resection: A rare case and review of literature OTOLARYNGOLOGY CASE REPORTS Kiessling, P., Kim, G., Meister, K., Balakrishnan, K., Din, T. 2025; 34

  View details for DOI 10.1016/j.xocr.2025.100654

  View details for Web of Science ID 001412223100001

• Persistent headache in granulomatosis with polyangiitis. European annals of otorhinolaryngology, head and neck diseases Fieux, M., Kiessling, P., Chang, M. T. 2024; 141 (6): 351-352

  View details for DOI 10.1016/j.anorl.2024.06.006

  View details for PubMedID 38945778

• Response to "The Role of the Otolaryngologist in Sexual Health". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Kiessling, P., Nuyen, B. 2023

  View details for DOI 10.1002/ohn.622

  View details for PubMedID 38123760

• Rhinolithiasis misdiagnosed as intranasal osteoma: Diagnostic challenges in the telehealth era. SAGE open medical case reports Kiessling, P., Hwang, P., Chang, M. 2023; 11: 2050313X231207204

  Abstract

  Rhinolithiasis is a rare clinical presentation and may be a diagnostic challenge, often mimicking other intranasal pathologies and difficult to differentiate based on imaging alone. We present the case of a 50-year-old patient with rhinolithiasis who presented with chronic left nasal obstruction and unilateral cyclic pain with foul discharge. After review of her imaging, she was initially misdiagnosed with an intranasal osteoma via telehealth and scheduled for surgical resection. Her true pathology of rhinolithiasis was subsequently identified and treated during an in-person pre-operative clinic visit. In this case report, we review the key characteristic elements of rhinolithiasis presentation, and in doing so, we reveal the limitations inherent to telehealth evaluations, and the considerations needed to be taken into account by providers evaluating intranasal lesions. Specifically, in-person assessment with a detailed endoscopy is critical as part of the complete workup of nasal cavity lesions.

  View details for DOI 10.1177/2050313X231207204

  View details for PubMedID 37860281

• Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey. The Laryngoscope Kiessling, P., Balakrishnan, K., Fauer, A., Sanan, A., McDonald, D., Thomas, J., Erickson-Direnzo, E., Sung, C. K., Nuyen, B. 2022

  Abstract

  To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood.Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits.The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative.This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions.N/A Laryngoscope, 2022.

  View details for DOI 10.1002/lary.30498

  View details for PubMedID 36453533

• Predicting Gag, Discomfort, and Laryngeal Visualization in Patients Undergoing Flexible Laryngoscopy with Stroboscopy. The Annals of otology, rhinology, and laryngology Kiessling, P., Bayan, S., Lohse, C., Orbelo, D. 2022; 131 (2): 164-172

  Abstract

  To investigate potential associations between the Predictive Gagging Survey (PGS) with patient experience of gag and discomfort as well as provider perception of patient gag and level of laryngeal visualization during flexible laryngoscopy with stroboscopy (FL-S).A total of 53 adult patients undergoing FL-S were recruited for this prospective non-controlled study. PGS was completed before FL-S. Patients rated perceived level of gag and discomfort on a 10-point severity scale after FL-S. Additionally, providers completed a Gagging Severity Index (GSI) reflecting their impression of patient gag and level of laryngeal visualization following FL-S. Spearman rank correlation coefficients were used to assess associations.There was a positive association with PGS score and patient perception of gagging (0.34; P = .013) and patient perception of discomfort (0.38; P = .005). No significant association was found between PGS score and provider GSI (-0.12; P = .39) or level of laryngeal visualization (0.15; P = .29). A negative association was found between level of laryngeal visualization and patient perception of gagging (-0.34; P = .012) and discomfort (-0.44; P = .001). No significant differences were found between current and former smokers compared to never smokers for GSI or patient-perceived gag or discomfort.While not predictive of GSI or level of laryngeal visualization, the PGS was found to be a useful tool in predicting patient experience of gagging and discomfort during FL-S, further reinforcing the subjective experience of this procedure. Use of the PGS may be helpful in identifying specific candidates who may struggle with subjective discomfort or gagging during FL-S for future studies considering interventions to manage and meaningfully decrease discomfort. Having such an instrument is important given the low number of individuals who struggle with discomfort during the exam.

  View details for DOI 10.1177/00034894211011453

  View details for PubMedID 33890497

• Postoperative dysphagia immediately following pediatric endoscopic laryngeal cleft repair. International journal of pediatric otorhinolaryngology Kiessling, P., Smith, A., Puccinelli, C., Balakrishnan, K. 2021; 142: 110625

  Abstract

  OBJECTIVES: In pediatric patients undergoing endoscopic laryngeal cleft repair, immediate postoperative dysphagia is not well-characterized. This study examined whether worsened dysphagia is present in the immediate postoperative period as detected by clinical swallow evaluation, and evaluated how this relates to postoperative change in presenting symptoms and findings on swallow studies.METHODS: A retrospective cohort was conducted at a tertiary academic medical center, evaluating all pediatric patients who underwent endoscopic laryngeal cleft repair by a single surgeon from October 2014 through December 2018. All patients underwent instrumental swallow evaluation preoperatively and clinical swallow evaluation within 24h following surgery.RESULTS: Thirty-nine patients met inclusion criteria. Based on clinical swallow evaluation performed within 24h after surgery, 4 patients (10%) were recommended to thicken their diet from preoperative baseline; all others were unchanged. All patients were admitted to the PICU for observation; 34 (87%) discharged on postoperative day 1. Thirty-seven patients attended 6-week follow-up, with 2 (5%) requiring thicker diet since discharge; all others were stable or improved. Prevalence of recurrent respiratory infections, subjective dysphagia, chronic cough, and wheezing significantly decreased after surgery. No statistically significant change occurred in prevalence of aspiration or penetration on instrumental swallow studies postoperatively.CONCLUSION: Endoscopic laryngeal cleft repair is well-tolerated in pediatric patients, and most do not have obviously worsened dysphagia at immediate postoperative evaluation. Improvement in symptoms postoperatively may be a more useful indicator of surgical outcomes beyond instrumental swallow studies alone. The relative stability of these patients provides further evidence that they can likely be managed on the floor or as outpatients rather than in the ICU postoperatively.

  View details for DOI 10.1016/j.ijporl.2021.110625

  View details for PubMedID 33454453

• Creation of a New Educational Podcast: "Headmirror's ENT in a Nutshell". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Barnes, J. H., Choby, G., Smith, A. J., Kiessling, P., Marinelli, J. P., Bowe, S., Carlson, M. L. 2020; 163 (4): 623-625

  Abstract

  Podcasts are online digital audio programs that are disseminated via online subscription that are easily accessible through computers or smartphones. Increasingly, residents and medical students are prioritizing podcasts for asynchronous medical education due to ease of use, convenience (eg, use while exercising or commuting), and repeatability. Some trainees have found podcasts more useful than traditional didactic lectures. Given the increasing requirements of social distancing and the need for distance medical education platforms, podcast production can serve as a useful tool to complement resident and medical student education and is a resource that will remain accessible in perpetuity. An otolaryngology specialty podcast, "Headmirror's ENT in a Nutshell," was created to augment asynchronous learning and address the acute need for distance learning opportunities. Over the first 7 weeks of production, 50 episodes were created. Episodes were posted on www.headmirror.com, with subscription services available through Apple Podcast, Spotify, and other platforms.

  View details for DOI 10.1177/0194599820930662

  View details for PubMedID 32513092

• Cranial Base Manifestations of Granulomatosis with Polyangiitis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Kiessling, P. T., Marinelli, J. P., Peters, P. A., DeLone, D. R., Lane, J. I., Koster, M. J., Carlson, M. L. 2020; 162 (5): 666-673

  Abstract

  Although granulomatosis with polyangiitis (GPA; Wegener's granulomatosis) is classically characterized by systemic disease involving the kidneys and airway, approximately 10% of patients who have it present with isolated central nervous system disease. When involving the skull base, GPA frequently mimics more common pathology, resulting in diagnostic challenges and delay. The primary objective of this study is to characterize the cranial base manifestations of GPA, highlighting aspects most relevant to the skull base surgeon.Retrospective review.Tertiary academic referral center.Retrospective analysis of all patients with skull base GPA treated at a tertiary referral center from January 1, 1996, to May 1, 2018.Twenty-nine patients met inclusion criteria. Twenty-one (72%) initially presented with skull base symptomatology as their cardinal manifestation of GPA. Twenty-four (82%) presented with cranial neuropathy at some point in their disease course. The trigeminal nerve was most commonly involved (12 of 24, 50%), followed by the facial (11 of 24, 46%) and optic (8 of 24, 33%) nerves. Eighteen patients reported hearing loss attributed to the GPA disease process, presenting as conductive, sensorineural, or mixed. The most common locations for GPA-derived inflammatory skull base disease on imaging included the cavernous sinus (12 of 29, 41%) and the orbit (7 of 29, 24%).Establishing the diagnosis of skull base GPA remains challenging. Cranial neuropathy is diverse in presentation and often mimics more common conditions. Imaging findings are also unpredictable and frequently nonspecific. Careful review of patient history, clinical presentation, serology and biopsy results, and imaging can reveal important clues toward the diagnosis.

  View details for DOI 10.1177/0194599820912025

  View details for PubMedID 32178578

• Coordinated approach to spinal and tracheal reconstruction in a patient with morquio syndrome. International journal of pediatric otorhinolaryngology Kiessling, P., Stans, A. A., Dearani, J. A., Boesch, R. P., Fogelson, J. L., Matsumoto, J. M., Haile, D. T., Balakrishnan, K. 2020; 128: 109721

  Abstract

  Morquio syndrome (Mucopolysaccharidosis IVA) is an autosomal recessive lysosomal storage disease with manifestations ranging from mild to severe phenotype. Mechanical spinal cord injury and airway insufficiency are major causes of mortality. A 17-year-old male patient with severe Morquio syndrome presented with cervical and upper thoracic spinal stenosis with spinal cord myelopathy, and progressive severe tracheal stenosis. Coordinated care among otolaryngology, orthopedic surgery, neurosurgery, anesthesiology, cardiovascular surgery, radiology, and pulmonology teams facilitated the successful planning and execution of two major surgical interventions in rapid succession. This is the first description of a successful coordinated spine and airway repair in the literature.

  View details for DOI 10.1016/j.ijporl.2019.109721

  View details for PubMedID 31639621

• Identification of aggressive Gardner syndrome phenotype associated with a de novo APC variant, c.4666dup COLD SPRING HARBOR MOLECULAR CASE STUDIES Kiessling, P., Dowling, E., Huang, Y., Ho, M., Balakrishnan, K., Weigel, B. J., Highsmith, W., Niu, Z., Schimmenti, L. A. 2019; 5 (2)

  Abstract

  Gardner syndrome describes a variant phenotype of familial adenomatous polyposis (FAP), primarily characterized by extracolonic lesions including osteomas, dental abnormalities, epidermal cysts, and soft tissue tumors. We describe a 2-yr-old boy presenting with a 2-cm soft tissue mass of the forehead. Pathologic evaluation revealed a nuchal-type/Gardner-associated fibroma. Sequencing of the APC gene revealed a pathologic variant c.4666dupA. Parental sequencing of both blood and buccal tissue supported the de novo occurrence of this pathologic variant. Further imaging revealed a number of additional lesions including a large lumbar paraspinal desmoid, a 1-cm palpable lesion posterior to the left knee, firm lesions on bilateral heels, and multiple subdermal lesions. Colonoscopy was negative. This case illustrates a genetic variant of Gardner syndrome resulting in an aggressive early childhood phenotype and highlights the need for an individualized approach to treatment.

  View details for DOI 10.1101/mcs.a003640

  View details for Web of Science ID 000462938400004

  View details for PubMedID 30696621

  View details for PubMedCentralID PMC6549566