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Douglas Sidell, MD

  • “Taking care of children is an honor unlike anything else in the world.”

Taking care of children is an honor unlike anything else in the world. As a physician and surgeon, I have the privilege of helping children with problems involving the neck, airway, ears, nose and throat. When a patient is able to breathe and sleep better, become more active in sports, and hear better in the classroom, I know that I am making a difference.

Childhood is arguably one of the most important experiences of our lifetime, and I have never let go of my inner child. Children are unique individuals; I approach them with compassion and make sure that they are comfortable during each visit. I take the time out to listen carefully to what they have to say.

It is a source of pride to work at Stanford Children's Health, where everyone I work with shares a common goal: to provide the best possible care for all children. This pride shines through everything that I do, from performing the basic clinic evaluations to providing the most innovative surgical treatment approaches available.

Specialties

Ear, Nose, and Throat (Head and Neck Surgery)

Otolaryngology

Work and Education

Professional Education

George Washington University Medical School, Washington, DC, 05/4/2007

Internship

David Geffen School of Medicine at UCLA, Los Angeles, CA, 06/30/2008

Residency

David Geffen School of Medicine at UCLA, Los Angeles, CA, 06/30/2012

Fellowship

Cincinnati Children's Medical Center, Cincinnati, OH, 06/30/2014

Board Certifications

Otolaryngology, American Board of Otolaryngology

Conditions Treated

Children with tracheostomies

Complex airway disorders

Drooling and aspiration

Head and neck tumors and masses

Laryngomalacia

Nasal and sinus disorders

Stridor and noisy breathing

Subglottic and tracheal stenosis

Swallowing dysfunction

Tonsil and adenoid enlargement

Vocal cord paralysis

Voice disorders

All Publications

Conservative management of pediatric tracheal rupture. Pediatric pulmonology Sidell, D. R., Wood, R. E., Hart, C. K. 2017; 52 (1): E1-E3

Abstract

Traumatic injuries to the pediatric trachea are uncommon events that require prompt diagnosis and management. When they do occur, tracheal injuries often arise in the setting of high impact trauma and are accompanied by major injuries to other organ systems. In this report, we present the diagnosis and conservative management of tracheal rupture at the carina in an 11-year-old female with severe intracranial injuries. Pediatr Pulmonol. 2016; 9999:1-3. 2016 Wiley Periodicals, Inc.

View details for DOI 10.1002/ppul.23507

View details for PubMedID 27333290

Surgical Management of Posterior Glottic Diastasis in Children. The Annals of otology, rhinology, and laryngology 2014

Abstract

The purpose of this study was to report our clinical experience in the surgical management of patients with posterior glottic diastasis (PGD) secondary to prolonged intubation and/or laryngotracheoplasty (LTP) during childhood.We reviewed the charts of patients with a history of prolonged intubation and/or LTP who had undergone surgical correction for PGD at our institution between 2010 and 2014. We documented demographic data and pertinent information regarding medical and surgical histories. The Pediatric Voice Handicap Index (pVHI) and/or the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were used to assess patients both before and after undergoing treatment for voice disorders.Six patients met our inclusion criteria. With 1 exception, all patients with complete voice data demonstrated improvements in perceptual, patient-reported, and acoustic voice measures. There were no perioperative complications.Our case series demonstrates that operative intervention can lead to improved voice in carefully selected patients with PGD secondary to prolonged intubation and/or LTP during childhood. Patients exhibited postoperative improvement in loudness and vocal endurance; however, they also exhibited a degree of compromise in voice quality.

View details for DOI 10.1177/0003489414543100

View details for PubMedID 25063682

Pediatric Exercise Stress Laryngoscopy following Laryngotracheoplasty: A Comparative Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2014; 150 (6): 105661

Abstract

Exercise-induced airway obstruction in pediatric patients is a unique phenomenon with multiple potential etiologies. An accurate diagnosis can be challenging to establish in pediatric patients because they are frequently asymptomatic at rest. Exercise stress laryngoscopy (ESL) is a modality by which pediatric patients can be evaluated under physiologic conditions that produce their symptoms. The purpose of this study was to demonstrate (1) the diagnostic effectiveness of pediatric ESL and (2) the ability of ESL to guide treatment for "normal" and post-airway reconstruction patients with exercise intolerance.Case series with chart review.Tertiary care children's hospital.Patients undergoing ESL for exercise intolerance were reviewed. Demographics, surgical history, examination findings, and management recommendations were extracted.Thirty-seven patients (average age, 13.5 years; range, 5-21 years) were included. There were 14 male and 23 female patients. Airway abnormalities became evident in 56% of patients. Of these, 24% had focal supraglottic collapse, 43% had evidence of paradoxical vocal fold motion, 24% had combined supraglottic and glottic dysfunction, and 9% had distal airway abnormalities. Overall, 18 patients had changes in management after ESL. Twelve patients in this review had histories of laryngotracheoplasty with equivocal findings on operative bronchoscopy. Of these patients, 10 (83%) received focal diagnoses after ESL.ESL is a contemporary modality by which complex patients with undiagnosed exercise intolerance can be effectively evaluated. ESL can be an important tool used to guide treatment in pediatric patients with exercise-induced dyspnea after airway reconstruction.

View details for DOI 10.1177/0194599814528097

View details for PubMedID 24671463

Food choking hazards in children INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY Sidell, D. R., Kim, I. A., Coker, T. R., Moreno, C., Shapiro, N. L. 2013; 77 (12): 1940-1946

Abstract

To review the literature on pediatric food choking risks, with the long-term goal of supporting legislation regulating the production, labeling, and distribution of high-risk foods.A PubMed search (Keywords: choking, obstruction, asphyxiation, foreign body, food) was conducted in July-September 2010 with publication dates ranging from 1966 to 2010.Articles related to pediatric foreign body aspiration (FBA) were selected by three independent reviewers. 1145 articles were initially identified. Abstracts were then screened utilizing a tool designed to isolate relevant pediatric choking events; this tool helped to only select abstracts which presented data on patients younger than 18 years of age who had choked on food items. Through this, a total of 72 pertinent articles were isolated (55 observational studies, 17 case reports/series).For each study, patient age, sex, foreign body location, presenting signs and symptoms, utility of radiographic studies, and type of foreign body detected in the majority of study participants were determined. A "majority" of patients for each study was predetermined arbitrarily to be 2/3 of the studied population.The majority of patients in each observational study was determined to be: male (87% of all studies) and age <5 years (95% of all studies). Aspirated foreign bodies were mostly detected in the right main bronchus foreign body (72% of all studies), and there were abnormal radiographic signs (81% of all studies) at the time of evaluation. Food-object foreign bodies were the most frequent factors associated with choking (94% of all studies).Childhood aspiration of food-objects is a significant public health issue. Although there is substantial legislation regulating non-food items that pose a choking hazard, equivalent guidelines do not exist for high-risk foods. Our study identifies and confirms several risk factors for pediatric FBA events. In doing so, it echoes the concerns and suggestions of various groups in supporting the development of legislation which may reduce the incidence of food-object aspiration.

View details for DOI 10.1016/j.ijporl.2013.09.005

View details for Web of Science ID 000328870800007

View details for PubMedID 24113156

Management and Outcomes of Laryngeal Injuries in the Pediatric Population Meeting of the American-Broncho-Esophagological-Association Sidell, D., Mendelsohn, A. H., Shapiro, N. L., John, M. S. ANNALS PUBL CO. 2011: 78795

Abstract

Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature.The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted.There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge.Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.

View details for Web of Science ID 000298270900004

View details for PubMedID 22279950

Bronchoscopy in children with tetralogy of fallot, pulmonary atresia, and major aortopulmonary collaterals. Pediatric pulmonology Sidell, D. R., Koth, A. M., Bauser-Heaton, H., McElhinney, D. B., Wise-Faberowski, L., Tracy, M. C., Hanley, F. L., Asija, R. 2017

Abstract

Children with Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for developing more postoperative respiratory complications than children undergoing other types of congenital heart surgery. Bronchoscopy is used in the perioperative period for diagnostic and therapeutic purposes. In this study, we describe bronchoscopic findings and identify factors associated with selection for bronchoscopy.Retrospective case-control.All patients with TOF/PA/MAPCAs who underwent unifocalization surgery from September 2005 through March 2016 were included. Patients who underwent bronchoscopy in the perioperative period were compared to a randomly selected cohort of 172 control patients who underwent unifocalization without bronchoscopy during the study period.Forty-three children underwent perioperative bronchoscopy at a median of 9 days postoperatively. Baseline demographics were similar in bronchoscopy patients and controls. Patients who underwent bronchoscopy were more likely to have a chromosome 22q11 deletion and were more likely have undergone unifocalization surgery without intracardiac repair. These patients had a longer duration of mechanical ventilation, ICU duration, and length of hospitalization. Abnormalities were detected on bronchoscopy in 35 patients (81%), and 20 (35%) of bronchoscopy patients underwent a postoperative intervention related to abnormalities identified on bronchoscopy.Bronchoscopy is a useful therapeutic and diagnostic instrument for children undergoing unifocalization surgery, capable of identifying abnormalities leading to an additional intervention in over one third of patients. Special attention should be given to children with a 22q11 deletion to expedite diagnosis and intervention for possible airway complications.

View details for DOI 10.1002/ppul.23732

View details for PubMedID 28504356

Palatal Petechiae in the Absence of Group A Streptococcus in Pediatric Patients with Acute-Onset Neuropsychiatric Deterioration: A Cohort Study. Journal of child and adolescent psychopharmacology Mahony, T., Sidell, D., Gans, H., Cooperstock, M., Brown, K., Cheung, J. M., Farhadian, B., Gustafson, M., Thienemann, M., Frankovich, J. 2017

Abstract

Palatal petechiae are 95% specific for streptococcal pharyngitis. Despite this, and despite prior research demonstrating that Group A Streptococcus (GAS) is a common antecedent to pediatric acute-onset neuropsychiatric syndrome (PANS) episodes, we anecdotally observed a low rate of documented GAS in patients with PANS and palatal petechiae. This retrospective chart review was conducted to formally report the rate of palatal petechiae and concurrent GAS in a cohort of patients with PANS and investigate other etiologic factors.The clinical notes of 112 patients seen at the Stanford PANS Clinic who met PANS research criteria were reviewed for mention of palatal petechiae. The medical records of patients who demonstrated palatal petechiae on physical examination were reviewed for signs of infection, a clinical history of trauma, and laboratory results that could indicate other causes of petechiae.Twenty-three patients had documented palatal petechiae on physical examination (ages 5-16, 13/23 [57%] male). Fifteen patients had a rapid GAS test and GAS culture in the Stanford PANS clinic, all with negative results. Evidence of recent GAS infection was found in 8/23 (32%) patients (elevated GAS titers [n=6] or documentation of a positive rapid GAS test at another facility [n=2]), one of whom also had potential herpes simplex virus (HSV) infection. One patient had potential HSV infection and recent palatal trauma. No patients had thrombocytopenia. 14/23 (61%) of patients with palatal petechiae had no discernable cause of petechiae. 10/19 (53%) of patients had antihistone antibodies.Despite the established relationship between palatal petechiae and GAS, no patient with palatal petechiae in our clinic tested positive for GAS and only 32% had evidence of recent GAS. Most did not have an identifiable cause for the palatal lesions. This finding suggests the potential for alternative causes of palatal petechiae or undetectable GAS in our patient population. The high prevalence of palatal petechiae without GAS infection suggests that the pathogenesis of PANS is multifactorial and may involve disruption or inflammation of the microvasculature. Additional research is needed to further elucidate these findings.

View details for DOI 10.1089/cap.2016.0153

View details for PubMedID 28387528

Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. Laryngoscope Rutter, M. J., Hart, C. K., Alarcon, A. d., Daniel, S., Parikh, S. R., Balakrishnan, K., Lam, D., Johnson, K., Sidell, D. R. 2017

Abstract

Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI.Multicenter review.A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS.Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway.Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.4 Laryngoscope, 2017.

View details for DOI 10.1002/lary.26547

View details for PubMedID 28271539

Langerhans Cell Histiocytosis of the Maxillary Sinus. Clinical pediatrics Noel, J. E., Messner, A. H., Sidell, D. R. 2017; 56 (2): 184-186

View details for DOI 10.1177/0009922816645522

View details for PubMedID 27121594

Diagnosis and treatment of pediatric frontotemporal pits: report of 2 cases JOURNAL OF NEUROSURGERY-PEDIATRICS Bliss, M., Grant, G., Tittler, E., Loven, T., Yeom, K. W., Sidell, D. 2016; 18 (4): 471-474

Abstract

In contrast to more common nasal and cervical lesions, the frontotemporal pit is a rarely encountered lesion that is often associated with a dermoid and may track intracranially. Due to delays in diagnosis, the propensity to spread intracranially, and the risk of infection, awareness of these lesions and appropriate diagnosis and management are important. The authors present 2 cases of frontotemporal pits from a single institution. Epidemiology, presentation, and management recommendations are discussed.

View details for DOI 10.3171/2016.5.PEDS1687

View details for Web of Science ID 000383938500015

View details for PubMedID 27391653

Inferior alveolar nerve hemangioma. Laryngoscope Vaezeafshar, R., Liu, S. Y., Sidell, D. 2016; 126 (9): 2168-2170

Abstract

A 14-year-old male presented with lower lip numbness and a slowly enlarging mandibular mass. Computed tomography demonstrated an expansile lesion centered in the marrow space of the left mandibular body, extending along the course of the inferior alveolar nerve (IAN), and expanding the mental foramen. Preoperative diagnosis was consistent with an IAN schwannoma. Surgical planning was performed using PROPLAN CMF software. The lesion was approached via a sagittal split osteotomy and excised en bloc with the IAN. Final pathology demonstrated a capillary hemangioma originating from the inferior alveolar nerve. Based on a detailed PubMed search, this is the first capillary hemangioma of the inferior alveolar nerve reported in the literature.NA Laryngoscope, 2016.

View details for DOI 10.1002/lary.25869

View details for PubMedID 26863892

Combination therapies using an intratympanic polymer gel delivery system in the guinea pig animal model: A safety study. International journal of pediatric otorhinolaryngology Sidell, D., Ward, J. A., Pordal, A., Quimby, C., Nassar, M., Choo, D. I. 2016; 84: 132-136

Abstract

High dose antivirals have been shown to cause hearing loss when applied via the intratympanic route. The aim of this study was to determine if a combination therapy using dexamethasone (DXA) with either Cidofovir (CDV) or Ganciclovir (GCV), in solution or in PLGA-PEG-PLGA (PPP) hydrogel, is innocuous to the inner ear.Cytomegalovirus (CMV)-free guinea pigs were separated into four principal study groups and treated via intratympanic injection (IT) of CDV/DXA solution, CDV/DXA Hydrogel, GCV/DXA solution and GCV/DXA hydrogel. Hearing thresholds were evaluated with pretreatment ABR and post injection weekly ABRs for a total follow up of 28 days. Temporal bone tissue was harvested and stained with Hematoxylin and Eosin for histologic analysis.ABR analysis revealed that GCV/DXA in solution and in hydrogel led to a mild hearing loss at days 7-21 but returned to baseline by day 28 When administered via PPP hydrogel, CDV/DXA demonstrated mild persistent hearing loss at 32kHz at 28 days. An inflammatory response was identified in the cochlear specimen of the CDV/DXA/PPP hydrogel group, in concert with mild hearing loss, at days 21 and 28.Results of this study support the safe intratympanic use of higher concentrations of antivirals when combined with DXA, both in solution and when applied via PPP hydrogel.

View details for DOI 10.1016/j.ijporl.2016.03.002

View details for PubMedID 27063768

Ultrasound-Guided Botulinum Toxin Type A Salivary Gland Injection in Children for Refractory Sialorrhea: 10-Year Experience at a Large Tertiary Children's Hospital PEDIATRIC NEUROLOGY Lungren, M. P., Halula, S., Coyne, S., Sidell, D., Racadio, J. M., Patel, M. N. 2016; 54: 70-75
Outcomes and Resource Utilization of Endoscopic Mass-Closure Technique for Laryngeal Clefts OTOLARYNGOLOGY-HEAD AND NECK SURGERY Balakrishnan, K., Cheng, E., de Alarcon, A., Sidell, D. R., Hart, C. K., Rutter, M. J. 2015; 153 (1): 119-123

Abstract

To compare resource utilization and clinical outcomes between endoscopic mass-closure and open techniques for laryngeal cleft repair.Case series with chart review.Tertiary academic children's hospital.Pediatric patients undergoing repair for Benjamin-Inglis type 1-3 laryngeal clefts over a 15-year period. All 20 patients undergoing endoscopic repair were included. Eight control patients undergoing open repair were selected using matching by age and cleft type. Demographic, clinical, and resource utilization data were collected.Twenty-eight patients were included (20 endoscopic, 8 open). Mean age, rates of tracheostomy and vocal fold immobility, and distribution of cleft types were not different between the 2 groups (all P > .2). Mean operative time (P = .004) and duration of hospital stay (P < .001) were significantly shorter in the endoscopic group. All repairs were intact in both groups at final postoperative endoscopy. Rates of persistent laryngeal penetration or aspiration on swallow study were not different between groups (P = 1.000), although results were available for only 11 patients.Endoscopic laryngeal cleft repair using a mass-closure technique provides a durable result while requiring significantly shorter operative times and hospital stays than open repair and avoiding the potential morbidity of laryngofissure. However, open repair may allow the simultaneous performance of other airway reconstructive procedures and may be a useful salvage technique when endoscopic repair fails. Postoperative swallowing results require further study.

View details for DOI 10.1177/0194599815576718

View details for Web of Science ID 000357297000019

View details for PubMedID 25782984

Standardized Outcome and Reporting Measures in Pediatric Head and Neck Lymphatic Malformations OTOLARYNGOLOGY-HEAD AND NECK SURGERY Balakrishnan, K., Bauman, N., Chun, R. H., Darrow, D. H., Grimmer, J. F., Perkins, J. A., Richter, G. T., Shin, J. J., Shivaram, G. M., Sidell, D. R., Elluru, R. G. 2015; 152 (5): 948-953

Abstract

To develop general and site-specific treatment effect and outcome measures to standardize the reporting of head and neck lymphatic malformation (HNLM) treatments.Consensus statement/expert opinion.Multiple tertiary academic institutions.The modified Delphi method is an iterative process of collecting expert opinions, refining opinions through discussion and feedback, statistically aggregating opinions, and using these aggregates to generate consensus opinion in the absence of other data. The modified Delphi method was used by a multi-institutional group of otolaryngology and interventional radiology experts in the field of vascular anomalies to formulate a list of recommended reporting outcomes for the study and treatment of head and neck lymphatic malformations.Through 3 rounds of iteration, 10 expert panelists refined 98 proposed outcome measures and 9 outcome categories to a final consensus set of 50 recommended outcome measures in 3 global categories (general, demographics, and treatment complications) and 5 site-specific categories (orbit, oral cavity, pharynx, larynx, and neck).We propose the first consensus set of standardized reporting measures for clinical and treatment outcomes in studies of HNLMs. Consistent outcome measures across future studies will facilitate comparison of treatment options and allow systematic review. We hope that these guidelines facilitate the design and reporting of subsequent HNLM studies.

View details for DOI 10.1177/0194599815577602

View details for Web of Science ID 000354261400029

View details for PubMedID 25829389

Comment Regarding Article "An Adolescent Found Unconscious" CLINICAL PEDIATRICS Sidell, D. R., Myer, C. M. 2014; 53 (5): 507-507

View details for DOI 10.1177/0009922814529019

View details for Web of Science ID 000337493000018

View details for PubMedID 24707024

Epstein-barr DNA serology and positron-emission tomography imaging of the head and neck in pediatric transplant recipients LARYNGOSCOPE Sidell, D., Venick, R. S., Shapiro, N. L. 2014; 124 (5): 1236-1241

Abstract

Epstein-Barr virus (EBV) infection is a potential precursor of post-transplantation lymphoproliferative disorder (PTLD) in the pediatric transplant patient. Positron-emission tomography (PET) imaging is increasingly utilized in this population to monitor for neoplasia and PTLD. We assess the association between EBV serum titers and Waldeyer's ring and cervical lymph node PET positivity in the pediatric transplant recipient.Retrospective analysis of EBV serology and PET imaging results in pediatric orthotopic liver transplantation (OLT) recipients.Imaging results and laboratory data were reviewed for all pediatric OLT recipients from January 2005 to July 2011 at a single institution. Charts were evaluated for PET positivity at Waldeyer's ring or cervical lymphatics, and for EBV serology results. Demographic data extracted include patient sex and age at transplantation.A total of 122 pediatric OLT recipients were reviewed. Twelve patients (10%) underwent PET imaging. Overall, four patients (33%) had evidence of PET positivity at Waldeyer's ring or cervical lymphatics. Five patients (42%) had positive EBV serology. There was a significant association between PET imaging results and EBV DNA serology results (P = .01).PTLD surveillance in the pediatric transplant recipient is an important component of long-term care in this population. Although PET imaging is a new modality in monitoring pediatric transplant recipients for early signs of PTLD, an association between EBV serology and PET imaging results appears to exist. With increased implementation, PET imaging will likely prove valuable in its ability to monitor the transplant recipient at risk for PTLD.

View details for DOI 10.1002/lary.24376

View details for Web of Science ID 000334680500047

View details for PubMedID 24105893

High-Dose Sublesional Bevacizumab (Avastin) for Pediatric Recurrent Respiratory Papillomatosis Meeting of the American-Broncho-Esophagological-Association Sidell, D. R., Nassar, M., Cotton, R. T., Zeitels, S. M., de Alarcon, A. ANNALS PUBL CO. 2014: 21421

Abstract

We review and report the use of high-dose bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP) in pediatric patients.We included all patients with pediatric-onset RRP who underwent bevacizumab (25 mg/mL) injections by a single practitioner. A series of 5 consecutive subepithelial injections were administered at 4- to 6-week intervals with concomitant 532 nm KTP laser ablation. The lesions were staged according to the Derkay staging system. The outcomes included pretreatment and posttreatment Derkay scores, the time interval between procedures, and voice outcomes. The demographic data extracted included sex, age at diagnosis, and current age.Nine patients were included in this study, with 1 patient lost to follow-up; their median age was 8 years (range, 3 to 21 years). The mean bevacizumab dose was 14.25 mg (range, 5 to 45 mg). There was a median Derkay score of 11.5 (range, 4 to 23) at the time of diagnosis and a median 58% improvement following therapy. All patients demonstrated an increased time interval between injections, for a median improvement of 2.05 (range, 1.6 to 3.25).Evidence exists in support of vascular endothelial growth factor as an important factor in the development of RRP. Although some variability in response is demonstrated by this study, high-dose bevacizumab appears to yield promising results for pediatric patients with RRP.

View details for DOI 10.1177/0003489414522977

View details for Web of Science ID 000332436700008

View details for PubMedID 24633948

Role of obesity in otitis media in children. Current allergy and asthma reports Ahmed, S., Arjmand, E., Sidell, D. 2014; 14 (11): 469

Abstract

The ongoing childhood obesity epidemic has garnered significant attention among healthcare providers due to its short- and long-term sequelae. Multiple diseases have been associated with obesity, not limited to hypertension, diabetes, and attention deficit hyperactivity disorder. Over the past decade, the relationships between obesity and otologic conditions have been investigated. In this setting, otitis media has remained the focus of research, representing one of the most common pediatric illnesses. Initial studies suggesting a relationship between the two conditions have been supported with epidemiological studies controlling for socioeconomic factors. The purpose of this article is to review our current understanding of the relationship between otitis media and obesity and to discuss the healthcare implications of this association. In addition, several identifiable factors associated with each condition are discussed, as are potential pathophysiologic mechanisms that may help to elucidate the complex and multifactorial relationship between the two disease entities.

View details for DOI 10.1007/s11882-014-0469-x

View details for PubMedID 25183362

Risk Factors for Preoperative and Postoperative Hearing Loss in Children Undergoing Pressure Equalization Tube Placement. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2014; 150 (6): 104855

Abstract

Pressure equalization tube (PET) placement is the most common surgical procedure performed during childhood. Current guidelines recommend more prompt management of children with otitis media with effusion who are at greater risk for speech-language and developmental problems. This study was designed to examine risk factors for continued post-PET hearing loss in a large pediatric clinical sample.Retrospective analysis using the electronic medical record.Tertiary care children's hospital.Pediatric patients undergoing PET placement between January 2009 and October 2012 who had audiometric tests.Demographics, patient diagnoses, and hearing loss information were extracted. Multivariate binary logistic regression models were used to identify associations between patient-specific characteristics and the presence of hearing loss.In total, 3949 children with 4598 audiology visits were included (2357 males and 1592 females; mean age, 3.3 years), and 1272 preoperative and 3329 postoperative audiograms were performed. Using multivariate modeling, the only variable significantly associated with preoperative hearing loss was low tympanometric static acoustic admittance. Postoperative hearing loss was positively associated with patient age, preoperative hearing loss, lower tympanometric equivalent canal volumes, and Down syndrome. Other factors, including cranial/facial anomalies, low birth weight or prematurity, allergies, and asthma, were not determined to be risk factors for hearing loss.Our results support hearing testing to identify candidates for PET surgery and to determine treatment effectiveness after surgery, since hearing loss cannot be predicted on the basis of risk or demographic factors. These data have important preoperative counseling and postoperative management implications.

View details for DOI 10.1177/0194599814529080

View details for PubMedID 24705221

Defining the Critical-Sized Defect in a Rat Segmental Mandibulectomy Model Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation (AAO-HNSF) and OTO Expo DeConde, A. S., Lee, M. K., Sidell, D., Aghaloo, T., Lee, M., Tetradis, S., Low, K., Elashoff, D., Grogan, T., Sepahdari, A. R., St John, M. AMER MEDICAL ASSOC. 2014: 5865

Abstract

Advances in tissue engineering offer potential alternatives to current mandibular reconstructive techniques; however, before clinical translation of this technology, a relevant animal model must be used to validate possible interventions.To establish the critical-sized segmental mandibular defect that does not heal spontaneously in the rat mandible.Prospective study of mandibular defect healing in 29 Sprague-Dawley rats in an animal laboratory.The rats underwent creation of 1 of 4 segmental mandibular defects measuring 0, 1, 3, and 5 mm. All mandibular wounds were internally fixated with 1-mm microplates and screws and allowed to heal for 12 weeks, after which the animals were killed humanely.Analysis with micro-computed tomography of bony union and formation graded on semiquantitative scales.Seven animals were included in each experimental group. No 5-mm segmental defects successfully developed bony union, whereas all 0- and 1-mm defects had continuous bony growth across the original defect on micro-computed tomography. Three of the 3-mm defects had bony continuity, and 3 had no healing of the bony wound. Bone union scores were significantly lower for the 5-mm defects compared with the 0-, 1-, and 3-mm defects (P<.01).The rat segmental mandible model cannot heal a 5-mm segmental mandibular defect. Successful healing of 0-, 1-, and 3-mm defects confirms adequate stabilization of bony wounds with internal fixation with 1-mm microplates. The rat segmental mandibular critical-sized defect provides a clinically relevant testing ground for translatable mandibular tissue engineering efforts.

View details for DOI 10.1001/jamaoto.2013.5669

View details for Web of Science ID 000331369700010

View details for PubMedID 24232293

Safety of cidofovir by intratympanic delivery technique ANTIVIRAL THERAPY Ward, J. A., Sidell, D. R., Nassar, M., Reece, A. L., Choo, D. I. 2014; 19 (1): 97-105

Abstract

Congenital cytomegalovirus (CMV) infection is one of the most common infectious causes of congenital sensorineural hearing loss. To date, a safe and effective therapy for CMV-induced hearing loss does not exist. We hypothesize that the antiviral cidofovir (CDV) can be delivered to the inner ear via intratympanic (IT) injections to safely and effectively mitigate CMV-induced hearing loss.To evaluate the safety of CDV IT injections, weanling guinea pigs with normal hearing were injected intratympanically with 3 mg or 5 mg concentrations of CDV and compared to control animals injected with sterile saline. A separate group of weanling guinea pigs were inoculated with CMV and a subset of this group was treated with CDV following inoculation.The 3 mg/ml and 5 mg/ml CDV concentrations resulted in hearing loss following IT injection into uninfected animals. No signs of inflammation or toxicity were noted on histologic analysis and there was no evidence of systemic toxicity in serology. Hearing loss induced as a result of guinea pig CMV infection recovered by day 21 in animals treated with IT injections of 5 mg/ml CDV.We provide promising evidence demonstrating both the efficacy and safety of IT CDV in the guinea pig animal model. This research further establishes a sound framework upon which ongoing investigations into drug delivery mechanisms for CMV-induced hearing loss will be based.

View details for DOI 10.3851/IMP2693

View details for Web of Science ID 000335231800010

View details for PubMedID 24153022

Obesity and the Risk of Chronic Rhinosinusitis, Allergic Rhinitis, and Acute Otitis Media in School-Age Children LARYNGOSCOPE Sidell, D., Shapiro, N. L., Bhattacharyya, N. 2013; 123 (10): 2360-2363

Abstract

To determine if obesity is a significant risk factor for acute otitis media (AOM), allergic rhinitis (AR), or chronic rhinosinusitis (CRS) in children and to understand the potential otolaryngological implications of childhood obesity.Cross-Sectional Analysis.The 2006 and 2008 the Medical Expenditure Panel Survey was utilized to identify school-aged children with AOM, AR, and/or CRS. Risk factors for the diagnoses extracted included standard demographics and the presence or absence of obesity. Multivariate analyses were conducted for associations between childhood obesity and AOM, AR, and CRS.42.1 million (95% CI, 40.4-44.2) school-age children (unweighted N=10623) were sampled in 2006 and 2008. There was a slight male predominance (51.0% [95% CI, 49.8-52.2]). Of these patients, 2.2 million (95% CI 1.9-2.4) received a diagnosis of AOM, 4.0 million (95% CI 3.6-4.4) received a diagnosis of AR, and 1.7 million (95% CI 1.4-1.9) received a diagnosis of CRS. Approximately 9.3 million (95% CI 8.7-10.0) children were obese, representing 22.2% (95% CI 21.0-23.3) of the U.S. population (age 6-17). Utilizing an adjusted multivariate model, childhood obesity was found to be associated with AOM (odds ratio, 1.44; [95% CI 1.08-1.93]; P=0.033). Significant associations between obesity and AR (OR 1.14; [95% CI 0.88-1.47]; P=0.60) or obesity and CRS (OR0.73; [95% CI 0.48-1.10]; P=0.79) were not identified.Childhood obesity appears to be associated with the development of AOM; however, an association between obesity and AR or CRS was not demonstrated. Given that in the United States nearly one-fourth of all children seeking health care are obese, these data may have important preventative care implications.2C.

View details for DOI 10.1002/lary.24038

View details for Web of Science ID 000325091100007

View details for PubMedID 23918707

Bone Morphogenetic Protein-2-Impregnated Biomimetic Scaffolds Successfully Induce Bone Healing in a Marginal Mandibular Defect LARYNGOSCOPE DeConde, A. S., Sidell, D., Lee, M., Bezouglaia, O., Low, K., Elashoff, D., Grogan, T., Tetradis, S., Aghaloo, T., St John, M. 2013; 123 (5): 1149-1155

Abstract

To test the osteoregenerative potential and dosing of bone morphogenetic protein-2 (BMP-2)-impregnated biomimetic scaffolds in a rat model of a mandibular defect.Prospective study using an animal model.Varied doses of BMP-2 (0.5, 1, 0.5, 0.5 in microspheres, 5, and 15 g) were absorbed onto a biomimetic scaffold. Scaffolds were then implanted into marginal mandibular defects in rats. Blank scaffolds and unfilled defects were used as negative controls. Two months postoperatively, bone healing was analyzed with microcomputerized tomography (microCT).MicroCT analysis demonstrated that all doses of BMP-2 induced successful healing of marginal mandibular defects in a rat mandible. Increasing doses of BMP-2 on the scaffolds produced increased tissue healing, with 15 g demonstrating significantly more healing than all other dosing (P < .01).BMP-2-impregnated biomimetic scaffolds successfully induce bone healing in a marginal mandibular defect in the rat. Percentage healing of defect, percentage of bone within healed tissue, and total bone volume are all a function of BMP-2 dosing. There appears to be an optimal dose of 5 g beyond which there is no increase in bone volume.NA.

View details for DOI 10.1002/lary.23782

View details for Web of Science ID 000320782200018

View details for PubMedID 23553490

Acute tonsillitis. Infectious disorders drug targets Sidell, D., Shapiro, N. L. 2012; 12 (4): 271-276

Abstract

Acute tonsillitis is an inflammatory process of the tonsillar tissues and is usually infectious in nature. Acute infections of the palatine tonsils predominantly occur in school-aged children, but patients of any age may be affected. Tonsillitis of viral origin is usually treated with supportive care. Bacterial tonsillitis is most commonly caused by Streptococcus pyogenes. Polymicrobial infections and viral pathogens are also important sources of infection. Penicillins remain the treatment of choice for S. pyogenes tonsillitis, and augmented aminopenicillins have gained utility in concert with the increasing incidence of beta-lactamase producing bacteria. We describe the anatomic features and the immunologic function of the palatine tonsils, including a detailed discussion of history and physical examination findings, treatment recommendations, and possible complications of acute tonsillitis. Establishing an accurate diagnosis and initiating appropriate treatment are key components of managing this common pathologic process.

View details for PubMedID 22338587

Composite Mandibulectomy: A Novel Animal Model 115th AAO-HNSF Annual Meeting and OTO EXPO Sidell, D. R., Aghaloo, T., Tetradis, S., Lee, M., Bezouglaia, O., DeConde, A., St John, M. A. SAGE PUBLICATIONS LTD. 2012: 93237

Abstract

Segmental mandibular defects can result after the treatment of various pathologic processes, including osteoradionecrosis, tumor resection, or fracture nonunion with sequestration. The variety of etiologies and the frequency of occurrence make the reconstruction of segmental mandibular defects a topic of significant interest. Despite these incentives, a well-established small-animal model of the segmental mandibulectomy, including composite resection, does not exist. The objective of this study is the creation of a reliable animal model that can be used to study the reconstruction of en bloc mandibular defects. Surgical techniques and an array of reconstructive options are described.Description of an animal model.Animal laboratory at a quaternary care university medical center.We present an Animal Research Oversight Committee-approved prospective analysis of survival operations in the rat model. A detailed, stepwise description of surgical technique and relevant intraoperative anatomy is presented. Postoperative management, early pitfalls, surgical complications, and future applications are discussed.A total of 72 operations were performed by a single individual between July and October 2010. Two intraoperative and 9 postoperative complications were recognized. There were 6 orocutaneous fistulas, 2 abscesses, and 1 seroma. There were 4 fatalities, which were attributed to anesthetic complications (2, intraoperative), hematoma formation (1, postoperative), and foreign-body aspiration (1, postoperative).This novel animal model reliably replicates the en bloc segmental mandibular defects seen in our patient population and can be manipulated to achieve a wide variety of research objectives.

View details for DOI 10.1177/0194599811435633

View details for Web of Science ID 000305522400010

View details for PubMedID 22282867

Demographic Influences on Antibiotic Prescribing for Pediatric Acute Otitis Media OTOLARYNGOLOGY-HEAD AND NECK SURGERY Sidell, D., Shapiro, N. L., Bhattacharyya, N. 2012; 146 (4): 653-658

Abstract

To understand the epidemiologic antibiotic treatment patterns and the potential impact of race and insurance status on the medical management of acute otitis media (AOM).Cross-sectional analysis of a national database.National ambulatory care setting.Cases of isolated AOM in children 16.0 years were extracted from the National Ambulatory Medical Care Survey (2006-2008). The frequency and type of antibiotic prescribed were extracted. A multivariate logistic regression model incorporating age, sex, race, ethnicity, and insurance type was used to determine the influence of these demographic variables on antibiotic prescribing patterns.A total of 15.8 1.5 million cases of AOM were studied (mean age, 3.6 0.3 years; 55.1% 2.9% male). Of the children, 15.0% 2.8% were Hispanic and 10.4% 3.1% were black. Medicaid/State Children's Health Insurance Program and private insurance covered 30.6% 4.4% and 69.4% 4.4% of children, respectively. Overall, 83.1% 2.2% of children received an antibiotic prescription. The most commonly prescribed antibiotics were amoxicillin (6.5 0.9 million), beta-lactamase inhibitors (2.6 0.4 million), and third-generation cephalosporins (2.3 0.4 million prescriptions). On multivariate analysis, insurance status, ethnicity, race, age, and sex did not influence the likelihood of an antibiotic being prescribed during the visit (P = .884, .909, .849, .102, and .931 respectively).Most children receiving medical treatment for AOM receive an antibiotic prescription during their visit. Ethnicity, race, and insurance type do not significantly influence antibiotic prescribing rates for AOM, and nearly all patients have medical insurance.

View details for DOI 10.1177/0194599811431228

View details for Web of Science ID 000303546600026

View details for PubMedID 22166962

Hypoglossal schwannoma masquerading as a carotid body tumor. Case reports in otolaryngology Lee, M. K., Sidell, D. R., Mendelsohn, A. H., Blackwell, K. E. 2012; 2012: 842761-?

Abstract

Study Objective. To describe the clinical presentation, evaluation, and treatment of a hypoglossal schwannoma. Methods. We report an unusual case of a hypoglossal schwannoma presenting as a pulsatile level II neck mass at the bifurcation of the external and internal carotid arteries, mimicking a carotid body tumor. Radiologic findings are reviewed in detail. Results. A 59-year-old female presented to a tertiary care medical center with complaints of a pulsatile right-sided neck mass. An MRA of the neck was obtained demonstrating a 5cm mass located at the carotid artery bifurcation and causing splaying of the internal and external carotids. Based on clinical presentation and imaging, a diagnosis of a carotid body tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the carotid artery. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion. Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a parapharyngeal space mass. As this report demonstrates, the clinical and radiologic presentation of a hypoglossal schwannoma may closely mimic that of the more common carotid body tumor.

View details for DOI 10.1155/2012/842761

View details for PubMedID 23213586

Optimal Timing of Surgical Intervention Following Adult Laryngeal Trauma 114th Annual Meeting of the Triological-Society Mendelsohn, A. H., Sidell, D. R., Berke, G. S., St John, M. WILEY-BLACKWELL. 2011: 212227

Abstract

Laryngeal trauma is an infrequent diagnosis with a scarcity of published data. We aim to further define the factors associated with positive surgical outcomes of adult laryngeal trauma.Multi-institution database analysis.Of the 1.9 million trauma cases from the National Trauma Database (NTDB), 564 adult trauma events were selected with ICD-9 codes specific to laryngeal trauma.Laryngeal trauma was seen predominately in white (61.5%), middle-aged (40.6 years), male (83.7%) patients experiencing blunt (70.7%) laryngeal injury with multiorgan system (92.2%) trauma. There was an overall 17.9% mortality rate. Within the 564 cases, 133 direct laryngoscopies, 185 tracheostomies, 53 laryngeal suturing, and 60 laryngeal fracture repairs were performed. In univariate negative binomial regression models, trauma severity (P .01), placement of tracheostomy (P lt; .01), and delayed tracheostomy placement (P = .04, .03, .048) were associated with increased ventilator dependence, intensive care unit (ICU) stay, and overall hospital admission duration. Multivariate regression models demonstrated significant associations between tracheostomy performed within 24 hours and shortened ICU stay (P = .03, = -.28, SE = 1.7) and overall hospital stay (P = .009, = -.23, SE = 3.1).The NTDB allows study of the largest laryngeal trauma cohort in modern literature. Although complexities arise in the treatment of laryngeal traumas, when indicated, surgical airway should be placed within 24 hours of presentation to improve the overall hospital course.

View details for DOI 10.1002/lary.22163

View details for Web of Science ID 000295228800013

View details for PubMedID 21898446

Malignant Phosphaturic Mesenchymal Tumor of the Larynx LARYNGOSCOPE Sidell, D., Lai, C., Bhuta, S., Barnes, L., Chhetri, D. K. 2011; 121 (9): 1860-1863

Abstract

Phosphaturic mesenchymal tumors are rare neoplasms predominantly originating in the trunk and extremities. Malignant variants are exceedingly rare, and can present significant diagnostic challenges to the pathologist and otolaryngologist alike. This report describes the first case of malignant phosphaturic mesenchymal tumor involving the larynx, and emphasizes the importance of vigilance in both histopathologic and clinical actions so that appropriate treatment can be provided in a timely manner. The clinical presentation, radiologic and histologic features, and management are discussed.

View details for DOI 10.1002/lary.21916

View details for Web of Science ID 000294219900009

View details for PubMedID 21721013

CO2 Laser Ablation and Balloon Dilation for Acquired Nasopharyngeal Stenosis: A Novel Technique Annual Combined Sections Meeting of the Triological-Society Sidell, D., Chhetri, D. K. WILEY-BLACKWELL. 2011: 148689

Abstract

Although acquired nasopharyngeal stenosis (NPS) is frequently attributed to infectious and granulomatous processes, it can also occur secondary to external beam radiation therapy for head and neck cancer. NPS can be treated with local flaps, laser excision, nasal stenting, and combinations thereof. Unfortunately, the postoperative course is frequently complicated by scarring and restenosis that often necessitates multiple revision surgeries. The objective of this study is to report a novel endoscopic approach, employing the use of a flexible CO(2) laser in combination with balloon dilation and mitomycin-C application, allowing for the successful treatment of acquired NPS with lasting results.Retrospective review of case series.An endoscope with a working channel is passed transnasally to the location of nasopharyngeal stenosis. A flexible CO(2) laser fiber is then inserted via the working channel of the scope. Precise radial incisions are made on the stenosis using the laser under direct visualization. The laser is removed, and a controlled radial expansion balloon dilation device is inserted, advanced to span the segment of stenosis, and inflated to achieve adequate dilation. Mitomycin-C is then applied topically to the area of dilation.Three patients with severe NPS were treated using this novel technique. All patients had successful long-lasting dilation of NPS without complications over a follow-up period ranging from 12 to 18 months.Acquired NPS can be successfully treated with durable results with radial laser incisions and controlled radial expansion balloon dilation.

View details for DOI 10.1002/lary.21843

View details for Web of Science ID 000292425300026

View details for PubMedID 21647909

Diagnostic Accuracy of Ultrasonography for Midline Neck Masses in Children Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation and OTO EXPO Sidell, D. R., Shapiro, N. L. SAGE PUBLICATIONS LTD. 2011: 43134

Abstract

To evaluate the diagnostic accuracy and to assess the utility of preoperative ultrasonography in the pediatric patient with a midline neck mass.Diagnostic test study.Tertiary care university hospital.An institutional review board (UCLA Office of the Human Research Protection Program)-approved retrospective review of pediatric patients undergoing excision of a midline neck mass between 1999 and 2010 at a tertiary care institution was performed. The preoperative imaging modality, imaging diagnosis, and pathologic results were evaluated.Forty patients were included in this review. This study failed to demonstrate an association between preoperative ultrasound-based diagnoses and postoperative pathologic results (P > .99).Ultrasonography is commonly used in the workup of a midline neck mass in the pediatric population. Despite the utility of preoperative ultrasonography, the diagnostic accuracy of this imaging modality may have significant limitations.

View details for DOI 10.1177/0194599810391743

View details for Web of Science ID 000293997400017

View details for PubMedID 21493208

Spurious decline in intraoperative parathyroid hormone: false positives in parathyroid surgery AMERICAN JOURNAL OF OTOLARYNGOLOGY Sidell, D., Wang, J., Sercarz, J. 2010; 31 (6): 479-481

Abstract

The aims of this study were to (1) describe a false-positive result using a highly sensitive intraoperative parathyroid hormone (PTH) assay in an adult patient with primary hyperparathyroidism and (2) discuss the potential pitfalls of revision parathyroid surgery and the implication of various localization techniques described in the literature.A case report is described from a tertiary care university hospital. A literature review detailing diagnostic tools used to improve outcomes in parathyroid surgery is presented. The potential inaccuracies of intraoperative PTH assays are discussed.We present a 71-year-old woman with primary hyperparathyroidism who was referred to our institution for revision surgery. The patient had preoperative sestamibi imaging that localized a right inferior parathyroid lesion. Intraoperatively, a specimen consistent with parathyroid tissue was removed and sent for frozen section. The intraoperative PTH levels were noted to decrease from 154 pg/mL (preincision) to 28 pg/mL (20 minutes postexcision). The frozen section results were consistent with a lymph node. This stimulated a 4-gland exploration, which confirmed normal left superior and inferior parathyroid glands. A 1.5-cm right retroesophageal parathyroid was subsequently discovered and excised. Final intraoperative PTH levels were 20 pg/mL.Rapid PTH assays have become the mainstay of parathyroid surgery at many institutions; however, despite their accuracy, false-positive results are known to occur. We present a case of an inaccurate decline in intraoperative PTH and use this case report as a means to highlight some potential pitfalls of the test.

View details for DOI 10.1016/j.amjoto.2009.07.003

View details for Web of Science ID 000283977700014

View details for PubMedID 20015796

Unsedated office-based tracheoesophageal puncture using a novel guidewire technique 113th Annual Meeting of the American-Academy-of-Otolaryngology-Head-and-Neck-Surgery-Foundation-and-OTO-EXPO Sidell, D., Ghadiali, M., Chhetri, D. K. SAGE PUBLICATIONS LTD. 2010: 28485

View details for DOI 10.1016/j.otohns.2009.09.030

View details for Web of Science ID 000276574500025

View details for PubMedID 20115990

Improved Tracheoesophageal Prosthesis Sizing in Office-Based Tracheoesophageal Puncture 89th Annual Meeting of the American-Broncho-Esophagological-Association Sidell, D., Shamouelian, D., Erman, A., Gerratt, B. R., Chhetri, D. ANNALS PUBL CO. 2010: 3741

Abstract

Tracheoesophageal puncture (TEP) for postlaryngectomy speech is increasingly being performed as an office-based procedure. We review our experience with office-based TEP and compare outcomes with those of operating room-based TEP. Our hypothesis was that office-based TEP results in improved prosthesis sizing, reducing the number of visits dedicated to prosthesis resizing.A retrospective chart review was performed of all patients who underwent secondary TEP at our institution from 2001 to 2008. The primary dependent measure was the change in the length of the voice prosthesis. We also evaluated the number of visits made to the speech-language pathologist for resizing before a stable prosthesis length was achieved, and the number of days between voice prosthesis placement and the date a stable prosthesis length was observed.Thirty-one patients were included in this study. There was a significant difference in prosthesis length change between patients who had office-based TEP and patients who had operating room-based TEP (p < 0.001). In addition, the office-based cohort required fewer visits to the speech-language pathologist for TEP adjustments before a stable TEP length was achieved (p < 0.001).Voice prosthesis sizing was better in patients who had office-based TEP than in patients who had operating room-based TEP. This outcome is likely due to the lesser degree of swelling of the tracheoesophageal party wall in the office-based procedure.

View details for Web of Science ID 000273680600007

View details for PubMedID 20128185

The Use of Ultrasonic Shears for the Harvest of Perforator Free Flaps ARCHIVES OF FACIAL PLASTIC SURGERY Ahmed, S., Sidell, D., Blackwell, K. E., Sercarz, J. A., Abemayor, E., Nabili, V. 2009; 11 (5): 343-346

Abstract

A retrospective chart review was performed at a university medical center to evaluate the use of ultrasonic shears for the harvest of perforator free flaps over an 18-month period. The anterolateral thigh (ALT) was the perforator free flap site selected for the study. The site of origin and the number of musculocutaneous perforator vessels that were dissected using ultrasonic shears were recorded, and ALT flap viability and wound-healing complications were evaluated to assess safety. Seventeen patients underwent harvest of ALT perforator free flaps. Successful dissection of musculocutaneous perforators was achieved in 96% (27 of 28) of the descending branch perforators and in 100% (9 of 9) of the transverse branch perforators. Flap viability was 100% (17 of 17). We found that ultrasonic shears were effective and safe to use for harvesting perforator free flaps. According to these preliminary findings, the use of ultrasonic shears appears promising, yet further prospective analysis is needed.

View details for Web of Science ID 000270041600011

View details for PubMedID 19797098

Pediatric Squamous Cell Carcinoma: Case Report and Literature Review Annual Meeting of the Western Section of the Triological-Society Sidell, D., Nabili, V., Lai, C., Cheung, G., Kirsch, C., Abemayor, E. JOHN WILEY & SONS INC. 2009: 153841

Abstract

Describe a rare pediatric malignancy. Discuss the clinical, diagnostic, and therapeutic differences between squamous cell carcinoma (SCC) of the adult and pediatric population.Case report including a detailed radiological and histopathologic analysis and review of the literature.A case report is described from a tertiary care university hospital. Histopathologic assessment and radiological details are reviewed. A literature review of the background, incidence, disease course, and treatment options are presented.This case report presents a 6-year-old male with a 2-month history of an enlarging oral lesion. The patient denied dysphagia, pain, weight loss, bleeding, or loosening of the teeth. Biopsy demonstrated invasive, well-differentiated, exophytic squamous cell carcinoma with perineural and angiolymphatic invasion. Computed tomography and magnetic resonance imaging demonstrated a 2.7 x 3.0 cm poorly marginated infiltrative mass involving the gingival aspect of the superior alveolar ridge and the adjacent bony marrow, primarily to the right of midline. Multiple small subcentimeter lymph nodes were also identified in the bilateral level II to V posterior cervical triangles bilaterally.Pediatric SCC of the oral cavity is indeed a rare entity; however, its presence in the pediatric population should not be ignored. This case report describes the occurrence of SCC in the oral cavity of a 6-year-old male patient, the youngest case ever reported, and is a reminder that a multidisciplinary approach tailored to pediatric individuals is essential to obtain clear diagnoses and appropriate treatment plans.

View details for DOI 10.1002/lary.20531

View details for Web of Science ID 000268739500013

View details for PubMedID 19522006

Cystic Lymphatic Malformation of the Middle Ear ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY Tanna, N., Sidell, D., Schwartz, A. M., Schessel, D. A. 2008; 117 (11): 824-826

Abstract

We review the clinical, radiologic, and histopathologic features of cystic lymphangioma of the middle ear, and discuss the developmental etiology and management of such a lesion.We present an unusual location for the development of a cystic lymphangioma with emphasis on etiology, clinical implications, and current treatment.A 10-year-old girl presented with a mass involving the medial surface of the right tympanic membrane. T2-weighted magnetic resonance imaging demonstrated a hyperintense lesion in the anterior-superior middle ear cavity without evidence of vascular abnormalities.To our knowledge, this is the only report of lymphangioma involving the middle ear represented in the English-language literature. Such a lesion has been demonstrated to arise from abnormalities in growth factors that contribute to the tightly regulated process of lymphangiogenesis. Lymphatic malformations can be diagnosed presumptively by virtue of magnetic resonance imaging in combination with a detailed physical examination. The treatment of choice for lymphangiomas located in the middle ear is surgical excision. Definitive diagnosis of the lesion is then made by identifying specific histopathologic characteristics. Although rare and histologically benign, middle ear lymphangiomas may produce significant patient discomfort and ultimately a conductive hearing loss. Therefore, these lesions warrant early recognition and treatment.

View details for Web of Science ID 000261066800005

View details for PubMedID 19102127

Adult intralesional cidofovir therapy for laryngeal papilloma Combined Otolaryngological Spring Meeting Tanna, N., Sidell, D., Joshi, A. S., Bielamowicz, S. A. AMER MEDICAL ASSOC. 2008: 497500

Abstract

To assess the long-term efficacy of intralesional cidofovir therapy in a previously reported cohort of adult subjects with laryngeal papilloma.Retrospective review.Tertiary care medical center.We previously reported on the favorable clinical response to intralesional cidofovir therapy in 13 adult subjects. The subjects were enrolled in an open-trial prospective study (1997-2001) and completed the injection-only treatment protocol, and all subjects achieved a disease remission after a mean of 6 injections. In the present study, we review the clinical course of these subjects during an extended observational period (2001-2006).Patients with documented relapse of disease underwent additional intralesional cidofovir injections.Additional interventions, disease severity, and adverse outcomes are reported.Following the original cidofovir protocol, 6 patients (46%) received no further interventions. The remaining 7 patients (54%) required further treatment for disease relapse, with a mean duration of remission before relapse of 1.05 years. Of the 7 patients who experienced disease relapse, 2 continued to have stable disease with regular injections, 2 were lost to follow-up during relapse treatment, and 3 achieved disease remission again. For this latter cohort, the mean number of injections per year necessary to achieve a second remission was 3.82. This compares with a mean of 1.77 injections per year that these patients received on an as-needed basis prior to the original study.Intralesional cidofovir injections have been shown to be an effective therapy for adult laryngeal papilloma and should be considered in those patients who experience disease relapse.

View details for Web of Science ID 000255905300006

View details for PubMedID 18490570

Adolescent tracheobronchomalacia - Double aortic arches revisited 34th Annual Meeting of the Society-for-Ear-Nose-and-Throat-Advances-in-Children Tanna, N., Joshi, A. S., Sidell, D., Shah, R. K., Preciado, D. A. AMER MEDICAL ASSOC. 2008: 43436

View details for Web of Science ID 000254797000014

View details for PubMedID 18427012

Pathology quiz case 1: Plexiform neurofibroma ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Tanna, N., Joshi, A. S., Sidell, D., Misra, S., Santi, M., Collins, W. O. 2007; 133 (3): 302-?

View details for Web of Science ID 000244935700016

View details for PubMedID 17372092

Tonsillar inclusion cysts in Gorlin's syndrome. Ear, nose, & throat journal Sidell, D., Tanna, N., Preciado, D. 2006; 85 (12): 818-?

View details for PubMedID 17240705