2023 Annual Clinical Assembly Poster Competition- Otolaryngology Entries

I am a third year medical student at California Health Science University. I have an interest in otolaryngology and hope to apply during the 2024 application cycle.

View Abstract Tracheomalacia (TM) is a common finding within the pediatric population due to developing, weak cartilage and shorter trachea. However, such a presentation is rare in the adult population who have fully developed cartilages. Most cases of TM are expiratory. Indicating excessive trachea narrowing when intrathoracic pressure is substantially greater than intraluminal pressure, as it is during forced expiration, cough, or the Valsalva maneuver. Tracheomalacia in the adult population is typically due to an acquired injury or chronic lung disease. Intubation injuries, chronic compression due to goiter or recurrent infections are also common causes of adult-TM. In this article we present a case of TM in a 67-year-old man with no direct identifiable cause presenting with of dyspnea and stridor.

Olivia Matz, OMS IV, MSA is a 3rd year medical student at Des Moines University College of Osteopathic Medicine in Des Moines, IA. She graduated from Briar Cliff University in 2019 with a BS in Biology and BA in Spanish. While pursuing her DO degree, she completed her Masters in Anatomy in 2021. In 2022-2023, she was chosen for a pre-graduate osteopathic fellowship at Des Moines University and currently maintains that role before going onto her final year of medical school.

View Abstract The sphenopalatine (pterygopalatine) ganglion is the most superficial ganglia to manipulate from the oral cavity. It has parasympathetic and sensory fibers directly affecting the paranasal sinuses and can be manipulated by providers using manual osteopathic techniques to relieve congestion associated with sinusitis, allergies, and upper respiratory infections. In traditional dissections, this ganglion is found from a deep to superficial approach through bisection of the head with challenges the understanding of its osteopathic relevance. By performing a superficial to deep dissection of the face, we were not only able to find the ganglion but were able to further appreciate the orientation and depth to allow for providers to more accurately and efficiently manipulate the sphenopalatine ganglion.

3rd year medical student at Ohio University Heritage College of Osteopathic Medicine

View Abstract This is a case report detailing the presentation of a rare anterior nasal schwannoma. This patient was a 65-year-old female that presented with an enlarging mass in her left nasal cavity that had been causing her obstructive nasal symptoms for the past 3 months. Histologic examination of the mass upon excision supported the diagnosis of a nasal schwannoma- a rare, benign sinonasal neoplasm.

Lauren Poplaski is an OMS-III at the University of New England College of Osteopathic Medicine, currently completing her core clinical rotations at Northern Light Eastern Maine Medical Center in Bangor, ME. She graduated from Villanova University with a Bachelor of Science in Neuroscience, and a minor in Psychology. Before medical school, she worked for the Rhode Island Department of Health and Rhode Island Hospital on several research projects for opioid overdose prevention and addiction medicine. At the University of New England, Student Doctor Lauren Poplaski is a member of the Sigma Sigma Phi honors fraternity, served as a representative of the Student Government Association and as chair for a variety of philanthropic organizations on campus, including Alex’s Lemonade Stand Foundation for childhood cancer. Last year she completed an otolaryngology elective rotation with Dr. Mark Andreozzi, DO at The Sinus Institute of Rhode Island, a division of ENT & Allergy Inc., which solidified her decision to pursue a residency in otolaryngology. She continues to be involved in research during her medical training, with topics ranging from neurobiological theories of schizophrenia to the treatment of rare histiocytic disease of the head and neck.

View Abstract Sinonasal Rosai-Dorfman Disease (RDD), refractory to multiple treatment modalities including more than a half-dozen debulking surgeries. Remarkable improvement on partial course of MEK inhibitor cobimetinib.

Anitha Kunnath is a third-year medical student at the Lake Erie College of Osteopathic Medicine (Bradenton Campus). Her passion for medicine has led her to pursue a career as a full-spectrum family medicine physician, with a special focus on serving rural and underserved communities. In her free time, she enjoys creating 3-D printed medical artwork and kayaking.

View Abstract The article discusses the autoimmune component of Ménière's disease (MD), which is an inner ear disorder characterized by vertigo, hearing loss, and tinnitus. The study investigates the association between MD and specific Human Leukocyte Antigen (HLA) alleles, which are genes that encode Major Histocompatibility Complex (MHC) proteins involved in immunity and detection of malignancies. The systematic review analyzed 11 studies between 1998 and 2018 that met inclusion criteria and assessed 790 patient alleles and 3,229 control alleles. The results showed that the presence of HLA-DR11 conferred increased odds of developing MD, while the presence of HLA-DR13 conferred decreased odds. Future research should focus on investigating combined haplotypes and HLA class III genes.

Ryan Witcher is a current LECOM Bradenton OMS-III with aspirations towards otolaryngology during the 2023-2024 application cycle. He has a interest in clinical research, retrospective studies, as well as genetic meta-analysis with a focus on allergy as well as pediatric otolaryngology. Ryan is a current Lake Erie College of Osteopathic Medicine third year medical student, and has a bachelors from UCF where he studied biomedical sciences. Aside from medicine, he enjoys cooking, paddle boarding, and physical fitness.

View Abstract Nasogastric tube (NGT) insertion is a common medical procedure with potential complications including accidental placement, leading to rare but significant outcomes. One of these complications is iatrogenic NGT pneumocephalus, where the tube enters the cranial cavity. While this is usually due to trauma, it can also occur during surgery. This case report describes a non-traumatic conscious NGT skull base injury leading to pneumocephalus, and its subsequent repair. NGT placement can cause a range of complications, including epistaxis, esophageal perforation, esophagitis, pulmonary hemorrhage, and pneumocephalus. Proper technique and understanding of techniques to minimize susceptibility of the cribriform plate after sinonasal surgery are crucial to the prevention of these adverse outcomes.

My name is Sugosh M. Anur, 3rd year medical student at Rowan University School of Osteopathic Medicine. I was born in Bangalore, India and moved to Parsippany, New Jersey when I was 6 months old. I grew up in an academic-focused household with my mother, father, grandmother, and younger sister. My father, mechanical engineer by training, and mother, accounting by training, had always stressed the importance of education and well-roundedness to my sister and me. Growing up, I represented my hometown’s soccer team for 15 years by playing at the travel and intramural level as a right midfielder. Music began to interest me, and although I had learned to play the Trumpet, I transitioned into exploring music through dance. I trained at the Denville Dance Arts Center in Hip-Hop dance, where I performed at festivals with my dance team. Attending a health care academy high school, I was exposed to the human anatomy and dissections, which caught my interest. I pursued these interests in college, where I attended New Jersey Institute of Technology in Newark New Jersey. I played soccer at the recreation level and danced for the Rutgers Bollywood Fusion Ehsaas Dance team, competing at national circuits. I graduated in 2020 with a Bachelor of Science in Biomedical Engineering (Biomaterial Specialization) and Biology minor. The hands-on learning in college fostered my interest in surgery and motivated me to pursue a medical education. In my first year of medical school, though I enjoyed learning the entire human anatomy, I found myself diving deeper into the intricate structures of the head and neck. During my third-year clinical rotations, I learned that I enjoyed not only being in the operating room, but also in the clinic setting providing medical management to patients. Shadowing a rhinologist, otologist/neurologist, and endocrine specialist broadened my exposure to Otolaryngology and confirmed my passion to pursue this field.

View Abstract Platelet-rich plasma injection has been studied to promote wound healing postoperatively. The effect of preoperative platelet values in patients undergoing laryngectomy to assess its effect on complications has not been reported. This poster displays the association between normal, elevated, and decreased platelet levels and patient demographics, comorbidities, and complications following laryngectomy procedure. Platelet values were associated with comorbidities like ventilator support, dyspnea, and obesity. Complication association included acute renal failure, wound disruption, bleeding transfusion, and infection. Patients with thrombocytosis had a longer operative time. Adjusting for confounding variables significant association existed between thrombocytosis and postoperative complication, specifically stroke, bleeding transfusion, infection, and length of stay.

My name is Jordan Higgs. I graduated from Brigham Young University Provo with a bachelor's degree in exercise science. I am an OMS III student at Rocky Vista University College of Osteopathic Medicine-Southern Utah. The opportunity to receive my medical education and training is humbling and fulfilling. I am passionate about surgery and the field of otolaryngology and look forward to continuing my education. My interests when I am not involved with studying for school or pursuing school-related opportunities are spending time with my wife and baby, art, and playing disc golf.

View Abstract Introduction Hereditary angioedema (HAE) with C1q deficiency is a rare hereditary condition characterized by repeated attacks of angioedema. This condition most frequently affects the skin or mucosal tissues of the upper respiratory and gastrointestinal tracts. HAE can be associated with lymphoproliferative disorders such as splenic marginal zone non-Hodgkin’s lymphoma and should be considered in the differential for patients with recurrent attacks of angioedema or abdominal pain that is unresponsive to treatment. HAE is underdiagnosed and continued research and education on diagnosis and management of the disease are warranted. Case Presentation A 71-year-old woman presented to the ED with a complaint of abdominal pain. Her symptoms included cramping, constipation, diarrhea, nausea, and severe vomiting. The patient’s previous medical history consists of splenic marginal zone non-Hodgkin’s lymphoma, treated successfully with chemotherapy; common variable immunodeficiency with ongoing IVIG treatment; positive anticardiolipin antibody testing with daily 81 mg of aspirin and no current thrombotic events. Subsequent diagnostic testing results indicated a diagnosis of late-onset C1q hereditary deficiency angioedema was made. Discussion HAE due to acquired C1-INH deficiency is difficult to identify and is most commonly diagnosed after many years of recurring attacks. Currently, HAE treatment relies on short- and long-term prevention and treatment for acute attacks. The goal of HAE therapy is to reduce the frequency and severity of angioedema and improve patient quality of life. Due to the variable clinical presentation and severity of the disease, if untreated, it is essential to recognize and initiate appropriate treatment for HAE.

Olivia Matz, OMS IV, MSA is a 3rd year medical student at Des Moines University College of Osteopathic Medicine in Des Moines, IA. She graduated from Briar Cliff University in 2019 with a BS in Biology and BA in Spanish. While pursuing her DO degree, she completed her Masters in Anatomy in 2021. In 2022-2023, she was chosen for a pre-graduate osteopathic fellowship at Des Moines University and currently maintains that role before going onto her final year of medical school.

View Abstract Vertigo is a symptom of illusory movement with a wide range of etiologies that can be as diverse as the patients it affects. The wide spectrum of etiologies can make a diagnosis difficult and therefore delay definitive treatment. To highlight the importance of investigating for somatic dysfunctions related to a patient’s presentation of vertigo and emphasize the value of critical thinking within the osteopathic framework to treat a patient, we saw a 73-year-old female presenting with a long-standing history of vertigo, Eustachian tube dysfunction, and a current feeling of fullness and ringing in her ears. We were able to use the Galbreath maneuver for the patient in this case study, which is classically described for otitis media, with the goal to enhance the impaired eustachian tube function. Considering the immediate improvement, the Galbreath maneuver may be considered as an adjunctive therapy to the current treatment regimen for dysfunctions of the eustachian tube.

View Abstract A prospective study comparing flap outcomes to size of vessels utilized for microvascular anastomosis. We showed a trend that smaller arteries used in free flap microvascular anastomosis increase the likelihood of flap failure. Also, we showed a trend that when recipient and donor arteries used for microvascular reconstruction had a greater disparity in size, the flap had a greater risk of failure. None of these findings were statistically significant due to small sample size.

Kilee was born and raised in Connecticut, received her B.S. magna cum laude in Biochemistry, Mathematics and Environmental Science from Fairfield University and D.O. from Liberty University School of Medicine, graduating in the top 10% of her class. She is currently completing her post-graduate Otolaryngology training at Bons Secour Mercy Health St. Elizabeth Boardman Hospital. She is an active member of the hospital on multiple committees and is a representative for her residency program for the Academy Osteopathic Colleges of Ophthalmology and Otolaryngology Head and Neck Surgery as well as the alternate delegate for the AAOHNS-ACS division. Kilee and her husband enjoy hiking, skiing and playing tennis in their free time.

View Abstract We present an interesting case of a young male with multiple month history of oral cavity lesion and enlarging neck mass. Work up included incisional biopsy and CT neck with contrast. The CT scan showed ~3cm left level IIA neck mass, bilateral lymphadenopathy and inflammatory changes over left lower lip. Biopsy showed spirochetes consistent with oral syphilis. Once asked about sexual history, it was confirmed the patient participated in unprotected sexual behaviors. This case is unique in the fact that syphilis is a rare entity especially with presentation in the oral cavity. Sexually transmitted diseases in the head and neck are not often thought of and should remain on the differential.

PGY-5 PCOM Otolaryngology Program

View Abstract Case presentation describing unusual presentation and clinical course of a case of acute epiglottitis.

Kathryn L. Collins received her D.O. from the New York Institute of Technology College of Osteopathic Medicine. She completed an internship in General Surgery at Nassau University Medical Center, a Level 1 trauma center, in Long Island, New York. She is currently an PGY-3 Otolaryngology resident at OhioHealth in Columbus Ohio. Dr. Collins area of research includes olfaction disorders and dysphagia.

View Abstract This poster will show that use of intranasal corticosteroids prior to and at time of COVID-19 diagnosis did not decrease the rate of hyposmia or anosmia as a presenting symptom. However, patients who were on a topical steroid at the time of COVID-19 diagnosis only suffered from mild symptoms. Therefore, using a nasal corticosteroid spray prior to becoming infected with COVID-19 may reduce the severity of viral symptoms overall.

View Abstract Rare type carcinoma affecting nasopharynx and its management

Carter Denne DO, MS is a PGY 5 at the UPMC-Hamot Otolaryngology program. Following graduation, he will join the Bayfront ENT group located in Erie, PA. He has an undergraduate degree in sport sciences from Gannon University. He also has a master's degree in exercise science from Wake Forest University. He has a passion for health, fitness, and medicine.

View Abstract Noise exposure is a known cause of hearing loss and regulations have been set forth to protect the hearing of workers exposed to loud noise. Not only are individuals exposed to sound during work but also during recreational activity. There is limited research pertaining to the noise exposure experienced when performing weightlifting. ​This study is an attempt to quantify the noise produced during two common weightlifting activities. The findings of this study could impact the way in which athletes approach hearing protection during training.

Christine Evans recently graduated from Michigan State University where she earned her physiology degree. She assisted in the investigation of intra-tumoral sensory nerves and tumor-released small extracellular vesicles as they relate to cancer pain and had a supporting role in various other projects in the lab. She will continue her education at Michigan State University College of Osteopathic Medicine.

View Abstract This poster demonstrates the relevance of research performed to help head and neck cancer patients. It documents the methods used (Von Frey and Mouse Grimace Scale) to test the hypothesis that cancer-derived sEVs communicate with neurons and contribute to pain. The conclusions drawn from the data indicate that sEVs have a mediating role and therefore appear as new therapeutic targets for cancer pain.

Originally from Venezuela, Roberto moved to the United States at seventeen to pursue medicine. He attended the University of Mississippi for his undergraduate studies. He attended Ohio University Heritage College of Osteopathic Medicine for medical school. He took a research year within the Department of Otolaryngology and Biomedical Engineering at UC Davis. There he researched a new technology to delineate cancer margins called fluorescence lifetime imaging microscopy. He now serves as a first year otolaryngology resident at OhioHealth and lives in Columbus with his wife and daughter.

View Abstract This case report delves into a rare case of laryngeal myxedema due to severe hypothyroidism with longstanding subglottic edema. This is the first report published in the literature of longstanding subglottic edema due to severe hypothyroidism. This poster will illustrate the progression of our patients hospital course and ultimate resolution of symptoms after months of support and thyroid medication.

McLaren Oakland Otolaryngology Head and Neck Surgery Resident

View Abstract A 46-year-old male presented to an outside emergency department with five days of progressively worsening diplopia and nasal congestion. Ophthalmology evaluation noted right papilledema and follow up computed tomography (CT) and magnetic resonance imaging (MRI) revealed an expansile mass of the right nasal cavity involving the bilateral ethmoid sinuses and bilateral sphenoid sinuses with orbital apex involvement and planum sphenoidale erosion. No intracranial extension was noted. Endoscopic biopsy revealed alveolar rhabdomyosarcoma (RMS). The patient was presented at a multidisciplinary tumor board as a T2a RMS of the ethmoid sinus. Tumor board recommendation was for neoadjuvant induction chemotherapy followed by definitive resection followed by adjuvant chemotherapy and radiation. The patient had a significant clinical and radiographic response to induction chemotherapy. He underwent definitive endoscopic resection including an orbital/optic nerve decompression and extended pterygopalatine fossa dissection to obtain negative frozen section margins along the sphenoid and ethmoid skull base, periorbita, pterygopalatine fossa (PPF), and optic nerve sheath. Final pathology did unexpectedly reveal microscopic disease along the optic nerve sheath. The patient is currently one year out from completion of concurrent adjuvant chemotherapy and proton beam radiation therapy with intact vision and without radiologic or clinic evidence of disease recurrence.

PGY-4

PGY-4

View Abstract We created a cross-sectional observational study (survey) regarding utilization, location, and complications of frontal sinus balloon sinuplasty and sent it to the ENT members of the AOCOO-HNS. We characterized geographic utilization along with the operative setting. We found the most common adverse events in frontal sinus BSP are epistaxis with intranasal packing, headache, synechiae, ABRS, tooth/facial numbness, orbital complications, and skull base complications. We also report the first incidence of an inadvertent sphenopalatine fossa dilation as an adverse event in BSP. This is a pilot study, and we plan to expand this survey to other ENT societies worldwide.

I am a 4th year ENT resident at Beaumont Hospital.

View Abstract The objective of this study was to assess the perioperative morbidity, immediate recovery, and postoperative complications associated with an opioid and opioid-free anesthetic and analgesic protocol for pediatric tonsillectomy patients. This was a retrospective chart review comparing perioperative experiences of pediatric tonsillectomy patients who received narcotic pain medications (opioid group) with patients who did not receive narcotic pain medication (non-opioid group). A total of 75 patients were enrolled in this study, 36 in the opioid group and 39 in the opioid-free group. There were no statistically significant difference in average pain scores, postoperative complications, or oral intake in the PACU. The non-opioid group appeared to have enhanced recovery and were discharge from the PACU sooner, although, this was not statistically significant. This study showed that an opioid-free perioperative protocol for pediatric tonsillectomy patients was feasible and due to the known risks of opioid-induced respiratory depression, nausea, vomiting, and overdose, a non-opioid protocol for anesthesia and analgesia may be better suited for this population.

5th year Otolaryngology - Head & Neck Surgery resident at Grandview Medical Center in Dayton, OH. Attended undergraduate at Capital University in Columbus, OH and graduated from Ohio University Heritage College of Osteopathic Medicine in 2018.

Hypoglossal nerve stimulator implantation is a rapidly growing modality for treatment of obstructive sleep apnea in patients who fail CPAP. In order to be a candidate for a hypoglossal nerve stimulator implant patients must satisfy the following criteria: be 18 years of age or older, have an apnea-hypopnea index (AHI) of 15-65 (moderate to severe obstructive sleep apnea), BMI <32, have trialed CPAP, and have undergone a drug induced sleep endoscopy to rule out complete concentric collapse at the velopharynx. Hypoglossal nerve stimulator implantation has shown promising results in patients who have failed CPAP, however, in the adult patient population airway obstruction during sleep can occur at multiple levels, and patients who undergo hypoglossal nerve stimulator implantation can have varying degrees of reduction in their AHI following surgery. In this retrospective chart review, we sought to investigate whether patients who have undergone nasal airway procedures for nasal obstructive symptoms have shown any additional improvement in their post-operative AHI and implant settings following hypoglossal nerve stimulator implantation compared to those who underwent hypoglossal nerve stimulator implantation alone.