Alex Joseph Fejta Tampio

Objectives: To evaluate histologic changes in middle ear and eustachian tube (ET) mucosa of mice after exposure to tobacco or electronic cigarette (e‐cigarette) smoke. To determine whether there were any mitigating effects of middle ear application of anti‐IL‐13 or the epidermal growth factor receptor antagonist AG1478 on noted changes within ET mucosa.Study Design: Controlled animal study.Methods: Fifty BALB/cJ mice were randomly assigned to one of five groups: A control group with no smoke exposure, two groups exposed to tobacco smoke, and two groups exposed to e‐cigarette vapor. Within the exposed groups after 4 weeks of exposure, one ear was infiltrated with a saline hydrogel and the other ear with hydrogel of either Anti‐IL‐13 or AG1478. After four more weeks of exposure, the animals were euthanized and the ETs were evaluated for mucosal changes.Results: Compared to control animals with no smoke exposure, there were significant decreases in the numbers of goblet cells within the ET mucosa of mice exposed to tobacco smoke and e‐cigarette vapor. No significant differences in cilia, mucin, or squamous metaplasia were noted. Neither anti‐IL‐13 nor AG178 significantly altered goblet cell count in the ET mucosa of mice exposed to tobacco smoke; however, both agents significantly increased goblet cells within the ET mucosa of mice exposed to e‐cigarette vapor.Conclusion: Short‐term tobacco smoke and e‐cigarette vapor significantly decrease goblet cell count in mouse ET mucosa. Middle ear application of both anti‐IL‐13 and AG1478 resulted in an increase in goblet cell count among mice exposed to e‐cigarette vapor, but not to tobacco smoke.Level of Evidence: NA Laryngoscope, 132:648–654, 2022

Objective(s): Climate variables are implied in the pathogenesis of certain otologic diseases, including benign paroxysmal positional vertigo (BPPV). Using internet search data obtained through Google Trends (GT), we explored the relationship between climate patterns and symptom search frequencies for BPPV. We hypothesized that increased latitude, as a proxy for decreased sunlight exposure, would lead to increase in BPPV symptom searches.Methods: GT searches for symptoms related to BPPV were obtained for five U.S. cities of different latitudes via the Google Trends online interface. Comparisons were made using SPSS via ANOVA analysis. Figures were made using Microsoft Excel.Results: Searches for BPPV‐related symptoms increased with increasing latitude. BPPV‐related symptoms did show seasonal variations, but not in predictable manners.Conclusion(s): GT may be a viable research tool when comparing geographical differences in searches, but may be less sensitive in detecting time dependent changes. We offer suggestions as to how big data tools may be altered for research purposes.Level of Evidence: NA.

Objectives: Present the case of a 67-year-old male with stage IV malignant melanoma who presented with uveitis and sensorineural hearing loss (SNHL) while on nivolumab and review the literature for likely etiologies. Methods: A retrospective case review was conducted. The current literature was accessed to inquire about possible pathologic mechanisms and treatment options. Results: A 67-year-old male with stage IV malignant melanoma was treated with nivolumab. During therapy, the patient presented with bilateral uveitis, vertigo, and bilateral moderate sloping to moderate–severe SNHL. After 4 cycles of nivolumab, restaging scans showed no evidence of disease. Nivolumab was discontinued. The patient was placed on a 3-week course of systemic high dose steroids and topical steroid eye drops. Both his uveitis and SNHL resolved after treatment. Nivolumab enhances the antitumor activity of T cells by inhibiting the programed death-1 receptor. While nivolumab has shown great promise in the treatment of many types of cancers, it has also been associated with many autoimmune side effects. We propose the etiology of this 67-year-old male’s SNHL and uveitis are the result of an autoimmune process secondary to an augmented T cell response induced by nivolumab. Conclusion: While immunotherapeutic agents such as nivolumab have shown great promise in the treatment of cancer, one should maintain an awareness and caution of autoimmune side effects such as uveitis and SNHL.

Objective Review the safety, efficacy and cost of robot-assisted sialolithotomy with sialoendoscopy (RASS) for large submandibular gland hilar sialoliths. Study Design Retrospective case series. Methods Patients ≥18 years diagnosed with submandibular hilar sialolithiasis between 1/1/2015 and 7/31/2018 who underwent RASS were identified. Procedure success, post-operative complications, procedure duration, and costs associated with the procedure were reviewed. Results 33 patients fit inclusion criteria. 94% of patients had successful sialolith removal. Mean sialolith size was 8.9 mm. 15.1% had transient tongue paresthesia. 0% had permanent tongue paresthesia compared to a 2% rate of lingual nerve damage cited in the literature for combined approach sialolithotomy (CAS). The average total cost was $16,921. Insurance paid 100%, 90–99%, 70–89.9%, and 40–69.9% of the expected reimbursement in 43.8%, 18.7%, 18.7% and 12.5% of patients respectively. 6% of patients self-paid. Compared to CAS, the cost of reusable robotic arms and drapes totaled $475, though these costs were included in the standardized operative cost per minute and were not forwarded to the patient. The mean procedure time was 62 minutes. Compared to published mean procedure times for CAS, the reduced operative time may account for a savings of $3332–$6069. Conclusion RASS is a safe modality for submandibular hilar sialolith removal with a high success rate, low risk for temporary tongue paresthesia, and lower rate of permeant lingual nerve damage compared to CAS. Compared with CAS, RASS may result in a net reduction of operative room costs given its shorter procedure time.