Browsing by Author "Alwani, Mohamedkazim"

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    Audiologic Improvement Following MCF Approach for Spontaneous Cerebrospinal Fluid Leaks
    (Wolters Kluwer, 2019-09) Alwani, Mohamedkazim; Bandali, Elhaam; Van Buren, Lauren; Yates, Charles; Nelson, Rick; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To determine the audiologic improvement after middle cranial fossa (MCF) approach to repair spontaneous cerebrospinal fluid (sCSF) leaks. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Twenty-four consecutive patients (27 ears) with temporal bone sCSF leak over a 4-year period. Patient age, sex, ethnicity, body mass index (BMI), location of CSF leak, recurrence of CSF leak, and presence of encephalocele(s) were recorded. Intervention: Audiometric testing in patients undergoing MCF repair of temporal bone sCSF leak. Main Outcome Measures: Comparison of preoperative and postoperative pure-tone average (PTA), air-bone gap (ABG), and word recognition score (WRS) in the sCSF leak ear. Results: Out of 27 ears, 55% had multiple tegmen defects and 82% had more than or equal to 1 encephaloceles. There were no recurrent CSF leaks at a median follow up of 4 months. The mean (SD) preoperative PTA and ABG were 40.58 [15.67] and 16.44 [6.93] dB, respectively. There was significant improvement in mean PTA (10.28 [8.01] dB; p < 0.001; Cohen d = 0.95) and ABG (9.31 [7.16] dB; p < 0.001; Cohen d = 0.88) after sCSF repair. Mean WRS improved (by 3.07 [6.11] %; p = 0.024; Cohen d = 0.46) from a mean preoperative WRS of 93.16 [9.34]% to a mean postoperative WRS of 96.26 [6.49]%. Conclusions: MCF approach for repair of sCSF leaks yields significant improvement in conductive hearing loss and is highly effective in management of the entire lateral skull base where multiple bony defects are often identified.
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    Facing Facts: Facial Injuries from Stand-up Electric Scooters
    (ACOG, 2020-01-15) Alwani, Mohamedkazim; Jones, Alexander J.; Sandelski, Morgan; Bandali, Elhaam; Lancaster, Benjamin; Sim, Michael W.; Shipchandler, Taha; Ting, Jonathan; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Background Stand-up electric scooters (SES) are a popular public transportation method. Numerous safety concerns have arisen since their recent introduction. Methods A retrospective chart review was performed to identify patients presenting to the emergency departments in Indianapolis, who sustained SES-related injuries. Results A total of 89 patients were included in our study. The average patient age was 29 ± 12.9 years in a predominantly male cohort (65.2%). No patient was documented as wearing a helmet during the event of injury. Alcohol intoxication was noted in 14.6% of accidents. Falling constituted the leading trauma mechanism (46.1%). Injuries were most common on Saturday (24.7%) from 14h00 to 21h59 (55.1%). Injury types included: abrasions/contusions (33.7%), fractures (31.5%), lacerations (27.0%), or joint injuries (18.0%). The head and neck region (H&N) was the most frequently affected site (42.7%). Operative management under general anesthesia was necessary for 13.5% of injuries. Nonoperative management primarily included conservative orthopedic care (34.8%), pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) (34.8%) and/or opioids (4.5%), bedside laceration repairs (27.0%), and wound dressing (10.1%). Individuals sustaining head and neck injuries were more likely to be older (33.8 vs. 25.7 years, p=0.003), intoxicated by alcohol (29.0% vs. 3.9%, p=0.002), and requiring CT imaging (60.5% vs. 9.8%, p <0.001). Conclusion Although SESs provide a convenient transportation modality, unregulated use raises significant safety concerns. More data need to be collected to guide future safety regulations.
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    Head and Neck Juxtacortical Chondrosarcoma: A Systematic Review
    (SciTeMed, 2019-03) Jones, Alexander Joseph; Alwani, Mohamedkazim; Summerlin, Don-John; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To present a case and systematically evaluate trends in clinical presentation, imaging, histopathology, and management modalities and outcomes of all head and neck juxtacortical chondrosarcoma (HNJCS) cases reported in the existing literature. Methods: We describe a rare case of HNJCS from our tertiary referral center following which the PubMed, MEDLINE, Embase, and Web of Science databases were searched for all HNJCS reports. Relevant titles and abstracts were screened. Resulting full-text articles were assessed for eligibility, and remaining studies were included for data extraction, summarization, and analysis. Results: Potential studies were identified dating from May 1946 to February 2019. A total of nine cases were included in our systematic review, eight of which were identified from full-text articles and one recruited from our tertiary referral center. The median presentation age was 41 years with a 66.7% male preponderance. The commonest presenting sign was a painless, isolated swelling after a median symptom duration of 2.5 months. CT imaging revealed hypodense lesions with peripheral enhancement and micro-calcifications. T1-weighted MRI showed hypo- to iso-intense, lobulated masses with peripheral and/or septal enhancement. The masses were diffusely hyper-intense on T2-weighted MRI. Histopathology demonstrated septated lobules of malignant hyaline cartilage with a peripheral fibrous capsule. Most tumors were low- or intermediate-grade tumors with average diameter of 4.3 cm. Local recurrence was identified in only one case (four years after initial resection). No distal and/or nodal metastases were identified. All tumors were managed by wide- or narrow-margin surgical excision. Two reports employed adjuvant treatment. There was no evidence of disease at final follow-up (median of 1.5 years). Conclusion: To the best of our knowledge, only nine cases of HNJCS have been adequately described. HNJCS have relatively consistent clinical and diagnostic profile regardless of location in the body. Surgical management yields excellent outcomes with low recurrence rates.
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    Low Misrepresentation Rates of Scholarly Work in Otolaryngology-Head and Neck Surgery Residency Applications
    (Cureus, 2020-02) Alwani, Mohamedkazim; Sandelski, Morgan; Van Buren, Lauren; Bandali, Elhaam; Ting, Jonathan; Shipchandler, Taha; Illing, Elisa A.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objectives To evaluate research trends, including rates of misrepresentation of scholarly work, in otolaryngology residency applications received by a single institution during the 2018-2019 residency application cycle. Methods After obtaining Institutional Review Board approval, all residency applications to the Department of Otolaryngology-Head and Neck Surgery at Indiana University School of Medicine, Indianapolis, IN for the 2018-2019 cycle were de-identified and analyzed. Demographic and research information including the number of listed peer-reviewed articles/abstracts, types of research projects, and misrepresentations were retrospectively evaluated. Results Our institution received 321 applications, which represented 69.5% of the entire 2018-2019 otolaryngology applicant pool. The average United States Medical Licensing Examination (USMLE) Step 1 score was 246 ±12.4. There were 203 (62.2%) applicants who reported 591 published citations with 20 (6.2%) applicants misrepresenting 26 items (4.4%). Applicants who misrepresented research output had lower average Step 1 scores (237.4 vs 246.4, p: <0.05). Self-promotion to higher authorship status was the most common form of misrepresentation (61.5%). Conclusions The role of scholarly work in stratifying applicants continues to expand. Although a competitive application climate motivates a minority of applicants to misrepresent scholarly work, rates of misrepresentation in otolaryngology applications are low and continue to decline. The level of evidence assigned to this study is III.
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    Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery
    (Wiley, 2021-04) Jones, Alexander Joseph; Campiti, Vincent J.; Alwani, Mohamedkazim; Novinger, Leah J.; Tucker, Brady Jay; Bonetto, Andrea; Yesensky, Jessica A.; Sim, Michael W.; Moore, Michael G.; Mantravadi, Avinash V.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR). Methods: A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm2/m2), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion. Results: Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age (P = .035), more frequent alcoholism (P = .028) and sarcopenia (P < .001), greater mCCI (P < .001), lower preoperative hemoglobin (P < .001), reconstruction with flaps other than forearm (P = .003), and greater operative times (P = .001), intravenous fluids (P < .001), and estimated blood loss (EBL, P < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P < .001). Multivariate regression determined sarcopenia (P = .023), mCCI (P = .013), preoperative hemoglobin (P = .002), operative time (P = .036), and EBL (P < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin (P = .007), osseous flap (P = .036), and CD ≥ 3 (P < .001). A perioperative transfusion was predicted by sarcopenia (P = .021), preoperative hemoglobin (P < .001), operative time (P = .008), and CD ≥ 3 (P = .018). Conclusion: Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios.
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    Telemedicine in Otolaryngology During COVID-19: An Exploratory Assessment of Provider and Patient Attitudes
    (Sage, 2023) Alwani, Mohamedkazim; Campiti, Vincent; Nesemeier, Ryan; Vernon, Dominic; Shipchandler, Taha; Ting, Jonathan; Parker, Noah; Otolaryngology -- Head and Neck Surgery, School of Medicine
    Objective: To determine provider and patient attitudes toward telemedicine in Otolaryngology-Head and Neck Surgery (OHNS). Methods: Otolaryngology practitioners conducting outpatient clinics at an academic tertiary referral center were provided with a pre-Study Provider Perception Questionnaire (pre-PPQ) designed to evaluate pre-study perception of telemedicine in otolaryngology. A post-study Provider Perception Questionnaire (post-PPQ) designed to evaluate elements similar to those constituting the PrePPQ was completed at 6 weeks. Additionally, following each visit, providers and patients completed Individual Encounter Survey Questionnaires (IESQ) to evaluate the virtual clinical encounter experience. Results: The pre-PPQ was completed by 29 providers, while the post-PPQ was completed by 12 providers. A total of 236 post-visit provider IESQs were completed, of which 208 were deemed successful. Audio/visual (AV) difficulties and limited server connectivity for the patient were most common causes for unsuccessful encounters. Providers reported that the most appropriate use of telemedicine, on both pre-PPQ and post-PPQ, was triaging patients to determine the need for in-person visits. The inability to perform a physical exam was rated as the primary barrier to telemedicine in OHNS on both pre-PPQ and post-PPQ. Patients strongly agreed with the statements, "My healthcare provider was able to understand my healthcare condition" and, "I felt comfortable communicating with my healthcare provider" 92.0% and 95.4% of the time, respectively. Conclusion: Both providers and patients demonstrated an overall positive attitude toward the use of telemedicine in the provision of otolaryngologic care.