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Article ; Online: Tracheostomy time-out: New safety tool in the setting of COVID-19.

Dharmarajan, Harish / Snyderman, Carl H

2020 Volume 42, Issue 7, Page(s) 1397–1402

Abstract: Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks when approaching a surgical airway. To standardize ... ...

Abstract	Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time-out applicable to all patients including those suspected of having COVID-19. The aim of the tracheostomy time-out is to reduce preventable errors that may increase the risk of transmission of SARS-CoV-2.
MeSH term(s)	COVID-19 ; Clinical Decision-Making ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Critical Care/methods ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Male ; Occupational Health ; Pandemics/prevention & control ; Pandemics/statistics & numerical data ; Patient Selection ; Personal Protective Equipment/statistics & numerical data ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Risk Assessment ; Severe Acute Respiratory Syndrome/epidemiology ; Severe Acute Respiratory Syndrome/therapy ; Surveys and Questionnaires ; Time Out, Healthcare/statistics & numerical data ; Tracheostomy/methods ; United States
Keywords	covid19
Language	English
Publishing date	2020-05-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	645165-2
ISSN	1097-0347 ; 0148-6403 ; 1043-3074
ISSN (online)	1097-0347
ISSN	0148-6403 ; 1043-3074
DOI	10.1002/hed.26253
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Article ; Online: Tracheostomy time‐out

Dharmarajan, Harish / Snyderman, Carl H.

Head & Neck

New safety tool in the setting of COVID ‐19

2020 Volume 42, Issue 7, Page(s) 1397–1402

Keywords	Otorhinolaryngology ; covid19
Language	English
Publisher	Wiley
Publishing country	us
Document type	Article ; Online
ISSN	1043-3074
DOI	10.1002/hed.26253
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Outcomes of dupilumab treatment versus endoscopic sinus surgery for chronic rhinosinusitis with nasal polyps.

Dharmarajan, Harish / Falade, Oluleke / Lee, Stella E / Wang, Eric W

International forum of allergy & rhinology

2022 Volume 12, Issue 8, Page(s) 986–995

Abstract: Background: Outside of SINUS-24 (A Controlled Clinical Study of Dupilumab in Patients With Bilateral Nasal Polyps) and SINUS-52 (Controlled Clinical Study of Dupilumab in Patients With Nasal Polyps), there are limited data on the efficacy of dupilumab ... ...

Abstract	Background: Outside of SINUS-24 (A Controlled Clinical Study of Dupilumab in Patients With Bilateral Nasal Polyps) and SINUS-52 (Controlled Clinical Study of Dupilumab in Patients With Nasal Polyps), there are limited data on the efficacy of dupilumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). The objective was to compare dupilumab with functional endoscopic sinus surgery (FESS) in patients with CRSwNP by assessing the change in nasal polyp and Sino-Nasal Outcome Test (SNOT-22) scores postintervention. Methods: A retrospective matched cohort study compared 54 patients who had CRSwNP treated with dupilumab with 54 patients who had CRSwNP treated with FESS; both cohorts were treated with topical corticosteroids. The primary end points were change in nasal polyp score and overall SNOT-22 score. Secondary end points were change in SNOT-22 domain scores and SNOT-22 olfaction score. Results: Patients who underwent FESS had a greater improvement in nasal polyp score (5.18 ± 2.01) compared with patients treated with dupilumab (4.27 ± 1.98, p = 0.02). There was no significant difference in terms of the change in overall SNOT-22 score. Patients treated with dupilumab had greater improvement in the extranasal rhinologic SNOT-22 domain scores (4.87 ± 3.91) compared with patients treated with FESS (2.93 ± 4.32, p = 0.02). There was a greater improvement in the SNOT-22 olfaction scores for patients treated with dupilumab (2.35 ± 2.17) compared with patients treated with FESS (1.48 ± 2.24, p = 0.04). Patients taking dupilumab were followed on average for 12.20 months and patients treated with FESS were followed for 17.90 months. Conclusion: Overall, both therapies are effective at reducing symptoms in patients with CRSwNP according to SNOT-22. Patients treated with dupilumab reported improved olfaction and decreased cough, postnasal drainage, and thick nasal drainage as compared with patients treated with FESS, while patients treated with FESS had a greater reduction in polyp burden.
MeSH term(s)	Antibodies, Monoclonal, Humanized ; Chronic Disease ; Cohort Studies ; Humans ; Nasal Polyps/complications ; Nasal Polyps/drug therapy ; Nasal Polyps/surgery ; Quality of Life ; Retrospective Studies ; Rhinitis/complications ; Rhinitis/drug therapy ; Rhinitis/surgery ; Sinusitis/complications ; Sinusitis/drug therapy ; Sinusitis/surgery ; Treatment Outcome
Chemical Substances	Antibodies, Monoclonal, Humanized ; dupilumab (420K487FSG)
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2625826-2
ISSN	2042-6984 ; 2042-6976
ISSN (online)	2042-6984
ISSN	2042-6976
DOI	10.1002/alr.22951
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Article: Tracheostomy time-out: New safety tool in the setting of COVID-19

Dharmarajan, Harish / Snyderman, Carl H

Head Neck

Abstract	Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time-out applicable to all patients including those suspected of having COVID-19. The aim of the tracheostomy time-out is to reduce preventable errors that may increase the risk of transmission of SARS-CoV-2.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #209758
Database	COVID19

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Article ; Online: Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach.

Dharmarajan, Harish / Belsky, Michael A / Anderson, Jennifer L / Sridharan, Shaum

The Annals of otology, rhinology, and laryngology

2021 Volume 131, Issue 1, Page(s) 12–26

Abstract: Objective: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic.: Methods: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology ... ...

Abstract	Objective: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. Methods: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. Results: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. Conclusions: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency department ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; COVID-19 ; Clinical Protocols ; Cohort Studies ; Female ; Hospitals, University ; Humans ; Male ; Middle Aged ; Otolaryngology ; Otorhinolaryngologic Diseases/diagnosis ; Otorhinolaryngologic Diseases/therapy ; Pennsylvania ; Referral and Consultation/trends ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2021-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	120642-4
ISSN	1943-572X ; 0003-4894
ISSN (online)	1943-572X
ISSN	0003-4894
DOI	10.1177/00034894211005937
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Article ; Online: Treatment of unilateral olfactory neuroblastoma: Appropriate extent of surgical resection and potential for olfactory preservation.

Dharmarajan, Harish / Choby, Garret / Abi Hachem, Ralph / Kuan, Edward C / Levine, Corinna G / Sanusi, Olabisi / Schuman, Theodore / Tang, Dennis / Yim, Michael / Geltzeiler, Mathew

International forum of allergy & rhinology

2024 Volume 14, Issue 5, Page(s) 881–886

Abstract: Historically, comprehensive surgical resection for olfactory neuroblastoma has included the bilateral olfactory epithelium, cribriform plate, overlying dura, olfactory bulbs and tracts. This results in postoperative anosmia that may significantly impact ... ...

Abstract	Historically, comprehensive surgical resection for olfactory neuroblastoma has included the bilateral olfactory epithelium, cribriform plate, overlying dura, olfactory bulbs and tracts. This results in postoperative anosmia that may significantly impact a patient's quality of life without definitive added benefit in survival. The prevalence of occult intracranial disease is low, especially for Hyams grade I and II tumors. A unilateral approach sparing the contralateral cribriform plate and olfactory system can be considered for select cases of early stage, low-grade tumors when the disease does not cross midline to involve the contralateral olfactory cleft or septal mucosa and when midline dural margins can be cleared with frozen pathology. Approximately half of patients who undergo unilateral resection may have residual olfaction even with adjuvant unilateral radiation. Early data suggest favorable disease-free survival and overall survival for patients who underwent the unilateral approach; however, larger sample studies are needed to confirm comparability to bilateral resections regarding oncologic outcomes.
MeSH term(s)	Humans ; Esthesioneuroblastoma, Olfactory/surgery ; Esthesioneuroblastoma, Olfactory/pathology ; Nose Neoplasms/surgery ; Nose Neoplasms/pathology ; Nasal Cavity/surgery ; Nasal Cavity/pathology ; Smell ; Treatment Outcome
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2625826-2
ISSN	2042-6984 ; 2042-6976
ISSN (online)	2042-6984
ISSN	2042-6976
DOI	10.1002/alr.23345
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Article ; Online: Mature and immature pediatric head and neck teratomas: A 15-year review at a large tertiary center.

Dharmarajan, Harish / Rouillard-Bazinet, Noémie / Chandy, Binoy M

International journal of pediatric otorhinolaryngology

2018 Volume 105, Page(s) 43–47

Abstract: Introduction: Pediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established.: Objectives: To review the ... ...

Abstract	Introduction: Pediatric head and neck teratomas account for less than 4% of congenital teratomas. The distinct presentations and outcomes of mature and immature head and neck teratomas have not been well established. Objectives: To review the management and outcomes of pediatric head and neck teratomas. To distinguish differences between mature and immature tumors with respect to the age at presentation and surgery, tumor size and location, alpha fetoprotein (AFP) levels, airway management, and recurrence. Methods: A 15-year retrospective chart review of patients treated for head and neck teratomas at Texas Children's Hospital was performed. A total of 20 patients were included. Wilcoxon rank and Fisher's exact tests were used for statistical analysis. Results: Immature teratomas were associated with both higher AFP levels (80800 ng/ml, p = 0.02) and maximum tumor dimensions (14.4 cm, p = 0.0034) than mature teratomas (24400 ng/ml and 6.44 cm). Patients with immature tumors were younger at the time of surgical resection (19.8 days, p = 0.025) compared to those with mature tumors (348 days). 89% of immature teratomas involved anterior neck localization compared to 27% for mature teratomas (p = 0.0098); 88% of the immature teratomas required an EXIT (Ex Utero Intrapartum Treatment) procedure compared with 40% of the mature teratomas (p = 0.0656). Recurrence was noted in only two cases: an immature teratoma 51 months after incomplete resection and a mature teratoma 33 months after complete resection. Long-term consequences of surgical resection included cleft palate (38.9%), dysphagia (33.3%), facial nerve paresis/paralysis (16.7%) and tracheotomy (16.7%). Conclusion: Immature teratomas had higher AFP levels, tumor dimensions, frequency of anterior neck localization, and requirement of EXIT than mature teratomas. Given that there was no significant difference between the recurrence rates of immature and mature teratomas, follow-up vigilance should be maintained equally regardless of tumor maturity.
MeSH term(s)	Child ; Child, Preschool ; Female ; Head and Neck Neoplasms/epidemiology ; Head and Neck Neoplasms/surgery ; Humans ; Infant ; Male ; Neoplasm Recurrence, Local ; Retrospective Studies ; Teratoma/epidemiology ; Teratoma/surgery ; Texas ; alpha-Fetoproteins/analysis
Chemical Substances	alpha-Fetoproteins
Language	English
Publishing date	2018-02
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2017.11.031
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Article ; Conference proceedings: Olfactory Outcomes in Patients Undergoing Transplanum and Transtuberculum Skull Base Surgery

Dharmarajan, Harish / Balogun, Zainab / Kanwar, Anandraj / Gardner, Paul / Zenonos, Georgios / Snyderman, Carl / Traylor, Katie / Wang, Eric W.

Journal of Neurological Surgery Part B: Skull Base

2022 Volume 83, Issue S 01

Event/congress	31st Annual Meeting North American Skull Base Society, Online, 2022-02-18
Language	English
Publishing date	2022-02-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	2654269-9
ISSN	2193-634X ; 2193-6331
ISSN (online)	2193-634X
ISSN	2193-6331
DOI	10.1055/s-0042-1743833
Database	Thieme publisher's database

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Article: Self-Reported Olfactory Outcomes in Transplanum and Transtuberculum Approaches

Balogun, Zainab / Dharmarajan, Harish / Kanwar, Anandraj / Gardner, Paul A. / Zenonos, Georgios A. / Snyderman, Carl H. / Traylor, Katie / Wang, Eric W.

Journal of Neurological Surgery Part B: Skull Base

2023

Abstract: Objectives: The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) ... ...

Abstract	Objectives: The aim of this study was to determine the clinical characteristics and cephalometric risk factors associated with decreased postoperative olfaction in patients in whom the transplanum and transtuberculum expanded endonasal approach (EEA) was performed. Methods: A retrospective cohort of 41 patients treated with the transplanum and transtuberculum EEA was divided into two groups based on the maximum change in the postoperative 22-item Sino-Nasal Outcome Test (SNOT22) olfaction score: prolonged olfactory loss group ( n = 5) with a ΔSNOT22 olfaction score of ≥ 4 without a return to baseline and a preserved olfaction group ( n = 36) with a ΔSNOT22 olfaction score ≤ 3 with return to baseline on follow-up of at least 3 months. Demographics, operative details, and cephalometric measurements were compared between the two groups. Results: There were no differences in terms of the type of surgical approach (transplanum and transtuberculum), resection of turbinates (middle and superior), use of reconstructive flap (nasoseptal flap and reverse flap), or tumor pathology between the two groups. In the prolonged olfactory loss group, there was a smaller angle between the planum and the face of the sella (89.75 ± 9.18 vs. 107.17 ± 16.57 degrees, p = 0.05) and a smaller angle between the anterior nasal spine and the sphenoid sinus face (21.20 ± 2.49 vs. 25.89 ± 4.90 degrees, p = 0.047) compared with the preserved olfaction group. Conclusions: Patients with a narrow angle between the planum and the face of the sella or that between the anterior nasal spine and the sphenoid sinus face are at a higher risk of prolonged olfactory dysfunction with the transplanum and transtuberculum approaches. Level of Evidence: IV.
Keywords	transplanum ; transtuberculum ; endoscopic approach ; olfactory outcome
Language	English
Publishing date	2023-08-22
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2654269-9
ISSN	2193-634X ; 2193-6331
ISSN (online)	2193-634X
ISSN	2193-6331
DOI	10.1055/a-2158-5901
Database	Thieme publisher's database

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Article ; Online: Droplet and Aerosol Generation With Mastoidectomy During the COVID-19 Pandemic: Assessment of Baseline Risk and Mitigation Measures With a High-performance Cascade Impactor.

Freiser, Monika E / Dharmarajan, Harish / Sri Kavya Boorgu, Devi Sai / Sim, Edward S / Corcoran, Timothy E / Jabbour, Noel / Chi, David H

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

2021 Volume 42, Issue 4, Page(s) 614–622

Abstract: Hypothesis: Aerosols are generated during mastoidectomy and mitigation strategies may effectively reduce aerosol spread.: Background: An objective understanding of aerosol generation and the effectiveness of mitigation strategies can inform ... ...

Abstract	Hypothesis: Aerosols are generated during mastoidectomy and mitigation strategies may effectively reduce aerosol spread. Background: An objective understanding of aerosol generation and the effectiveness of mitigation strategies can inform interventions to reduce aerosol risk from mastoidectomy and other open surgeries involving drilling. Methods: Cadaveric and fluorescent three-dimensional printed temporal bone models were drilled under variable conditions and mitigation methods. Aerosol production was measured with a cascade impactor set to detect particle sizes under 14.1 μm. Field contamination was determined with examination under UV light. Results: Drilling of cadaveric bones and three-dimensional models resulted in strongly positive aerosol production, measuring positive in all eight impactor stages for the cadaver trials. This occurred regardless of using coarse or cutting burs, irrigation, a handheld suction, or an additional parked suction. The only mitigation factor that led to a completely negative aerosol result in all eight stages was placing an additional microscope drape to surround the field. Bone dust was scattered in all directions from the drill, including on the microscope, the surgeon, and visually suspended in the air for all but the drape trial. Conclusions: Aerosols are generated with drilling the mastoid. Using an additional microscope drape to cover the surgical field was an effective mitigation strategy to prevent fine aerosol dispersion while drilling.
MeSH term(s)	Aerosols ; COVID-19/prevention & control ; COVID-19/transmission ; Cadaver ; Humans ; Mastoidectomy/adverse effects ; Mastoidectomy/instrumentation ; Mastoidectomy/methods ; SARS-CoV-2
Chemical Substances	Aerosols
Language	English
Publishing date	2021-01-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2036790-9
ISSN	1537-4505 ; 1531-7129
ISSN (online)	1537-4505
ISSN	1531-7129
DOI	10.1097/MAO.0000000000002987
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