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Article ; Online: Awake bedside nasal endoscopy for primary management of neonatal dacryocystoceles with intranasal cysts.

Zhao, Nina W / Chan, Dylan K

International journal of pediatric otorhinolaryngology

2019 Volume 123, Page(s) 93–96

Abstract: Objective: To present outcomes of neonatal dacryocystoceles treated through endoscopic intranasal cyst marsupialization (EICM) without general anesthesia and nasolacrimal duct (NLD) probing or irrigation.: Methods: Records of eleven consecutive ... ...

Abstract	Objective: To present outcomes of neonatal dacryocystoceles treated through endoscopic intranasal cyst marsupialization (EICM) without general anesthesia and nasolacrimal duct (NLD) probing or irrigation. Methods: Records of eleven consecutive infants diagnosed with unilateral or bilateral congenital cysts associated with the nasolacrimal system between January 2016 and February 2019 at our institution were retrospectively reviewed. Results: Age at diagnosis ranged from 0 to 56 days, and 45.5% were male. 54.5% had dacryocystitis before surgical intervention. Patients were initially treated with a combination of massage and topical antibiotics; some received parenteral antibiotics if infected. Nearly all patients (90.9%) had one or more intranasal cysts. Of these patients, two underwent lacrimal probing and EICM in the operating room. One underwent EICM only in the operating room. Another patient initially failed bedside NLD probing and subsequently underwent bedside nasal endoscopy and awake EICM. The final six patients underwent EICM without general anesthesia or NLD probing. No complications were noted. Follow-up ranged from 7 to 906 days. Complete resolution was observed in all ten patients who underwent EICM, regardless of anesthesia. Conclusions: Neonatal dacryocystoceles and/or intranasal cysts are successfully treated at the bedside through nasal endoscopy with simple awake endoscopic intranasal cyst marsupialization. Avoidance of general anesthesia and NLD probing or irrigation would greatly simplify and decrease the cost of dacryocystocele management.
MeSH term(s)	Cysts/complications ; Cysts/surgery ; Dacryocystitis/etiology ; Dacryocystorhinostomy ; Endoscopy/methods ; Female ; Humans ; Infant ; Infant, Newborn ; Lacrimal Duct Obstruction/complications ; Lacrimal Duct Obstruction/congenital ; Male ; Nasolacrimal Duct/surgery ; Nose Diseases/surgery ; Retrospective Studies ; Wakefulness
Language	English
Publishing date	2019-05-06
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.2019.04.043
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Article ; Online: Are You Thinking What I'm Thinking? Exploring Response Process Validity Evidence for a Workplace-based Assessment for Operative Feedback.

Zhao, Nina W / Haddock, Lindsey M / O'Brien, Bridget C

Journal of surgical education

2021 Volume 79, Issue 2, Page(s) 475–484

Abstract: Objective: Workplace-based assessments (WBAs) are used in multiple surgical specialties to facilitate feedback to residents as a form of formative assessment. The validity evidence to support this purpose is limited and has yet to include investigations ...

Abstract	Objective: Workplace-based assessments (WBAs) are used in multiple surgical specialties to facilitate feedback to residents as a form of formative assessment. The validity evidence to support this purpose is limited and has yet to include investigations of how users interpret the assessment and make rating decisions (response processes). This study aimed to explore the validity evidence based on response processes for a WBA in surgery. Design: Semi-structured interviews explored the reasonings and strategies used when answering questions in a surgical WBA, the System for Improving and Measuring Procedural Learning (SIMPL). Interview questions probed the interpretation of the three assessment questions and their respective answer categories (level of autonomy, operative performance, case complexity). Researchers analyzed transcripts using directed qualitative content analysis to generate themes. Setting: Single tertiary academic medical center. Participants: Eight residents and 13 faculty within the Department of Otolaryngology-Head and Neck Surgery participating in a 6-month pilot of SIMPL. Results: We identified four overarching themes that that characterized faculty and resident response processes while completing SIMPL: (1) Faculty and resident users had similar content-level interpretations of the questions and corresponding answer choices; (2) Users employed a variety of cognitive, behavioral, and emotional processes to make rating decisions; (3) Contextual factors influenced ratings; and (4) Tensions during interpretation contributed to rating uncertainty. Conclusions: Response processes are a key source of evidence to support the validity for the formative use of WBAs. Evaluating response process evidence should go beyond basic content-level analysis as contextual factors and tensions that arise during interpretation also play a large role in rating decisions. Additional work and a continued critical lens are needed to ensure that WBAs can truly meet the needs for formative assessment.
MeSH term(s)	Clinical Competence ; Feedback ; Humans ; Internship and Residency ; Workplace
Language	English
Publishing date	2021-10-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2021.09.007
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Article ; Online: Objective Fluoroscopic Outcomes After Endoscopic Staple Versus Laser Zenker's Diverticulotomy.

Zhao, Nina W / Stasyuk, Anastasiya / Hernandez, Brian O / Cates, Daniel J / Kuhn, Maggie A / Belafsky, Peter C

The Laryngoscope

2023 Volume 133, Issue 11, Page(s) 3057–3060

Abstract: Objective: Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. ...

Abstract	Objective: Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD. Methods: A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre- to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT-10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). Results: Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre-operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT-10, PAS, PCR, or PESo between groups. Conclusion: The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy. Level of evidences: Level 3 Laryngoscope, 133:3057-3060, 2023.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; Esophagoscopy/methods ; Treatment Outcome ; Zenker Diverticulum/diagnostic imaging ; Zenker Diverticulum/surgery ; Fluoroscopy ; Retrospective Studies ; Diverticulum ; Lasers, Gas/therapeutic use
Language	English
Publishing date	2023-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30726
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Article: Clinician accuracy in identifying essential laryngeal landmarks on swallowing fluoroscopy.

Zhao, Nina W / MacDonald, Bridget V / Pietrowski, Jessica R / Laus, Joey / Evangelista, Lisa M / Joseph, Ian / Rosen, Clark A / Belafsky, Peter C

Laryngoscope investigative otolaryngology

2023 Volume 8, Issue 5, Page(s) 1265–1271

Abstract: Objective: Identification of anatomical landmarks is essential for interpretation of video fluoroscopic swallow studies (VFSS). This investigation sought to confirm the location of essential laryngeal landmarks and determine clinician accuracy in ... ...

Abstract	Objective: Identification of anatomical landmarks is essential for interpretation of video fluoroscopic swallow studies (VFSS). This investigation sought to confirm the location of essential laryngeal landmarks and determine clinician accuracy in structure identification on VFSS. Methods: A single human cadaver was used to generate unmarked standard lateral and anterior-posterior (AP) fluoroscopic images. Essential laryngeal structures (e.g., true vocal fold, arytenoid) were directly identified using a guidewire placed through an endoscope while obtaining corresponding marked fluoroscopic images. Licensed clinicians (speech-language pathologists [SLP], laryngologists) and trainees (otolaryngology residents, SLP clinical fellows [CF]) identified 18 structures (9 lateral, 9 AP) on unmarked images. Answers were compared to corresponding marked images. The percentage of accurate identification was calculated for each clinician and then compared between groups using Results: Twenty-four individuals (10 SLPs, 1 CF, 9 residents, 4 laryngologists) from six institutions completed structure identification. Mean overall accuracy was 41.7 ± 13.0% (range 18.8-68.8%). There were no significant differences in mean overall accuracy between trainees (41.9 ± 12.9%) and clinicians (42.0 ± 13.1%), Conclusions: The ability of certified clinicians and trainees to correctly identify essential anatomic landmarks on swallowing fluoroscopy may be poor. Future work is needed to identify how we can train clinicians on more accurate identification of essential anatomic structures on swallowing fluoroscopy.Level of Evidence: NA.
Language	English
Publishing date	2023-07-29
Publishing country	United States
Document type	Journal Article
ISSN	2378-8038
ISSN	2378-8038
DOI	10.1002/lio2.1127
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Article: Isolated Malleus Fracture from Sneezing: A Case Report.

Zhao, Nina W / Perez, Philip / Sharon, Jeffrey D

Cureus

2019 Volume 11, Issue 6, Page(s) e5037

Abstract: Isolated malleus fractures are an infrequent cause of hearing loss. Even more unusual is a fracture secondary to a sneeze. Here, we review the case of a 32-year-old man with the first surgically confirmed malleus fracture due to a suppressed sneeze, ... ...

Abstract	Isolated malleus fractures are an infrequent cause of hearing loss. Even more unusual is a fracture secondary to a sneeze. Here, we review the case of a 32-year-old man with the first surgically confirmed malleus fracture due to a suppressed sneeze, which was then successfully repaired with hydroxyapatite bone cement. We discuss the presentation, diagnosis, and management of this patient and review the literature on isolated malleus injuries.
Language	English
Publishing date	2019-06-29
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.5037
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Article ; Online: Enhancing Operative Feedback: A Descriptive Trajectory for Surgical Development in Otolaryngology.

Zhao, Nina W / O'Sullivan, Patricia S / Huang, Emily

Journal of surgical education

2019 Volume 77, Issue 3, Page(s) 572–581

Abstract: Objective: Developmental frameworks are narrative descriptions of learner performance that may be useful to provide operative feedback tools in surgical education. The authors previously proposed the Technician, Anatomist, Anticipator, Strategist, ... ...

Abstract	Objective: Developmental frameworks are narrative descriptions of learner performance that may be useful to provide operative feedback tools in surgical education. The authors previously proposed the Technician, Anatomist, Anticipator, Strategist, Executive (TAASE) framework utilizing data collected from general surgeons and conjectured its applicability in other surgical specialties. Here, we construct a developmental framework in otolaryngology using similar techniques, then compare the results to TAASE. Design: Ten otolaryngology educators participated in semi-structured, audio-recorded interviews, to explore how otolaryngology faculty characterize surgical learning at different levels of training. Researchers analyzed the transcripts using a thematic analysis approach to build a developmental framework. Results were then qualitatively compared to the TAASE trajectory. Setting: Single tertiary academic medical center. Participants: Faculty within the Department of Otolaryngology-Head and Neck Surgery. Results: Otolaryngology faculty characterized surgical development as an integrated trajectory of technical and cognitive skills progressing from specific operative tasks to a global understanding of patients and procedures largely consistent with stages outlined in the Technician, Anatomist, Anticipator, Strategist, and Executive model. A new theme identified was learner emotions, which may impact learning and hinder or enhance progression along the trajectory. Conclusions: Otolaryngology and general surgeons agree upon a common arc to operative maturity reflected by the TAASE trajectory. The TAASE framework may be useful as a tool for intraoperative assessment in otolaryngology to help promote quality feedback. Further research is needed to understand how emotions may influence operative skill development.
MeSH term(s)	Clinical Competence ; Feedback ; Humans ; Internship and Residency ; Otolaryngology/education ; Surgeons
Language	English
Publishing date	2019-12-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277538-9
ISSN	1878-7452 ; 1931-7204
ISSN (online)	1878-7452
ISSN	1931-7204
DOI	10.1016/j.jsurg.2019.11.009
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Article ; Online: Voice and Stroboscopic Characteristics in Transgender Patients Seeking Gender-Affirming Voice Care.

Young, VyVy N / Yousef, Andrew / Zhao, Nina W / Schneider, Sarah L

The Laryngoscope

2020 Volume 131, Issue 5, Page(s) 1071–1077

Abstract: Objective: Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire ( ... ...

Abstract	Objective: Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire (TVQ Methods: Retrospective review of transgender patients presenting to tertiary-care laryngology center between February 2018-February 2019. Mean VHI-10, TVQ, and Singing VHI-10 (SVHI-10) scores; audio-perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI-10 and SVHI-10 vs TVQ Results: Sixty-one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty-nine percent presented full-time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI-10), 19 ± 13 (SVHI-10), and 81 ± 22 (TVQ Conclusion: Trans women report perceived voice handicap in speaking and singing, which appears separate from gender-related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI-10 or SVHI-10 and TVQ Level of evidence: 4 Laryngoscope, 131:1071-1077, 2021.
MeSH term(s)	Acoustics ; Adult ; Disability Evaluation ; Dysphonia/diagnosis ; Dysphonia/psychology ; Dysphonia/therapy ; Female ; Gender Dysphoria/psychology ; Gender Dysphoria/therapy ; Gender Identity ; Humans ; Male ; Psychometrics/statistics & numerical data ; Quality of Life ; Retrospective Studies ; Self Concept ; Sex Factors ; Sex Reassignment Procedures ; Singing/physiology ; Speech Acoustics ; Stroboscopy/statistics & numerical data ; Surveys and Questionnaires/statistics & numerical data ; Transgender Persons/psychology ; Transgender Persons/statistics & numerical data ; Voice Quality/physiology ; Young Adult
Language	English
Publishing date	2020-08-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.28932
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Article ; Online: Using Item-Response Theory to Improve Interpretation of the Trans Woman Voice Questionnaire.

Zhao, Nina W / Mason, James M / Blum, Alexander M / Kim, Eric K / Young, VyVy N / Rosen, Clark A / Schneider, Sarah L

The Laryngoscope

2022 Volume 133, Issue 5, Page(s) 1197–1204

Abstract: Objective: The Trans Woman Voice Questionnaire (TWVQ) is commonly used to quantify self-perceptions of voice for trans women seeking gender-affirming voice care, but the interpretation of TWVQ scores remains challenging. The objective of this study was ... ...

Abstract	Objective: The Trans Woman Voice Questionnaire (TWVQ) is commonly used to quantify self-perceptions of voice for trans women seeking gender-affirming voice care, but the interpretation of TWVQ scores remains challenging. The objective of this study was to use item-response theory (IRT) to evaluate the relationship between TWVQ items and persons on a common scale and identify improvements to increase the meaningfulness of TWVQ scores. Methods: A retrospective review of TWVQ scores from trans women patients between 2018-2020 was performed. Rasch-family models were used to generate item-person maps positioning respondent location and item difficulty estimates on a logit scale, which was then converted into a scaled score using linear transformations. Results: TWVQ responses from 86 patients were analyzed. Initial item-person maps demonstrated that the middle response categories ("sometimes" and "often") performed inconsistently across items (poor threshold banding); interpretability improved when these ratings were scored as one category. The models were rerun using revised scoring, which retained high reliability (0.93) and supported a unidimensional construct. Updated item-person maps revealed four scaled score zones (≤54, >54 to ≤101, >101 to ≤140, and >140) that each corresponded to an increasing pattern of item thresholds (probability of selecting one response category vs. others). These ranges can be interpreted as minimal, low, moderate, and high, respectively. Conclusions: Empiric data from Rasch analysis supports new interval scoring for the TWVQ that advances the clinical and research utility of the instrument and lays the foundation for future improvements in clinical care and outcomes assessment. Level of evidence: NA Laryngoscope, 133:1197-1204, 2023.
MeSH term(s)	Humans ; Female ; Reproducibility of Results ; Psychometrics/methods ; Surveys and Questionnaires ; Outcome Assessment, Health Care ; Self Concept
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30360
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Article ; Online: Can EAT-10 Become EAT-5? Improving Measurement Efficiency of Dysphagia with Item Response Theory.

Ahanotu, Adaobi / DeVore, Elliana Kirsh / Carroll, Thomas L / Edelen, Maria / Morcos, Mary / Willard, Elizabeth / Zhao, Nina W / Belafsky, Peter / Shin, Jennifer J

The Laryngoscope

2023 Volume 133, Issue 12, Page(s) 3327–3333

Abstract: Objectives: To assess: (1) the Eating Assessment Tool (EAT-10) with item response theory (IRT) to determine which individual items provide the most information, (2) the extent to which dysphagia is measured with subsets of items while maintaining ... ...

Abstract	Objectives: To assess: (1) the Eating Assessment Tool (EAT-10) with item response theory (IRT) to determine which individual items provide the most information, (2) the extent to which dysphagia is measured with subsets of items while maintaining precise score estimates, and (3) if 5-item scales have the differing discriminatory ability, as compared to the parent 10-item instrument. Methods: Prospectively collected data from 2,339 patients who completed the EAT-10 questionnaire during evaluation at a tertiary care otolaryngology clinic were utilized. IRT analyses provided discrimination and location parameters associated with individual questions. Residual item correlations were also assessed for redundant information. Based on these results, three 5-item subsets were further evaluated using item information function curves. Areas under receiver-operator characteristic curves (ROC-AUC) were also calculated to evaluate the discriminatory ability for dysphagia-related clinical diagnoses. Results: Item discrimination parameter estimates ranged from 1.71 to 5.46, with higher values indicating more information. Residual item correlations were determined within item pairs, and location parameters were calculated. Based on these data, in combination with clinical utility, three 5-item subsets were proposed and assessed. ROC-AUC analyses demonstrated no significant difference between the EAT-5-Alpha subset and the original 10-item instrument for discriminating dysphagia as a primary diagnosis (0.88, 0.88). The EAT-5-Clinical subset outperformed the original 10 instruments in ROC-AUC for aspiration. The EAT-5-Range subset was significantly associated with problems with thin liquids. Conclusions: IRT analyses distinguished three proposed 5-item subsets of the EAT-10 instrument, supporting shorter survey options, while still reflecting the impact of dysphagia without significant loss of discrimination. Level of evidence: 3 (Diagnostic testing with consistently applied reference standards, partial blinding). Laryngoscope, 133:3327-3333, 2023.
MeSH term(s)	Humans ; Deglutition Disorders/diagnosis ; ROC Curve ; Surveys and Questionnaires ; Reproducibility of Results
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30732
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Article ; Online: Technical skill improvement with surgical preparatory courses: What advantages are reflected in residency?

Green, Courtney A / Huang, Emily / Zhao, Nina W / O'Sullivan, Patricia S / Kim, Edward / Chern, Hueylan

American journal of surgery

2017 Volume 216, Issue 1, Page(s) 155–159

Abstract: Introduction: Sustainability of skill acquisition gained from graduating medical student (GMS) preparatory courses remains uncertain. GMS skills were assessed before (T1) and after a preparatory course (T2) and then again 2 (T3) and 4 (T4) months into ... ...

Abstract	Introduction: Sustainability of skill acquisition gained from graduating medical student (GMS) preparatory courses remains uncertain. GMS skills were assessed before (T1) and after a preparatory course (T2) and then again 2 (T3) and 4 (T4) months into residency and compared to surgical interns without such a course. Methods: In April, GMS took the preparatory course. In July-August all interns participated in a basic skills curriculum. Learners completed four technical exercises pre/post each course. Three surgeons scored performances. GMS scores were compared across the 4 time points. Control interns were compared at T3 and T4. Results: Thirty-two interns completed all pre/post course assessments (T3 and T4); seven of those were GMSs. GMS scores increased from 74.5%(T1) to 94.2%(T2) (p < 0.001), and were maintained into residency. Control interns also improved (65.8%(T3) to 91.8%(T4), p < 0.001). GMS-interns scored higher starting residency compared to control interns (T3, 89.08% vs 65.03%, p < 0.001). Conclusions: These findings support existing literature and demonstrate that students maintain their skills into residency. Preparatory courses provide a head start. Without such course, interns require a steep learning curve.
MeSH term(s)	Clinical Competence ; Computer Simulation ; Curriculum ; Education, Medical, Graduate/standards ; Educational Measurement ; General Surgery/education ; Humans ; Internship and Residency/methods ; Retrospective Studies ; Surveys and Questionnaires
Language	English
Publishing date	2017-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2017.10.037
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