Publications by authors named "Michael Kohanski"

In this multi-center sinonasal malignancies (SNM) cohort, the Sino-nasal Outcome Test has a correlation with the University of Washington Quality of Life (UWQOL) for assessing QOL. The use of both instruments remains recommended to provide complete and complementary information. Future design of an easy-to-use tool specific to SNM is needed to encompass all aspects of QOL.

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Background: To reduce recurrence rates of inverted papilloma (IP), some have argued for the use of intraoperative frozen margins; results remain mixed and studies critically lack lengthy surveillance periods.

Objective: We aim to elucidate the impact of prolonged surveillance and intraoperative frozen margins on IP recurrence.

Methods: This is a retrospective analysis of patients who underwent resection of IP at a tertiary care center over a 10-year period from 2008 to 2018 followed by subsequent surveillance.

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Objectives: Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids.

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  • This study examines the recurrence of sinonasal squamous cell carcinoma (SNSCC) and the importance of early detection using various surveillance methods.
  • A retrospective analysis of 105 patients revealed a mean recurrence time of 12.1 months and identified factors that increase recurrence rates, such as higher comorbidity indices and certain surgical approaches.
  • Results showed varying sensitivity and specificity among surveillance techniques, with PET/CT exhibiting the highest sensitivity, suggesting that a combination of methods and personalized follow-up plans could improve monitoring effectiveness beyond current guidelines.
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  • - Racial disparities affect the age at which individuals complete aspirin desensitization and receive a diagnosis for ASA-exacerbated respiratory disease (AERD).
  • - Having public insurance is linked to receiving an official AERD diagnosis after the age of 50.
  • - Social factors, such as race and insurance status, play a significant role in AERD diagnosis and the ability to adhere to aspirin desensitization protocols.
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Background: Viral infections have long been implicated in the development of chronic rhinosinusitis with nasal polyps (CRSwNP). Given widespread exposure to the common cold coronavirus 229E (HCoV229E), we sought to investigate how HCoV-229E is cleared and stimulates interferon pathways in air-liquid interface (ALI) cultures from patients with CRSwNP.

Objective: The objective of this study was to identify whether viral clearance and ISG expression is different in ALI cultures from donors with CRSwNP compared with controls.

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Objective: Surgical resection is associated with higher overall survival (OS) than definitive radiotherapy (RT) or chemoradiotherapy (CRT) in cT4b sinonasal squamous cell carcinoma (SCC). Our study investigates the survival benefit of surgical resection in cT4b sinonasal non-SCC.

Methods: The 2004 to 2019 National Cancer Database was queried for patients with cT4b sinonasal non-SCC undergoing definitive treatment with (1) surgical resection + additional therapy (RT, chemotherapy, or both), (2) RT alone, or (3) CRT.

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  • Functional endoscopic sinus surgery (FESS) is a common procedure with significant cost variability, influenced by factors such as surgery duration and the presence of nasal polyps.
  • A study analyzed 221 patients and found the average cost for the procedure was around $8960, with operating room time making up the largest portion of expenses.
  • The results suggest that improving operating room efficiency could significantly reduce costs, highlighting the need for evidence-based decisions regarding surgical supplies and practices.
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  • Endoscopic sinus surgery (ESS) is effective for treating nasal polyps, but the extent of surgery can vary, making it crucial to know when revision surgery is needed, especially with new treatments available.
  • A new Completion of Surgery Index (CoSI) was created to evaluate the effectiveness of surgery in polyp patients by comparing CT scans before and after the procedure.
  • In a study of 100 patients, those needing revision surgery showed significant improvements in quality of life, with CoSI scores indicating that those with lower preoperative scores benefited more from the surgery, helping to identify candidates for future interventions.
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  • Endoscopic sinus surgery (ESS) is crucial for treating odontogenic sinusitis (ODS), particularly in cases involving the frontal sinus, but the effectiveness of different surgical extents needs further study.
  • A multicenter study compared the outcomes of wide maxillary antrostomy (MA) against complete ESS in patients with ODS who showed involvement of frontal and anterior ethmoid sinuses.
  • The results indicated that, while both surgical methods led to significant symptom relief, complete ESS had a faster resolution of anterior ethmoidal sinus purulence compared to MA alone, although long-term outcomes were similar between the two groups.
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Inverted papilloma conversion to squamous cell carcinoma is not always easy to predict. AutoML requires much less technical knowledge and skill to use than traditional ML. AutoML surpassed the traditional ML algorithm in differentiating IP from IP-SCC.

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Background: Empty nose syndrome (ENS) is a poorly understood, debilitating condition affecting a minority of patients who underwent nasal airway surgery, most commonly following inferior turbinate surgery. Few publications have demonstrated middle turbinate resection (MTR) causing ENS, but MTR is still considered a potential cause of ENS. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) is validated for ENS diagnosis, with ENS6Q ≥ 11 considered highly suggestive of ENS.

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Background: Sinonasal malignancy surveillance paradigms are often based on Head and Neck National Comprehensive Cancer Network guidelines, which do not recommend standard surveillance imaging beyond 6 months without concerning symptomatology or physical examination findings.

Methods: This was a retrospective analysis of all patients who underwent resection of sinonasal malignancy at a tertiary care center over a 20-year period from 2000 to 2020, with an ensuing surveillance period demonstrating recurrence.

Results: Fifty-two patients with sinonasal malignancy recurrence were included, with an average time to recurrence of 30.

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Background: Inverted papilloma (IP) is a benign tumor characterized by epithelial proliferation, which has the potential for malignant transformation. However, the mechanisms driving this transformation are poorly defined. Matrix metalloproteinase-11 (MMP-11), a regulator of the tumor microenvironment that degrades extracellular matrix, is upregulated in IP with dysplasia.

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Purpose: Sinonasal malignancies (SNMs) adversely impact patients' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients.

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Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches.

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Background: Patients with sinonasal malignancy (SNM) present with significant sinonasal quality of life (QOL) impairment. Global sinonasal QOL as measured by the 22-item Sinonasal Outcomes Test (SNOT-22) has been shown to improve with treatment. This study aims to characterize SNOT-22 subdomain outcomes in SNM.

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There is currently interest regarding CRSsNP patients with refractory symptomatology following functional endoscopic sinus surgery, and which of these patients can derive benefit from low-dose macrolide therapy. In the present study, we analyze a cohort of over fifty CRSsNP patients on macrolide therapy; structured histopathological findings at the time of surgery were analyzed against the success of macrolide treatment. Independently, fibrosis, absence of squamous metaplasia, absence of eosinophilia, presence of neutrophilic infiltrate, and lymphoplasmocytic predominance were all associated with objective success of macrolide treatment; these findings may allow clinicians to more appropriately select patients for this therapy.

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Objectives: The use of topical corticosteroids to manage postoperative sinonasal symptoms after endoscopic skull base surgery (ESBS) has not been well studied. We quantified long-term impact of postoperative steroid irrigations (SIs) on quality of life of patients after ESBS.

Methods: Retrospective review of patients at the University of Pennsylvania undergoing ESBS from 2010 to 2019.

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Background: The impact of sinonasal malignancies (SNMs) on quality of life (QOL) at presentation is poorly understood. The Sinonasal Outcome Test (SNOT-22) and University of Washington Quality of Life (UWQOL) are validated QOL instruments with distinctive subdomains. This study aims to identify factors impacting pretreatment QOL in SNM patients to personalize multidisciplinary management and counseling.

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Patients are increasingly turning to online education materials to aid with disease management. Patient education materials on aspirin-exacerbated respiratory disease are of poor readability with significant room for improvement.

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Background: Postoperative nausea and vomiting (PONV) are adverse effects after surgery, which may increase the risk of complications. Aprepitant is a neurokinin-1 receptor blocker and has been shown to reduce chemotherapy-related nausea and vomiting and PONV. However, its role in endoscopic skull base surgery remains unclear.

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