3400 Spruce St 5 Silverstein Bldg
Philadelphia PA 19104
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: MD050143L
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Influences of age, tongue region, and chorda tympani nerve sectioning on signal detection measures of lingual taste sensitivity. - Physiology & behavior
Although the ability to taste is critical for ingestion, nutrition, and quality of life, a clear understanding of the influences of age, sex, and chorda tympani (CT) resection on taste function in different regions of the anterior tongue is generally lacking. In this study we employed criterion-free signal detection analysis to assess electric and chemical taste function on multiple tongue regions in normal individuals varying in age and sex and in patients with unilateral CT resections. The subjects were 33 healthy volunteers, ranging from 18 to 87 years of age, and 9 persons, 27 to 77 years of age, with unilateral CT lesions. The influences of age, sex, tongue region, and chorda tympani resections on signal detection sensitivity (d') and response bias (Î²) measures was assessed in 16 tongue regions to weak electric currents and solutions of sucrose, sodium chloride, and caffeine. Significant age-related decrements in d' were found for sucrose (p=0.012), sodium chloride (p=0.002), caffeine (p=0.006), and electric current (EC) (p=0.0001). Significant posterior to anterior, and medial to lateral, gradients of increasing performance were present for most stimuli. Î² was larger on the anterior than the posterior tongue for the electrical stimulus in the youngest subjects, whereas the opposite was true for sucrose in the oldest subjects. No sex differences were apparent. d' was depressed ipsilateral to the CT lesion side to varying degrees in all tongue regions, with the weakest influences occurring on the medial and anterior tongue. CT did not meaningfully influence Î². This study is the first to employ signal detection analysis to assess the regional sensitivity of the tongue to chemical and electrical stimuli. It clearly demonstrates that tongue regions differ from one another in terms of their age-related sensitivity and their susceptibility to CT lesions.Copyright Â© 2015 Elsevier Inc. All rights reserved.
IL-1 Receptor Antagonist Inhibits Early Granulation Formation. - The Annals of otology, rhinology, and laryngology
Using a functional model of airway granulation tissue in laryngotracheal stenosis, we investigated changes in histopathology and inflammatory markers within granulation tissue in response to an interleukin-1 receptor antagonist (IL-1Ra). This study allows us to further delineate the immune response to wound healing and potentially identify treatment markers.Laryngotracheal complexes (LTCs) of donor mice underwent direct airway injury. The LTCs were transplanted into subcutaneous tissue of recipient mice in 2 groups: IL-1Ra treated and untreated. The IL-1Ra-treated arm received daily intraperitoneal injections of IL-1Ra for 3 weeks. The LTCs were then harvested. Granulation formation was measured. The mRNA expression of transforming growth factor (TGF) beta and IL-1 was quantified using real-time reverse transcript polymerase chain reaction.There were statistically significant differences in lamina propria thickness. There were no statistically significant changes in mRNA expression of TGF-Î²â€ƒand IL-1Î² between the treated and untreated specimens.Using a previously described murine model, we delineate inflammatory markers that can be targeted for potential therapy. While the levels of inflammatory markers do not change significantly, the lamina propria thickness shows that the effects of IL-1 have been inhibited. The early use of the IL-1Ra will inhibit the efficacy of IL-1 in the inflammatory cascade and can prevent early granulation formation.Â© The Author(s) 2015.
Trauma-induced schwannoma of the recurrent laryngeal nerve after thyroidectomy. - The Laryngoscope
Laryngeal schwannomas are rare, benign tumors, most often arising from the superior laryngeal nerve. We describe a case of a 68-year-old female with a laryngeal schwannoma of the recurrent laryngeal nerve after traumatic injury. We postulate that trauma to the recurrent laryngeal nerve during thyroidectomy or thyroplasty incited growth of a nerve sheath tumor. This is the first reported case of a trauma-induced schwannoma of the recurrent laryngeal nerve and second case of a recurrent laryngeal nerve schwannoma. Although rare, this case demonstrates that these tumors should be considered during workup of vocal cord paresis after surgery or failed thyroplasty. Laryngoscope, 126:1408-1410, 2016.Â© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
First bite syndrome: Our experience with intraparotid injections with botulinum toxin type A. - The Laryngoscope
First bite syndrome is the sudden onset of acute and severe pain in the parotid region at the initiation of mastication. Although it generally lasts less than a minute, it is disabling for these individuals and leads to a fear of oral intake. It is typically seen after parapharyngeal or deep parotid space surgery. Intraparotid injection of botulinum toxin A (BTA) has been suggested as a treatment for this condition, but there is little supporting literature to this effect. The purpose of this study is to document our experience using this treatment method for first bite syndrome.Retrospective case review.Five patients with first bite syndrome, developed after parapharyngeal space surgery, were treated by multisite injection of BTA into the parotid gland. Between 17.5 and 50 total U of BTA were injected into four or more sites in the parotid region. The patients were then followed up every 4 months.Three of five patients reported a significant improvement in symptoms at the 4-month follow-up visit, although complete resolution was not reported. One patient reported only moderate improvement, and despite two series of injections there was no improvement in one patient, leading us to question our initial diagnosis.Unilateral BTA injection into the affected parotid gland produces a decrease in the severity of symptoms. It is a safe and viable noninvasive treatment for this difficult to treat condition and may lead to permanent resolution of symptoms in some patients.Â© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Anesthetic Management for Laser Excision of Ball-Valving Laryngeal Masses. - Case reports in anesthesiology
A 47-year-old obese woman with GERD and COPD presents for CO2-laser excision of bilateral vocal fold masses. She had a history of progressive hoarseness and difficulty in breathing. Nasopharyngeal laryngoscopy revealed large, mobile, bilateral vocal cord polyps that demonstrated dynamic occlusion of the glottis. We describe the airway and anesthetic management of this patient with a topicalized C-MAC video laryngoscopic intubation using a 4.5â€‰mm Xomed Laser Shield II endotracheal tube. We examine the challenges of anesthetic management unique to the combined circumstances of a ball-valve lesion and the need for a narrow-bore laser compatible endotracheal tube.
Anticholinergic Use Is a Major Risk Factor for Dysphonia. - The Annals of otology, rhinology, and laryngology
We hypothesize that many cases of dysphonia of unclear etiology are a form of sicca caused by anticholinergic medication use, and we aim to determine their association.This was a cross-sectional study conducted over a 6-month time period. Participants were drawn from a tertiary care laryngology practice within an academic institution.One hundred forty-nine patients met inclusion criteria. Patients rated the symptom of chronic hoarseness; scores were compared with participants' medication lists, comorbidities, age, and sex, and a multivariate logistic regression model was developed. Significance was set at P<.05. As a secondary analysis, participants rated a variety of other symptoms using the Voice Handicap Index-10, Reflux Symptom Index, and the GRBAS scale, which were likewise compared to anticholinergic use.Any patient taking at least 1 anticholinergic medication had a 2.32 increased odds (P=.03) of experiencing hoarseness. If the patient was taking 2 or more anticholinergic medications, those odds rose to 4.52 (P=.009).This is the first study, to our knowledge, that implicates medication use as a major risk factor for dysphonia of unclear etiology. An awareness of this association is invaluable when attributing cause to hoarseness and when considering treatment options.Â© The Author(s) 2015.
Influences of hormone replacement therapy on olfactory and cognitive function in postmenopausal women. - Neurobiology of aging
Olfactory dysfunction can be an early sign of Alzheimer's disease. Since hormone replacement therapy (HRT) may protect against Alzheimer's disease in postmenopausal women, the question arises as to whether it also protects against olfactory dysfunction in such women. A total of three olfactory and 12 neurocognitive tests were administered to 432 healthy postmenopausal women with varied HRT histories. Serum levels of reproductive hormones were obtained for all subjects; APOE-Îµ4 haplotype was determined for 77 women. National Adult Reading Test and Odor Memory/Discrimination Test scores were positively influenced by HRT. Odor Identification and Odor Memory/Discrimination Test scores were lower for women who scored poorly on a delayed recall test, a surrogate for mild cognitive impairment. The Wechsler Adult Intelligence Scale, Revised, as a Neuropsychological Instrument Spatial Span Backwards Test scores were higher in women receiving estrogen and progestin HRT and directly correlated with serum testosterone levels, the latter implying a positive effect of testosterone on spatial memory. APOE-Îµ4 was associated with poorer odor threshold test scores. These data suggest that HRT positively influences a limited number of olfactory and cognitive measures during menopause.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Inflammatory protein expression in human subglottic stenosis tissue mirrors that in a murine model. - The Annals of otology, rhinology, and laryngology
We undertook to describe the genetic and protein composition of subglottic stenosis (SGS) by measuring an array of protein expression and messenger RNA levels within human SGS tissue. We also sought to compare this human array to cytokine expression from a murine model of SGS in order to confirm the effective translational nature of our animal model.Human granulation tissue from 10 patients with early symptomatic SGS was compared to control bronchus. The expression levels of 24 different cytokines were measured by a Luminex protein assay and real-time polymerase chain reaction.The protein expression in human SGS mirrors that seen in murine SGS. Transforming growth factor Î²1, interleukin 1Î², and matrix metalloproteinase 9 were markedly elevated in both human and mouse SGS tissues. The protein array showed a statistically significant elevation in the proinflammatory cytokines tumor necrosis factor Î±, interleukin 1, granulocyte macrophage colony-stimulating factor, and interferon Î³.This is the first study, to our knowledge, to measure an array of protein expression within human SGS tissue. The expression profile suggests that symptomatic tracheal granulation tissue is mostly within the early inflammatory phase of wound healing and has only begun fibrotic and angiogenic remodeling. This study validates our murine model of SGS, and also helps to define the exact pathways of tissue injury, in the hope of leading to new treatments for this difficult condition.
Presentation and publication rates among women and men at AAO-HNS meetings. - ORL; journal for oto-rhino-laryngology and its related specialties
We attempted to assess the percentages of abstracts submitted to annual American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS) meetings from 2000 to 2004 by both women and men. We sought to determine the subsequent peer-reviewed overall publication rates for all submissions. We also studied trends of submission among female presenters and compared them to males.Cross-sectional study.Tertiary academic medical center.2,463 total abstracts presented between 2000 and 2004 were searched in the computerized databases Medline and Pubmed in 2008. The published articles were examined by reviewers to assess publication rate, time to publication, gender of authorship and subspecialty of publication.1,413 (57.35%) posters and 1,051 (42.65%) oral presentations were presented from 2000 to 2004. Of the 1,413 posters presented, 275 (19.46%) were presented by female first authors. The female first-author poster publication rate was 33.81%, while the male first-author poster publication rate was 36.99% (p = 0.353). Of 1,051 oral presentations, 154 (14.65%) were presented by female first authors. The male first-author oral presentation publication rate was 60.98%, while the female first-author oral presentation publication rate was 59.09% (p = 0.657). There were no statistical differences in time to publication for posters (p = 0.796) or oral presentations (p = 0.737) between the genders. The majority of female first-author submissions involved pediatric (29.94%) and general (17.88%) otolaryngology.While women are increasingly drawn to otolaryngology, they represented less than 20% of total submissions at the annual AAO-HNS meetings from 2000 to 2004. Women more commonly submit poster than oral presentations. The eventual publication rates of abstracts and the average time to publication of presentations are equal between the genders.Copyright Â© 2013 S. Karger AG, Basel.
Pulse steroid therapy inhibits murine subglottic granulation. - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
Using a functional model of airway granulation tissue in subglottic stenosis, we investigated changes in inflammatory markers within granulation tissue in response to intraperitoneal dexamethasone injections. Changes in inflammatory markers will allow us to identify potential targets for immunological therapy.Institutional Animal Care and Use Committee-approved animal study.Philadelphia Veterans Administration Medical Center animal research facility.Laryngotracheal complexes of donor mice underwent direct airway injury and were transplanted into subcutaneous tissue of 19 recipient mice in 2 groups: steroid treated and untreated, with sample sizes of 10 and 9, respectively. The steroid-treated arm received intraperitoneal injection of dexamethasone for 3 weeks. Laryngotracheal complexes were then harvested, and granulation formation was measured. The messenger RNA (mRNA) expression of transforming growth factor (TGF)-Î²(1) and interleukin (IL)-1 was quantified.At 3 weeks posttransplantation, there were statistically significant differences in observable granulation formation as well as mRNA expression of TGF-Î²(1) and IL-1Î² in all groups within the steroid treated arm as compared with the untreated arm.Systemic steroids have been used to prevent formation of granulation tissue and subglottic stenosis. However, the study of the immunologic markers and the corresponding changes with steroid treatment has not been well studied in animal models. Using a previously described novel murine model, we begin to delineate inflammatory markers that can be applied for potential therapeutic targets.
Map & Directions
3400 Spruce St 5 Silverstein Bldg Philadelphia, PA 19104
34Th Street & Civic Ctr Blvd
3401 Civic Ctr Blvd Children's Hsptl Of Philadelphia - Emergency Med
3401 Civic Ctr Blvd Children's Hospital Of Philadelphia - Cardiology
3401 Civic Ctr Blvd Children's Hospital Of Philadelphia - Neurology
34Th & Civic Ctr Blvd Children's Hospital Of Philadelphia
34Th & Civic Ctr Blvd Children's Hospital Of Philadelphia
3400 Spruce St 1 Maloney Building
34Th And Civic Ctr Blvd Children's Hsptl Of Philadelphia - Dept Of Radiology