Division Chief, Comprehensive Otolaryngology, Stanford University School of Medicine (2019 - Present) Otolaryngology Clerkship Director, Stanford University School of Medicine (2017 - Present) Director of Otolaryngology, Queens Hospital Center, Jamaica, NY, USA (2011 - 2015) Assistant Regional Director of Otolaryngology, Queens Health Network, Queens, NY, USA (2011 - 2015)


  • Association of Human Papillomavirus Status With Suicide Risk Among Patients With Head and Neck Cancer. JAMA otolaryngology-- head & neck surgery Chakoma, T., Moon, P. K., Osazuwa-Peters, O. L., Megwalu, U. C., Osazuwa-Peters, N. 2023


    Human papillomavirus (HPV) is strongly associated with head and neck cancer, and HPV status is considered a prognostic factor. Being a sexually transmitted infection, HPV-related cancers may have greater risk of stigma and psychological distress; however, the potential association of HPV-positive status with psychosocial outcomes, such as suicide, is understudied in head and neck cancer.To investigate the association between HPV tumor status and suicide risk among patients with head and neck cancer.This population-based retrospective cohort study included adult patients with clinically confirmed cases of head and neck cancer based on HPV tumor status from the Surveillance, Epidemiology, and End Results database from January 1, 2000, to December 31, 2018. Data analysis was conducted from February 1 to July 22, 2022.The outcome of interest was death by suicide. Primary measure was HPV status of tumor site, dichotomized as positive or negative. Covariates included age, race, ethnicity, marital status, cancer stage at presentation, treatment modality, and type of residence. Cumulative risk of suicide among patients with HPV-positive and HPV-negative head and neck cancer was assessed using Fine and Gray competing risk models.Of 60 361 participants, the mean (SD) age was 61.2 (13.65) years, and 17 036 (28.2%) were women; there were 347 (0.6%) American Indian, 4369 (7.2%) Asian, 5226 (8.7%) Black, 414 (0.7%) Native Hawaiian or Other Pacific Islander, and 49 187 (81.5%) White individuals. A competing risk analysis showed a significant difference in the cumulative incidence of suicide between HPV-positive cancers (5-year suicide-specific mortality, 0.43%; 95% CI, 0.33%-0.55%) and HPV-negative cancers (5-year suicide-specific mortality, 0.24%; 95% CI, 0.19%-0.29%). Tumor status that was HPV positive was associated with increased suicide risk in the unadjusted model (hazard ratio [HR], 1.76; 95% CI, 1.28-2.40), but not the fully adjusted model (adjusted HR, 1.18; 95% CI, 0.79-1.79). Among people with oropharyngeal cancer only, HPV status was associated with increased suicide risk, but the width of the confidence interval prevented definitive conclusion (adjusted HR, 1.61; 95% CI 0.88-2.94).The results of this cohort study suggest that patients with HPV-positive head and neck cancer have similar risk of suicide as patients with HPV-negative cancer, despite differences in overall prognosis. Early mental health interventions may be associated with reduced suicide risk in all patients with head and neck cancer and should be assessed in future work.

    View details for DOI 10.1001/jamaoto.2022.4839

    View details for PubMedID 36795392

  • Disparities in Outcomes for Pacific Islander Patients vs Asian and non-Hispanic White Patients With Head and Neck Cancer-Reply. JAMA otolaryngology-- head & neck surgery Moon, P. K., Megwalu, U. C. 2022

    View details for DOI 10.1001/jamaoto.2022.3373

    View details for PubMedID 36301566

  • In Reference to: How Many Nodes to Take? Lymph Node Ratio Below 1/3 Reduces Papillary Thyroid Cancer Nodal Recurrence. The Laryngoscope Megwalu, U. C. 2022

    View details for DOI 10.1002/lary.30460

    View details for PubMedID 36271915

  • Associations of Hearing Loss Severity and Hearing Aid Use With Hospitalization Among Older US Adults. JAMA otolaryngology-- head & neck surgery Thai, A., Khan, S. I., Choi, J., Ma, Y., Megwalu, U. C. 2022


    Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited.To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization.This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022.Audiometric hearing loss severity and participant-reported hearing aid use.The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement.Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92).In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.

    View details for DOI 10.1001/jamaoto.2022.2399

    View details for PubMedID 36048464

  • Thyroid Cancer Incidence, Clinical Presentation, and Survival Among Native Hawaiian and Other Pacific Islanders. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Moon, P. K., Chakoma, T., Ma, Y., Megwalu, U. C. 2022: 1945998221118538


    OBJECTIVE: To assess the incidence, clinical presentation, and survival in Native Hawaiian and other Pacific Islander (NHPI) patients with well-differentiated thyroid cancer.STUDY DESIGN: This population-based incidence analysis and retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results database.SETTING: Incidence analysis included patients diagnosed between 1990 and 2014, while the cohort to study clinical presentation and survival comprised patients diagnosed between 2004 and 2015.METHODS: Incidence rates and trends were compared among NHPI, Asian, and non-Hispanic White (NHW) populations. Clinical presentation was assessed via multivariable logistic regression. Survival was assessed per Cox regression.RESULTS: Recent incidence trends (2009-2014) show that the rate of increase remained consistent among NHPI patients (annual percentage change, 3.67%; 95% CI, 2.66%-4.69%), while it slowed in the NHW population and plateaued among Asians as compared with previous years. NHPI patients were more likely to present with distant metastasis than NHW patients (odds ratio, 3.37; 95% CI, 1.97-5.36) and Asian patients (odds ratio, 1.82; 95% CI, 1.05-2.97). NHPI race was also associated with advanced T stage and nodal metastasis as compared with the NHW race. Survival outcomes were similar among NHPI, NHW, and Asian patients.CONCLUSION: Well-differentiated thyroid cancer incidence has increased at a higher rate for the NHPI population as opposed to the NHW and Asian populations in recent years. NHPI patients are more likely to present with advanced disease when compared with NHW and Asian patients. These results highlight the importance of disaggregating the often-combined Asian/Pacific Islander group in epidemiologic studies.

    View details for DOI 10.1177/01945998221118538

    View details for PubMedID 35943808

  • Head and Neck Cancer Among Native Hawaiian and Other Pacific Islander Patients-Disparities in Cancer Stage at Presentation and Survival Outcomes Compared With Other Races: A Population-Based Cohort Study. JAMA otolaryngology-- head & neck surgery Moon, P. K., Ma, Y., Megwalu, U. C. 2022


    Importance: Research studies often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races.Objective: To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients.Design, Setting, and Participants: This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded.Main Outcomes and Measures: Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022.Results: The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR] 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients.Conclusions and Relevance: This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions to promote earlier detection of head and neck cancer and improved survival among the Native Hawaiian and Other Pacific Islander population.

    View details for DOI 10.1001/jamaoto.2022.1086

    View details for PubMedID 35616952

  • Moving Beyond Detection: Charting a Path to Eliminate Health Care Disparities in Otolaryngology. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Bowe, S. N., Megwalu, U. C., Bergmark, R. W., Balakrishnan, K. 2022: 1945998221094460


    The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.

    View details for DOI 10.1177/01945998221094460

    View details for PubMedID 35439090

  • Systemic Steroids for Otolaryngology-Head and Neck Surgery Disorders: An Evidence-Based Primer for Clinicians. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery McCoul, E. D., Megwalu, U. C., Joe, S., Gray, R., O'Brien, D. C., Ference, E. H., Lee, V. S., Patel, P. S., Figueroa-Morales, M. A., Shin, J. J., Brenner, M. J. 2022: 1945998221087664


    OBJECTIVE: To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders.DATA SOURCES: PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines.REVIEW METHODS: A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings.CONCLUSIONS: Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Meniere's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss.IMPLICATIONS FOR PRACTICE: Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.

    View details for DOI 10.1177/01945998221087664

    View details for PubMedID 35349383

  • Risk of Second Primary Malignancies After External Beam Radiotherapy for Thyroid Cancer. Anticancer research Jin, M. C., Qian, Z. J., Megwalu, U. C. 2022; 42 (3): 1359-1365


    AIM: To investigate the association between external beam radiotherapy (EBRT) and the incidence of second primary tumors in patients with thyroid cancer.MATERIALS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results 9 database. The study cohort included patients diagnosed with thyroid cancer between 1973 and 2017. Risk factors for second primary malignancies were identified with Cox proportional hazards models. Propensity score-matched analyses were used to assess the association between EBRT and second primary malignancies.RESULTS: Out of 72,392 patients with thyroid cancer, 7,684 (10.6%) developed a subsequent primary malignancy. Propensity score-matched analysis demonstrated patients receiving EBRT were more likely to develop second primary malignancies [30-year cumulative incidence=35.3% (95% confidence interval (CI)=30.4-39.8% vs. 28.1% (95% CI=27.0-29.2%); hazard ratio=1.17 (95% CI=1.03-1.33)].CONCLUSION: In patients with thyroid cancer, EBRT is associated with an increased incidence of second primary malignancies.

    View details for DOI 10.21873/anticanres.15605

    View details for PubMedID 35220228

  • Benign Ectopic Thyroid in the Lateral (Level II) Neck Compartment CUREUS JOURNAL OF MEDICAL SCIENCE Liu, G. S., Berry, G. J., Desai, K., Megwalu, U. C. 2022; 14 (2)

Research Goals

Our purpose is to conduct research that directly impacts health care delivery and health outcomes for patients with diseases of the head and neck. Our multi-disciplinary team includes researchers, clinicians, and trainees with complimentary expertise and experience in clinical care and outcomes/health services research