Publications

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)

Publications

  • Update on Pediatric Thyroid Cancer Incidence and Mortality Trends in the United States, 2000-2018. Cancer investigation Li, G., Tai, J. W., Moon, P. K., Megwalu, U. C. 2024: 1-4

    Abstract

    Thyroid cancer is the most common endocrine malignancy in the pediatric population. A recent study has revealed a recent decline in overall US thyroid cancer incidence rates. The aim of this study is to assess whether there has been a corresponding decline in incidence rates in the pediatric population. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the pediatric thyroid cancer incidence rate. The results demonstrate that the incidence rate of pediatric thyroid cancer continued to increase from 2000 to 2018. Future studies are needed to understand how recent changes in guidelines are affecting incidence rates.

    View details for DOI 10.1080/07357907.2024.2353313

    View details for PubMedID 38742680

  • Thyroid Cancer Incidence Among Korean Individuals: A Comparison of South Korea and the United States. The Laryngoscope Kim, D., Li, G., Moon, P. K., Ma, Y., Sim, S., Park, S. Y., Oh, M., Megwalu, U. C. 2024

    Abstract

    OBJECTIVE: To compare thyroid cancer incidence rates and trends between Korean, non-Korean Asian, and non-Hispanic White populations in the United States, and between the US Korean population and the South Korean population.METHOD: Population-based analysis of cancer incidence data. Cases of thyroid cancer diagnosed during 1999-2014 from the Korean Central Cancer Registry (KCCR) and the Surveillance, Epidemiology, and End Results (SEER) 9 detailed Asian/Pacific Islander subgroup incidence and population dataset were included. Incidence rates were obtained from the datasets, and annual percent change (APC) of the incidence rates was calculated using Joinpoint regression analysis.RESULTS: Thyroid cancer incidence rate for 1999-2014 was significantly higher for South Korea (48.05 [95% CI 47.89-48.22] per 100,000 person-years) than for the US Korean population (11.12 [95% CI 10.49-11.78] per 100,000 person-years), which was slightly higher than the Non-Korean Asian population (10.23 [95% CI 10.02-10.43] per 100,000 person-years), and slightly lower than the Non-Hispanic White population (12.78 [95% CI 12.69-12.87] per 100,000 person-years). Incidence rates in South Korea increased dramatically (average APC 17.9, 95% CI 16.0-19.9), significantly higher than the US Korean population (average APC 5.0, 95% CI 3.1-6.8), which was similar to the non-Korean Asian (average APC 2.5, 95% CI 0.9-4.2) and the non-Hispanic White (average APC 5.1, 95% CI 4.7-5.6) populations.CONCLUSIONS: South Korea's high thyroid cancer incidence rates cannot be attributed to genetic factors, but are likely due to health care system factors.LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

    View details for DOI 10.1002/lary.31490

    View details for PubMedID 38727257

  • Oral cavity cancer in young, non-smoking, and non-drinking patients: a contemporary review. Critical reviews in oncology/hematology Tran, Q., Maddineni, S., Arnaud, E. H., Divi, V., Megwalu, U., Topf, M. C., Sunwoo, J. B. 2023: 104112

    Abstract

    Oral squamous cell carcinoma (OSCC) in non-smoking and non-drinking (NSND) individuals appears to be distinct from the traditional head and neck squamous cell carcinoma (HNSCC). The incidence of this subset is increasing, as are the number of studies examining its characteristics. NSND OSCC individuals tend to be younger (<45 years) compared to traditional HNSCC patients. The proportion of females in the NSND OSCC cohort is also higher. The tongue is the predominantly affected subsite. Studies have revealed several gene mutations and unique epigenomic profiles but no definitive genetic etiology. Transcriptomic analysis has not found any causative viral agents. Other proposed etiologies include chronic dental trauma, microbiome abnormalities, marijuana consumption, and genetic disorders. There are international efforts to determine the relative prognostic outcome of this unique cohort, but no consensus has been reached. Here, we review the incidence, demographics, subsite, possible etiologies, prognosis, and therapy implications of the NSND OSCC cohort.

    View details for DOI 10.1016/j.critrevonc.2023.104112

    View details for PubMedID 37633348

  • Nonopioid Versus Opioid Analgesics After Thyroid and Parathyroid Surgery: A Systematic Review. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Moon, P. K., Wei, E. X., Hamid, M. S., Borghi, J. A., Megwalu, U. C. 2023

    Abstract

    To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid analgesic regimens. Secondarily, we sought to determine if nonopioid analgesic regimens decrease the number of opioid medications taken after thyroid and parathyroid surgery, and to assess adverse events associated with opioid versus nonopioid regimens.PubMed, Embase, Cochrane.A comprehensive search of the literature was performed according to the PRISMA guidelines, and identified 1299 nonduplicate articles for initial review of which 2 randomized controlled trials (RCTs) were identified as meeting all eligibility criteria. Meta-analysis was not conducted due to heterogeneity in the data and statistical analyses.Both RCTs included in this systematic review found no significant differences in postoperative pain scores between individuals discharged with a nonopioid only analgesic regimen compared to analgesic regimen that included oral opioid medications. One study reported significantly increased number of postoperative calls related specifically to pain in the nonopioid arm compared to the opioid arm (15.6% vs. 3.2%, P = .045).This systematic review of RCTs revealed a limited number of studies examining nonopioid versus opioid postoperative pain medications among adults who undergo thyroid and parathyroid surgery. Among the 2 RCTs on this topic, there is a shared finding that nonopioid analgesic regimens are noninferior to opioid analgesic regimens in managing postoperative pain after thyroid and parathyroid surgery, supporting the use of nonopioid pain regimens given the risk of opioid dependence associated with prescription opioid medications.

    View details for DOI 10.1002/ohn.503

    View details for PubMedID 37595107

  • Association between insurance status and hearing healthcare use in the United States. American journal of otolaryngology Bernstein, I. A., Megwalu, U. C. 2023; 44 (6): 103993

    Abstract

    Despite the high prevalence and morbidity of hearing loss, many individuals with hearing loss do not have access to hearing healthcare. This study aims to assess the relationship between insurance status and prior audiogram, and hearing aid use among subjects with hearing loss.This cross-sectional study of the 2009-10, 2011-12, and 2015-16 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) included 5270 adult subjects 18 years or older with subjective or audiometric hearing loss. Subjects were stratified by insurance: Medicare, Medicaid, private, uninsured, and 'other or unspecified'.After adjusting for covariates, among subjects with audiometric hearing loss, prior audiogram was not associated with insurance type, including no insurance (OR 0.80, 95 % CI 0.45 to 1.42), Medicare (OR 1.34, 95 % CI 0.69 to 2.59), Medicaid (OR 1.27, 95 % CI 0.55 to 2.93), or 'other or unspecified' (OR 1.73, 95 % CI 0.67 to 4.47). Hearing aid use was not associated with insurance type, including no insurance (OR 0.20, 95 % CI 0.03 to 1.29), Medicare (OR 0.56, 95 % CI 0.27 to 1.14), Medicaid (OR 2.03, 95 % CI 0.47 to 8.71), or 'other or unspecified' (OR 1.76, 95 % CI 0.59 to 5.23).Health insurance status was not associated with hearing healthcare use in our nationally-representative sample of individuals with hearing loss. Given variations in hearing coverage by Medicaid between states, future studies should compare the impact of Medicaid insurance on hearing aid use between states that cover hearing aids and those that do not.

    View details for DOI 10.1016/j.amjoto.2023.103993

    View details for PubMedID 37454432

  • 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

    Abstract

    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

    Abstract

    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

    Abstract

    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

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