Publications

Uchechukwu Megwalu, MD, MPH
Uchechukwu Megwalu, MD, MPH
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

  • Head and Neck Cancer Stage at Diagnosis and Survival Outcomes Among South Asian Patients. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Huynh, J. D., Halagur, A. S., Polkampally, S., Moon, P. K., Ma, Y., Megwalu, U. C. 2026

    Abstract

    OBJECTIVE: To compare head and neck cancer (HNC) stage at diagnosis and survival outcomes between South Asian, Other Asian, and non-Hispanic white individuals in the United States.STUDY DESIGN: Retrospective population-based cohort study.SETTING: Data from Surveillance, Epidemiology, and End Results Research Plus 17 database.METHODS: Patients diagnosed with squamous HNC from 2006 to 2020 were categorized as South Asian, Other Asian, and non-Hispanic white. Logistic regression assessed the association between race/ethnicity and advanced-stage disease (stage III/IV vs I/II). Overall survival (OS) and disease-specific survival (DSS) outcomes were evaluated using Kaplan-Meier analysis and Cox proportional hazards regression models, respectively.RESULTS: Among 92,664 patients (1066 South Asian, 3260 Other Asian, and 88,338 non-Hispanic white individuals), adjusted logistic regression showed South Asian individuals had a higher risk of advanced stage at diagnosis (odds ratio [OR] 1.48, 95% CI 1.29-1.70) than Other Asian (OR 1.13, 95% CI 1.05-1.22) and non-Hispanic white individuals. Adjusted Cox regression showed Other Asian (hazard ratio [HR] 0.89, 95% CI 0.84-0.94) individuals had improved OS, while South Asian individuals had similar OS (HR 1.09, 95% CI 0.99-1.21) as non-Hispanic white individuals. South Asian individuals had worse DSS (HR 1.30, 95% CI 1.16-1.46) than Other Asian (HR 1.05, 95% CI 0.98-1.12), and non-Hispanic white individuals.CONCLUSION: South Asian individuals with HNC are more likely to present with advanced disease stage and have worse survival compared with Other Asian and non-Hispanic white individuals, highlighting the importance of disaggregating Asian ethnic groups when assessing HNC outcome disparities.

    View details for DOI 10.1002/ohn.70215

    View details for PubMedID 41865270

  • Is the Risk of Clinically Significant Hemorrhage Following Tonsillectomy Greater in Adults Than Children? The Laryngoscope Tham, T., Megwalu, U. C. 2025

    View details for DOI 10.1002/lary.70120

    View details for PubMedID 40923521

  • Mediators of Racial Disparities in Head and Neck Cancer Survival. The Laryngoscope Megwalu, U. C., Ma, Y., Divi, V., Tian, L. 2025

    Abstract

    To evaluate and quantify the mediation effects of neighborhood socioeconomic status (SES), insurance status, and quality of care on racial disparities in HNC survival.Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Mediators included insurance status, SES, hospital quality, and National Comprehensive Cancer Network (NCCN) guideline-compliant care.Black patients (HR 1.14, 95% CI 1.05-1.24) had worse OS compared with White patients after adjusting for demographic, clinical, and treatment factors. SES accounted for 49.0% (95% CI 13.1%-84.8%) of the disparity. Health insurance (commercial: 21.9% (95% CI 12.3%-38.4%), Medicaid: 19.7% (95% CI 10.1%-45.4%)), hospital quality (high-quality: 5.1% (95% CI 2.1%-9.3%), low-quality: 4.9% (95% CI 1.2%-9.8%)), and guideline-compliant care (10.9% (95% CI 3.2%-23.6%)) also mediated the disparity. Asian/Pacific Islander patients (HR 1.26, 95% CI 1.10-1.43) had worse DSS. Health insurance had a small mediation effect (commercial: 3.0% (95% CI 1.0%-6.6%), Medicaid: 5.1% (95% CI 2.1%-8.9%)), while SES, hospital quality, and guideline-compliant care did not.SES, insurance status, and quality of care mediate racial disparities in HNC survival. These findings suggest that health system and policy interventions targeting SES, insurance reform, and quality of care may lead to reductions in HNC disparities.

    View details for DOI 10.1002/lary.70107

    View details for PubMedID 40910720

  • Feasibility of Automated Precharting using GPT-4 in New Specialty Referrals. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science Liang, A. S., Banda, J. M., Savage, T., Pandya, A., Carey, R., Megwalu, U. C., Chang, M. T., Dash, D., Corbin, C. K., Sharma, A., Thapa, R., Kotecha, N., Shah, N. H., Lee, J. Y., Chen, J. H. 2025; 2025: 312-321

    Abstract

    This study evaluates the feasibility of using GPT-4 to automate precharting for specialty referrals, focusing on new patients referred to an otolaryngology clinic for nasal congestion. We describe the design decisions and strategies tested in creating this precharting utility, including methods for prompt design and token limit handling. Through iterative testing and building, our tool achieved 95.0% agreement with physician consensus in a small retrospective test sample. Results from a small prospective pilot showed favorable feedback of summaries in a real-world clinical setting, though there was a discrepancy between high intention to use the summary but lower perception of time savings. Our results demonstrate that automated pre-charting with accuracy and clinical relevance can be feasible with large language models such as GPT-4. Our design features can inform the development of vendor chart summarization solutions.

    View details for PubMedID 40502261

    View details for PubMedCentralID PMC12150724

  • Impact of the 2015 American Thyroid Association Guidelines on Treatment of Low-Risk Thyroid Cancer. Laryngoscope investigative otolaryngology Halagur, A. S., Huynh, J. D., Megwalu, U. C. 2025; 10 (3): e70175

    Abstract

    The 2015 American Thyroid Association (ATA) guidelines recommended lobectomy for management of low-risk differentiated thyroid carcinomas (DTC), aiming to mitigate overtreatment. The primary objective of this study was to assess the impact of the 2015 ATA guidelines on the rates of lobectomy versus total thyroidectomy for the treatment of low-risk DTC, using the Surveillance, Epidemiology, and End Results (SEER) 17 database. Our secondary objectives were to examine the modifying effects of tumor size on the change in the rates of lobectomy between the pre- and post-guideline periods and to identify factors that are associated with the use of lobectomy in the post-guideline period.A retrospective cohort analysis of adults diagnosed with low-risk DTC from 2011 to 2020 was conducted using the SEER 17 database. Logistic regression assessed the likelihood of lobectomy and total thyroidectomy before and after guideline implementation, including size-stratified and post-guideline subgroup analyses.Among 61,078 patients, lobectomy rates increased from 16% pre-guideline to 25% post-guideline (aOR 1.81, 95% CI 1.74-1.89). Lobectomy increased across both T1 and T2 tumors; post-guideline subgroup analysis indicates T2 tumors were less likely to receive lobectomy than T1 tumors.The use of lobectomy for treatment of low-risk DTC has significantly increased since the publication of the 2015 ATA guidelines. However, total thyroidectomy remains the predominant treatment.Level 3.

    View details for DOI 10.1002/lio2.70175

    View details for PubMedID 40567401

    View details for PubMedCentralID PMC12187957

  • Cost of Neoadjuvant Immunotherapy vs Up-Front Surgery in Cutaneous Squamous Cell Carcinoma: A Post Hoc Analysis of a Nonrandomized Clinical Trial. JAMA otolaryngology-- head & neck surgery Wu, S. S., Colevas, A. D., Martinez Ramirez, L., Megwalu, U. C., Chen, M. M., Atwell, A., Divi, V. 2025

    Abstract

    There is increasing interest in use of neoadjuvant immunotherapy (NAT) in advanced cutaneous squamous cell carcinoma (cSCC) to reduce surgical morbidity and forego adjuvant therapy, while potentially improving survival outcomes.To assess the cost to Medicare of NAT compared with up-front surgery.This cohort study was a post hoc analysis of a phase 2 clinical trial evaluating the feasibility of neoadjuvant atezolizumab. The study was conducted from June 2021 to December 2023 at a tertiary-level academic institution among 20 patients with advanced stage II-IV cSCC.Up to 3 doses of neoadjuvant atezolizumab, followed by surgical resection with or without adjuvant radiation therapy.Direct medical costs in US dollars of care received on trial were compared with baseline treatment plans of up-front surgery developed a priori from a Medicare payer perspective.Of 20 patients with advanced cSCC enrolled (median [range] age, 71.5 [53-88] years; 17 male [85.0%]), most individuals had stage III (12 patients [60.0%]) or IV (5 patients [25.0%]) disease. The median (range) follow-up was 14.2 (3.5-28.7) months. Compared with

  • Clarification Regarding Insurance Disparities Among Patients With Head and Neck Cancer-Reply. JAMA otolaryngology-- head & neck surgery Megwalu, U. C., Ma, Y. 2025

    View details for DOI 10.1001/jamaoto.2024.4671

    View details for PubMedID 39745742

  • Feasibility of Automated Precharting using GPT-4 in New Specialty Referrals. AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science Liang, A. S., Banda, J. M., Savage, T., Pandya, A., Carey, R., Megwalu, U. C., Chang, M. T., Dash, D., Corbin, C. K., Sharma, A., Thapa, R., Kotecha, N., Shah, N. H., Lee, J. Y., Chen, J. H. 2025; 2025: 312-321

    Abstract

    This study evaluates the feasibility of using GPT-4 to automate precharting for specialty referrals, focusing on new patients referred to an otolaryngology clinic for nasal congestion. We describe the design decisions and strategies tested in creating this precharting utility, including methods for prompt design and token limit handling. Through iterative testing and building, our tool achieved 95.0% agreement with physician consensus in a small retrospective test sample. Results from a small prospective pilot showed favorable feedback of summaries in a real-world clinical setting, though there was a discrepancy between high intention to use the summary but lower perception of time savings. Our results demonstrate that automated pre-charting with accuracy and clinical relevance can be feasible with large language models such as GPT-4. Our design features can inform the development of vendor chart summarization solutions.

    View details for PubMedID 40502261

  • Association of race and ethnicity with quality of care among head and neck cancer patients in California. Oral oncology Megwalu, U. C., Ma, Y., Divi, V. 2024; 161: 107144

    Abstract

    There are significant racial disparities in head and neck cancer (HNC) outcomes. Racial differences in survival may be explained by differential access to high-quality care. The goal of this study was to evaluate the association of race and ethnicity with the quality of the treating hospital, and receipt of guideline-compliant care among HNC patients.Retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics. The study cohort included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Outcome measures included the quality of treating hospital, and NCCN guideline-compliant care.Black (OR 0.76, 95 % CI 0.67 to 0.85) and Hispanic (OR 0.68, 95 % CI 0.63 to 0.74) patients were less likely to be treated in top-quality hospitals compared with non-Hispanic White patients, after adjusting for demographic, and clinical factors. This association disappeared for Black patients, but persisted for Hispanic patients, after additionally adjusting for socioeconomic status and insurance status. Black patients with advanced-stage disease were less likely to be treated with dual-modality therapy (OR 0.82, 95 % CI 0.70 to 0.96), however, this association disappeared after adjusting for demographic, and clinical factors, and hospital quality.There are significant racial and ethnic disparities in quality of care for patients with HNC. Our findings suggest that differential access to high-quality care may account for some of the racial disparities in HNC survival, and highlight the need for continued investigation into the drivers of racial disparities in HNC outcomes.

    View details for DOI 10.1016/j.oraloncology.2024.107144

    View details for PubMedID 39700600

  • Perioperative Use of Systemic Steroids Within Otolaryngology-Head and Neck Surgery: Evidence-Based Guidance for Clinicians. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Ikeda, A. K., Gray, R., Lee, V., Dixon Johns, J., Briggs, S., Raol, N. R., Megwalu, U. C., Joe, S., Garritano, F., Brenner, M. J., McCoul, E. D. 2024

    Abstract

    To review and synthesize the available evidence for use of perioperative systemic steroids for otolaryngologic surgical procedures.A comprehensive literature review with evidence-informed recommendations.Databases were queried for medical subject heading terms and keywords related to perioperative systemic corticosteroids use for comprehensive otolaryngology and subspecialty procedures including otologic, sinonasal, sleep, laryngeal, head and neck, facial plastics, and pediatric surgery. Perioperative period included preoperative (up to 7 days prior to surgery), intraoperative (on the day of surgery), and postoperative (initiated within 24 hours after surgery) timeframes.Evidence from clinical practice guidelines, systematic reviews, and original research studies supports perioperative systemic corticosteroid use for specific otolaryngologic indications. Numerous studies support perioperative steroid use for nausea, vomiting, or edema in tonsillectomy, rhinoplasty, and thyroidectomy, although formal guideline recommendations are limited. Strong evidence supports perioperative steroid use before and after endoscopic sinus surgery for chronic rhinosinusitis with polyposis and fungal sinusitis. Evidence of benefit is sparse or absent on systemic perioperative steroid use for the middle and inner ear, laryngeal, salivary gland surgery, and reconstructive facial plastic surgery.Although perioperative administration of systemic steroids is routinely performed for many otolaryngologic surgeries, high-level evidence is limited to specific contexts. Evidence supports the benefit for reducing nausea, vomiting, or edema for several otolaryngologic procedures, as well as for either chronic rhinosinusitis with polyposis or fungal sinusitis. However, these benefits need to be weighed against risks, and further investigations are needed to define the role for perioperative steroids in otolaryngology.

    View details for DOI 10.1002/ohn.1067

    View details for PubMedID 39624920

Tristan Tham, MD
Tristan Tham, MD
Professor of Otolaryngology — Head & Neck Surgery

Publications

  • A Novel Risk Stratification Tool for Sinonasal Inverted Papilloma Recurrence: Multi-Institutional Nomogram Incorporating Dysplasia Severity. International forum of allergy & rhinology Tham, T., Giannaris, P., Kokabee, M., Kim, A., Wilensky, J., Tsang, C., Wang, B. Y., Panara, K., Kuan, E. C., Papagiannopoulos, P., Tajudeen, B., Eide, J. G., Craig, J. R., Kshirsagar, R. S., Christian, Z., Locke, T. B., Fastenberg, J. H., Chaskes, M. B., Pollack, A. Z., Har-El, G., Cui, S., Guerrero, D., Ahn, S., Oh, E. J., Kennedy, D. W., Workman, A. D., Kohanski, M. A., Douglas, J., Adappa, N. D., Palmer, J. N., Tong, C. C. 2026

    Abstract

    High-risk dysplasia and multifocal attachment independently predict inverted papilloma recurrence. Novel nomogram generates individualized 3-, 6-, and 9-year recurrence risk estimates. Risk-stratified surveillance may optimize postoperative monitoring intensity and intervals.

    View details for DOI 10.1002/alr.70102

    View details for PubMedID 41508928

  • Is the Risk of Clinically Significant Hemorrhage Following Tonsillectomy Greater in Adults Than Children? The Laryngoscope Tham, T., Megwalu, U. C. 2025

    View details for DOI 10.1002/lary.70120

    View details for PubMedID 40923521

  • Functional and radiological sinonasal outcomes of CFTR modulators for sinus disease in cystic fibrosis: A meta-analysis. International forum of allergy & rhinology Tham, T., Li, F. A., Schneider, J. R., Saleem, M. I., Werner, M. T., Chaskes, M. B., Tong, C. C., Fastenberg, J. H. 2024

    Abstract

    Cystic fibrosis transmembrane conductance regulator (CFTR) modulators improve pulmonary outcomes in cystic fibrosis (CF) by stabilizing the CFTR protein on respiratory epithelial surfaces. To determine the efficacy of CFTR modulators on sinonasal outcomes in patients with CF, we performed a meta-analysis of clinical trials to date that include functional and radiographic evidence of sinus disease.English full-text articles were searched in PubMed, Embase, and Scopus databases. Two reviewers screened articles and a third reviewer resolved disagreements. Articles were included if they reported functional or radiological sinonasal outcomes in patients with CF before and after CFTR modulator therapies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the risk of bias in non-randomized studies of interventions tool was used for quality assessment. The generic inverse variance method with random effects model was used for meta-analysis. Standardized mean difference (SMD) and mean difference (MD) were used as effect measurements.Seven prospective and two retrospective studies representing 248 patients were included in this analysis. There was a significant improvement in sinonasal outcome test-22 scores on elexacaftor‒tezacaftor‒ivacaftor (MD = 12.80, [95% confidence interval, CI: 10.46‒15.13], p < 0.001, n = 222), with no heterogeneity detected (I2 = 0%, p = 0.820). There was also a significant improvement in Lund‒Mackay scores (SMD = 1.25, [95% CI: 0.58‒1.91], p < 0.001, n = 88), with heterogeneity detected (I2 = 67%, p = 0.030).CFTR modulators improve functional and radiologic sinonasal outcomes. Given the utility of CFTR modulators, the treatment paradigm for CF-related chronic rhinosinusitis promises to evolve.

    View details for DOI 10.1002/alr.23439

    View details for PubMedID 39212072

  • Machine Learning Methods in Classification of Prolonged Radiation Therapy in Oropharyngeal Cancer: National Cancer Database. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Ahn, S., Oh, E. J., Saleem, M. I., Tham, T. 2024

    Abstract

    To investigate the accuracy of machine learning (ML) algorithms in stratifying risk of prolonged radiation treatment duration (RTD), defined as greater than 50 days, for patients with oropharyngeal squamous cell carcinoma (OPSCC).Retrospective cohort study.National Cancer Database (NCDB).The NCDB was queried between 2004 to 2016 for patients with OPSCC treated with radiation therapy (RT) or chemoradiation as primary treatment. To predict risk of prolonged RTD, 8 different ML algorithms were compared against traditional logistic regression using various performance metrics. Data was split into a distribution of 70% for training and 30% for testing.A total of 3152 patients were included (1928 prolonged RT, 1224 not prolonged RT). As a whole, based on performance metrics, random forest (RF) was found to most accurately predict prolonged RTD compared to both other ML methods and traditional logistic regression.Our assessment of various ML techniques showed that RF was superior to traditional logistic regression at classifying OPSCC patients at risk of prolonged RTD. Application of such algorithms may have potential to identify high risk patients and enable early interventions to improve survival.

    View details for DOI 10.1002/ohn.926

    View details for PubMedID 39082895

  • Impact of Treatment Parameters on Racial Survival Differences in Oropharyngeal Cancer: National Cancer Database Study. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Zhu, D., Wong, A., Oh, E. J., Ahn, S., Wotman, M., Sahai, T., Bottalico, D., Frank, D., Tham, T. 2022; 166 (6): 1134-1143

    Abstract

    To investigate how differences in treatment parameters account for survival differences between races of patients with oropharyngeal squamous cell carcinoma (OPSCC).Retrospective cohort study.National Cancer Database.Data of patients with OPSCC undergoing radiation therapy (RT) or concurrent chemoradiation therapy as primary treatment were obtained from the National Cancer Database from 2004 to 2016. We analyzed 4 treatment-related time intervals to determine their impact on survival between races when controlling for human papilloma virus (HPV) status. Cox proportional hazards models, stepwise logistic regressions, covariate adjustments, and propensity score matching were performed.A total of 3152 patients were identified (2877 White, 275 Black). In HPV- cases, Black patients with prolonged radiation duration had a significantly worse overall survival as compared with White patients (hazard ratio, 1.77; 95% CI, 1.03-3.05; P = .039). In a logistic regression model, the only covariate that was significantly associated with prolonged RT was facility type. When further adjusted for facility type, the survival difference between Black and White patients with HPV- status and prolonged RT times was no longer significant (hazard ratio, 1.55; 95% CI, 0.90-2.69; P = .116).There is a significant disparity in overall survival between Black and White patients with HPV- OPSCC when RT duration is prolonged. Clinicians should be aware of the negative impact of prolonged RT, especially in Black patients, so that they can attempt to decrease treatment-related time intervals. Facility type was also found to affect the outcomes of patients with OPSCC, and efforts should be made to improve patient access to well-equipped, high-volume facilities.

    View details for DOI 10.1177/01945998211035056

    View details for PubMedID 34399637

  • The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Tong, J. Y., Wong, A., Zhu, D., Fastenberg, J. H., Tham, T. 2020; 163 (1): 3-11

    Abstract

    To determine the pooled global prevalence of olfactory and gustatory dysfunction in patients with the 2019 novel coronavirus (COVID-19).Literature searches of PubMed, Embase, and Scopus were conducted on April 19, 2020, to include articles written in English that reported the prevalence of olfactory or gustatory dysfunction in COVID-19 patients.Search strategies developed for each database contained keywords such as anosmia, dysgeusia, and COVID-19. Resulting articles were imported into a systematic review software and underwent screening. Data from articles that met inclusion criteria were extracted and analyzed. Meta-analysis using pooled prevalence estimates in a random-effects model were calculated.Ten studies were analyzed for olfactory dysfunction (n = 1627), demonstrating 52.73% (95% CI, 29.64%-75.23%) prevalence among patients with COVID-19. Nine studies were analyzed for gustatory dysfunction (n = 1390), demonstrating 43.93% (95% CI, 20.46%-68.95%) prevalence. Subgroup analyses were conducted for studies evaluating olfactory dysfunction using nonvalidated and validated instruments and demonstrated 36.64% (95% CI, 18.31%-57.24%) and 86.60% (95% CI, 72.95%-95.95%) prevalence, respectively.Olfactory and gustatory dysfunction are common symptoms in patients with COVID-19 and may represent early symptoms in the clinical course of infection. Increased awareness of this fact may encourage earlier diagnosis and treatment, as well as heighten vigilance for viral transmission. To our knowledge, this is the first meta-analysis to report on the prevalence of these symptoms in COVID-19 patients.

    View details for DOI 10.1177/0194599820926473

    View details for PubMedID 32369429

  • Intra-arterial cetuximab for the treatment of recurrent unresectable head and neck squamous cell carcinoma†. Journal of experimental therapeutics & oncology Tham, T., White, T. G., Chakraborty, S., Lall, R. R., Ortiz, R., Langer, D. J., Shatzkes, D., Filippi, C. G., Kraus, D., Boockvar, J. A., Costantino, P. D. 2016; 11 (4): 293-301

    Abstract

    Management of recurrent head and neck squamous cell carcinoma is a common and challenging clinical problem in head and neck oncology.Here we present the first reported case of super-selective intra-arterial (SSIA) microcatheter based local delivery of cetuximab for head and neck cancer. This technical report describes the techniques used to deliver the SSIA dose of cetuximab, as well as the patient outcome.This technical report is part of an ongoing Phase I Clinical Trial.The New York Head and Neck Institute (NYHNI) is a full-service otolaryngology and neurosurgery department at Lenox Hill Hospital, part of the Northwell Health System. The NYHNI serves a diverse patient population with a wide range of head and neck diseases in a tertiary hospital setting.SSIA Cetuximab.A patient presents to our clinic with recurrent unresectable squamous cell carcinoma of the nasopharynx. He is recruited into the first cohort of a phase I clinical trial to assess the safety of SSIA cetuximab, dose starting at 100mg/m2. Adjuvant chemo-radiation therapy is also given.Safety, as measured by toxicity of SSIA cetuximab.SSIA Cetuximab has been demonstrated to be a safe and feasible procedure in this technical report.This case illustrates technical feasibility and a very preliminary assessment of the safety of a novel delivery of a biologic agent for squamous cell carcinoma of the head and neck, which is part of an ongoing phase I clinical trial.NCT02438995.

    View details for PubMedID 27849340

  • Sinonasal Inverted Papilloma and Clinical Significance of Dysplasia: A Multi-Institutional Study LARYNGOSCOPE Kim, A. H., Tham, T., Giannaris, P. S., Kokabee, M., Wilensky, J., Tsang, C., Wang, B. Y., Panara, K., Kuan, E. C., Papagiannopoulos, P., Tajudeen, B., Eide, J. G., Craig, J. R., Kshirsagar, R. S., Christian, Z., Locke, T. B., Fastenberg, J. H., Chaskes, M. B., Pollack, A. Z., Har-el, G., Cui, S., Guerrero, D., Ahn, S., Oh, E., Workman, A. D., Kohanski, M. A., Douglas, J., Robertson, E. S., Jalaly, J., Adappa, N. D., Palmer, J. N., Tong, C. C. L. 2025

    Abstract

    Sinonasal inverted papilloma (SNIP) is a benign sinonasal tumor with a tendency to recur and potential for malignant transformation. Dysplasia may be present, ranging from mild to severe. We aim to evaluate the effect of dysplasia on tumor behavior and patient outcomes.Retrospective chart review of SNIP cases from 2002 to 2023 treated by fellowship-trained Rhinologists at seven institutions. Clinical data were extracted, and tumors were histologically confirmed.Four hundred and forty-eight patients were eligible for analysis. The mean age was 58 years with an average postoperative surveillance of 27 months. Most patients had tumors without dysplasia (74.3%), followed by severe (10.5%), mild (10.0%), and moderate (5.1%) dysplasia. The overall recurrence rate was 11.6%. Unifocal attachment was most prevalent in tumors without dysplasia. Among patients with multifocal attachment, recurrence was highest in those with severe dysplasia (38.1%) compared to no dysplasia (17.2%). Unifocal attachment was associated with improved recurrence-free survival in all three histology types (without, mild, and moderate dysplasia).In the largest study to date examining the effect of dysplasia on patient outcomes, we found that SNIP that has severe dysplasia to be high risk for recurrence while the other three types of dysplasia to be of lower risk. We therefore propose a two-tiered grading system to improve consensus among pathologists and to guide patient counseling. In the treatment of SNIP, high-risk dysplasia is more often associated with multifocal attachment pattern and remains the most challenging to treat.

    View details for DOI 10.1002/lary.70263

    View details for Web of Science ID 001619990900001

    View details for PubMedID 41273225

  • Frontal Sinus Inverted Papilloma: Surgical Challenges and Outcomes of a Multi-Institutional Cohort. The Laryngoscope Tham, T., Kim, A. H., Wilensky, J., Tsang, C., Giannaris, P. S., Wang, B. Y., Panara, K., Christian, Z., Kuan, E. C., Papagiannopoulos, P., Tajudeen, B., Eide, J. G., Craig, J. R., Kshirsagar, R. S., Locke, T. B., Ahn, S., Oh, E. J., Fastenberg, J. H., Chaskes, M. B., Pollack, A. Z., Har-El, G., Workman, A. D., Kohanski, M. A., Douglas, J., Adappa, N. D., Palmer, J. N., Tong, C. C. 2025

    Abstract

    Inverted papilloma (IP) is typically a benign sinonasal tumor with a propensity to recur. The surgical treatment of IP arising from the frontal sinus is complicated by proximity to the orbit and skull base. The objective of this study is to describe the surgical challenges when managing this disease and report treatment outcomes in a multicenter cohort.A retrospective review was performed on frontal sinus IP resected from 1993 to 2023. Demographic and clinicopathologic data, complications, surgical approach, and outcomes were analyzed.Ninety-eight patients (60 males, 38 females) were identified. Mean age was 59 years, with a median follow-up of 44 months. Histopathologic evaluation identified 13 lesions with carcinoma in situ or invasive carcinoma (13.3%). Bilateral involvement was found in 28 patients (28.6%). Overall, 17 patients (17.3%) had recurrent disease with a median recurrence time of 29.2 months. Fourteen patients (14.3%) underwent staged procedures, with a median time to the second procedure of 7.7 months. Twenty-three patients (23.5%) presented with skull base dehiscence on perioperative imaging. Skull base dehiscence had a significant effect on intraoperative cerebrospinal fluid leak (OR 9.1, 95% CI 3.0-27.4 p < 0.001).Frontal sinus IP is commonly attached at the skull base and associated with skull base dehiscence, CSF leak, and often requires operative repair and staged procedures. Complete tumor removal can be challenging and may necessitate a combined open and endoscopic approach. Careful surgical planning and close follow-up in the postoperative period are essential for disease control.Level 4.

    View details for DOI 10.1002/lary.70103

    View details for PubMedID 40899433

  • Synchronous yet distinct HPV-associated sinonasal carcinomas on an immune-dysfunctional background. Journal of surgical case reports Thomas, J., Giannaris, P., Lee, K., Gomez Marti, J. L., Tham, T., Pollack, A. Z., Westra, W. H., Opher, E., Tong, C. C. 2025; 2025 (9): rjaf693

    Abstract

    Human papillomavirus (HPV)-associated multiphenotypic sinonasal carcinoma (HMSC) is a relatively new classification of head and neck carcinomas that displays histological combinations of multiple different neoplasms. Despite their high-grade appearance, the disease course is often indolent. Here, we report a unique case of HMSC in which a patient with a prior history of sarcoidosis presented with two histologically, and anatomically distinct tumors in the sinonasal tract. One of the tumors was denoted as HMSC, and the other resembled a nonkeratinizing squamous cell carcinoma. Importantly, these two tumors were both found to be driven by the same high-risk HPV strain, HPV45, which has not been reported previously in HMSC. In this patient, it is important to note that the concomitant diagnosis of malignancy and sarcoidosis makes disease monitoring challenging, given the ability of sarcoidotic nodules to mimic the metabolic characteristics of tumors on PET scans.

    View details for DOI 10.1093/jscr/rjaf693

    View details for PubMedID 40904594

    View details for PubMedCentralID PMC12401870