Bio

Bio


Dr. Megwalu was born in Ottawa, Ontario, Canada, but spent most of his childhood in Nigeria. He received his undergraduate degree from McMaster University in Hamilton, Ontario, Canada. Dr. Megwalu received his medical degree from Washington University School of Medicine, completed his residency at New York Eye and Ear Infirmary, and received his MPH degree from Icahn School of Medicine at Mount Sinai. After residency, Dr. Megwalu joined the faculty at Icahn School of Medicine at Mount Sinai, where he served as Director of Otolaryngology at Queens Hospital Center, and Assistant Regional Director of Otolaryngology for Queens Health Network from 2011 to 2015.
Dr. Megwalu Joined the Division of Comprehensive Otolaryngology at Stanford in 2016. His clinical interests include thyroid and parathyroid disorders, head and neck tumors, sinusitis, and chronic ear disorders. Dr. Megwalu conducts outcomes/health services research, with a focus on health literacy, health disparities, and comparative effectiveness research.

Clinical Focus


  • Comprehensive Otolaryngology
  • Thyroid Neoplasms
  • Thyroid Cancer
  • Parathyroid Neoplasms
  • Salivary gland tumors
  • Chronic sinusitis
  • Endoscopic Sinus Surgery
  • Otitis Media
  • Tympanoplasty
  • Otolaryngology

Academic Appointments


Administrative Appointments


  • 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)

Honors & Awards


  • New York City Health and Hospitals Corporation Doctor’s Day Award, New York City Health and Hospitals Corporation (May, 2015)
  • Senator Jose Peralta Certificate of Recognition, New York State Senate (January, 2015)
  • New York City Council Citation, New York City Council (January, 2015)
  • Certificate of Special Congressional Recognition, US Congressman Joseph Crowley (January, 2015)
  • Queens Courier Rising Stars Award, Queens Courier (January, 2015)
  • Hyun Taik Cho, MD Research Scholarship Award, New York Eye and Ear Infirmary (November, 2009)
  • Robert Carter Medical School Award, Washington University School of Medicine (5/19/2006)
  • Distinguished Minority Medical Scholar, Washington University School of Medicine (8/10/2002 – 5/19/2006)

Boards, Advisory Committees, Professional Organizations


  • Member, American Academy of Otolaryngology – Head and Neck Surgery (2006 - Present)

Professional Education


  • Professional Education:Icahn School of Medicine at Mount Sinai (2014) NY
  • Board Certification: Otolaryngology, Royal College of Physicians and Surgeons of Canada (2012)
  • Board Certification: Otolaryngology, American Board of Otolaryngology (2012)
  • Residency:New York Eye and Ear Infimary (2011) NY
  • Internship:New York Eye and Ear Infimary (2007) NY
  • Medical Education:Washington University School of Medicine (2006) MO
  • MD, Washington University School of Medicine, Medicine (2006)
  • Residency, New York Eye and Ear Infirmary, Otolaryngology - Head and Neck Surgery (2011)
  • Board Certification, American Board of Otolaryngology, Otolaryngology - Head and Neck Surgery (2012)
  • Board Certification, Royal College of Physicians and Surgeons of Canada, Otolaryngology - Head and Neck Surgery (2012)
  • MPH, Icahn School of Medicine at Mount Sinai, Public Health - Outcomes Research Track (2014)

Research & Scholarship

Current Research and Scholarly Interests


I have an interest in Outcomes/Health Services Research. Specific areas of interest include: health literacy, head and neck cancer epidemiology and comparative effectiveness research using large population-based cancer databases.

Health Literacy:
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health. Health literacy goes beyond the ability to read and write (fundamental literacy), but also includes other skills such as speaking, listening, adequate background medical knowledge, and the ability for self-advocacy. It is estimated that 90 million adults in the United States have inadequate health literacy. Health literacy has been shown to impact outcomes in a number of medical conditions, including asthma, COPD, diabetes, and hypertension.
Unfortunately, health literacy is grossly studied in the otolaryngology literature. Our research team is examining the impact of health literacy on otolaryngology – head and neck surgery patient outcomes. Ongoing work includes: identifying appropriate and practical measures of health literacy in clinical practice; assessing the determinants of health literacy; and evaluating the impact of health literacy on specific outcomes such as treatment compliance and quality of life.

Head and Neck Cancer Epidemiology and Comparative Effectiveness:
Head and neck cancer is the seventh most common cancer in the world. It accounts for approximately 10% of cancers, with an estimated 130,000 new cases in the United States in 2015. Head and neck cancer is an important cause of cancer mortality, with an average 5-year cumulative survival of 65% in the United States. In addition to tumor-specific factors, non-clinical factors, such as race, gender, and socioeconomic status, are known to significantly impact patient outcomes.
My research interest is in the use of large datasets, such as the SEER database, to evaluate the impact of sociodemographic and clinical factors on treatment choice and survival outcomes. Ongoing work includes evaluating the comparative effectiveness of treatment options in the management of head and neck cancer. Research methods utilized include traditional univariable and multivariable methods, as well as quasi experimental methods, such as propensity score analysis and instrumental variable analysis.

Publications

All Publications


  • Evaluation of a laryngopharyngeal reflux management protocol. American journal of otolaryngology Gupta, N., Green, R. W., Megwalu, U. C. ; 37 (3): 245–50

    Abstract

    To evaluate the effectiveness of a protocol for management of patients with laryngopharyngeal reflux (LPR) in a multi-provider clinic.This is a retrospective cohort study of 188 patients treated for LPR. A standardized clinical protocol for diagnosis and management was instituted in 2012. Two cohorts were established: those managed according to the protocol, and those who were not. For patients managed with the LPR protocol, diagnosis was made using clinical judgment, guided by the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). Patients were treated with proton pump inhibitors (PPI) with the goal of weaning therapy after symptom resolution. Response to therapy was rated using a global rating scale with three response levels: no response, partial response, and complete response. The primary outcome measure was complete response to therapy and the secondary outcome measures were any response (complete or partial) and successful wean off PPI therapy.The patients treated with the LPR protocol had higher rates of complete response (p<0.001). There was no statistically significant difference in rates of any response (complete or partial) between the two groups (p=0.08). Patients treated using the LPR protocol were more likely to be successfully weaned off PPI therapy (p=0.006).The use of an LPR protocol improved treatment effectiveness in our clinic, highlighting the role of clinical protocols in reducing variability in care, thereby improving patient outcomes.

    View details for DOI 10.1016/j.amjoto.2016.01.008

    View details for PubMedID 27178517

  • Jaw Opening Decreases Window to the Deep Parotid Lobe. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Lee, Y., Megwalu, U., Melara, E., Divi, V., Fernandes, V. T., Sirjani, D. 2018: 194599818766317

    Abstract

    To describe the relationship between jaw opening and access to the deep parotid window, we identified the following distances in 10 human skulls: symphysis to angle of mandible, mastoid tip to angle of mandible, angle of mandible to condylar process, and mastoid tip to condylar process. With the jaw closed and open, these distances were measured with 1 to 3 wooden blocks, each measuring 1 cm, between the upper and lower incisors. The triangular deep parotid area formed by the last 3 distances was calculated. A repeated measures analysis of variance showed a significant decrease in the deep parotid area with increasing interincisal distance ( P < .01). A generalized estimating equation model demonstrated a statistically significant decreasing area of the deep parotid window with increasing interincisal distance. These results suggest that nasal intubation may improve access to the parotid window.

    View details for DOI 10.1177/0194599818766317

    View details for PubMedID 29609515

  • Dysphagia and Pharyngeal Obstruction in a Nonsmoker JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Nuyen, B. A., Berry, G., Megwalu, U. 2018; 144 (2): 171–72

    View details for DOI 10.1001/jamaoto.2017.2436

    View details for Web of Science ID 000425152700014

    View details for PubMedID 29222562

  • Surrogate for oropharyngeal cancer HPV status in cancer database studies HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK Megwalu, U. C., Chen, M. M., Ma, Y., Divi, V. 2017; 39 (12): 2494–2500

    Abstract

    The utility of cancer databases for oropharyngeal cancer studies is limited by lack of information on human papillomavirus (HPV) status. The purpose of this study was to develop a surrogate that can be used to adjust for the effect of HPV status on survival.The study cohort included 6419 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, identified in the National Cancer Database (NCDB). The HPV surrogate score was developed using a logistic regression model predicting HPV-positive status.The HPV surrogate score was predictive of HPV status (area under the curve [AUC] 0.73; accuracy of 70.4%). Similar to HPV-positive tumors, HPV surrogate positive tumors were associated with improved overall survival (OS; hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.59-0.91; P = .005), after adjusting for important covariates.The HPV surrogate score is useful for adjusting for the effect of HPV status on survival in studies utilizing cancer databases.

    View details for DOI 10.1002/hed.24921

    View details for Web of Science ID 000423179300017

    View details for PubMedID 28963794

  • Oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States, 1973-2013. The Laryngoscope Megwalu, U. C., Sirjani, D., Devine, E. E. 2017

    Abstract

    OBJECTIVE: To analyze oropharyngeal squamous cell carcinoma incidence and mortality trends in the United States for the years 1973 through 2013.STUDY DESIGN: Cross-sectional study using a large population-based cancer database.METHODS: Data on incidence and mortality rates were extracted from the Surveillance, Epidemiology, and End Results (SEER) 9 Database. Annual percentage change in rates was calculated using Joinpoint regression analysis (National Cancer Institute, Bethesda, MD).RESULTS: Incidence rates increased (annual percent change [APC]; 1.52, 95% confidence interval [CI] 0.17 to 2.88) from 1973 to 1983, remained stable (APC -0.52, 95% CI -1.30 to 0.26) from 1983 to 1997, and increased (APC 1.32, 95% CI 0.83 to 1.81) from 1997 to 2013. Overall, incidence rates increased for males (APC 0.73, 95% CI 0.22 to 1.25) but not females (APC -0.77, 95% CI -0.68 to 0.82). Incidence rates increased in the white population (APC 0.79, 95% CI 0.33 to 1.25) but decreased in the black population (APC -0.72, 95% CI -1.41 to -0.02). The incidence rates increased for tongue-base tumors (APC 1.17, 95% CI 0.42 to 1.92) and tonsil tumors (APC 0.47, 95% CI 1.10 to 4.96) but decreased for other sites. Incidence-based mortality decreased (APC -0.78, 95% CI -1.13 to -0.42) from 1993 to 2013.CONCLUSION: Oropharyngeal squamous cell carcinoma incidence rates increased in a nonlinear fashion from 1973 to 2013, whereas mortality rates declined. This, along with variation in trends by demographic and tumor factors, suggest that human papilloma virus is the main driver of the recent rise in incidence.LEVEL OF EVIDENCE: 2b. Laryngoscope, 2017.

    View details for DOI 10.1002/lary.26972

    View details for PubMedID 29086431

  • Retrograde Parotidectomy and facial nerve outcomes: A case series of 44 patients AMERICAN JOURNAL OF OTOLARYNGOLOGY Kligerman, M. P., Song, Y., Schoppy, D., Divi, V., Megwalu, U. C., Haughey, B. H., Sirjani, D. 2017; 38 (5): 533–36

    Abstract

    The most common surgical method to remove benign parotid tumors remains the prograde approach. We examined if a retrograde surgical technique offers better outcomes than historical prograde controls.A retrospective chart review at Stanford Hospital was conducted to identify retrograde parotidectomies between February 2012 and October 2014 that were staffed by the senior author (DS) with resident involvement. Facial nerve (FN) outcomes and other post-surgical parameters were recorded.We identified 44 consecutive cases and found that 18.2% (n=8) of patients experienced temporary paresis and 2.3% (n=1) experienced minor (HB 2) permanent paresis limited to one branch. The average hospital length of stay was 0.64 days and complication rate was 6.8%.The retrograde technique has complication rates comparable to historical rates for the prograde technique and is amenable to minimally invasive outpatient superficial parotidectomy.

    View details for DOI 10.1016/j.amjoto2017.05.003

    View details for Web of Science ID 000411304900006

    View details for PubMedID 28647300

  • Health Literacy in Patients With Head and Neck Cancer: An Understudied Issue. JAMA otolaryngology-- head & neck surgery Megwalu, U. C. 2017

    View details for DOI 10.1001/jamaoto.2017.0242

    View details for PubMedID 28494059

  • Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study. JAMA otolaryngology-- head & neck surgery Megwalu, U. C., Nuyen, B. A. 2017

    View details for DOI 10.1001/jamaoto.2017.0025

    View details for PubMedID 28301632

  • Health Literacy. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C. 2017; 156 (3): 395-396

    Abstract

    Health literacy has been shown to affect outcomes in a number of medical conditions. Despite the complexity of care that is often required among otolaryngology patients, the literature on health literacy in this field is sparse. Otolaryngologists need to be aware of issues related to health literacy due to the changing health care environment. The increased complexity of medical care, the greater involvement of patients in shared decision making, and the higher administrative burden on patients have increased their health literacy requirements. Assessing health literacy in clinical practice may help identify patients who might require additional help in navigating the health care system. The Brief Health Literacy Screen and the Newest Vital Sign are 2 measures that are easy to apply in clinical practice.

    View details for DOI 10.1177/0194599816683664

    View details for PubMedID 28248601

  • Risk of Malignancy in Thyroid Nodules 4 cm or Larger. Endocrinology and metabolism (Seoul, Korea) Megwalu, U. C. 2017: -?

    Abstract

    Several authors have questioned the accuracy of fine-needle aspiration cytology (FNAC) in large nodules. Some surgeons recommend thyroidectomy for nodules ≥4 cm even in the setting of benign FNAC, due to increased risk of malignancy and increased false negative rates in large thyroid nodules. The goal of our study was to evaluate if thyroid nodule size is associated with risk of malignancy, and to evaluate the false negative rate of FNAC for thyroid nodules ≥4 cm in our patient population.This is a retrospective study of 85 patients with 101 thyroid nodules, who underwent thyroidectomy for thyroid nodules measuring ≥4 cm.The overall risk of malignancy in nodules ≥4 cm was 9.9%. Nodule size was not associated with risk of malignancy (odds ratio, 1.02) after adjusting for nodule consistency, age, and sex (P=0.6). The false negative rate for FNAC was 0%.Nodule size was not associated with risk of malignancy in nodules ≥4 cm in our patient population. FNAC had a false negative rate of 0. Patients with thyroid nodules ≥4 cm and benign cytology should not automatically undergo thyroidectomy.

    View details for PubMedID 28181427

  • Racial disparities in oropharyngeal cancer survival ORAL ONCOLOGY Megwalu, U. C., Ma, Y. 2017; 65: 33-37

    Abstract

    Oropharyngeal cancer is an important cause of mortality and morbidity. Several studies have revealed racial disparities in head and neck cancer outcomes. The goal of our study was to evaluate the impact of race on survival in patients with oropharyngeal cancer, using a large population-based cancer database.This was a retrospective cohort study. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. The outcomes of interest were overall survival (OS) and disease-specific survival (DSS).After adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with worse OS (HR 1.67, p<0.0001) and DSS (HR 1.67, p<0.0001).Black race is associated with worse survival in patients with oropharyngeal cancer. Further research is needed to elucidate the mechanism by which race impacts survival in oropharyngeal cancer. This may reveal potential areas of opportunity for public health interventions aimed at addressing disparities in cancer outcomes.

    View details for DOI 10.1016/j.oraloncology.2016.12.015

    View details for Web of Science ID 000392641100007

    View details for PubMedID 28109465

  • Risk of Nodal Metastasis in Major Salivary Gland Adenoid Cystic Carcinoma. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C., Sirjani, D. 2017: 194599817690138-?

    Abstract

    Objective To determine the risk of nodal metastasis, examine risk factors for nodal metastasis, and evaluate the impact of nodal metastasis on survival in patients with major salivary gland adenoid cystic carcinoma. Study Design Retrospective cohort study from a large population- based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 720 patients diagnosed with major salivary gland adenoid cystic carcinoma between 1988 and 2013. Results The overall rate of lymph node metastasis was 17%. T3 disease (odds ratio, 4.74) and T4 disease (odds ratio, 9.24) were associated with increased risk of nodal metastasis. Age, sex, and site were not associated with nodal metastasis. Nodal metastasis was associated with worse overall survival (hazard ratio, 2.56) and disease-specific survival (hazard ratio, 3.27), after adjusting for T stage, presence of distant metastasis, site, surgical resection, radiotherapy, neck dissection, age, sex, race, marital status, and year of diagnosis. Conclusion Major salivary gland adenoid cystic carcinoma carries significant risk of nodal metastasis. Advanced T stage is associated with increased risk of nodal metastasis. Nodal metastasis is associated with worse survival.

    View details for DOI 10.1177/0194599817690138

    View details for PubMedID 28168897

  • Impact of County-Level Socioeconomic Status on Oropharyngeal Cancer Survival in the United States. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Megwalu, U. C. 2017: 194599817691462-?

    Abstract

    Objective To evaluate the impact of county-level socioeconomic status on survival in patients with oropharyngeal cancer in the United States. Study Design Retrospective cohort study via a large population-based cancer database. Methods Data were extracted from the SEER 18 database (Surveillance, Epidemiology, and End Results) of the National Cancer Institute. The study cohort included 18,791 patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012. Results Patients residing in counties with a low socioeconomic status index had worse overall survival (56.5% vs 63.0%, P < .001) and disease-specific survival (62.7% vs 70.3%, P < .001) than patients residing in counties with a high socioeconomic status index. On multivariable analysis, residing in a county with a low socioeconomic status index was associated with worse overall survival (hazard ratio, 1.21; 95% CI, 1.14-1.29; P < .001) and disease-specific survival (hazard ratio, 1.21; 95% CI, 1.12-1.30; P < .001), after adjusting for race, age, sex, marital status, year of diagnosis, site, American Joint Committee on Cancer stage group, presence of distant metastasis, presence of unresectable tumor, histologic grade, surgical resection of primary site, treatment with neck dissection, and radiation therapy. Conclusion Residing in a county with a low socioeconomic status index is associated with worse survival. Further research is needed to elucidate the mechanism by which socioeconomic status affects survival in oropharyngeal cancer.

    View details for DOI 10.1177/0194599817691462

    View details for PubMedID 28195022

  • Observation versus thyroidectomy for papillary thyroid microcarcinoma in the elderly. journal of laryngology and otology Megwalu, U. C. 2017; 131 (2): 173-176

    Abstract

    To compare the effectiveness of non-surgical versus surgical therapy in elderly patients with papillary thyroid microcarcinoma.The study cohort included 2323 elderly patients (aged 65 years and over) diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.The five-year overall survival rate was 23 per cent for non-surgical patients compared with 91 per cent for surgical patients (p < 0.0001). Unadjusted analysis revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.06; p < 0.0001). Propensity score analysis also revealed significantly improved survival in surgical patients compared with non-surgical patients (hazard ratio = 0.11; p < 0.0001).Thyroidectomy appears to provide a survival benefit for elderly patients with papillary thyroid microcarcinoma. High-quality prospective studies are needed to better evaluate the comparative effectiveness of immediate thyroidectomy versus observation for elderly patients with papillary thyroid microcarcinoma.

    View details for DOI 10.1017/S0022215116009762

    View details for PubMedID 28007045

  • Racial disparities in papillary thyroid microcarcinoma survival. journal of laryngology and otology Megwalu, U. C., Saini, A. T. 2017; 131 (1): 83-87

    Abstract

    To evaluate the impact of race on survival in patients with papillary thyroid microcarcinoma.The study cohort included 17 668 patients diagnosed with papillary thyroid microcarcinoma between 1988 and 2009, identified in the Surveillance, Epidemiology, and End Results 18 database of the National Cancer Institute.Black patients had lower overall survival than other racial groups (p < 0.001). Black patients had significantly worse overall survival (hazard ratio = 2.59) after adjusting for sex, marital status, age, year of diagnosis, multifocal disease and type of surgery. A subset analysis of Black patients revealed no significant difference in overall survival for total thyroidectomy versus lobectomy (p = 0.15).Black race is a negative prognostic factor in thyroid cancer, which cannot be explained by advanced disease stage. Further research on mechanisms by which race affects survival is needed to reveal areas of opportunity for interventions aimed at reducing health disparities in cancer care.

    View details for PubMedID 27917722

  • Racial Disparities in Oropharyngeal Cancer Stage at Diagnosis. Anticancer research Megwalu, U. C., Ma, Y. 2017; 37 (2): 835-839

    Abstract

    To evaluate the impact of race on disease stage at diagnosis in patients with oropharyngeal cancer.The cohort included 18,791 adult patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012, from the Surveillance, Epidemiology, and End Results 18 Database.After adjusting for age, sex, marital status, tumor site, and year of diagnosis, black race was associated with increased risk of presenting with Stage III or IV disease (OR 1.24, p=0.016), T3 or T4 tumors (OR 2.16, <0.001), distant metastasis (OR 2, p<0.001), and unresectable tumors (OR 1.65, p<0.001). Race was not associated with risk of presenting with nodal metastasis diagnosis (OR 0.93, p=0.241).Black race is associated with increased risk of advanced disease presentation in oropharyngeal cancer.

    View details for PubMedID 28179339

  • The rising incidence of major salivary gland cancer in the United States. Ear, nose, & throat journal Del Signore, A. G., Megwalu, U. C. 2017; 96 (3): E13–E16

    Abstract

    We performed a population-based historical cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to determine trends in the incidence of major salivary gland cancer and to evaluate the effect of sex, tumor size, histology, primary site, and extent of disease. Participants were men and women with major salivary gland cancer, diagnosed 1973-2009. The incidence of major salivary gland cancer increased from 10.4 per 1,000,000 in 1973 to 16 per 1,000,000 in 2009 (annual percent change [APC] 0.99; 95% confidence interval [CI] 0.78 to 1.20; p < 0.05). The incidence of parotid cancers increased (APC 1.13; 95% CI 0.88 to 1.39; p < 0.05) and paralleled the increase in major salivary gland cancer overall. There was an increase in the incidence of tumors measuring 0 to 2.0 cm (APC 1.99; 95% CI 0.61 to 3.38; p < 0.05), but no change in tumors measuring 2.1 to 4.0 cm (APC 1.02; 95% CI -0.46 to 2.52; p > 0.05) and tumors measuring > 4 cm (APC -0.52; 95% CI -1.72 to 0.69; p > 0.05). There was an increase in the incidence of regional (APC 0.77; 95% CI 0.32 to 1.23; p < 0.05) and distant (APC 2.43; 95% CI 1.43 to 3.45; p < 0.05) disease, but not localized disease (APC 0.35; 95% CI 0 to 0.71; p > 0.05). We conclude that the incidence of major salivary gland cancer is increasing, especially small parotid tumors. The incidence of tumors with regional and distant metastasis is also increasing. These findings highlight the need for further research on the etiology of salivary gland cancer, which may reveal opportunities for further public health efforts aimed at prevention.

    View details for PubMedID 28346649

  • Health Literacy Assessment in an Otolaryngology Clinic Population OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Lee, J. Y. 2016; 155 (6): 969-973

    Abstract

    To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy.Cross-sectional study.Tertiary care otolaryngology clinic.The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen.Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy.Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes.

    View details for DOI 10.1177/0194599816664331

    View details for Web of Science ID 000389146500009

    View details for PubMedID 27554512

  • Identifying Intraoperative Nerve Monitoring in Thyroid Surgery Using Administrative Databases. JAMA otolaryngology-- head & neck surgery Megwalu, U. C. 2016

    View details for DOI 10.1001/jamaoto.2016.3653

    View details for PubMedID 27918789

  • Migration of an ingested fish bone into the paraglottic space. journal of laryngology and otology Megwalu, U. C. 2016; 130 (10): 973-974

    Abstract

    Ingested foreign bodies are common emergencies encountered in otolaryngology practice. The vast majority can be managed with endoscopic removal. Migration of foreign bodies into the paraglottic space is a rare event that often necessitates using a more invasive procedure for removal.A 68-year-old man presented with sore throat and odynophagia 4 days after ingesting a fish bone.A computed tomography scan revealed a 2.5 cm linear foreign body embedded in the larynx within the right paraglottic space. The patient underwent endoscopic examination and transcervical exploration of the paraglottic space via a posterolateral approach, with successful removal of the foreign body on the second attempt.This is the first case report of an ingested paraglottic space foreign body managed by transcervical exploration using a posterolateral approach to the paraglottic space.

    View details for PubMedID 27499336

  • Exploring the Use of Oropharyngeal Cancer Histology to Account for HPV Status in Population-based Studies. Anticancer research Megwalu, U. C. 2016; 36 (10): 5515-5518

    Abstract

    To assess whether poorly differentiated tumors and non-keratinizing tumors have similar demographic and clinical characteristics as human papilloma virus (HPV)-positive tumors in patients with oropharyngeal cancer.The study cohort included patients diagnosed with oropharyngeal squamous cell carcinoma between 2004 and 2012 identified in the Surveillance, Epidemiology, and End Results 18 Database.Poorly differentiated tumors were associated with early T stage (odds ratio (OR)=1.23), nodal metastasis (OR=1.66) and tonsil fossa origin (OR=1.22). Non-keratinizing tumors were associated with early T stage (OR=1.23), nodal metastasis (OR=1.66) and tonsil fossa origin (OR=1.22). Poorly differentiated tumors were associated with improved overall survival (OS) (hazard ratio (HR)=0.78, p<0.001). Non-keratinizing tumors were associated with improved OS (HR=0.71, p<0.001).Histological grade and keratinization may be useful surrogates to adjust for the effects of HPV status in oropharyngeal cancer studies utilizing population-based cancer databases.

    View details for PubMedID 27798923

  • Adenoid cystic carcinoma of the external ear: a population based study AMERICAN JOURNAL OF OTOLARYNGOLOGY Green, R. W., Megwalu, U. C. 2016; 37 (4): 346-350

    Abstract

    To determine the incidence of adenoid cystic carcinoma of the external ear in the United States, and to evaluate the clinical characteristics and survival outcomes associated with the disease.Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with adenoid cystic carcinoma of the external ear from 1973 to 2012.The incidence of adenoid cystic carcinoma of the external ear was 0.004 per 100,000. The SEER database identified 66 patients meeting the inclusion criteria. Nodal metastasis was noted in 13.1% of patients, while 7.9% had distant metastasis. Distant metastasis was associated with worse overall survival (HR 10.18). However, nodal metastasis had no impact on overall survival (HR 0.15, p = 0.09). Surgery alone was associated with improved overall survival (HR 0.26), compared with combination surgery and radiotherapy, while radiotherapy alone was associated with worse overall survival (HR 20.12). Increasing age (HR 1.12) and black race (HR 6.83) were associated with worse overall survival, while female sex (HR 0.26) was associated with improved overall survival.ACC of the external ear is rare. Distant metastasis is a poor prognostic factor. However, nodal metastasis does not appear to impact survival. Advanced age, black race, and male sex are also poor prognostic factors. Surgical resection alone is associated with better survival than combination surgical resection and radiation, or radiotherapy alone.

    View details for DOI 10.1016/j.amjoto.2016.02.001

    View details for Web of Science ID 000378979600011

    View details for PubMedID 27040415

  • Survival Outcomes in Early Stage Laryngeal Cancer ANTICANCER RESEARCH Megwalu, U. C., Panossian, H. 2016; 36 (6): 2903-2907

    Abstract

    To evaluate survival outcomes of radiotherapy versus surgical resection in the treatment of early stage laryngeal cancer.Data was extracted from the Surveillance, Epidemiology, and End Results 18 Database. The cohort included 5,301 patients diagnosed with stages I and II laryngeal squamous cell carcinoma between 1992 and 2009, treated with either surgical therapy or radiotherapy.Patients who received surgical therapy had better overall survival (OS) than patients who received radiation therapy (p<0.001). The difference in OS between treatment groups remained after stratification by stage (p<0.001 for Stage I; p=0.03 for Stage II) and subsite (p<0.001). On multivariable analysis, the radiotherapy group had worse OS (hazard ratio (HR)=1.29).Patients with early-stage laryngeal cancer treated with surgical therapy have better survival outcomes than patients treated with non-surgical therapy.

    View details for Web of Science ID 000377464200034

    View details for PubMedID 27272804

  • Total Thyroidectomy Versus Lobectomy for the Treatment of Follicular Thyroid Microcarcinoma ANTICANCER RESEARCH Megwalu, U. C., Green, R. W. 2016; 36 (6): 2899-2902

    Abstract

    To compare the effectiveness of total thyroidectomy versus thyroid lobectomy for the treatment of follicular thyroid microcarcinoma.Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database. The study cohort included patients diagnosed with follicular thyroid microcarcinoma between 1988 and 2009, treated with either total thyroidectomy or thyroid lobectomy. Propensity-score analysis using inverse probability weighting was used to control for allocation bias.A total of 203 patients were identified. The 5-year overall survival was 98% for patients treated with lobectomy and 99% for those treated with total thyroidectomy; this difference was not statistically significant (p=0.13). Unadjusted analysis and propensity-score analysis revealed no difference in overall survival between the two treatment groups (p=0.15 and p=0.49, respectively).Total thyroidectomy does not appear to offer any survival advantage over thyroid lobectomy for patients with follicular thyroid microcarcinoma.

    View details for Web of Science ID 000377464200033

    View details for PubMedID 27272803

  • Sociodemographic disparities in choice of therapy and survival in advanced laryngeal cancer. American journal of otolaryngology Saini, A. T., Genden, E. M., Megwalu, U. C. 2016; 37 (2): 65-69

    Abstract

    To determine if sociodemographic factors are associated with treatment choice and survival in patients with advanced stage laryngeal cancer in the U.S.Population-based, non-concurrent cohort study of 5381 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma from 1992-2009. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) database.Choice of therapy (surgical vs. non-surgical) and disease-specific survival (DSS).Age ≥60years (odds ratio [OR]=0.78; 95% CI, 0.70-0.88) and more recent year of diagnosis (OR=0.89; 95% CI, 0.87-0.90) decreased the odds of receiving surgical therapy, while residing in a county with low median household income (OR=1.36; 95% CI, 1.17-1.57) increased the odds of receiving surgical therapy. Age ≥60years (hazard ratio [HR]=1.45; 95% CI, 1.33-1.59) and Black race (HR=1.14; 95% CI, 1.02-1.27) were negatively associated with DSS, while female sex (HR=0.81; 95% CI, 0.72-0.90) and married status (HR=0.69; 95% CI, 0.63-0.75) were positively associated with DSS.For patients with advanced laryngeal cancer, younger age and residing in a low-income county increase the likelihood of receiving surgical therapy. Female sex and married status provide a survival benefit, while Black race appears to be a negative prognostic factor. This highlights the impact of sociodemographic factors on treatment strategies and outcomes and highlights areas for further research on health disparities.

    View details for DOI 10.1016/j.amjoto.2015.10.004

    View details for PubMedID 26954853

  • Survival Outcomes in Advanced Laryngeal Cancer JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Megwalu, U. C., Sikora, A. G. 2014; 140 (9): 855-860

    Abstract

    Chemoradiation therapy has become increasingly popular in the treatment of advanced laryngeal cancer as part of an organ preservation protocol. However, several studies have reported a decline in survival, possibly attributable to the increased use of radiation and chemoradiation therapy.To evaluate survival outcomes of laryngeal conservation vs surgical therapy in the treatment of advanced laryngeal cancer in the United States using a large population-based cancer database.Population-based, nonconcurrent cohort study of 5394 patients who received a diagnosis of stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009. Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database.Surgical or nonsurgical therapy.Overall survival (OS) and disease-specific survival (DSS).Patients who received surgical therapy had better 2-year and 5-year DSS (70% vs 64% and 55% vs 51%, respectively; P < .001) and 2-year and 5-year OS (64% vs 57% and 44% vs 39%, respectively; P < .001) than patients who received nonsurgical therapy. The difference in DSS and OS between treatment groups remained after stratification by year-of-diagnosis cohorts (P < .001). The survival gap consistently narrowed with subsequent year-of-diagnosis cohorts. On multivariable analysis, nonsurgical patients had worse DSS (hazard ratio [HR], 1.33 [95% CI, 1.21-1.45]) and OS (HR, 1.32 [95% CI, 1.22-1.43]) after adjustment for year of diagnosis, American Joint Committee on Cancer stage, age, sex, subsite, race, and marital status. Stage III disease (HR, 0.59 [95% CI, 0.54-0.65]), glottic subsite (HR, 0.74 [95% CI, 0.67-0.82]), 2004 to 2009 year-of-diagnosis cohort (HR, 0.79 [95% CI, 0.70-0.90]), female sex (HR, 0.80 [95% CI, 0.72-0.89]), and married status (HR, 0.68 [95% CI, 0.62-0.75]) positively affected DSS. Black race (HR, 1.17 [95% CI, 1.05-1.30]) and increased age (HR, 1.03 [95% CI, 1.02-1.03] for each year) negatively affected DSS.Surgical therapy leads to better survival outcomes than nonsurgical therapy for patients with advanced laryngeal cancer. Patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection.

    View details for DOI 10.1001/jamaoto.2014.1671

    View details for Web of Science ID 000342358000011

    View details for PubMedID 25144163

  • The Impact of Demographic and Socioeconomic Factors on Major Salivary Gland Cancer Survival. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Olarte, L. S., Megwalu, U. C. 2014; 150 (6): 991–98

    Abstract

    This study aimed to investigate the impact of demographic and socioeconomic factors on survival in patients with major salivary gland malignancies.Population-based study using the Surveillance, Epidemiology, and End Results (SEER) cancer database.The study cohort consisted of 10,735 men and women ages 20 and older who were diagnosed with major salivary gland carcinoma from 1973 to 2009.Kaplan-Meier analysis revealed that the overall and disease-specific survival was higher for women than for men (P < .001). Overall and disease-specific survival decreased with increasing age (P < .001) and differed by race (P < .001) and marital status (P < .001). Patients residing in counties with higher rates of high school completion had higher overall and disease-specific survival (P < .001). Patients residing in counties with higher median household incomes had better overall and disease-specific survival than patients from lower income counties (P < .001). On multivariable analysis, male sex (hazard ratio [HR] = 1.41; 95% confidence interval [CI], 1.32-1.50), increasing age, and single status (HR = 1.36; 95% CI, 1.27-1.44) had poor prognostic impact on overall survival. Male sex (HR = 1.38; 95% CI, 1.27-1.49), increasing age, and single status (HR = 1.29; 95% CI, 1.19-1.39) had poor prognostic impact on disease-specific survival.For patients with salivary gland malignancies, there is a survival benefit for younger patients, female patients, and married patients. This highlights the significance of demographic factors on survival outcomes for patients with salivary gland malignancies and highlights areas for further research on health disparities.

    View details for DOI 10.1177/0194599814526556

    View details for PubMedID 24647644

  • A systematic review of proton-pump inhibitor therapy for laryngopharyngeal reflux ENT-EAR NOSE & THROAT JOURNAL Megwalu, U. C. 2013; 92 (8): 364-371

    Abstract

    The author performed a MEDLINE literature search to identify and evaluate all randomized, placebo-controlled trials of the treatment of laryngopharyngeal reflux (LPR) with an oral proton-pump inhibitor (PPI) that have been published since 1966. Eight such trials that included a total of 358 patients were identified. These eight studies contained seven different definitions of LPR. Validity scores (maximum: 9) ranged from 5 to 9 (mean: 7.5). One study investigated low-dose once-daily therapy, two studies investigated low-dose twice-daily therapy, and five studies investigated high-dose twice-daily therapy. Outcomes measures were not consistent among studies, and most studies used unvalidated outcomes measures. Only two studies found that a PPI was significantly better than placebo-one in the low-dose twice-daily group and one in the high-dose twice-daily group. The author concludes that the current body of literature is insufficient to draw reliable conclusions about the efficacy of PPI therapy for the treatment of LPR.

    View details for Web of Science ID 000326904700010

    View details for PubMedID 23975490

  • Estrogen-Mediated Angiogenesis in Thyroid Tumor Microenvironment Is Mediated Through VEGF Signaling Pathways ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Kamat, A., Rajoria, S., George, A., Suriano, R., Shanmugam, A., Megwalu, U., Prakash, P. B., Tiwari, R., Schantz, S. 2011; 137 (11): 1146-1153

    Abstract

    To explore the induction of a proangiogenic phenotype in endothelial cells in the thyroid tumor microenvironment by estrogen-treated thyroid cancer cells and to define the role of vascular endothelial growth factor (VEGF) in this interaction.Cell-based in vitro systems analysis.Thyroid tumor cell lines (BCPAP [papillary thyroid cancer] and ML-1 [follicular thyroid cancer]) were cultured with estradiol with and without an estrogen receptor (ER) inhibitor (fulvestrant or ICI) and used to treat human umbilical vein endothelial cells (HUVECs).Immunofluorescence was used to confirm the presence of ERα and ERβ in BCPAP cells. Conditioned medium was then used to evaluate the induction of HUVEC tubulogenesis and migration. Secretion of VEGF in this medium was evaluated by Western blot analysis. The expression of phosphoinositide 3-kinase (PI3K), the initiator of a proangiogenic pathway, was evaluated with Western blot analysis of HUVEC lysates. The subsequent effects of an ER inhibitor (fulvestrant/ICI) and a neutralizing VEGF antibody were also observed.Estrogen receptor α and ERβ are expressed in thyroid cancer cells. Estrogen-stimulated ML-1 cells secreted an increased amount of VEGF likely as a result of ER signaling. In contact with this environment, HUVECs demonstrate enhanced tubulogenesis and migration. Western blot analysis documented estrogen-mediated upregulation of PI3K in HUVECs. These effects were mitigated by an ER inhibitor (fulvestrant/ICI) and a neutralizing VEGF antibody.Our data provide evidence that estrogen can induce a proangiogenic endothelial cell phenotype in the thyroid tumor microenvironment through ER and VEGF signaling. Our findings suggest that the effect of antiestrogenic therapy targeting tumor angiogenesis can be enhanced through VEGF inhibition.

    View details for Web of Science ID 000297228100014

    View details for PubMedID 22106242

  • Second Primaries after Major Salivary Gland Cancer OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Shin, E. J. 2011; 145 (2): 254-258

    Abstract

    To evaluate the risk of second primary cancers in patients with major salivary gland cancer using a large population database and to examine the effects of sex, salivary gland cancer histology, and radiation therapy on the risk of second primaries.Population-based study using the Surveillance, Epidemiology, and End Result (SEER) cancer database.The subjects were 15,572 men and women ages 15 and above, diagnosed with cancer of the major salivary glands from 1973 to 2006.There was an increased risk of oral cavity (standardized incidence ratio [SIR] = 3.48, P < .05), salivary (SIR = 9.97, P < .05), lung and bronchus (SIR = 1.60, P < .05), kidney (SIR = 1.68, P < .05), and thyroid (SIR = 2.66, P < .05) cancers. Men had an increased risk of developing kidney cancer (SIR = 1.70, P < .05) compared with women (SIR = 1.64, P > .05). Patients with mucoepidermoid carcinoma had an increased risk of a second salivary gland cancer (SIR = 8.97, P < .05) and thyroid cancer (SIR = 3.97, P < .05). Patients with adenoid cystic carcinoma had an increased risk of oral cavity (SIR = 3.76, P < .05) and nasopharyngeal (SIR = 16.88, P < .05) cancers. Patients with acinar cell carcinoma had an increased risk of salivary (SIR = 31.36, P < .05), kidney (SIR = 2.98, P < .05), and thyroid (SIR = 3.85, P < .05) cancers. Patients who received radiation therapy had a higher incidence of lung and bronchus (SIR = 2.11, P < .05), laryngeal (SIR = 3.08, P < .05), and thyroid (SIR = 2.95, P < .05) cancers compared with patients who did not receive radiation therapy (SIR = 1.18, 0.48, and 2.39, respectively; P > .05). Patients had an increased risk of developing second primaries, even 10 years after diagnosis of primary salivary gland cancer.Patients with major salivary gland cancers are at a risk for certain second primary cancers. This highlights the need for long-term surveillance in these patients, not only for recurrence but also for second primary cancers.

    View details for DOI 10.1177/0194599811402899

    View details for Web of Science ID 000294071200014

    View details for PubMedID 21493280

  • 3,3 '-Diindolylmethane Modulates Estrogen Metabolism in Patients with Thyroid Proliferative Disease: A Pilot Study THYROID Rajoria, S., Suriano, R., Parmar, P. S., Wilson, Y. L., Megwalu, U., Moscatello, A., Bradlow, H. L., Sepkovic, D. W., Geliebter, J., Schantz, S. P., Tiwari, R. K. 2011; 21 (3): 299-304

    Abstract

    The incidence of thyroid cancer is four to five times higher in women than in men, suggesting a role for estrogen (E₂) in the pathogenesis of thyroid proliferative disease (TPD) that comprises cancer and goiter. The objective of this study was to investigate the antiestrogenic activity of 3,3'-diindolylmethane (DIM), a bioactive compound derived from cruciferous vegetables, in patients with TPD.In this limited phase I clinical trial study, patients found to have TPD were administered 300 mg of DIM per day for 14 days. Patients subsequently underwent a total or partial thyroidectomy, and tissue, urine, and serum samples were collected. Pre- and post-DIM serum and urine samples were analyzed for DIM levels as well as estrogen metabolites. DIM levels were also determined in thyroid tissue samples.DIM was detectable in thyroid tissue, serum, and urine of patients after 14 days of supplementation. Urine analyses revealed that DIM modulated estrogen metabolism in patients with TPD. There was an increase in the ratio of 2-hydroxyestrones (C-2) to 16α-hydroxyestrone (C-16), consistent with antiestrogenic activity that results in more of C-2 product compared with C-16.Our data suggest that DIM enhances estrogen metabolism in TPD patients and can potentially serve as an antiestrogenic dietary supplement to help reduce the risk of developing TPD. The fact that DIM is detected in thyroid tissue implicates that it can manifest its antiestrogenic activity in situ to modulate TPD.

    View details for DOI 10.1089/thy.2010.0245

    View details for Web of Science ID 000288021200013

    View details for PubMedID 21254914

  • Methodological and statistical problems in uvulopalatopharyngoplasty research - A follow-up study ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY Megwalu, U. C., Piccirillo, J. F. 2008; 134 (8): 805-809

    Abstract

    To review the published literature on uvulopalatopharyngoplasty (UPPP) and assess the methodological quality of the research and compare it with a similar article published in 1995; and to determine what, if any, improvement in the methodological quality of the research resulted during the ensuing 10 years.Methodological and statistical evaluation of the published literature on UPPP. Thirty articles representing the clinical studies on UPPP and related procedures written from January 1996 to August 2005 were reviewed. Only articles reporting polysomnography data were included.Overall, the articles demonstrated fair methodological and statistical quality. Compared with the previous review by Schechtman et al, there was a slight increase in the number of articles that discussed statistical power and reported confidence intervals. There were increases in the mean sample size, the percentage of randomized controlled studies, the number of end points, and the use of validated subjective outcome measures; longer mean follow-up time; and more complete reporting of age and sex information. There was no increase in the percentage of published studies that used a prospective study design. None of the studies that required minimum acceptable baseline values of objective sleep parameter measures for enrollment indicated the use of separate screening and baseline assessments. There were 7 different definitions of sleep apnea and 17 different definitions of success in treatment.There has been an overall improvement in the quality of the articles published on UPPP since 1995. Several areas still need improvement: use of more prospective studies, decrease in number of end points, use of separate screening and baseline assessments, and consensus in the definitions of sleep apnea and success.

    View details for Web of Science ID 000258389000002

    View details for PubMedID 18711052

  • The effects of melatonin on tinnitus and sleep OTOLARYNGOLOGY-HEAD AND NECK SURGERY Megwalu, U. C., Finnell, J. E., Piccirillo, J. F. 2006; 134 (2): 210-213

    Abstract

    To determine if melatonin improves tinnitus and if this improvement is related to improvement in sleep.Prospective open-label study of 24 patients with tinnitus. The patients took 3 mg of melatonin per day for 4 weeks, followed by 4 weeks of observation. The Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI) were administered.The mean THI score decreased significantly between weeks 0 and 4, and between weeks 0 and 8. The mean PSQI significantly decreased between weeks 0 and 4 (P < 0.0001), and between weeks 0 and 8 (P = 0.0003). The change in PSQI was significantly associated with the change in THI between weeks 0 and 4. The change in PSQI was not significantly associated with the change in THI between weeks 0 and 8. The change in the PSQI in the first 4 weeks was associated with the initial PSQI. There was no association between the initial THI and the change in the THI in the first 4 weeks.Melatonin use is associated with improvement of tinnitus and sleep. There was an association between the amount of improvement in sleep and tinnitus. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus.Melatonin may be a safe treatment for patients with idiopathic tinnitus, especially those with sleep disturbance due to tinnitus.

    View details for DOI 10.1016/j.otohns.2005.10.007

    View details for Web of Science ID 000235293600005

    View details for PubMedID 16455366