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Objective: The proportion of women specializing in otolaryngology-head and neck surgery (Oto-HNS) and seeking fellowship training has steadily increased over the last several years. In academic Oto-HNS, gender differences exist in research productivity, scholarly impact, and funding. This study aims to evaluate gender differences in academic productivity between otolaryngologists in early, mid-, and later careers stages and within various subspecialties.Methods: Departmental websites for all Oto-HNS residency programs were accessed, and data including gender, academic rank, and fellowship training/subspecialty field was collected. Bibliometric data including h-index, publication years, number of citations, documents, and coauthors was obtained from the Scopus database. Career groups were defined as early (1-5 years), mid-(6-15 years), and later (16+ years). Continuous data was compared using the t test.Results: Data was collected on 1,754 academic otolaryngologists (412 women, 1,342 men). Overall, men exhibited significantly higher h-indices, number of documents, citations, and coauthors and actively published for more years compared to women (P < 0.0001 for all variables). Similar trends persisted across all subspecialties. When authors were broken down into career groups, women and men showed similar research productivity across all career groups in the subspecialties of otology, facial plastics, and rhinology; however, in head and neck, laryngology, and pediatrics, women continued to lag behind men.Conclusion: This study suggests that female otolaryngologists within certain subspecialties are keeping pace with their male counterparts in publication productivity in the early career time frame. This represents a change from prior studies which have shown women to be less productive in the early career period.

Importance HER2 is an important drug target in breast cancer, where anti-HER2 therapy has been shown to lead to improvements in disease recurrence and overall survival. HER2 status in head and neck squamous cell carcinoma (HNSCC) has not been well studied. Identification of HER2 positive tumors and characterization of response to HER2 therapy could lead to targeted treatment options in HNSCC. Objective To identify HER2 aberrations in HNSCCs and investigate potential for HER2 targeted therapy in HNSCCs. Design, Setting, and Participants Retrospective case series of patients with laryngeal and oral cavity SCC enrolled in the University of MichiganSPORE. Publically available sequencing data(TCGA) was reviewed to identify additional mutations and overexpression in HER2 in HNSCC. Established HNSCC cell lines were used for follow-up in vitro analysis. Interventions Using targeted, amplicon-based sequencing with the Oncomine Cancer Panel, we assessed the copy number and mutation status of commonly altered genes in HNSCCs. Immunohistochemical staining was performed on tissue microarrays of HNSCCs to assess expression of HER2. Western blotting for HNSCC cell line HER2 expression, and cell survival assays after treatment with HER2 inhibitors were performed. Main Outcomes and Measures Prevalence of HER2 genetic aberrations and HER2 overexpression in laryngeal and oral cavity squamous cell carcinomas (SCCs). Prevalence of HER2 aberrations in HNSCC in TCGA. HER2 protein expression in HNSCC cell lines. Response of HNSCC cell lines to targeted HER2 inhibitors. Results Forty-two laryngeal SCC samples were screened by targeted sequencing, of which 4 were positive for HER2 amplification. Two samples identified with sequencing showed HER2 overexpression on immunohistochemistry. Two of 94 oral cavity SCC samples were positive for HER2 on immunohistochemistry. Analysis of 288 patients from publicly available HNSCC sequencing data revealed 9 amplifications in HER2. Protein expression was variable across HNSCC cell lines, and a subset of these cell lines show responsiveness to anti-HER2 therapy. Conclusions and Relevance HER2 aberrations are identified in a subset of HNSCCs. These tumors may be responsive to targeted therapy against HER2. Screening for HER2 aberrations and applying targeted therapy in HER2 positive patients may provide a useful tool for personalized therapy trials, particularly in patients that are refractory to current treatment paradigms.

Background Targeted sequencing of epidemiologically low risk (ELR) HNSCC patients could help identify novel drivers or lost suppressors leading to precision medicine protocols and improved survival rates. Methods An ELR-HNSCC patient was selected for targeted sequencing. We then assessed next generation sequencing cohorts from the Oncomine Powertool Database, which contains pan-cancer data from The Cancer Genome Atlas(TCGA). Results Targeted sequencing revealed FGFR1 amplifications as a putative driver of the patient’s tumor. HNSCC patients from TCGA data demonstrated FGF family mutations, rearrangements or amplifications in over 35% of HNSCC cases, with a statistically significant higher frequency in African American populations. FGF alterations were unique from activating PIK3CA mutations. Conclusion Together, this data suggests that FGF signaling may be critical for a subset of HNSCC patients independent of other known pathways and provides rationale for leveraging ELR-HNSCC patients to define molecular subsets of high risk HNSCC.

About one-third of rhabdomyosarcomas arise in the head and neck, with parameningeal primaries accounting for half of these. Principles of management involve chemotherapy, radiation, or both, in addition to surgical biopsy, debulking, and complete or near-complete resection. In the head and neck, diagnostic biopsies have historically been performed without attempt at resection due to proximity to critical structures and cosmetic considerations. Retrospective chart review of three cases of rhabdomyosarcoma at the cranial base managed through minimally invasive endoscopic surgical resection and adjuvant therapy. Three patients were identified as having undergone endoscopic surgical debulking or margin-negative resection of a rhabdomyosarcoma of the cranial base. Two of three patients had complete resection based on intraoperative margin control. All three patients underwent adjuvant therapy within 1 month of diagnosis. Follow-up time ranged from 5 months to 3 years with all patients disease-free at last follow-up. Skull base surgeons should routinely be involved in multidisciplinary treatment planning for parameningeal rhabdomyosarcomas, as surgical options have evolved to allow for potential endoscopic resection with low morbidity and no or minimal delay in additional treatment options.