Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services.

Patients with eye and ear, nose, and throat complaints place a mean explicit value on specialty emergency services of $340 per visit, relative to general emergency care. Ultimately, CV data using WTP methodology are useful in valuing patient preferences in monetary terms and can help inform state-wide resource allocation and the availability of direct-to-specialist care.

Outcome Objectives: Demonstrate feasibility of performing endoscopic transcanal lateral graft tympanoplasty. Compare audiometric and clinical outcomes of transcanal endoscopic lateral graft with previously reported outcomes of microscopic post-auricular lateral graft tympanoplasty. Methods: A retrospective review of sequential pediatric and adult endoscopic transcanal lateral graft tympanoplasties (type I) performed between May 2014 and August 2015 at a single institution by two experienced otologists. Rate of perforation closure and audiometric outcomes (pure-tone average [PTA] and word recognition scores [WRS]) were obtained and compared with previous published outcomes of post-auricular microscopic lateral grafts. Results: Twenty patients, five right and 15 left ears, met criteria. Ninety percent of patients had successful closure of their perforation. One patient had a residual central perforation; active acute otitis media was noted intraoperatively in this case. One patient had graft lateralization. Mean follow up was 10.5 months (standard deviation [SD] = 141 d). Mean operative time was 160 (SD = 26.1) minutes. Mean improvement in PTA was 18 dB (SD = 10.3). Two patients had worsening of audiometric outcomes with <15 dB decreases in PTA and unchanged WRS; all other patients showed improvement or no change in audiometric outcomes. These results are similar to previously published outcomes for post-auricular microscopic approaches. Conclusion: Transcanal endoscopic lateral graft tympanoplasty is a novel technique for closure of anterior and subtotal perforations that avoids a postauricular incision. Outcomes in this cohort were similar to historical results for post-auricular microscopic approaches. Prospective studies with larger cohorts will be crucial to understanding the advantages and limitations of this new surgical approach.

The supraclavicular artery island flap (SCAIF) is increasingly employed for laryngectomy reconstruction with excellent success. Although tracheoesophageal puncture (TEP) with intraoperative prosthesis placement is also positively reported, this is not described in patients following SCAIF. We review our experience with primary TEP with prosthesis placement and voice outcomes in patients after SCAIF reconstruction. Seven patients underwent SCAIF with primary TEP after laryngectomy from 2011-2013. Five underwent total laryngectomy (TL) and two underwent TL with partial pharyngectomy. All patients had 16 French Indwelling BlomSinger prostheses placed intra-operatively without complications. Six patients achieved tracheoesophageal voice (median time =1.5 months). Two patients required cricopharyngeal segment Botox© injections. One patient remained aphonic. One patient developed prosthesis leakage addressed with prosthesis replacement. Our preliminary data demonstrates that, similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective.

Oral Presentations P37Results: Forty-eight applicants completed PET simulation. Survey response rate was 81% (39/48). Inclusion of a simulation exercise during interviewing positively changed the opinion of 21% (8/38) of the applicants, with 1 negative response. The majority of respondents (88%) had no negative response to inclusion of simulation if GRS scores are not included in ranking process. If GRS results are used for ranking, respondents felt it was more fair if the task was non-novel versus novel (54% vs 23%). The inclusion of GRS results in ranking engendered negative opinions of the program (28% non-novel task, 46% novel task). Mean GRS score for applicants was 16 ± 0.98. Time to completion and GRS score were correlated (P < .01), but neither GRS score (P = .91) nor time to completion (P = .31) were correlated to rank order.Conclusions: Simulated task performance may provide complementary information to that of traditional interviews. Inclusion in ranking may negatively affect resident perception of the program, notably if the task is novel.

Objectives: Although head and neck cancer (HNC) is associated with weight loss, little is known about the long-term body mass index (BMI) change in HNC survivors. Our goal was to determine the long-term BMI change after HNC treatment.Methods: Retrospective cohort study on patients with oral cavity and pharyngeal squamous cell carcinoma who received initial treatment at the University of Pennsylvania Health System in 2009, and were then followed for 3 years. Patient demographics, height, tobacco and alcohol use, cancer type, AJCC stage, treatments, and weight at all visits were collected from medical records. Underweight was defined as BMI<18.5, normal was BMI 18.5-24.9, overweight was BMI 25.0-29.9, and obesity was BMI > 30. Logistic regression was performed to identify factors associated with long-term BMI changes. Results:We identified 211 patients with complete data and follow-up visits. At the time of diagnosis, 7% patients were underweight (n = 15), 34% had normal-weight (n = 72), 36% were overweight (n = 75) and 23% were obese (n = 49). At the last follow-up visit, 7% were underweight (n = 14), 42% were normal-weight (n = 82), 33% were overweight (n = 65) and 18% were obese (n = 36). Thus, 17% patients (n = 21) who were overweight or obese at diagnosis improved to normal weight at the end of 3-year follow-up, and this change was not significantly affected by patients' age, gender, race, tobacco and alcohol use, cancer site, AJCC stage, and treatment type. Conclusions:Our study suggests BMI improves in overweight or obese HNC survivors after 3-year follow-up, and this change is independent of cancer severity and treatment type.Objectives: 1) Describe newly classified salivary gland tumor, mammary analog secretory carcinoma (MASC) of the salivary gland. 2) Present a patient with a right parotid mass with pathology consistent with MASC and discuss our institution's diagnostic and therapeutic approach.Methods: We identified a rare case of MASC of the parotid gland. We conducted a PubMed literature review on MASC with reports in the pathology and otolaryngology literature. Results:A 58-year-old female presented to our clinic after noticing swelling in her right cheek. An MRI of the neck found a well-encapsulated benign appearing parotid mass measuring 3.2 x 2.2 x 3.1 cm. A fine-needle aspiration was performed and was concerning for high-grade carcinoma, with a differential diagnosis including acinic cell carcinoma and mucoepidermoid carcinoma. She underwent a parotidectomy and modified radical neck dissection. Histologic evaluation was consistent with MASC. Subsequent FISH testing demonstrated the characteristic t(12;15) ETV6-NTRK3 translocation, confirming the diagnosis of MASC.Conclusions: First described in 2010, MASC of the salivary gland is a newly described pathologic diagnosis. It has few reports in the literature. Our case raises the question as to when to consider MASC in the differential diagnosis based on imaging, FNA, and final pathology, including de-differentiation from acinic cell carcinoma. Furth...

is the standard treatment for nasolacrimal duct obstruction. 1 Despite limited data from predominantly small single-surgeon studies showing clear benefit for patient outcomes, silicone stents are commonly placed, and we believe endonasal approaches are increasing in use. 1-4 In this study, we examined the rate of revision after DCR and evaluated associated risk factors in a national patient cohort.