Eric M Jaryszak

Children's National Medical Center, Washington, Washington, D.C., United States

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Publications (13)22.89 Total impact

  • Eric M Jaryszak · Rahul K Shah · June Amling · Maria T Peña ·
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    ABSTRACT: To determine the incidence and to describe wound complications and associated risk factors of pediatric tracheotomy. Retrospective case series. Freestanding tertiary care academic pediatric hospital. Sixty-five consecutive children undergoing tracheotomy over 15 months. Postoperative wound complications objectively and independently documented by an advanced practice nurse specializing in tracheotomy care. Secondary outcome measures included comorbidities, mortality rates, and wound status after subsequent examinations and management. The mean (SEM) patient age at tracheotomy was 45 (8.7) months (median age, 9.1 months). The most common indication for tracheotomy was pulmonary disease (36.9%), followed by neurologic impairment and laryngeal abnormalities. There were 19 patients (29%) with and 46 patients (71%) without wound complications. There were no significant differences between the 2 groups in age (P = .68) or weight (P = .55); however, infants younger than 12 months had an increased complication rate (39% vs. 17%, P = .04). The type of tracheotomy tube was predictive of postoperative wound complications (P = .02). All patients with wounds received aggressive local wound care. Five of 13 patients had complete resolution of stomal wounds, whereas 8 patients had persistent wound issues. There were 5 non-wound-related mortalities. With attempts to classify tracheotomy wound breakdowns as reportable events, including never events, increasing emphasis is being placed on posttracheotomy care. This study demonstrates that wound breakdown in pediatric tracheotomy patients is common. These complications can be mitigated, although not prevented completely, with aggressive wound surveillance and specialized wound care.
    Archives of otolaryngology--head & neck surgery 04/2011; 137(4):363-6. DOI:10.1001/archoto.2011.33 · 2.33 Impact Factor
  • Eric M Jaryszak · Lina Lander · Anju K Patel · Sukgi S Choi · Rahul K Shah ·
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    ABSTRACT: To determine variables predictive of recovery room times in pediatric outpatient adenotonsillectomy. Retrospective case-control. One-hundred ninety consecutive patients undergoing outpatient adenotonsillectomy at an ambulatory surgery center of a tertiary-care free standing pediatric hospital were grouped into upper and lower deciles of recovery room times. Twenty-one variables were analyzed to determine which variables are predictive of prolonged recovery time. Univariate and multivariate analyses were performed. Of the 190 patients, mean recovery room time was 103 min (SD 53.1), 22 patients were in the lower decile (mean recovery room time of 63 ± 6 min) and 17 patients were in the upper decile (155 ± 40 min, P<0.0001). Of the 21 variables analyzed, post-anesthesia care unit (PACU) nursing staff was the only significant predictor of prolonged recovery room time. Compared with one PACU nurse, other nurses (N=5) predicted a longer recovery time (OR=10.8, 95% CI 2.0-59.5, P=0.0017). This association remained significant when controlling for anesthesiologist and surgeon (OR=8.8, 95% CI 1.5-50.9, P=0.0072). There were no complications in any patients. Recovery room times after outpatient adenotonsillectomy vary significantly (mean 103 min (SD 53.1), range 50-241 min). Of potential predictors, only the human factor (PACU nursing staff) was associated with prolonged recovery room times, independent of surgeon and anesthesiologist. Development of standardized protocols for nurses to use for discharge has the potential to increase throughput for adenotonsillectomy patients in an outpatient surgery center setting.
    International journal of pediatric otorhinolaryngology 02/2011; 75(4):585-8. DOI:10.1016/j.ijporl.2011.01.024 · 1.19 Impact Factor
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    ABSTRACT: To present case vignettes of unusual pediatric parotid pathologies and discuss management paradigms in the context of these lesions. Retrospective case series. Free-standing, academic tertiary care pediatric hospital. All patients over the past 18 months undergoing parotidectomy for a parotid mass were reviewed (N=5). Ages ranged from 17 months to 16 years. All presented with a remarkably similar clinical course, consisting of a persistent parotid mass for more than 3 months which was usually painless. Most (4/5 patients) had been treated with antibiotics prior to Otolaryngology consultation. Fine-needle aspiration (FNA) was performed on 3 patients and was diagnostic in one. Complete excision of the mass was performed in each child through a parotidectomy approach (3 total, 2 lateral lobe). The final pathology showed metastatic neuroblastoma (17 months old), undifferentiated primitive sarcoma (22 months old), mucoepidermoid carcinoma (11 years old), nodular fasciitis (12 years old), and hyperplastic lymph node (16 years old). The patient with neuroblastoma died from complications of bone marrow transplant. The differential diagnosis for a persistent pediatric parotid mass is expansive and differs from that found in the adult population. As this series highlights, in many cases, it is impossible to discern the pathology, or rule out malignancy, based upon the clinical course, imaging, or FNA results. Surgical excision remains the standard for management of these patients and is both diagnostic and therapeutic. Our anecdotal case series highlights the importance of having a low threshold for parotidectomy in these children.
    International journal of pediatric otorhinolaryngology 02/2011; 75(4):558-63. DOI:10.1016/j.ijporl.2011.01.019 · 1.19 Impact Factor
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    ABSTRACT: To determine polysomnographic (PSG) variables that may potentially predict adverse respiratory events after pediatric adenotonsillectomy. Retrospective, case-control study. Free-standing academic tertiary-care pediatric hospital. The study included 1131 patients undergoing adenotonsillectomy by 2 attending surgeons. There were no exclusion criteria. Variables from preoperative PSGs were analyzed to determine predictors of postoperative respiratory complications. Logistic regression analysis was performed. A total of 151 patients (13.4%) underwent preoperative PSG. Twenty-three of these patients (15.2%) had adverse respiratory events. The primary adverse event was desaturation requiring supplemental oxygen therapy, with 1 case of postobstructive pulmonary edema. Patients with adverse events had a significantly higher apnea-hypopnea index) (31.8 vs 14.1; P = .001), higher hypopnea index (22.6 vs 8.9; P = .004), higher body mass index (z score, 1.43 vs 0.70; P = .02), and lower nadir oxygen saturation (72% vs 84%; P <.001). Patients with adverse events had a prolonged hospital course (odds ratio, 32.1; 95% confidence interval, 7.8-131.4). There were no differences in age or other PSG variables. There were no intubations or mortalities. Polysomnography may be used to predict which patients are at higher risk for adverse respiratory events after adenotonsillectomy. Such knowledge is valuable for planning optimal postoperative management and intraoperative anesthesia. Predictors of increased respiratory complications include apnea-hypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.
    Archives of otolaryngology--head & neck surgery 01/2011; 137(1):15-8. DOI:10.1001/archoto.2010.226 · 2.33 Impact Factor
  • Anju K. Patel · Eric M. Jaryszak · Skye Stewart · Rahul K. Shah · Arjun S. Joshi ·
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    ABSTRACT: OBJECTIVES: Fourth branchial cleft anomalies are rare and can present in a variety of ways in the head and neck. Limited data exists on the treatment of complex recurrent fistulas. We present a unique case utilizing a pedicled submental flap in the management of a persistent fourth branchial anomaly and discuss the use of pedicled flaps in the pediatric population. Study Design: Retrospective chart review. Methods: Patient data were collected from a tertiary care pediatric hospital medical record. Results: An 8 year old patient presented to our institution with a history of recurrent left neck infections and multiple failed incision and drainage procedures. Aggressive surgical options failed. She eventually underwent a complete resection of the fistula with partial pharyngectomy, left selective neck dissection, and two layered closure of the pharyngotomy defect with an oversewn pedicled submental island flap. The surgery was uneventful and the patient is without evidence of recurrence 7 months postoperatively. Conclusions: Treatment options for fourth branchial anomalies include incision and drainage, endoscopic cauterization via direct laryngoscopy or open neck surgery with complete sinus tract excision and thyroidectomy. Persistent disease requires aggressive management with partial pharyngectomy with/without the use of additional soft tissue for coverage. For significant pharyngeal defects, submental pedicled flaps can be utilized in repair and closure. To our knowledge this is the first reported case of a pedicled submental flap for closure of a pharyngotomy defect in the pediatric population. The use of the submental flap in this group is feasible, with few to no complications, and offers very acceptable cosmesis.
    The Laryngoscope 01/2011; 121(S4). DOI:10.1002/lary.22099 · 2.14 Impact Factor
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    ABSTRACT: No abstract is available for this article.
    The Laryngoscope 10/2010; 120(S3):S98. DOI:10.1002/lary.21305 · 2.14 Impact Factor
  • Eric M Jaryszak · Christopher Vanison · Amanda L Yaun · Diego A Preciado ·
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    ABSTRACT: Educational Objective: At the conclusion of this presentation, the participants should be able to discuss the differential diagnosis of a pars squamosa temporal bone mass, discuss unusual locations in which cholesteatoma may appear, and explain the need for long term followup in canal wall down mastoidectomy patients. Objectives: To present a case of an acquired cholesteatoma presenting as a large lateral pars squamosa temporal bone mass and review the literature on cholesteatoma presenting in unusual locations. Study Design: Case report and review of the literature. Methods: While congenital cholesteatomas have been reported to arise in atypical locations such as the maxillary sinus and occipitoparietotemporal junction, there have been very few reports of acquired cholesteatomas arising in unusual locations. A 16 year old female with an acquired cholesteatoma presenting as a large lateral squamous temporal bone mass with intracranial extension nine years after canal wall down (CWD) mastoidectomy and six years after revision surgery is presented. Her management and followup are discussed and a review of the literature for atypical locations of cholesteatoma is presented. Results: Review of the English literature revealed only a single case of acquired cholesteatoma within the squamous temporal bone. Our patient underwent successful excision of the mass through a lateral approach, confirming the diagnosis. Conclusions: Acquired cholesteatoma typically arises in the middle ear and mastoid. Rarely, it can present in atypical locations. The consequences of undiagnosed, untreated cholesteatoma can be significant. This case highlights the need for routine long term surveillance in children with CWD mastoidectomy cavities. Copyright © 2010 The American Laryngological, Rhinological, and Otological Society, Inc.
    The Laryngoscope 10/2010; 120(S3):S77. DOI:10.1002/lary.21266 · 2.14 Impact Factor
  • Eric M Jaryszak · Susan T Verghese · Michael F Guerrera · Rahul K Shah ·
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    ABSTRACT: There are multiple modalities by which trauma occurs to the neck. One of these includes minor suction trauma which usually results in a superficial bruising of the skin. While this usually self-resolves, patients with hemophilia are at higher risk for the development of bleeding from such trauma. Hematomas of the head and neck in patients with hemophilia have seldom been reported. We report a unique case of expanding bilateral neck hematomas secondary to suction trauma in a patient with Hemophilia A with high-titer inhibitor and highlight the importance of a multidisciplinary approach in the management of this complex patient.
    International journal of pediatric otorhinolaryngology 07/2010; 74(7):828-30. DOI:10.1016/j.ijporl.2010.04.003 · 1.19 Impact Factor
  • Eric M Jaryszak · Edith M Sampson · Patrick J Antonelli ·
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    ABSTRACT: Ossicular chain reconstruction may be complicated by prosthesis extrusion. As prostheses are commonly placed in middle ears contaminated with biofilm-forming bacteria, such as Pseudomonas aeruginosa (PA), extrusion may be caused by development of a biofilm on the prosthesis and the host response to this biofilm. The purpose of this experiment was to determine if PA forms biofilm on different ossicular chain reconstruction prostheses to a different degree. Prostheses made of titanium, hydroxylapatite (HA), and plastic (23 each) were cultured with PA in broth for 96 hours. Biofilm formation was assessed by electron microscopy and quantitative microbiology. Titanium prostheses formed less biofilm than plastic (P = .0003) and HA (P = .003), but there was no difference between HA and plastic. Correction for surface area did not alter these significant differences. Pseudomonas aeruginosa forms biofilm on ossicular prostheses, particularly those made of plastic and HA. These differences could, in part, explain the extrusion propensity of certain biomaterials.
    American journal of otolaryngology 11/2009; 30(6):367-70. DOI:10.1016/j.amjoto.2008.07.007 · 0.98 Impact Factor
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    ABSTRACT: Deficient cochlear nerves (CN) have been associated with poor cochlear implant performance. Normative data on CN diameter based on radiographic imaging have not been published. The objectives of this study were to determine if CN diameter could be reproducibly measured on parasagittal constructive interference in steady state (CISS)-sequence magnetic resonance imaging (MRI) and to establish a normative range for CN diameter. Retrospective review of MRI images by two independent blinded observers. Thirty patients (45 ears) with a CISS-sequence MRI done for auditory complaints in patients with normal hearing in one ear were included. CN diameters were measured in a parasagittal plane just medial to the internal auditory canal (IAC) fundus by two independent observers. Cross-sectional areas were calculated and interobserver agreement was evaluated. The CN was identified in 100% of studied ears. In 93%, the diameters were able to be measured by both observers. In 7% of ears, the cochlear nerve was unable to be measured secondary to the proximity of the CN to IAC wall. The CN vertical diameter (1.4 mm +/- 0.21 mm), horizontal diameter (1.0 mm +/- 0.15 mm), and cross-sectional area (1.1 mm +/- 0.26 mm(2)) were normally distributed. There was good interobserver correlation for each measure. CN diameter can be reliably measured at the IAC fundus. This study establishes normative radiographic data for the CN diameter. These data may be used to evaluate the cause and treatment prognosis in patients with sensorineural hearing loss.
    The Laryngoscope 10/2009; 119(10):2042-5. DOI:10.1002/lary.20516 · 2.14 Impact Factor
  • Eric M Jaryszak · Edith M Sampson · Patrick J Antonelli ·
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    ABSTRACT: Microbial biofilms have been associated with poor outcomes with a variety of biomedical implants; however, this relationship has not been established with ossicular chain reconstruction prostheses (ORPs). The purpose of this study was to determine if biofilms are present on ORPs in patients undergoing revision ossicular chain reconstruction and if their presence correlates with middle ear scarring or hearing outcomes. Prospective and blinded. Tertiary referral center. Patients undergoing revision ossicular chain reconstruction with previous ORP placement were enrolled. INTERVENTION/MAIN OUTCOME MEASURE: Ossicular chain reconstruction prostheses associated with poor hearing and residual or recurrent disease were cultured and examined using scanning electron microscopy. Audiometric thresholds and middle ear scarring scores were recorded. Twelve patients were included in the study. Of the prostheses, 25% were culture positive, and 67% had microscopic evidence of biofilm. No difference was found between the middle ear scarring scores (p = 0.31) and hearing outcomes (p = 0.11) of biofilm and nonbiofilm prostheses. There was no correlation between middle ear scarring and degree of conductive hearing loss (R2 = 0.04; p = 0.54). Biofilms are commonly found on ORPs at the time of revision ossicular chain reconstruction. The interaction between biofilms and the host environment is complex. Many factors besides biofilms may impact middle ear scarring and hearing.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 09/2009; 30(8):1191-5. DOI:10.1097/MAO.0b013e3181be64b3 · 1.79 Impact Factor
  • Eric M. Jaryszak · Carol J. Langdoc ·
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    ABSTRACT: Objectives: To present an unusual case of ectopic cervical thymoma in a pediatric patient and review the literature on this rare disorder. Background: The thymus develops primarily from the third branchial pouch forming the thymopharyngeal duct during the 6th week of gestation. It descends along a tract from the pyriform sinus to the mediastinum passing posterior to the glossopharyngeal nerve and lateral to the thyroid gland. Ectopic cervical thymomas have been most frequently described along this typical path of descent, however, rarely, they present in other cervical locations. Methods: We present a case of a posterolateral ectopic cervical thymoma, the first such reported case, with review of imaging and pathology. We also review the English literature on ectopic cervical thymoma, including perioperative management, and discuss potential pitfalls in diagnosis and management. Results: Only approximately 30 cases of ectopic hamartomatous cervical thymoma have been described in the English literature. Of these, the majority are in the supraclavicular region with a single report involving the submandibular gland and another involving the sternocleidomastoid muscle. There were no reports of this tumor in the posterolateral neck. Conclusion: Ectopic cervical thymoma is an uncommon cause of a neck mass. It is important, however, to maintain this in the differential as there can be implications after removal in the perioperative period.
    The Laryngoscope 01/2009; 119(S1):S141 - S141. DOI:10.1002/lary.20455 · 2.14 Impact Factor
  • Eric M Jaryszak · William O Collins ·
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    ABSTRACT: Acquired subglottic cysts are a rare cause of stridor in infants. The two major risk factors for development of these cysts are prematurity and history of intubation. Microlaryngeal decompression and carbon dioxide laser resection of these cysts have been the most common treatment methods with recurrence rates as high as 43% [J. Lim, W. Hellier, J. Harcourt, S. Leighton, D. Albert, Subglottic cysts: the Great Ormond Street experience, Int. J. Pediatr. Otorhinolaryngol. 67 (2003) 461-465]. Carbon dioxide laser therapy also carries the risk of airway fire, injury to adjacent structures, and possible delayed scarring. We present a case of bilateral subglottic cysts in a premature infant with progressive stridor, treated using a microdebrider, and review the literature regarding the treatment of these lesions.
    International Journal of Pediatric Otorhinolaryngology 12/2008; 73(1):139-42. DOI:10.1016/j.ijporl.2008.09.024 · 1.19 Impact Factor

Publication Stats

64 Citations
22.89 Total Impact Points


  • 2011
    • Children's National Medical Center
      • Division of Otolaryngology
      Washington, Washington, D.C., United States
  • 2010-2011
    • George Washington University
      Washington, Washington, D.C., United States
  • 2009
    • University of Florida
      • Department of Otolaryngology
      Gainesville, Florida, United States