Andres Godoy | Johns Hopkins University (original) (raw)

Papers by Andres Godoy

To propose a new surgical technique for fixing the nasal septum to the midline, for long term pre... more To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated.

Introducción: La disfagia orofaríngea es una condición patológica frecuente, especialmente en pac... more Introducción: La disfagia orofaríngea es una condición patológica frecuente, especialmente en pacientes añosos. Se asocia a una serie de enfermedades (principalmente neurológicas y traumáticas), y conlleva un riesgo considerable de aspiración y neumonía. La evaluación fibroscópica de la deglución es una técnica que permite estudiar la fisiología de la deglución, estimar el riesgo de aspiración y orientar sobre la forma más segura de alimentar al paciente. Objetivo: Revisar la experiencia de nuestra institución en la evaluación fibroscópica de la deglución. Material y método: Entre abril de 2006 y julio de 2007 se evaluaron prospectivamente 75 pacientes, realizándose 96 exámenes en total. Hubo un franco predominio masculino (2/3 del grupo), y la edad promedio de los pacientes evaluados fue de 65,6 ± 23,3 años (rango: 12-99 años). El examen se realizó utilizando un nasofaringolaringoscopio flexible y administrando alimento (papilla y líquido espeso) teñido con colorante azul natural. ...

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 16, 2015

To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patien... more To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patients with obstructive sleep apnea and nasal airway obstruction improves obstructive sleep apnea. Computerized searches were performed in PubMed, EMBASE, and the Cochrane Library through October 2014. Manual searches and subject matter expert input was also solicited. A search protocol was defined a priori, and 2 independent investigators performed the data extraction, focusing on relevant data, including quality data polysomnography data, and taking note of methodological quality and risk for bias. The 10 studies meeting criteria included a total of 320 patients. There were 2 randomized controlled trials, 7 prospective studies, and 1 retrospective study. There was a significant improvement in the pooled results of both Epworth Sleepiness Scale (ESS; difference 3.53, 95% confidence interval [CI] [0.64, 6.23]) and Respiratory Disturbance Index (RDI; 11.06, 95% CI [5.92, 16.19]) scores with i...

The Laryngoscope, 2012

There is a paucity of data showing the perception penalty caused by facial paralysis. Our objecti... more There is a paucity of data showing the perception penalty caused by facial paralysis. Our objective was to measure society's perception of facial paralysis on the characteristic of beauty. We hypothesized that patients with paralysis would be considered by society as less attractive than normals, a difference amplified by smiling. Randomized controlled experiment. Forty subjects viewed photographs of normal and paralyzed faces. They rated attractiveness, identified paralysis if present, its severity, and the feature most affected. There were significant differences in attractiveness scores for normal and paralyzed faces (Wilcoxon rank sum test, z = 16.912; P < .001). A mixed effects regression model was used to explain differences in the scores. The fixed portion of the model shows paralyzed faces were 1 standard deviation less attractive than normal faces. Smiling increased attractiveness for normals (constant, 5.9; smile effect, 0.735; P < .001). The smile × paralysis interaction term was -0.892; P < .001, but not significantly different from the smile term (χ(2) (1) = 0.87; P = .352). The random effects model showed an intersubject rating variability of 1.32. The attractiveness penalty imposed by facial paralysis is significant, with paralyzed faces considered markedly less attractive than normals. However, the ratings did not change significantly when patients smiled, despite the increased asymmetry that occurs through smiling. Observers were moderately good at identifying the presence of facial paralysis, but less good at distinguishing side of involvement. These results have important implications for patient counseling and management of facial paralysis patients in an evidence-based manner.

The Laryngoscope, 2011

To determine the effect of facial lesion size and location on perceptions of attractiveness and i... more To determine the effect of facial lesion size and location on perceptions of attractiveness and importance for repair. We hypothesized that attractiveness scores and importance for repair would be dependent on lesion size and location. Randomized controlled experiment. Forty-five subjects viewed 35 photographs of normal faces and faces with lesions of different sizes and locations. They rated attractiveness, how disfiguring, how bothered, and how important they considered repair. Iterated factor analysis showed "bothered, disfigured, and important to repair" addressed the same domain, so a disfigured/bothersome/repair factor score (DBRFS) was used. A mixed-effects regression model for attractiveness showed small-central and small-peripheral coefficients were not significantly different, χ(2) (1) = 0.03, P = 1.000; but large-central and large-peripheral differences and small-central and large-peripheral differences were significantly different, χ(2) (1) = 10.34, P = 0.004; and χ(2) (1) = 50.55, P < .001, respectively. DBRFS and attractiveness were poorly correlated (χ = -0.29). A mixed-effects regression for DBRFS showed small-central to large-central and the small-central to large-peripheral coefficients were significantly different, χ(2) (1) = 129.20, P < .001; and χ(2) (1) = 115.25, P < .001; but large-central to large-peripheral coefficients were not, χ(2) (1) = 0.14, P = 1.000. The attractiveness penalty caused by a lesion was correlated with size but not location. Importance to repair was correlated with how disturbing and bothersome it was but not with how the lesion diminished attractiveness. All large lesions and small central lesions were considered important to repair by observers. These results will help us predict the true impact of lesions and support evidence-based treatment plans.

Otolaryngology - Head and Neck Surgery, 2010

To assess the association between pathogenic bacteria found in bronchoalveolar lavages and parana... more To assess the association between pathogenic bacteria found in bronchoalveolar lavages and paranasal cavity cultures in patients with cystic fibrosis (CF) who underwent endonasal endoscopic sinus surgery. The authors hypothesized that the pathogenic bacterial pattern of the upper airway would be associated with that of the lower airway. Prospective case series with planned data collection. Tertiary referral center. A group of 16 patients with diagnosis of CF who underwent endonasal endoscopic sinus surgery from July 2001 to August 2009 participated in the study. Culture samples were obtained from bronchoalveolar lavages and paranasal cavities. A Fisher exact test was performed to examine the significance of the association between upper airway and lower airway cultures. The most frequent microorganisms in cultures of para-nasal cavities and bronchoalveolar lavages were Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus viridans. Statistical analysis revealed a significant association between upper airway cultures (paranasal cavities) and lower airway cavities (bronchoalveolar lavages) for the 2 most frequent microorganisms, P. aeruginosa and S. aureus (P = .007 and P = .030, respectively). The authors confirmed their initial hypothesis that a significant association between bronchoalveolar lavages and sinus cultures was established, once more confirming the idea of a unified airway. They found chronic rhinosinusitis with polyps to be a common clinical presentation in patients with CF. Further studies are required to indicate the role of antibiotics and the pathogenesis of the microorganisms as a manifestation of clinical severity.

Otolaryngology -- Head and Neck Surgery, 2013

To evaluate the impact of facial lesions on affect display in patients as compared with individua... more To evaluate the impact of facial lesions on affect display in patients as compared with individuals without lesions. Prospective randomized controlled experiment. Setting Academic tertiary referral center. Forty-five normal observers viewed photographs of normal faces in repose and faces with lesions in repose. Observers classified the affect display of the patients and the normals using a survey containing choices of primary emotions and personal attributes. Latent class analysis was used to find the unmeasured or "latent" classes. Latent class regression was used to determine the impact of lesion size and location on class membership. Finally, lesion classes and normal classes were checked for differences. Latent class analysis identified 4 independent latent classes for faces with lesions. The normal data were best fit by 3 latent classes. As a group, faces with lesions were most likely to be classified as either negative-sad or negative-angry, accounting for a combined probability of 44%. This was in contrast to the normal group, where 62% were classified as positive and only 13.9% as negative. Size and location significantly affected negative class membership. There were significant differences in the lesion classes as compared with the normal classes. Faces with lesions were reported to display different affect in repose than normal faces in repose. The classification of the lesion faces was dependent on lesion size and location. These findings provide the first objective evidence of the affect display penalty caused by facial lesions.

Archives of Otolaryngology–Head & Neck Surgery, 2011

To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used ... more To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA). Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice. An academic facial plastic surgery practice and an academic rhinology practice. New patients to both practices. NOSE score and presence of septal deviation. The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%. Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.

The Laryngoscope, 2012

To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attracti... more To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attractiveness and the ability of rhinoplasty to minimize it. We hypothesized that the presence of a crooked nose would penalize symmetry and attractiveness ratings as compared to normal faces. We further hypothesized that straightening rhinoplasty would restore symmetry and improve attractiveness. Randomized controlled experiment. A group of 39 naïve observers viewed pictures of patients with crooked noses before and after straightening rhinoplasty, and normal patients. Observers rated the overall asymmetry and attractiveness, and the asymmetry of facial subunits using a survey with a rating scale of 1 to 10 for each category. For asymmetry, patient group (preoperative, postoperative, normal) was statistically significant by multivariate analysis of the variance. Post-analysis of variance showed significant differences in asymmetry scores for overall, nose subunit, and mouth subunit. Pairwise testing then showed significantly different overall asymmetry scores between normal and preoperative (P < .001), and preoperative and postoperative (P < .001), but not between normal and postoperative (P = .215) groups. Mixed linear regression analysis showed that decreasing nasal asymmetry by 1 point increases attractiveness by 0.18 points or 0.082 attractiveness standard deviations (P < .001). Faces with crooked noses were rated less symmetrical overall and less symmetrical at the nose and mouth subunits as compared to normal and postoperative faces. Straightening rhinoplasty diminished overall facial asymmetry and subunit asymmetry scores. Decreasing nasal asymmetry led to significant improvements in facial attractiveness. These data provide objective evidence supporting the idea that a straightening rhinoplasty can improve attractiveness.

To propose a new surgical technique for fixing the nasal septum to the midline, for long term pre... more To propose a new surgical technique for fixing the nasal septum to the midline, for long term prevention of nasal obstruction, in secondary and select cases of primary septoplasty. Patterns of septal deformity, materials used for titanium plates, surgical results, symptom improvement, and surgical complications were investigated.

Introducción: La disfagia orofaríngea es una condición patológica frecuente, especialmente en pac... more Introducción: La disfagia orofaríngea es una condición patológica frecuente, especialmente en pacientes añosos. Se asocia a una serie de enfermedades (principalmente neurológicas y traumáticas), y conlleva un riesgo considerable de aspiración y neumonía. La evaluación fibroscópica de la deglución es una técnica que permite estudiar la fisiología de la deglución, estimar el riesgo de aspiración y orientar sobre la forma más segura de alimentar al paciente. Objetivo: Revisar la experiencia de nuestra institución en la evaluación fibroscópica de la deglución. Material y método: Entre abril de 2006 y julio de 2007 se evaluaron prospectivamente 75 pacientes, realizándose 96 exámenes en total. Hubo un franco predominio masculino (2/3 del grupo), y la edad promedio de los pacientes evaluados fue de 65,6 ± 23,3 años (rango: 12-99 años). El examen se realizó utilizando un nasofaringolaringoscopio flexible y administrando alimento (papilla y líquido espeso) teñido con colorante azul natural. ...

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 16, 2015

To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patien... more To perform a systematic review and meta-analysis to determine if isolated nasal surgery in patients with obstructive sleep apnea and nasal airway obstruction improves obstructive sleep apnea. Computerized searches were performed in PubMed, EMBASE, and the Cochrane Library through October 2014. Manual searches and subject matter expert input was also solicited. A search protocol was defined a priori, and 2 independent investigators performed the data extraction, focusing on relevant data, including quality data polysomnography data, and taking note of methodological quality and risk for bias. The 10 studies meeting criteria included a total of 320 patients. There were 2 randomized controlled trials, 7 prospective studies, and 1 retrospective study. There was a significant improvement in the pooled results of both Epworth Sleepiness Scale (ESS; difference 3.53, 95% confidence interval [CI] [0.64, 6.23]) and Respiratory Disturbance Index (RDI; 11.06, 95% CI [5.92, 16.19]) scores with i...

The Laryngoscope, 2012

There is a paucity of data showing the perception penalty caused by facial paralysis. Our objecti... more There is a paucity of data showing the perception penalty caused by facial paralysis. Our objective was to measure society's perception of facial paralysis on the characteristic of beauty. We hypothesized that patients with paralysis would be considered by society as less attractive than normals, a difference amplified by smiling. Randomized controlled experiment. Forty subjects viewed photographs of normal and paralyzed faces. They rated attractiveness, identified paralysis if present, its severity, and the feature most affected. There were significant differences in attractiveness scores for normal and paralyzed faces (Wilcoxon rank sum test, z = 16.912; P < .001). A mixed effects regression model was used to explain differences in the scores. The fixed portion of the model shows paralyzed faces were 1 standard deviation less attractive than normal faces. Smiling increased attractiveness for normals (constant, 5.9; smile effect, 0.735; P < .001). The smile × paralysis interaction term was -0.892; P < .001, but not significantly different from the smile term (χ(2) (1) = 0.87; P = .352). The random effects model showed an intersubject rating variability of 1.32. The attractiveness penalty imposed by facial paralysis is significant, with paralyzed faces considered markedly less attractive than normals. However, the ratings did not change significantly when patients smiled, despite the increased asymmetry that occurs through smiling. Observers were moderately good at identifying the presence of facial paralysis, but less good at distinguishing side of involvement. These results have important implications for patient counseling and management of facial paralysis patients in an evidence-based manner.

The Laryngoscope, 2011

To determine the effect of facial lesion size and location on perceptions of attractiveness and i... more To determine the effect of facial lesion size and location on perceptions of attractiveness and importance for repair. We hypothesized that attractiveness scores and importance for repair would be dependent on lesion size and location. Randomized controlled experiment. Forty-five subjects viewed 35 photographs of normal faces and faces with lesions of different sizes and locations. They rated attractiveness, how disfiguring, how bothered, and how important they considered repair. Iterated factor analysis showed "bothered, disfigured, and important to repair" addressed the same domain, so a disfigured/bothersome/repair factor score (DBRFS) was used. A mixed-effects regression model for attractiveness showed small-central and small-peripheral coefficients were not significantly different, χ(2) (1) = 0.03, P = 1.000; but large-central and large-peripheral differences and small-central and large-peripheral differences were significantly different, χ(2) (1) = 10.34, P = 0.004; and χ(2) (1) = 50.55, P < .001, respectively. DBRFS and attractiveness were poorly correlated (χ = -0.29). A mixed-effects regression for DBRFS showed small-central to large-central and the small-central to large-peripheral coefficients were significantly different, χ(2) (1) = 129.20, P < .001; and χ(2) (1) = 115.25, P < .001; but large-central to large-peripheral coefficients were not, χ(2) (1) = 0.14, P = 1.000. The attractiveness penalty caused by a lesion was correlated with size but not location. Importance to repair was correlated with how disturbing and bothersome it was but not with how the lesion diminished attractiveness. All large lesions and small central lesions were considered important to repair by observers. These results will help us predict the true impact of lesions and support evidence-based treatment plans.

Otolaryngology - Head and Neck Surgery, 2010

To assess the association between pathogenic bacteria found in bronchoalveolar lavages and parana... more To assess the association between pathogenic bacteria found in bronchoalveolar lavages and paranasal cavity cultures in patients with cystic fibrosis (CF) who underwent endonasal endoscopic sinus surgery. The authors hypothesized that the pathogenic bacterial pattern of the upper airway would be associated with that of the lower airway. Prospective case series with planned data collection. Tertiary referral center. A group of 16 patients with diagnosis of CF who underwent endonasal endoscopic sinus surgery from July 2001 to August 2009 participated in the study. Culture samples were obtained from bronchoalveolar lavages and paranasal cavities. A Fisher exact test was performed to examine the significance of the association between upper airway and lower airway cultures. The most frequent microorganisms in cultures of para-nasal cavities and bronchoalveolar lavages were Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus viridans. Statistical analysis revealed a significant association between upper airway cultures (paranasal cavities) and lower airway cavities (bronchoalveolar lavages) for the 2 most frequent microorganisms, P. aeruginosa and S. aureus (P = .007 and P = .030, respectively). The authors confirmed their initial hypothesis that a significant association between bronchoalveolar lavages and sinus cultures was established, once more confirming the idea of a unified airway. They found chronic rhinosinusitis with polyps to be a common clinical presentation in patients with CF. Further studies are required to indicate the role of antibiotics and the pathogenesis of the microorganisms as a manifestation of clinical severity.

Otolaryngology -- Head and Neck Surgery, 2013

To evaluate the impact of facial lesions on affect display in patients as compared with individua... more To evaluate the impact of facial lesions on affect display in patients as compared with individuals without lesions. Prospective randomized controlled experiment. Setting Academic tertiary referral center. Forty-five normal observers viewed photographs of normal faces in repose and faces with lesions in repose. Observers classified the affect display of the patients and the normals using a survey containing choices of primary emotions and personal attributes. Latent class analysis was used to find the unmeasured or "latent" classes. Latent class regression was used to determine the impact of lesion size and location on class membership. Finally, lesion classes and normal classes were checked for differences. Latent class analysis identified 4 independent latent classes for faces with lesions. The normal data were best fit by 3 latent classes. As a group, faces with lesions were most likely to be classified as either negative-sad or negative-angry, accounting for a combined probability of 44%. This was in contrast to the normal group, where 62% were classified as positive and only 13.9% as negative. Size and location significantly affected negative class membership. There were significant differences in the lesion classes as compared with the normal classes. Faces with lesions were reported to display different affect in repose than normal faces in repose. The classification of the lesion faces was dependent on lesion size and location. These findings provide the first objective evidence of the affect display penalty caused by facial lesions.

Archives of Otolaryngology–Head & Neck Surgery, 2011

To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used ... more To determine if clinical data and Nasal Obstruction Symptom Evaluation (NOSE) scores can be used to identify patients at risk for obstructive sleep apnea (OSA). Intake surveys using the NOSE, Epworth Sleepiness Scale (ESS), and Snore Outcomes Scale (SOS) were administered to new patients visiting a facial plastic surgery practice and a rhinology practice. An academic facial plastic surgery practice and an academic rhinology practice. New patients to both practices. NOSE score and presence of septal deviation. The odds ratio (OR) for an ESS score higher than 10 was 2.98 (95% confidence interval [CI], 1.17-7.57) when snoring was present; 5.5 (95% CI, 1.35-22.58) when the NOSE score was 10 or higher; and 3.3 (95% CI, 0.98-11.0) when a deviated septum was found on clinical examination. The probability of an elevated ESS score was 88% when all 3 factors were present and 56% when the NOSE score was not elevated. Receiver operating characteristic analysis with predictors "snore" and NOSE score of 10 or higher had an area under the curve of 0.72. With a probability cutoff of 0.5, the sensitivity was 30%, and the specificity 90%. Sinonasal surgery is among the most common outpatient procedures performed in the United States each year. Many patients undergoing sinonasal surgery have undiagnosed OSA or nasal obstruction, a known risk factor for OSA. Patients with OSA have unique perioperative needs. In patients with nasal obstruction, a deviated septum, and/or snoring, there is an association between the NOSE score and the ESS score. The NOSE survey may serve as a simple screening instrument instead of the ESS for patients at risk for undiagnosed OSA and special perioperative needs.

The Laryngoscope, 2012

To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attracti... more To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attractiveness and the ability of rhinoplasty to minimize it. We hypothesized that the presence of a crooked nose would penalize symmetry and attractiveness ratings as compared to normal faces. We further hypothesized that straightening rhinoplasty would restore symmetry and improve attractiveness. Randomized controlled experiment. A group of 39 naïve observers viewed pictures of patients with crooked noses before and after straightening rhinoplasty, and normal patients. Observers rated the overall asymmetry and attractiveness, and the asymmetry of facial subunits using a survey with a rating scale of 1 to 10 for each category. For asymmetry, patient group (preoperative, postoperative, normal) was statistically significant by multivariate analysis of the variance. Post-analysis of variance showed significant differences in asymmetry scores for overall, nose subunit, and mouth subunit. Pairwise testing then showed significantly different overall asymmetry scores between normal and preoperative (P < .001), and preoperative and postoperative (P < .001), but not between normal and postoperative (P = .215) groups. Mixed linear regression analysis showed that decreasing nasal asymmetry by 1 point increases attractiveness by 0.18 points or 0.082 attractiveness standard deviations (P < .001). Faces with crooked noses were rated less symmetrical overall and less symmetrical at the nose and mouth subunits as compared to normal and postoperative faces. Straightening rhinoplasty diminished overall facial asymmetry and subunit asymmetry scores. Decreasing nasal asymmetry led to significant improvements in facial attractiveness. These data provide objective evidence supporting the idea that a straightening rhinoplasty can improve attractiveness.