Otolaryngologists, Surgical Specialist


Accepting new patients
875 Blake Wilbur Dr
Stanford, CA 94305
650-498-6000
Locations and availability (2)

Education ?

Medical School Score Rankings
University of Michigan Medical School
  • Currently 4 of 4 apples
Top 25%

Affiliations ?

Dr. Divi is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Lucile Salter Packard Children's Hospital @ Stanford
    725 Welch Rd, Palo Alto, CA 94304
    • Currently 3 of 4 crosses
    Top 50%
  • University of Michigan Health System
  • Palo Alto Veterans Affairs Medical Center
    3801 Miranda Ave, Palo Alto, CA 94304
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • Publications & Research

    Dr. Divi has contributed to 19 publications.
    Title Re-animation and Rehabilitation of the Paralyzed Face in Head and Neck Cancer Patients.
    Date April 2012
    Journal Clinical Anatomy (new York, N.y.)
    Excerpt

    Facial nerve paralysis can occasionally result from the treatment of head and neck cancer. The treatment of paralysis is patient specific, and requires an assessment of the remaining nerve segments, musculature, functional deficits, anticipated recovery, and patient factors. When feasible, reinnervation of the remaining musculature can provide the most natural outcome. However, the complex and topographic nature of facial innervation often prevents complete and meaningful movement. In these instances, a wide variety of procedures can be used to combat the functional and cosmetic sequella of facial paralysis.

    Title Primary Tep Placement in Patients with Laryngopharyngeal Free Tissue Reconstruction and Salivary Bypass Tube Placement.
    Date June 2011
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    The authors examined the feasibility and advantages of primary tracheoesophageal puncture (TEP) with intraoperative placement of the voice prosthesis for patients undergoing laryngopharyngectomy requiring free tissue reconstruction and salivary bypass tube placement. Six patients were identified; 4 underwent total laryngopharyngectomy, and 2 underwent total laryngectomy with partial pharyngectomy. All 6 required free tissue reconstruction, and a salivary bypass tube was placed in all cases. All patients had a 20F Indwelling Blom-Singer prosthesis (InHealth Technologies, Carpinteria, California) placed. No complications were noted with intraoperative prosthesis placement. No prostheses were dislodged in the postoperative period. At 6 months, 4 patients available for evaluation had successful voice outcomes, and 3 were disease free. This study demonstrates the effectiveness of voice prosthesis placement at the time of primary TEP associated with free tissue reconstruction of a laryngopharyngeal defect with salivary bypass tube placement.

    Title Chemotherapy Alone for Organ Preservation in Advanced Laryngeal Cancer.
    Date December 2010
    Journal Head & Neck
    Excerpt

    For patients with advanced laryngeal cancer, a trial was designed to determine if chemotherapy alone, in patients achieving a complete histologic complete response after a single neoadjuvant cycle, was an effective treatment with less morbidity than concurrent chemoradiotherapy.

    Title Fungal Laryngitis.
    Date October 2009
    Journal Ear, Nose, & Throat Journal
    Title Neuroendocrine Adenoma of the Middle Ear (name).
    Date August 2009
    Journal Ear, Nose, & Throat Journal
    Excerpt

    Neuroendocrine adenoma of the middle ear (NAME) is a rare tumor. We report a case of NAME, the clinical and pathologic findings of which illustrate the biologic behavior of adenomatous tumors of the middle ear and their relationship with rare carcinoid tumors of the middle ear. A 29-year-old man presented with a history of recurrent otitis media, right conductive hearing loss, and aural fullness. The tumor was removed in its entirety. Otolaryngologists should be familiar with this unusual but important entity.

    Title Vocal Fold Cyst and Fibrosis.
    Date March 2008
    Journal Ear, Nose, & Throat Journal
    Title Diagnosis and Management of Laryngopharyngeal Reflux Disease.
    Date January 2008
    Journal Current Opinion in Otolaryngology & Head and Neck Surgery
    Excerpt

    PURPOSE OF REVIEW: The recent findings and up-to-date practice guidelines for diagnosing, evaluating, and treating gastro-esophageal reflux disease are discussed. RECENT FINDINGS: The patient complaints for reflux disease are crucial in diagnosis. Although physical examination findings may correlate with laryngopharyngeal reflux, these findings may not improve after an adequate course of treatment. Behavioral modifications are a critical part of improving reflux; however, weight loss has not been shown to improve laryngopharyngeal reflux disease. Patients who used proton-pump inhibitors and histamine blockers were shown to have increased risk of developing Clostridium difficile infections. Laryngopharyngeal reflux has been shown to be a better predictor of Barrett's esophagus than gastroesophageal reflux, although specific screening recommendations have not been determined. SUMMARY: Current studies in laryngopharyngeal reflux demonstrate that improvements in physical examination findings are not a reliable way of determining patient improvement. An empiric trial of therapy is the best diagnostic test for laryngopharyngeal reflux. Future studies will examine the role of transnasal esophagoscopy in the screening of the laryngopharyngeal reflux patient for Barrett's esophagus.

    Title Medical History in Voice Professionals.
    Date November 2007
    Journal Otolaryngologic Clinics of North America
    Excerpt

    A careful and thoughtful history is extremely important in helping to elucidate the cause of a patient's voice complaints. An understanding of the patient's performance and rehearsal environment and demands is also important in guiding the treatment process. A thorough history helps the clinician understand the vocal problem and how to interpret findings on physical examination that may be contributing to the pathophysiology of the vocal complaint.

    Title Physical Examination of Voice Professionals.
    Date November 2007
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Comprehensive physical examination is essential when evaluating patients. Often it includes objective voice assessment and measures along with strobovideolaryngoscopy. In all cases physical examination involves a thorough examination of the ears, nose, throat, neck, posture, cranial nerve function (usually), and assessment of the patient's general (systemic) physical condition. Performance assessment usually should be included for professional voice.

    Title Voice Surgery.
    Date November 2007
    Journal Otolaryngologic Clinics of North America
    Excerpt

    There have been many advances in microsurgery for voice professionals over the last three decades. Driven by a greater understanding of the anatomy and physiology of phonation, most of the advances provide greater surgical precision through improved exposure and more delicate instrumentation. Laryngologists who perform laryngoscopic surgery should be familiar with the current state-of-the-art and should use the latest techniques and technology for all voice patients and particularly for voice professionals. Video procedures for surgical management of voice disorders accompany this content online.

    Title Use of Cross-sectional Imaging in Predicting Surgical Location of Parotid Neoplasms.
    Date June 2005
    Journal Journal of Computer Assisted Tomography
    Excerpt

    OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of using the retromandibular vein as seen on cross-sectional imaging to help differentiate superficial lobe from deep lobe tumors. METHODS: Of the patients who had parotid neoplasms between January 1997 and July 2002, we were able to identify 44 patients with preoperative imaging studies that were available for evaluation. The films were reviewed by a single head and neck radiologist to determine whether the neoplasms involved the superficial, deep, or both lobes of the parotid gland (total). The lateral margin of the retromandibular vein was used as a marker for the facial nerve, since the nerve is not always visible on CT and MRI scans. The radiologist's findings were then compared with the findings during surgery. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predicting the location of neoplasms were then calculated. RESULTS: For lesions in the superficial lobe, cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.91 (95% CI, 0.70-0.98), specificity of 0.86 (95% CI, 0.63-0.96), PPV of 0.88 (95% CI, 0.67-0.97), and NPV of 0.90 (95% CI, 0.67-0.98). For lesions in both lobes (total), cross-sectional imaging was able to predict the location of the neoplasm with a sensitivity of 0.94 (95% CI, 0.68-0.99), specificity of 0.89 (95% CI, 0.71-0.97), PPV of 0.83 (95% CI, 0.58-0.96), and NPV of 0.96 (95% CI, 0.78-0.99). CONCLUSION: Use of the retromandibular vein as a marker for the facial nerve is a sensitive method for identifying the location of parotid gland neoplasms on cross-sectional imaging. This supports the accuracy of using preoperative imaging to detect the position of parotid neoplasms with respect to the facial nerve.

    Title Use of Cross-sectional Imaging in Predicting Facial Nerve Sacrifice During Surgery for Parotid Neoplasms.
    Date March 2005
    Journal Orl; Journal for Oto-rhino-laryngology and Its Related Specialties
    Excerpt

    BACKGROUND: Neoplasms of the parotid gland are difficult management issues because of the wide variation in their biological behavior and the potential for sacrifice of the facial nerve during resection. Because of the significant associated morbidity, prediction of facial nerve sacrifice is critically important for planning surgical procedures and preoperative counseling of patients. We hypothesize that along with the knowledge of the tumor type we would be able to accurately predict the likelihood of facial nerve sacrifice using cross-sectional imaging. METHODS: All patients included in this study were previously untreated patients with parotid neoplasms operated on between January 1997 and July 2002. Only those patients with an available preoperative imaging were included and this resulted in 44 patients for review. Nine patients with preoperative deficits in facial nerve function were excluded from this study since these patients would require facial nerve sacrifice regardless of the radiological prediction. The prediction of facial nerve sacrifice was determined using a prediction of tumor location and an algorithm. The predicted results were compared to the operative record. RESULTS: For all lesions, cross-sectional imaging predicted the need for sacrifice of the facial nerve with a sensitivity of 0.83 (95% CI, 0.36-0.99), specificity of 0.90 (95% CI, 0.72-0.97), PPV of 0.63 (95% CI, 0.26-0.90), and NPV of 0.96 (95% CI, 0.79-0.99). For malignant lesions only, prediction of sacrifice of the facial nerve had a sensitivity of 0.83 (95% CI, 0.36-0.99), specificity of 0.80 (95% CI, 0.51-0.95), PPV of 0.63 (95% CI, 0.26-0.90), and NPV of 0.92 (95% CI, 0.62-0.99). CONCLUSION: Cross-sectional imaging and application of our algorithm is a sensitive method for identifying patients with parotid neoplasms who require facial nerve sacrifice. CT and MRI have a high negative predictive value for facial nerve sacrifice.

    Title Thoracic Outlet Decompression for Subclavian Vein Thrombosis: Experience in 71 Patients.
    Date February 2005
    Journal Archives of Surgery (chicago, Ill. : 1960)
    Excerpt

    HYPOTHESIS: There is a difference in outcomes when patients have neurogenic thoracic outlet syndrome in addition to subclavian vein thrombosis. METHODS: Analysis of a prospectively developed database, medical record review, and a patient questionnaire were used to summarize clinical experience from December 1990 to December 2001 on the basis of the patient's original evaluation. Patients were stratified on the presence (group 1) or absence (group 2) of additional neurogenic pathologic features. RESULTS: Of 928 patients evaluated for thoracic outlet syndrome, 71 underwent 73 operative procedures for subclavian vein obstruction. Men predominated (55%), and the mean age was 32 years. Group 1 (41%) had more preoperative disability, a higher incidence of persistent pain (24%), and less likelihood of returning to full activity compared with group 2 (67% vs 93%; P = .01). Catheter-directed thrombolysis was used in 65% of veins. Preoperative balloon angioplasty was used selectively (34%), and only 4% required stents. Supraclavicular decompression and venolysis were usually delayed 3 weeks to allow for healing of the venous endothelium. Complications included wound infection (3%) and postoperative hematoma (8%). CONCLUSIONS: Patients with isolated subclavian vein obstruction have a more favorable outcome relative to those with combined neurogenic and venous pathologic features. Decompression following thrombolysis should be delayed to reduce the incidence of postoperative complications.

    Title Postoperative Tonsillectomy Bleed: Coblation Versus Noncoblation.
    Date February 2005
    Journal The Laryngoscope
    Excerpt

    To examine the incidence of postoperative bleeding after coblation and noncoblation tonsillectomy and to use postoperative bleeding as an outcome measure to determine the presence of a learning curve with this new surgical technique.

    Title Mixed Myxoid/round Cell Liposarcoma of the Scalp.
    Date July 2003
    Journal American Journal of Otolaryngology
    Excerpt

    Liposarcoma of the head and neck is rare. Only 12 cases of scalp liposarcoma have been previously reported. In this report, we describe a case of myxoid/round cell liposarcoma in the scalp of a 28-year-old woman. This case report highlights a histologic pattern rarely reported in the head and neck but consistent with the evolving classification of liposarcomas.

    Title Influence of Functional Bowel Disease on Outcome of Surgical Antireflux Procedures.
    Date April 2003
    Journal Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
    Excerpt

    Patients with gastroesophageal reflux disease (GERD) have a coexisting diagnosis of functional bowel disease (FBD) in approximately 30% of cases. Symptom improvement after surgical therapy for GERD may be less in patients with FBD when compared to patients without this coexisting problem. A retrospective review of patients undergoing Nissen fundoplication between 1996 and 2000 evaluated patients with documented FBD or FBD symptoms to determine operative outcome. Poor postoperative outcome included recurrent heartburn, gas bloat syndrome, dysphagia requiring reoperation or dilation, or delay in resumption of normal diet. Bivariate comparison and multivariate logistic regression evaluated the independent impact of a documented diagnosis of FBD or preoperative symptoms of FBD on outcome. This study examined 155 patients: 32% reported having symptoms of FBD and 10% had a confirmed diagnosis of FBD. Poor postoperative outcomes occurred in 27%. Patients with a documented diagnosis of FBD were significantly more likely to have a poor outcome when compared to patients without symptoms of FBD (53% vs. 23%, P = 0.01). Patients with preoperative symptoms of FBD (but without a documented diagnosis of FBD) also had a higher incidence of poor outcome (5% vs. 23%, P = 0.09). Patients with FBD are at increased risk of poor results after antireflux surgery. Patients with these conditions should be counseled preoperatively regarding the potential for recurrent postoperative symptoms.

    Title Bilateral Occult Mucosal Bridges of the True Vocal Folds.
    Date
    Journal Journal of Voice : Official Journal of the Voice Foundation
    Excerpt

    A mucosal bridge of the true vocal fold is a rare, benign anatomical finding that can cause dysphonia. It has been described by some in the literature as "occult" as it is often not visibly evident on flexible nasopharyngolaryngoscopy or strobovideolaryngoscopy, but mistakenly diagnosed as a sulcus vocalis (Sataloff RT, Rosen C, Hawkshaw M. Occult mucosal bridge of the vocal fold. Ear Nose Throat J. 1997; 76(12):850).(2) Final diagnosis is usually not made until microscopic direct laryngoscopy is performed and palpation of the true vocal fold reveals the mucosal bridge (Tanaka S, Hirano M, Umeno H, Tanaka Y. Mucosal bridge of the vocal fold [Japanese].(4)Nippon Jibiinkoka Gakkai Kaiho. 1991; 94(12):1853-1856). We describe a case of a 15-year-old boy complaining of long-standing hoarseness and found to have bilateral mucosal bridges of the true vocal folds. Previous reports cite cases of a unilateral mucosal bridge. We believe this is the first reported case of bilateral mucosal bridges.

    Title Laryngeal Candidiasis.
    Date
    Journal Ear, Nose, & Throat Journal
    Title Metastatic Potential of Cancer Stem Cells in Head and Neck Squamous Cell Carcinoma.
    Date
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    to design in vitro and in vivo models of metastasis to study the behavior of cancer stem cells (CSCs) in head and neck squamous cell carcinoma (HNSCC).


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