title: Assessing Systemic Stress in Otolaryngology: Methodology and Feasibility of Hair and Salivary Cortisol Testing.
abstract: OBJECTIVE
  Elevated systemic stress is a predictor of adverse health outcomes, and stress can be objectively quantified by cortisol concentration. Despite its utility, such testing is rarely performed in otolaryngology. This manuscript provides details on the principles, methodology, and feasibility of performing laboratory assessments of hair and salivary cortisol to inform researchers wishing to incorporate these novel tests in future otolaryngologic studies.
  
  
  METHODS
  Participants were older adults with hearing impairment. One hair sample and eight saliva samples were collected. Feasibility of study design was assessed through rates of participation in hair and saliva sampling and protocol adherence for saliva collection. Area under the curve (AUC) was used to evaluate overall secretion, and cortisol awakening response (CAR) was used to evaluate the dynamic secretion response.
  
  
  RESULTS
  From 9/1/2013 to 12/31/2013, 26/30 (86.7%) eligible participants agreed to hair sampling. All 30 subjects agreed to collect saliva, with 29 (96.7%) adhering to the collection protocol. Mean AUC was 401.2 nmol/L per hour, and CAR was 4.5 nmol/L.
  
  
  CONCLUSIONS
  Evaluating systemic stress in an otolaryngologic population using hair and saliva is feasible with acceptable participation and adherence. Repeat measurements over time will allow for evaluation of changes in systemic stress in relation to treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 6210, Baltimore, Maryland 21287, USA ; Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA.
authors.forename: Dane J
authors.initials: DJ
authors.lastname: Genther
authors.affiliation: Department of Psychiatry, University of Colorado School of Medicine, 12700 E. 19 Ave., Building RC2, Aurora, Colorado 80045, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Laudenslager
authors.affiliation: Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA.
authors.forename: Yoon-Kyu
authors.initials: YK
authors.lastname: Sung
authors.affiliation: Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA.
authors.forename: Caitlin R
authors.initials: CR
authors.lastname: Blake
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 6210, Baltimore, Maryland 21287, USA ; Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., Suite 6210, Baltimore, Maryland 21287, USA ; Center on Aging and Health, Johns Hopkins University, 2024 E. Monument St. Suite 2-700, Baltimore, Maryland 21205, USA ; Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Cr., John R. Burton Pavilion, Room 163, Baltimore, Maryland 21224, USA ; Departments of Epidemiology and Mental Health, Johns Hopkins University Bloomberg School of Public Health, 615 Wolfe St., Baltimore, Maryland 21205, USA.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lin
keywords: Cortisol; feasibility; hair cortisol testing; methodology; salivary cortisol testing; systemic stress