Otolaryngology - Head and Neck Surgery

OBJECTIVE: To investigate the beneficial outcomes of intraoperative enteral feeding in free-flap regeneration after extended head and neck cancer resection and flap reconstruction surgery. STUDY DESIGN: A pilot randomized, double-blind, placebo-controlled clinical trial. SETTING: Single tertiary care center. METHODS: Patients with advanced head and neck cancers requiring radical tumor resections and free-flap reconstruction were randomly assigned to receive intraoperative enteral nutrition feeding (100 kcal/100 mL at 10-20 mL/h) via a nasogastric tube during free-flap reconstruction (n = 28) or continue fasting (n = 28)...

OBJECTIVE: Current definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL; >0 and ≤25 dB hearing level) has been associated with deleterious age-related conditions. SCHL prevalence and mean age of HL onset in the United States has not been characterized. STUDY DESIGN: A cross-sectional epidemiologic prevalence study. SETTING: US Community. METHODS: We analyzed cross-sectional audiometric data in the US National Health and Nutrition Examination Survey (2005-2012, 2015-2018, n = 15,649)...

OBJECTIVE: Investigate incidence and natural history of otologic and sinonasal disease associated with 22q11.2 deletion syndrome. STUDY DESIGN: Case series. SETTING: Tertiary care children's hospital. METHODS: Charts from consecutive children born 2000 to 2018 with a diagnosis of 22q11.2 deletion, DiGeorge, or velocardiofacial syndrome based on the International Classification of Diseases (ICD)-9 and ICD-10 codes were reviewed...

OBJECTIVE: External auditory exostosis (EAE) is a condition of progressive temporal bone growth into the external auditory canal most commonly from repeat cold water and wind exposure. Several tools have been utilized for EAE excision with varying implications for intra- and postoperative complications. However, comparisons of osteotome and microdrill are made difficult due to the few published cases and intervariability between surgeons. Furthermore, evidence is needed to analyze the safety of novel supplemental tools such as the piezoelectric bone-cutting device...

OBJECTIVE: In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings. STUDY DESIGN: Retrospective cohort study...

OBJECTIVE: To assess the needs of transgender and nonbinary (TNB) adults for gender-affirming face, neck, and voice procedures. STUDY DESIGN: Cross-sectional survey. SETTING: Online, February to May 2022. METHODS: Primary outcomes included utilization of otolaryngologists and speech-language pathologists; gender dysphoria felt from the face, neck, and voice self-reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender-affirming face, neck, and voice procedures...

Head and neck surgeons often have difficulty in relocating sites of positive margins due to the complex 3-dimensional (3D) anatomy of the head and neck. We introduce a new technique where resection specimens are 3D scanned with a smartphone, annotated in computer-assisted design software, and immediately visualized on augmented reality (AR) glasses. The 3D virtual specimen can be accurately superimposed onto surgical sites for orientation and sizing applications. During an operative workshop, a surgeon using AR glasses projected virtual, annotated specimen models back into the resection bed onto a cadaver within approximately 10 minutes...

OBJECTIVE: To assess transgender and nonbinary adults' awareness of Otolaryngologists' (ENT) and speech-language pathologists' (SLP) ability to perform various face, neck, and voice procedures for gender-affirming purposes. STUDY DESIGN: Cross-sectional survey. SETTING: Online, from February to May 2022. METHODS: We developed a list of nonsurgical and surgical gender-affirming face, neck, and voice procedures. We asked transgender and nonbinary (TNB) adults which procedures from this list they knew could be performed by specially-trained ENTs or SLPs for gender-affirmation and which listed procedures they knew existed as gender-affirming treatment before the survey...

OBJECTIVE: To explore the association between body composition and sensorineural hearing loss (SNHL). STUDY DESIGN: Cross-sectional study, prospective study and Mendelian randomization (MR) analyses. SETTING: UK Biobank. METHODS: This cross-sectional study included 147,296 adult participants with complete data on body composition and the speech-reception-threshold (SRT) test. We further conducted a prospective study with 129,905 participants without SNHL at baseline and followed up to 15 years to explore the association between body composition and new-onset SNHL...

OBJECTIVE: Evaluate health-related quality of life (HR-QOL) benefits with cochlear implantation (CI) in children with unilateral sensorineural hearing loss (USNHL) versus bilateral sensorineural hearing loss (BSNHL). STUDY DESIGN: A cross-sectional survey of parents of children who underwent CI for USNHL and BSNHL. SETTING: Tertiary care academic centers. METHODS: The "Children with cochlear implants: parental perspectives" survey was administered...

OBJECTIVE: To assess the effect of the pneumococcal vaccine (PCV) toward the surgical management and complications of otitis media. DATA SOURCES: MEDLINE, EMBASE, PubMed, Scopus, and clinicaltrial.gov. REVIEW METHODS: A systematic search was performed using a combination of keywords and standardized terms about PCV and surgical management or complications of otitis media. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies were screened by 3 independent reviewers...

OBJECTIVE: Identify the age at diagnosis and intervention of immigrant and/or non-English-speaking children with hearing loss (HL) and risk factors associated with delays. Identify barriers for non-English-speaking caregivers of deaf/hard-of-hearing children. STUDY DESIGN: Sequential mixed methods. SETTING: Tertiary care center in an urban city. METHODS: The analysis includes descriptive statistics, and 1-way and 2-way analysis of variance of the retrospective chart review...

OBJECTIVE: To evaluate harms reporting in systematic reviews (SRs) of microvascular free flap (MFF) in head and neck reconstruction. DATA SOURCES: This cross-sectional analysis included searches from the following major databases from 2012 to June 1, 2022: MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews. REVIEW METHODS: In a masked duplicate manner, screening was performed using Rayyan, and data were extracted using a pilot-tested Google form...

OBJECTIVE: The aim was to evaluate the difference in recovery when comparing total intravenous anesthesia (TIVA) to inhalational gas anesthesia in patients receiving rhinoplasty. STUDY DESIGN: Retrospective review. SETTING: Postoperative anesthesia care unit (PACU). METHODS: Patients who received a functional or cosmetic rhinoplasty at a single academic institution between April 2017 and November 2020 were included. Inhalational gas anesthesia was in the form of sevoflurane...

OBJECTIVE: To describe the outcomes of patients undergoing open stapler versus transoral rigid and flexible endoscopic therapies for symptomatic Zenker's diverticulum. STUDY DESIGN: Single institution retrospective review. SETTING: Tertiary care academic hospital. METHODS: We retrospectively evaluated the outcomes of 424 consecutive patients who underwent Zenker's diverticulotomy via an open stapler, rigid endoscopic CO2 laser, rigid endoscopic stapler, rigid endoscopic harmonic scalpel, or flexible endoscopic technique from January 2006 to December 2020...

OBJECTIVE: Determine the detection rate from an expanded targeted early cytomegalovirus (CMV) testing program implemented from a large healthcare system (Intermountain Healthcare, IHC). STUDY DESIGN: Retrospective review. SETTING: Tertiary medical center. METHODS: An electronic system was modified to include indications for testing whenever a provider placed an order for CMV testing. A retrospective analysis of this database was performed...

OBJECTIVE: To report key characteristics and patterns of captive insurance claims not publicly reported in otolaryngology across a large tertiary-level academic health system over the previous 2 decades. STUDY DESIGN: Case series. SETTING: The tertiary care health system. METHODS: The internal captive insurance database at a tertiary level healthcare system was queried to identify otolaryngology-related malpractice claims regardless of final disposition (settled or dismissed) filed from 2000 to 2020...

OBJECTIVE: To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status. STUDY DESIGN: Retrospective chart review. SETTING: Twenty-six clinic locations within a single healthcare system. METHODS: Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed...

OBJECTIVE: Preoperative planning for otologic or neurotologic procedures often requires manual segmentation of relevant structures, which can be tedious and time-consuming. Automated methods for segmenting multiple geometrically complex structures can not only streamline preoperative planning but also augment minimally invasive and/or robot-assisted procedures in this space. This study evaluates a state-of-the-art deep learning pipeline for semantic segmentation of temporal bone anatomy...

Ultrasonography is gaining popularity as a diagnostic imaging modality for airway pathology. Tracheal ultrasound (US) has several nuances that are important for clinicians, including imaging artifacts, which can be mistaken for pathology. Tracheal mirror image artifacts (TMIAs) occur when the US beam is reflected back to the transducer in a nonliner direction or with multiple timesteps. It has previously been believed that the convexity of the tracheal cartilage prevents mirror image artifacts, but in reality, the air column acts as an acoustic mirror and causes TMIA...