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Objectives/Hypothesis: Suboptimal ergonomics during endoscopic sinus surgery can lead to considerable physical discomfort and fatigue for the surgeon. The purpose of this pilot study is to objectively evaluate the ergonomic positions of trainee and attending surgeons while performing functional endoscopic sinus surgery (FESS). Study Design: Pilot prospective trial. Methods: Six surgeons (two attendings and four trainees) performed FESS while wearing 11 inertial measurement units (IMUs) affixed to either side of each major joint. Screen placement was standardized to be 1 m directly in front of the surgeon and on the patient's left, 0–15° declined from the surgeons' eyes. Bed height was standardized such that the workspace was 0 to 10 cm below the elbows. IMU data were analyzed to calculate joint angles. Ideal joint angles (i.e., <10° for neck and trunk) were determined by the validated Rapid Entire Body Assessment tool. Subjects subsequently completed a modified National Aeronautics and Space Administration Task Load Index to assess cognitive and physical burden and pain. Student's t‐test was employed to detect differences between groups. Results: Trainees adopted positions involving significantly greater neck flexion (9.90° vs. −6.48°, P =.03) and reported significantly higher frustration levels (3.04 vs. 1.33, P =.02) while operating than attendings. For both cohorts, increased operative time was significantly correlated with greater back flexion (r = 0.90, P =.02; r = 0.55, P =.04, respectively). Conclusions: Our data suggest that trainees operate with higher risk neck postures than do attendings. These data indicate high‐risk operative postures may be borne of inexperience and present an opportunity for postural interventions at an early stage of training. Level of Evidence: NA Laryngoscope, 132:1153–1159, 2022 [ABSTRACT FROM AUTHOR]

Objective: To review our hearing preservation rates and speech recognition outcomes in patients undergoing cochlear implantation with a recently developed lateral wall electrode. Study design: Retrospective cohort study. Methods: Retrospective case series of all patients, both pediatric and adult, undergoing cochlear implantation with the Advanced Bionics Hifocus™ SlimJ electrode between December 2017 and January 2020. Main outcomes included hearing preservation rates using several definitions, speech recognition testing primarily through Arizona Biosciences (AzBio) and Consonant‐Nucleus‐Consonant (CNC) testing, intra‐ and postoperative complications. Results: Sixty‐one ears underwent implantation with the new electrode. Hearing preservation rates were 13.0% to 36.0% depending on the definition used. Speech recognition testing showed significant increases from pre‐ to postoperative condition (Implant‐only AzBio: 24.1 to 48.3, P =.004, binaural AzBio: 46.1 to 65.9, P =.002, Implant‐only CNC: 9.7 to 35.1, P <.001, binaural CNC: 29.8 to 59.40, P <.001) with last speech recognition testing occurring an average of 8.8 months postoperatively. The elderly population had the worst hearing preservation rates across all definitions. Five explantations were required due to two infections and three device failures. Conclusion: Hearing preservation rates varied significantly depending on the definition used, but users experienced a significant improvement in speech recognition testing after implantation. More work is needed in the community to standardize the definition of residual hearing and hearing preservation. Level of Evidence: 4 Laryngoscope, 131:2782–2788, 2021 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Meniere's disease (MD) is a debilitating condition characterized by hearing loss, vertigo, and tinnitus. The objective of this study was to systematically investigate outcomes in MD after cochlear implantation (CoI), with and without labyrinthectomy. Study Design: Systematic review and meta‐analysis. Methods: A systematic review of articles in Medline and Embase was performed to identify all studies of patients with MD who underwent CoI. This analysis evaluates outcomes of speech recognition, pure tone audiometry, vertigo, tinnitus, and quality of life. Results: Of 321 studies identified, 37 were included, involving 216 patients. Mean age at implantation was 61.4 years (range 27–85 years) with average length of follow‐up at 1.7 years (range 0–9 years). Forty‐four (20.4%) patients underwent labyrinthectomy. Meta‐analysis demonstrated significant improvements in audiometric outcomes following CoI. There was a statistically significant improvement in Hearing in Noise Test performance, with a mean difference improvement of 44.7 (95% confidence interval [CI] [8.8, 80.6]) at 6 months and 60.1 (95% CI [35.3, 85.0]) at 12 months. The Freiburger Monosyllabic Test (FMT) and Consonant‐Nucleus‐Consonant (CNC) also improved significantly, with mean difference improvements of 46.2 (95% CI [30.0, 62.4]) for FMT and 19.3 (95% CI [8.1, 30.4]) for CNC. There was a statistically significant decrease in tinnitus, as measured by a mean difference reduction of 48.1 (95% CI [1.0, 95.2]) in the Tinnitus Handicap Index. Conclusions: CoI with and without simultaneous labyrinthectomy is a viable treatment option for patients with MD, yielding high rates of tinnitus suppression and vertigo control. Post‐CoI MD patients demonstrate similar postoperative speech perception outcomes to non‐MD implant recipients. Laryngoscope, 131:1845–1854, 2021 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: The purpose of this review is to summarize evidence‐based data regarding the ototoxic effects of potential COVID‐19 therapeutics to treat patients suffering from SARS‐CoV‐2. Methods: Medications under investigation as novel therapeutics to treat COVID‐19 were identified using the search term coronavirus therapeutics, COVID therapeutics, and SARS‐CoV‐2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID‐19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders, and vertigo. Results: Six proposed COVID‐19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir‐ritonavir, interferon, ribavirin, and ivermectin. Conclusions: Available evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus, or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long‐term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID‐19 therapeutics with known ototoxicity, especially in high‐risk patient groups such as the elderly and hearing impaired. Laryngoscope, 131:1626–1632, 2021 [ABSTRACT FROM AUTHOR]

Objectives: To determine independent risk factors for 30-day readmission, prolonged length of stay (PLOS), and discharge to a rehabilitation facility for those with malignant otitis externa.Methods: Retrospective cohort study of patients hospitalized with malignant otitis externa (International Classification of Diseases, 9th edition, code 380.14) in the Nationwide Readmissions Database (2013-2014). Overall and disease-specific complication and mortality data were analyzed using chi-squared and multivariate analysis.Results: There were 1267 cases of malignant otitis externa extracted. A PLOS of ≥8 days (90th percentile) was found in 14.2% (n = 180) of patients, and 13.7% (n = 174) were discharged to a facility. Patients were readmitted within 30 days at a rate of 12.5% (n = 159). The overall rates of uncomplicated and complicated diabetes were found to be 42.1% and 17.8%, respectively. Factors independently associated with PLOS included undergoing a surgical procedure (odds ratio [OR] 2.08, P < .001), and having central nervous system complications (OR 3.21, P < .001). Independent risk factors for disposition to a facility included nutritional deficiency (OR 1.91, P = .029), PLOS (OR 4.61, P < .001), and age 65-79 years (OR 6.57, P = .001). Readmission was independently linked to PLOS (OR 3.14, P < .001). Diabetes was not an independent risk factor for any outcome.Conclusions: Thirty-day readmission, PLOS, and ultimate discharge to a rehabilitation facility were common and closely intertwined. Despite the classic association between diabetes and malignant otitis externa, diabetes was not an independent risk factor for any of our outcomes.Level Of Evidence: 4 Laryngoscope, 130:2220-2228, 2020. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in female author representation within original otolaryngology research between 2000 and 2015.Methods: Original research articles published in 11 otolaryngology journals were analyzed for 2000, 2003, 2006, 2009, 2012, and 2015. The genders of the first and last authors for each article were recorded. Overall female authorship was calculated by summing the numbers of the first, last, and both first and last female-authored articles. Student t test and Cochran-Armitage trend test were utilized to determine significance between years and groups.Results: Of the 9,623 research articles published during 5 representative years, 223 were excluded due to one or more gender-indeterminate authors. Female first authorship exhibited a significant upward trend from 2000 to 2015 (P < 0.0001), as did the proportion of literature with female first and last authors (P < 0.0001). Although female senior authorship in literature with an impact factor (IF) greater than 2 did not increase significantly (10.0% in 2000 to 10.1% in 2015; P = 0.738), this metric did increase significantly just within journals with an IF between 1 and 2 (9.7%-12.3%, P = 0.036). The proportion of articles with a female author in the first, last, or both positions increased from 28% to 39% (P < 0.0001).Conclusion: Increasing female representation in otolaryngology literature may reflect the rising proportion of women within otolaryngology as well as greater mentorship availability. Despite these auspicious strides, female-authored articles nonetheless represent a smaller proportion of the literature, and female senior authors remain a stark minority. Future studies should identify the barriers to female access and advancement within the field.Level Of Evidence: III Laryngoscope, 130:2126-2132, 2020. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether image guidance improves dissection quality among residents in the temporal bone lab and to gauge their reactions to its use.Methods: Prospective cohort study of nine otolaryngology residents who dissected cadaveric temporal bones with and without image guidance in the temporal bone laboratory. Quality of dissection was measured with the Welling scale. A survey was administered assessing their interactions with the navigation system.Results: There was no significant difference in quality of dissection for the majority of structures or number of major errors with use of image guidance. Dissection quality of the tegmen (4.67 vs. 5.67, P = .034) and sinodural angle (0.83 vs. 1.56, P = .005) was superior in the non-navigation specimens. The majority of residents reported increased confidence with locating several critical anatomic structures and found the system intuitive to use. Nearly all thought it would be helpful in revision cases or for aural atresia.Conclusion: Image guidance did not improve quality of temporal bone dissection or number of major errors in this cohort of residents, but the majority found it intuitive and increased confidence in finding several structures. Navigation systems may play an important adjunctive role in resident education and further work is required to determine its optimal use.Level Of Evidence: NA Laryngoscope, 130:E368-E371, 2020. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis In pediatric patients with congenital malformations of the inner ear, anomalies within the anatomy may facilitate unintentional insertion of the cochlear implant electrode into the internal auditory canal. Revision procedures for removal and replacement of cochlear implant electrodes following internal auditory canal insertion are fraught with potential danger, including the theoretical risk of injury to vasculature within the internal auditory canal, repeat insertion within the internal auditory canal, and cerebrospinal fluid leak. The objective of this presentation is to describe a technique for revision cochlear implantation following internal auditory canal insertion to minimize the potential associated risks. Study Design Case series. Methods A retrospective chart review was performed on all patients at a tertiary care facility who underwent revision cochlear implantation for internal auditory canal insertion between January 1999 and July 2011. Results A total of four patients referred from outside institutions have undergone revision cochlear implantation for internal auditory canal insertion. The records from these patients were reviewed. Electrodes were safely removed in all cases without injury to the anterior inferior cerebellar artery or its branches (i.e., labyrinthine artery). Complete insertion was accomplished on reimplantation. Neural response telemetry was performed in all cases, and responses were noted. Fluoroscopy was utilized to visualize electrode progression during insertion. A detailed description of the operative technique is provided. Conclusions This case series describes a technique for revision cochlear implantation that appears to be safe and effective in preventing potential associated complications. Laryngoscope, 123:3141-3147, 2013 [ABSTRACT FROM AUTHOR]

The article discusses a study on surgical modifications to the standard retrosigmoid approach which eliminates the need for cerebellar retraction for visualization of cerebellopontine angle (CPA) by utilizing native bone for reconstruction of operative defect. It informs that demographic data, tumor pathology, and postoperative complications were recorded for the study. The result of the study suggests that anterior retraction of the sigmoid sinus obviates the need for cerebellar retraction.

The article focuses on several studies related to safety and effectiveness of cochlear implantation in elderly. Topics discussed include safety of anesthesia in elderly patients of cochlear implantation, lack of age difference in surgical complications and postoperative performance between elderly and young patients, no difference in speech perception scores between the two groups and early improvement of speech performance in younger patients.

In Reply: We would like to thank Narozny et al. for their interest in our publication "A narrative review of pharmacologic treatments for COVID-19: safety considerations and ototoxicity" and their insightful comments regarding the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and sudden sensorineural hearing loss (SSNHL).1,2 We agree with the authors that any COVID-19 patients experiencing SSNHL should be considered high-risk and receive urgent audiologic evaluation. PMID: 33491234 2 Narozny W, Tretiakow D, Skorek A. The challenges of pharmacotherapy of SARS-CoV-2 infection in patients with SSNHL due to COVID-19. [Extracted from the article]

Introduction: Diplopia following cerebellopontine angle (CPA) surgery is usually attributed to neuropathy of III, IV or VI cranial nerves. Diplopia in the absence of cranial neuropathy following CPA surgery is rare. We present a series of patients who developed vertical diplopia from skew deviation following resection of tumors in the CPA or labyrinthectomy. Primarily associated with brainstem lesions, this vertical misalignment of the visual axis is postulated to result from unilateral disruption of supranuclear input from the otolithic organs. Methods: Retrospective review of patients with complaints of diplopia following CPA surgery. Patients underwent neuroophthalmologic consultation and examination, including opticokinetic testing, confrontational visual field assessment, color plate, pupillary reflex, slit lamp examination and Head Tilt Test. Results: Four patients with residual hearing preoperatively developed skew deviation immediately following surgical intervention, including translabyrinthine(n=1) and retrosigmoid (n=2) approaches to the CPA and labyrinthectomy (n=1). Neuroophthalmologic exam demonstrated intact extraocular movements, and 2-14 mm prism diopter hypertropia on both primary gaze and Head Tilt Testing. In all cases, skew deviation resolved spontaneously with normalization of the neuroophthalmologic examination within 10 weeks. Conclusion: Patients undergoing CPA surgery or labyrinthectomy can develop postoperative diplopia due to skew deviation as a consequence of acute vestibular deafferentation. Patients with significant hearing preoperatively, a probable marker for residual vestibular function, may be specially at risk for developing skew deviation. As vestibular ablation occurs routinely with each of these procedures, skew deviation likely occurs more frequently than is currently diagnosed. Complaints of diplopia should prompt neuro-ophthalmologic consultation to reliably diagnose skew deviation and exclude cranial neuropathy. Patients can be reassured as spontaneous resolution typically occurs within 10 weeks. [ABSTRACT FROM AUTHOR]

Objective: Cochlear nerve deficiency (CND) is commonly implicated in moderate-to-profound pediatric sensorineural hearing loss (SNHL). Although cochlear implantation (CI) was previously contraindicated in CND patients, recent studies have demonstrated the potential for auditory response to CI in a subset of CND patients, though clinical outcomes remain variable. This study aims to evaluate pre- and postoperative speech and auditory outcomes of CI in pediatric patients with bilateral SNHL and radiographically confirmed CND., Data Sources: Embase and Ovid MEDLINE., Review Methods: A systematic review was conducted to identify studies reporting pre- and postoperative outcomes of children with CND confirmed by magnetic resonance imaging who underwent CI. A random-effects model was used to account for within- and between-study variance in speech and auditory outcomes., Results: After abstract screening of 818 distinct articles, 16 studies were selected for final inclusion, consisting of 248 patients with cochlear nerve hypoplasia or aplasia who underwent CI. Various speech perception and language development tests were investigated across studies (Speech Intelligibility Rating, Speech Perception Category, Speech Awareness Thresholds, Meaningful Auditory Integration Scale, Meaningful Use of Speech Scale, Categories of Auditory Performance, and Auditory Level). Pooled outcomes demonstrated improvement in speech perception after CI in pediatric patients with CND (SMD 2.18, 95% CI 1.68-2.69)., Conclusion: Indications for CI are expanding as research demonstrates benefit in populations previously thought inappropriate. Our study demonstrates global postoperative improvement in speech and auditory outcomes in children with bilateral SNHL and CND after CI., Level of Evidence: NA Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: To compare the sensitivity of an objective, computerized approach to measurement of facial synkinesis with that for a subjective approach and to examine the test-retest reliability of these approaches., Study Design: Prospective, nonrandomized, and blinded., Methods: Remote facial motion at the upper eyelids and oral commissures during a closed-lip smile and eyelid closure were measured using a commercially available computerized motion analysis system. Thirty healthy adults with normal facial nerve function were enrolled to establish normative data and a threshold value for synkinesis. Thirty consecutive patients were analyzed based on the synkinesis threshold value. Blinded subjective evaluations by two observers were also performed independently on the same patients., Results: Facial synkinesis was detected significantly more frequently with objective than subjective analysis for eyelid closure; no significant differences between approaches were shown for the closed-lip smile. Interestingly, five (17%) patients developed early synkinesis within 3 months from the onset of the facial nerve injury. The test-retest reliability of all objective measures was excellent for both expressions. Close agreement in percent of patients with synkinesis between test and retest subjective evaluations was obtained for both observers for both expressions., Conclusions: The objective, computerized approach to detection of facial synkinesis has excellent reliability and is more sensitive than the subjective approach to assessment to the presence of facial synkinesis associated with eyelid closure. The finding of early synkinesis suggests that central nervous reorganization plays a role in regeneration of the facial nerve.