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Objective: The 22-item Sinonasal Outcome Test (SNOT-22) is a trusted measure of symptom severity in chronic rhinosinusitis. The European Position Paper on Rhinosinusitis (EPOS) provides widely accepted diagnostic criteria, which include sinonasal symptoms, their duration, and imaging results. Our objective was to compare these approaches to assessing symptoms to determine if either was more indicative of radiologic findings, to support decisions in telehealth. Study Design: Observational outcomes study. Setting: Tertiary care center. Methods: In total, 162 consecutive patients provided a structured sinonasal history, completed the SNOT-22, and underwent sinus computed tomography (CT) within 1 month. SNOT-22 scores, EPOS-defined symptom sets, and Lund-Mackay results were assessed. To facilitate direct comparisons, we performed stepwise evaluations of sinonasal symptoms alone and combined with duration. The discriminatory capacity for imaging results was determined through areas under the receiver operating characteristic curves (ROC-AUC) for dichotomous outcomes and ordinal regression for multilevel outcomes. Results: In ROC-AUC analyses, SNOT-22 and EPOS-defined symptoms had similar discriminatory capacity for Lund-Mackay scores, regardless of duration. Within ordinal regression analyses, SNOT-22 nasal scores were significantly associated with Lund-Mackay scores, while EPOS-defined nasal symptoms were not statistically significantly related. Conclusions: SNOT-22 nasal scores and EPOS-defined nasal symptoms may have similar associations with imaging results when assessed via ROC-AUC, while SNOT-22 may have more association within ordinal data. Understanding the implications of discrete patterns of symptoms may confer benefit, particularly when in-person and fiberoptic exams are limited. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to evaluate the results of paper-patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes.Study Design and Setting: A retrospective survey of paper-patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations.Results: Closure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure.Conclusions and Significance: Paper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery. [ABSTRACT FROM AUTHOR]

: ObjectiveThis study was designed to evaluate the results of paper-patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes.: Study design and settingA retrospective survey of paper-patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations.: ResultsClosure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure.: Conclusions and significancePaper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery. [Copyright &y& Elsevier]

Objective: To compare the effectiveness of paper-patch, fat, and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. Subjects and Methods: This investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 3 main groups according to surgical procedures. Each group consisted of 3 subgroups, which had 1-mm, 2-mm, and 3-mm perforations. The patients underwent paper-patch, fat, or perichondrium myringoplasty via transcanal approach under local anesthesia. Healing of perforation, hearing improvement, and complications were investigated. Results: Closure rates of the perforations in the paper-patch, fat, and perichondrium myringoplasty groups were 66.7%, 86.7%, and 86.7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size. Conclusion: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm. [Copyright &y& Elsevier]

Statistics can be intimidating for clinicians and reviewers. Statistics are often important and useful but can mislead. Elaborate statistics can support conclusions that contradict clinical experience. This article explores some statistically related insights. Statistical reasons for rejecting papers were collated, and the frequency and complexity of statistical tests in accepted, published papers in otolaryngology journals were then studied. Most statistical errors in papers are logical misinterpretations of information rather than lack of understanding of statistics. Otolaryngology papers tend to employ relatively straightforward statistics that should be useful for clinicians. Although evidence-based medicine has changed medical publishing, clinical knowledge is more important that statistical knowledge for clinical applications of statistics. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic sinus and skull base surgery has led to significant improvements in patient outcomes, yet may have come at a cost to surgeons' musculoskeletal (MSK) health. We aimed to determine the prevalence and characteristics of work‐related MSK disorders (WRMDs) in endoscopic sinus and skull base surgeons; to investigate contributing factors for WRMD in this population; and to evaluate the effectiveness of ergonomic interventions on the severity or prevalence of WRMD in this population. Data Sources: Medline, Embase, CINAHL, Web of Science, and Scopus from inception to April 2, 2024. A bibliographic examination was performed for further papers. Review Methods: Inclusion criteria included original peer‐reviewed papers with work‐related MSK outcomes (prevalence, contributing factors, and interventions) relating to endoscopic sinus and/or skull base surgeons in any language. Results: Of 25,772 unique citations, 37 studies met the inclusion criteria. The pooled lifetime, point, and 12‐month prevalences of WRMD were 75.9% (95% confidence interval; I2, 67.2%‐83.6%, I2 95.6%), 80.8% (77.0%‐84.3%, I2 98.0%), and 82.0% (71.8%‐90.3%, I2 60.96%) respectively. The neck, lumbar spine, and thoracic spine were the most commonly involved areas. One of 9 studies on contributing factors investigated discomfort as an outcome. The remainder focussed on surrogate outcomes (eg, posture, hand dysfunction). Two of the 13 intervention studies investigated pain or fatigue as an outcome. The remainder targeted posture, muscle activity, or workload. Conclusion: WRMDs are highly prevalent in endoscopic sinus and skull base surgeons. Further studies focusing on the direct outcomes of WRMD such as pain are needed. [ABSTRACT FROM AUTHOR]

Objective: The multimodal treatments for pediatric head and neck (H&N) malignancies can have significant long‐term functional consequences for growing patients. This systematic review aims to analyze the current knowledge of functional outcomes for pediatric H&N cancer survivors. Data Sources: PubMed, Embase, Web of Science. Review Methods: Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines were followed, and 1356 papers were reviewed by 3 team members with conflict resolution by a senior member. Results: Fourteen studies were included. Nine of 14 (64%) papers reported issues with swallowing, characterized as either dysphagia, odynophagia, oropharyngeal fibrosis, esophageal stenosis, xerostomia, trismus, or general issues with the throat and mouth. Six of 14 papers noted nutritional and feeding deficiencies, and 5 of 14 additionally noted issues with speech and voice changes. Four of 14 (29%) reported hearing impairments and/or loss. A majority of papers (9/14) reported long‐term functional characteristics as a secondary outcome. Three of 14 (21%) reported a quality of life (QoL) measure. Heterogeneity in methodology and reporting precluded analysis of any relationship between treatment type and functional outcomes. Recommendations include integration of objective measures of feeding support and swallowing, as well as regular measurements of function and QoL parameters during treatment to better understand the evolution of QoL and function throughout care. Conclusion: Relatively few studies focus on functional outcomes following the treatment of pediatric H&N cancer. Swallowing difficulty is the most frequently reported deficit, but objective data is rarely reported. Standardization of functional outcome assessment could improve the quality of evidence for pediatric patients treated for H&N cancer. [ABSTRACT FROM AUTHOR]

Objective: Whether ligation or reconstruction should be performed after radical resection of the tumor and carotid artery in patients with head and neck cancers invading the carotid artery (HNC‐CA) has been controversial. This paper provides a review and meta‐analysis of the efficacy of these 2 modalities. Data Sources: PubMed, Cochrane, Web of Science, Scopus, and Ovid databases were searched through August 2023. Review Methods: Descriptive, graphical, tabular, and quantitative data were extracted. The statistical outcomes (risk difference, RD) were synthesized under a random‐effects model. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses reporting guidelines. Results: A total of 22 papers and 337 patients met the inclusion criteria for the literature review. Statistical analysis showed that the RD of overall survival (OS) rate at 1‐year was 32% (95% confidence interval [CI]: 21%‐42%) for ligation and 70% (95% CI: 65%‐76%) for reconstruction (P <.05). The RD for OS rate at 2‐year was 16% (95% CI: 7%‐26%) for ligation and 39% (95% CI: 30%‐47%) for reconstruction (P <.05). The RD for disease‐free survival rate at 1‐year was 27% (95% CI: 17%‐38%) for ligation and 60% (95% CI: 51%‐70%) for reconstruction (P <.05). There were no statistically significant differences (P >.05) between the 2 surgical modalities in terms of locoregional recurrence rate, carotid blowout rate, surgery‐related complications rate, neurological complications rate, and perioperative mortality rate. Conclusion: This review demonstrates the significant advantage of carotid artery reconstruction surgery in short‐term patient survival, thus making it a recommended option for HNC‐CA patients undergoing radical surgery. [ABSTRACT FROM AUTHOR]

Objective. To investigate the effects of the Steri-Strips patch (3M) on the treatment of large traumatic tympanic membrane perforations (TMP).Study Design. Prospective, randomized, controlled.Setting. Tertiary university hospital.Subjects and Methods. A randomized prospective analysis was performed between February 2009 and January 2011 for the treatment of traumatic TMP larger than 50% of the entire tympanic membrane. The results of closure rate, closure time, hearing gain, and rate of otorrhea between conservative observation, paper patching, and Steri-Strips patching groups were compared.Results. In total, 87 patients were analyzed in this study. The closure rates of the perforations in the Steri-Strips patching, paper patching, and observation groups were 93.3%, 84.2%, and 78.9%, respectively. There was no statistically significant difference in tympanic membrane closure rate between the 3 groups. The Steri-Strips technique decreased the need for repeat procedures. Overall, the Steri-Strips and paper patching groups showed shorter healing times compared with the observation group. However, there was an increased rate of otorrhea in the Steri-Strips group compared with the observation group.Conclusion. Steri-Strips patching reduced the healing time and need for repeat procedures in patients with large traumatic TMPs. However, the occurrence of otorrhea was significantly more common in patients treated with the Steri-Strips technique. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the distribution and scope of papers published in the world in otolaryngology (ORL) journals and to compare the impact of this research among different countries. Methods: Papers published in the 29 ORL journals screened by the Institute for Scientific Information (ISI, Philadelphia, PA, USA) in the 6-year period 1995-2000 were considered. The journal impact factor (IF), the source country population, and gross domestic product (GDP) were recorded. All key words, both those assigned by the authors and those attributed by ISI, were identified and their frequency was calculated using a special-purpose program. Results: The total number of papers in the ORL literature during the period 1995-2000 increased from 2036 to 3705. A percentage varying between 47.7% (1995) and 36.1% (2000) was published by EU authors whereas the USA accounted for a percentage varying between 28.1% (1995) and 38.8% (2000). In 2000, the leading countries were the USA, the EU, Japan, Canada, and Australia. In Europe the UK (28.5% of papers), Germany (26.2%), Italy (7.2%), Sweden (5.8 %), France (5.5%), and the Netherlands (4.9%) showed a very good performance trend. In the same year, the mean IF of EU papers was 0.8 in comparison with 1.1 for Australia and the USA and 0.9 for the world. In 1997, 1341 key words attributed by the authors and 696 attributed by ISI appeared in the ORL literature. Less than a tenth of them were cited more than twice. The leading key words were “cancer” for disease and “surgery” for treatment. Conclusions: Bibliometric findings are useful to follow research trends. Our data show high scientific production of relatively small countries. Dispersion of key words should be avoided and journal editors should promote their standardization. [Copyright &y& Elsevier]

: objectiveWe sought to develop a minimally invasive surgical technique using the CO2 laser to reduce or eliminate tympanic membrane atelectasis in a select group of patients.: Study designThirty-seven ears with varying degrees of tympanic membrane atelectasis underwent CO2 laser myringoplasty with the patients under intravenous sedation in the operating room setting. Atelectasis severity was graded for each patient and documented before and after laser myringoplasty through photodocumentation. Patients were followed for 1 year with comparison tympanic membrane photography.: SettingThe study was conducted in a tertiary care private otology-neurotology practice.: ResultsLaser myringoplasty significantly reduced retraction pocket severity in most patients. No patients required resection of the retraction pocket or tympanoplasty. The most favorable outcomes were observed in patients with atelectasis addressed early rather than later in its more advanced stages.: ConclusionLaser contraction myringoplasty can reduce or eliminate atelectatic areas of the tympanic membrane through immediate contraction and “tightening” of the tympanic membrane tissues. Clinicians should use a standardized tympanic membrane atelectasis grading format.: SignificanceA minimally invasive surgical technique for addressing tympanic membrane atelectasis is described, and a tympanic membrane atelectasis grading system is presented based on size, location, and depth of the atelectatic region. [Copyright &y& Elsevier]

Program Description: Key aspects of thyroid surgery have been addressed by published clinical practice guidelines, consensus statements, and position papers from the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO‐HSNF), the American Head and Neck Society (AHNS), and the American Thyroid Association (ATA). This miniseminar efficiently presents these society publications, focusing on their content, interpretation, and limitations. Specific topics include surgery for invasive carcinoma, imaging selection, improving postoperative voice outcomes, nerve monitoring, outpatient surgery, and goiter management. These documents will also be used to highlight the important overall differences between practice guidelines, consensus statements, and position papers and their respective influence on clinical decisions. Educational Objectives: (1) Differentiate between a clinical practice guideline, clinical consensus statement, and position paper. (2) Analyze the content, interpretation, and limitations of the key publications sponsored by the AAO‐HNSF, AHNS, and ATA regarding the management of thyroid surgical disease. [ABSTRACT FROM AUTHOR]

Objective: To summarize current knowledge on the indications, surgical strategies, and auditory outcomes of revision stapes surgery (RSS) for otosclerosis. Data Sources: The search was conducted in PubMed, Scopus, and Web of Science online databases, including papers published since 2000. Review Methods: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines. We considered original series describing RSS for otosclerosis, reporting postoperative hearing outcomes according to the American Academy of Otolaryngology–Head and Neck Surgery guidelines for conductive hearing loss (CHL) for at least 30 consecutive cases. The quality of included studies was assessed with the Joanna Briggs Institute checklist. Pooled proportion and odds ratio (OR) meta‐analysis were conducted using random effect models. Results: Nineteen studies were included, for a total of 2602 patients (2735 ears) and 2359 postoperative hearing results. RSS was mostly performed for recurrent CHL with air‐bone gap (ABG)>20 dB. Multiple concomitant causes were often present, with prosthesis placement defect and incus necrosis as the most common causes. The pooled proportion of postoperative ABG<10 dB and ABG<20 dB was 57.2% (95% confidence interval [CI]: 52.8%‐61.4%) and 79% (95% CI: 76.0%‐81.8%), respectively. Dead ears were 1.2% (95% CI: 0.7%‐2.1%). Compared to primary surgery, RSS had a significantly lower rate of ABG<10 dB (OR = 0.36, 95% CI: 0.24%‐0.54%; P <.001). Both revision incudostapedotomy with/without incus reconstruction and malleovestibulopexy are viable options with nonsignificant differences in ABG closure rates (P =.182). Conclusion: RSS is challenging and requires the surgeon to carefully evaluate all potential causes of previous failure and tailor the intervention according to intraoperative findings. In most cases, ABG closure within 20 dB can be achieved with a relatively low risk of dead ears. [ABSTRACT FROM AUTHOR]

Objective: Non‐echo‐planar diffusion‐weighted (DW) magnetic resonance imaging (non‐EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second‐look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. Study Design: Retrospective study. Setting: One university center comparative cohort. Methods: All patients who had a 2‐staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. Results: N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non‐EPI MRIs were performed 10.7 (±3.8) months after the first‐stage surgery and 2.2 (±2.6) months before the second‐stage procedure. Non‐EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. Conclusion: Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non‐EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non‐EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non‐EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion. [ABSTRACT FROM AUTHOR]

Objective: Olfactory neuroblastoma is a rare sinonasal malignancy with comparatively positive prognosis and survival, but with a range of biological behaviors that can be difficult to prognosticate with current means of risk stratification. Neutrophil‐to‐lymphocyte ratio (NLR) has been found across a diverse range of malignancies to be associated with poorer outcomes. This paper aims to elucidate the relationship of NLR with olfactory neuroblastoma to assess its prognostic value in this setting. Study Design: Retrospective chart review. Setting: A single tertiary care academic hospital. Methods: The study cohort included all patients treated for initial presentation of olfactory neuroblastoma from 2004 to 2020. NLR was calculated from preoperative labs, and each patient was evaluated for Kadish staging, Hyams grade, intraoperative positive margin, use of adjuvant therapy, posttreatment recurrence, and death. All statistical analysis was conducted using R and relationship between NLR and variables was assessed via binomial logistic regression. Results: Forty‐four patients were included, 24 were male. Average age 52.8, average length of follow‐up was 9.6 years. Patients were grouped by low (Kadish A/B) and advanced (Kadish C/D) stage, n = 23 and n = 21, respectively, and low (Hyams I/II) and high (Hyams III/IV) risk, n = 15 and n = 11, respectively. Advanced Kadish stage was associated with elevated NLR, odds ratio 5.69 [2.30, 20.7], P =.001. No other variables were associated with elevated NLR including Hyams grade, margin status, recurrence, and mortality. Conclusion: Higher Kadish grade is associated with elevated NLR which may provide novel prognostic value to current risk‐stratifying systems. [ABSTRACT FROM AUTHOR]

Objective: The endoscopic and laryngoscopic examination is paramount for laryngeal, oropharyngeal, nasopharyngeal, nasal, and oral cavity benign lesions and cancer evaluation. Nevertheless, upper aerodigestive tract (UADT) endoscopy is intrinsically operator‐dependent and lacks objective quality standards. At present, there has been an increased interest in artificial intelligence (AI) applications in this area to support physicians during the examination, thus enhancing diagnostic performances. The relative novelty of this research field poses a challenge both for the reviewers and readers as clinicians often lack a specific technical background. Data Sources: Four bibliographic databases were searched: PubMed, EMBASE, Cochrane, and Google Scholar. Review Methods: A structured review of the current literature (up to September 2022) was performed. Search terms related to topics of AI, machine learning (ML), and deep learning (DL) in UADT endoscopy and laryngoscopy were identified and queried by 3 independent reviewers. Citations of selected studies were also evaluated to ensure comprehensiveness. Conclusions: Forty‐one studies were included in the review. AI and computer vision techniques were used to achieve 3 fundamental tasks in this field: classification, detection, and segmentation. All papers were summarized and reviewed. Implications for Practice: This article comprehensively reviews the latest developments in the application of ML and DL in UADT endoscopy and laryngoscopy, as well as their future clinical implications. The technical basis of AI is also explained, providing guidance for nonexpert readers to allow critical appraisal of the evaluation metrics and the most relevant quality requirements. [ABSTRACT FROM AUTHOR]

Objectives (1) To evaluate changes in the resident publications over time, including before and after duty hour restrictions, and (2) to identify factors statistically associated with publications during residency. Study Design Retrospective review of bibliometric data. Subjects and Methods Residents who graduated from an otolaryngology residency program from 1996 to 2013 were evaluated. Thomson Reuters Web of Science was searched to determine the number of indexed peer-reviewed publications before and after implementation of resident duty hour restrictions in 2003. Resident demographics, PhD degrees, training tracks, and postgraduation plans were collected to determine factors associated with publication rate using multivariable regression analysis. Results During the studied period, 75 residents completed otolaryngology residency training and published a total of 294 papers, averaging 3.92 publications per resident during training. After work hour restrictions were implemented, the mean number of publications increased from 1.21 to 5.10 (P < .0001). First author publications, clinical publications, and basic science publications all increased (P < .001). In regression analysis, T32 grants (β = 6.98, standard error [SE] = 1.87, P = .0004) and the time period after duty hour restrictions were introduced (β = 4.72, SE = 1.73, P = .0083) were positively associated with resident publications. Gender, PhD degree, and pursuit of fellowship training were not associated with increased publications (P > .05). Conclusion There has been a significant increase in resident publications over time, coinciding with the implementation of work hour restrictions. T32 grants were most predictive of increased resident publications, while PhD degrees were not significantly associated. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes of facial nerve repair or grafting following facial nerve‐sacrificing procedures among patients treated with and without postoperative radiotherapy (RT). Data Sources: PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov. Review Methods: Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full‐text review. Studies that utilized the House‐Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis. Results: Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non‐RT groups (t stat = 0.92, p =.36). Conclusion: This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non‐RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial. [ABSTRACT FROM AUTHOR]

Objective: Convolutional neural networks (CNNs) have revolutionized medical image segmentation in recent years. This scoping review aimed to carry out a comprehensive review of the literature describing automated image segmentation of the middle ear using CNNs from computed tomography (CT) scans. Data Sources: A comprehensive literature search, generated jointly with a medical librarian, was performed on Medline, Embase, Scopus, Web of Science, and Cochrane, using Medical Subject Heading terms and keywords. Databases were searched from inception to July 2023. Reference lists of included papers were also screened. Review Methods: Ten studies were included for analysis, which contained a total of 866 scans which were used in model training/testing. Thirteen different architectures were described to perform automated segmentation. The best Dice similarity coefficient (DSC) for the entire ossicular chain was 0.87 using ResNet. The highest DSC for any structure was the incus using 3D‐V‐Net at 0.93. The most difficult structure to segment was the stapes, with the highest DSC of 0.84 using 3D‐V‐Net. Conclusions: Numerous architectures have demonstrated good performance in segmenting the middle ear using CNNs. To overcome some of the difficulties in segmenting the stapes, we recommend the development of an architecture trained on cone beam CTs to provide improved spatial resolution to assist with delineating the smallest ossicle. Implications for Practice: This has clinical applications for preoperative planning, diagnosis, and simulation. [ABSTRACT FROM AUTHOR]

ChatGPT is a new artificial intelligence‐powered language model of chatbot able to help otolaryngologists in clinical practice and research. We investigated the ability of ChatGPT‐4 in the editing of a manuscript in otolaryngology. Four papers were written by a nonnative English otolaryngologist and edited by a professional editing service. ChatGPT‐4 was used to detect and correct errors in manuscripts. From the 171 errors in the manuscripts, ChatGPT‐4 detected 86 errors (50.3%) including vocabulary (N = 36), determiner (N = 27), preposition (N = 24), capitalization (N = 20), and number (N = 11). ChatGPT‐4 proposed appropriate corrections for 72 (83.7%) errors, while some errors were poorly detected (eg, capitalization [5%] and vocabulary [44.4%] errors. ChatGPT‐4 claimed to change something that was already there in 82 cases. ChatGPT demonstrated usefulness in identifying some types of errors but not all. Nonnative English researchers should be aware of the current limits of ChatGPT‐4 in the proofreading of manuscripts. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Determine reliability of self-reported authorship disclosures of potential conflicts of interest in American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF)–sponsored presentations and publications. Study Design/Setting: Retrospective cohort study at academic center. Methods: Presenters'' self-reported disclosures made at the AAO-HNSF annual meeting for calendar years 2006 and 2007 were tabulated. Subsequent publications related to these presentations in the journal Otolaryngology–Head and Neck Surgery were analyzed with respect to disclosures revealed at the time of publication. Discrepancies between annual meeting disclosures and publication print disclosures were identified according to author and presentation/paper. Reliability statistics were computed to determine consistency of disclosure reporting and an analysis of potential conflicts of interest according to discrepancies was performed. Results: Five hundred seventy-eight presenters'' disclosures were identified at the annual meeting level, which ultimately led to 153 journal publications. A total of 51 authors (8.8%) with disclosure reporting discrepancies were identified (32 authors: one discrepancy; 11 authors: two discrepancies; eight authors: three or more discrepancies). Overall, a mean of 0.14 discrepancies per author (95% confidence interval: 0.10-0.19 discrepancies) was noted. Analyzed by publication, 39 papers (25.5%) contained one or more disclosure discrepancies among authors, ranging from one discrepancy (11.8% of papers) to nine discrepancies (0.7%), with an average of 2.1 authorship disclosure discrepancies per paper. Conclusions: A significant percentage of authors'' disclosures differ between time of presentation and subsequent publication within otolaryngology. Although valid reasons for these discrepancies may exist, analysis of these discrepancies is important for conflict-of-interest determination. [Copyright &y& Elsevier]

Complication rates become important in discussions for informed surgical consent and for quality assurance purposes. In an attempt to quantify literature-based rates for post-tonsillectomy bleeding, a MEDLINE search was carried out. Of 4,610 papers 63 reported post-tonsillectomy bleeding rates. The weighted mean, standard deviation and 95% confidence intervals were calculated for those papers. The mean (4.5%) plus 2 standard deviations (9.4%) suggests a maximum “expected” sustained bleeding rate of 13.9%. In the literature, which should reflect optimum results, there were 3 reports of bleed rates in the 18-20% range. These data may be useful for quality assurance committees and individual clinicians. [Copyright &y& Elsevier]

The barbed repositioning pharyngoplasty surgical technique is becoming more widely used for patients with obstructive sleep apnea due to its safety, effectiveness, and rapidity, as evidenced by multicenter studies and Meta‐analyses. In order to achieve uniform surgical outcomes, avoid errors that could worsen outcomes, and enable adequate data comparison, a standardized procedure is required to overcome surgeon‐related variability. The aim of this paper is to provide practical tips and tricks based on our surgical practice that can make the surgeon's work easier and aid in achieving desired outcomes. [ABSTRACT FROM AUTHOR]

Objective: To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP). Data Sources: PubMED, Scopus, and Cochrane Library. Review Methods: A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta‐analyses statements by 2 investigators. Results: Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost‐effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium. Conclusion: Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large‐cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others. [ABSTRACT FROM AUTHOR]

Otolaryngologists regularly receive invitations from open access otolaryngology–head and neck surgery journals to submit papers or to join the editorial board. Some of these journals are considered “predatory.” There has been no published attempt to see if bogus otolaryngological articles would be accepted by such journals. We sent a fake article describing a supposed otosclerotic lesion localized in the fallopian tube and surgically treated by phacoemulsification of the stapes to 41 such journals. Eight journals accepted the paper, 7 requested structural revision, 2 requested revision even though the reviewer recommended rejection, 4 rejected the paper only because they found it had already been published by another open access journal (without the authors’ knowledge), and 2 rejected the paper. Eighteen journals had not responded after 6 weeks. A contemporary retelling of the poem “The Fox and the Crow” concludes our article, which illustrates predatory practices among specific open access otolaryngology journals. [ABSTRACT FROM AUTHOR]

Objectives: Illustrate strong and weak statistical concepts used in otolaryngologic papers submitted for publication regardless of acceptance. Methods: For 1 calendar year, the type and number of statistical concerns were recorded for 56 otologic papers submitted for publication to 1 of 5 journals. Results: Ninety‐nine concerns were found in 32 of the 56 papers. Reviewers identified several concerns in many papers. For some papers, data reanalysis was possible with different statistical tests, but in none was the conclusion altered. A summary of the findings with some overlap of the categories follows. Conclusions not supported by data – 13. Confusion of correlation with causation – 13. "Fishing trip" – 12. Overgeneralization – 9. Multiple t tests for related outcomes – 8. Multiple tests ‐ inappropriate tests – 8. Parametric tests were used but underlying assumptions clearly violated – 7. Conclusion inappropriate or absent – 7. Lack of required power analysis – 4. Inappropriate assignment to groups when assessing group differences – 3. Partial data analysis – 3. Reviewer requests power analysis when not needed – 2. Reviewer requests inappropriate tests ‐ 2. Conclusions: Application of statistics in otology papers was surprisingly good. The most common flaws in statistical interpretation in submitted papers were (1) that the conclusion reported was not supported by the data or (2) confusion between association and causation. Even if statistics were applied inappropriately, thoughtful reviewers were generally able to detect errors in statistical logic even if they did not feel that they were qualified as statisticians. [ABSTRACT FROM AUTHOR]

Objective: To summarize the incidence of postoperative delirium among cancer patients undergoing head and neck surgery and determine the differential incidence rates among patients undergoing different types of head and neck surgeries. Data Sources: The databases of PubMed, Cochrane Library, Web of Science, EMBASE, and CINAHL were searched from inception till February 2023. Keywords based on the condition (delirium), context (postoperative), and population (head and neck cancer) were used as search terms. Review Methods: The PRISMA and MOOSE reporting guidelines were followed. The Joanna Briggs Institute critical appraisal checklists for cohort studies, case‐control studies, and randomized controlled trials were used to evaluate the methodological quality. Data were pooled using a random‐effects model, and the incidence with 95% confidence intervals was evaluated using the exact binomial method and Freeman‐Tukey double arcsine transformation of proportions. I2 was used to indicate heterogeneity. Predefined subgroup analysis and Meta‐regression, was performed to identify the factors affecting heterogeneity. Results: The summary incidence of postoperative delirium was 18.95% [95% confidence interval, 14.36%‐24.00%] with between‐study heterogeneity (I2 = 95.46%). The incidence of postoperative delirium in patients who underwent free flap reconstruction was 22.13%, which was higher than those of other types of surgeries. Meta‐regression revealed that conducted in sample size (P =.007) of the included studies was the factors affecting heterogeneity. Conclusions: The evidence on postoperative delirium incidence provided by the current Meta‐analysis enables effective treatment planning. [ABSTRACT FROM AUTHOR]

Hypocalcemia following thyroidectomy is a common and potentially life‐threatening complication. It is caused by intraoperative injury to the parathyroid glands or their blood supply. Although several studies have shown that patients with a prior history of bariatric surgery may be at an increased risk for hypocalcemia after thyroidectomy, no clear recommendations exist for preventing and managing this condition in this population. This paper highlights the significance of understanding this risk and of obtaining a history of prior bariatric surgery before thyroidectomy. We propose concise recommendations for preventing and managing hypocalcemia following thyroidectomy in patients with a history of bariatric surgery. [ABSTRACT FROM AUTHOR]

Objective: In head and neck ablative surgery, traditional teaching is that the key facial nerve branch to preserve along the plane of the lower border of the mandible is the marginal mandibular branch (MMb), which is considered to control all lower lip musculature. The depressor labii inferioris (DLI) is the muscle responsible for pleasing lower lip displacement and lower dental display during natural emotive smiling. Study Design: To understand the structure/function relationships of the distal lower facial nerve branches and lower lip musculature. Setting: In vivo extensive facial nerve dissections under general anesthesia. Methods: Intraoperative mapping was performed in 60 cases, using branch stimulation and simultaneous movement videography. Results: In nearly all cases, the MMb innervated the depressor anguli oris, lower orbicularis oris, and mentalis muscles. The nerve branches controlling DLI function were identified 2 ± 0.5 cm below the angle of the mandible, originating from a cervical branch, separately and inferior to MMb. In half of the cases, we identified at least 2 independent branches activating the DLI, both within the cervical region. Conclusion: An appreciation of this anatomical finding may help prevent lower lip weakness following neck surgery. Avoiding the functional and cosmetic consequences that accompany loss of DLI function would have a significant impact on the burden of potentially preventable sequelae that the head and neck surgical patient frequently carries. [ABSTRACT FROM AUTHOR]

The assessment of patient-reported outcome measures (PROMs) in the outpatient setting is gaining momentum in clinical and research venues. Implementing this data capture into one's practice, however, is not a one-size-fits-all venture, and it is critical to determine when, how, and where to include these patient-centered assessments. This installment of the "Evidence-Based Medicine in Otolaryngology" series provides insight into the implementation process and experiences with successful incorporation of PROMs into clinical practice. Specifically, 4 differing clinical scenarios and collection techniques are described, including data acquisition protocols, formats for clinician data usage, and applications of PROM results in clinical and research scenarios. [ABSTRACT FROM AUTHOR]

Objectives (1) Perform a meta-analysis of the available data on the outcomes of CyberKnife radiosurgery for treatment of vestibular schwannomas (VSs) in the published English-language literature and (2) evaluate the collective outcomes of CyberKnife treatment with respect to tumor control and hearing preservation. Data Sources A thorough literature search of published English-language articles was performed in the PubMed, Ovid, and Cochrane databases. Review Methods A database search was conducted with the keywords "CyberKnife" and "vestibular schwannoma" or "acoustic neuroma." A total of 25 papers were found and reviewed. Data were extracted for patient demographics, number of patients with neurofibromatosis type 2, pretreatment hearing status, tumor size, margin dose, and follow-up duration. The primary outcome variables evaluated were tumor control and hearing preservation. Results After careful review of the published articles, 11 papers reported data on outcomes of CyberKnife treatment for VS and were included in the analysis, comprising 800 patients studied during 1998 to 2012. The reported mean tumor volume ranged from 0.02 to 19.8 cm3, and the follow-up duration ranged from 6 to 120 months. Margin dose varied from 14 to 25 Gy. The collective mean tumor control rate was 96.3% (95% CI: 94.0%-98.5%). The collective hearing preservation rate was 79.1% (95% CI: 71.0%-87.3%) in 427 patients with measurable hearing. Conclusion Clinical data on outcomes of CyberKnife radiosurgery for treatment of VSs are sparse and primarily limited to single-institution analyses, with considerable variation in tumor volume and follow-up time. This meta-analysis not only provides an in-depth analysis of available data in the literature but also reviews reported outcomes and complications. [ABSTRACT FROM AUTHOR]

Objective. Quality-of-life (QOL) measures targeting youth with hearing loss are useful in population needs assessment, educational placement, and program design and evaluation. This study assesses the cross-sectional validity of the Youth Quality of Life Instrument–Deaf and Hard of Hearing Module (YQOL-DHH).Study Design. Instrument development and cross-sectional survey.Setting. Recruitment through schools, professional organizations, clinics, and programs for youth who are deaf or hard of hearing.Subjects and Methods. Thirty-five candidate items were administered to 230 adolescents aged 11 to 18 years: 49% female, 61% white, 11% mild hearing loss, 20% moderate/moderate-severe, 41% severe/profound, and 28% with cochlear implants. Participants completed individual or group-administered questionnaires by paper and pencil (58%), Web-based English (29%), American Sign Language (ASL) or Pidgin Signed English (PSE) (9%) on DVD, or interviewer-supervised ASL or PSE DVD (4%). The Children’s Depression Inventory (CDI-S) was also completed. Factor structure, reliability, construct validity, and respondent burden were assessed.Results. Thirty-two items were retained in the final instrument covering 3 domains: self-acceptance/advocacy (14 items, Cronbach α = 0.84), perceived stigma (8 items, Cronbach α = 0.85), and participation (10 items, Cronbach α = 0.86). QOL was not significantly associated with hearing level. One-week test-retest coefficients were acceptable: self-acceptance/ advocacy (0.70), perceived stigma (0.78), and participation (0.92). As predicted, the total CDI-S score was associated in the appropriate direction (P < .0001) with all YQOL-DHH domains. Time to complete the paper-and-pencil version was 12 minutes.Conclusion. The YQOL-DHH shows good reliability and validity for assessing hearing-specific QOL in adolescents. [ABSTRACT FROM PUBLISHER]

Objective: Congenital airway stenosis secondary to absent tracheal or bronchial rings is a rare congenital anomaly that is difficult to manage both clinically and surgically. This typically manifests as severe segmental tracheomalacia, and only isolated cases with short-term follow-up have been previously described. We aim to describe a series of children with absent tracheal or bronchial rings who underwent surgical management and had long-term follow-up. Study Design: Case series with chart review. Setting: Tertiary care pediatric hospital. Methods: Patients with absent tracheal or bronchial rings from 2002 to 2016. Electronic and paper medical records were queried to obtain demographics, age at diagnosis and surgery, pre- and postoperative symptoms, location of absent rings, procedure performed, length of follow-up, and adjunctive procedures performed. Results: Nine subjects were identified who underwent slide tracheoplasty for correction of congenital absent tracheal or bronchial rings. Age at diagnosis ranged from 10 days to 5 years of age (median, 4 weeks). Age at surgery ranged from 3 weeks to 5 years of age (median, 5 weeks). Six out of 9 subjects were extubated on postoperative day 1. Only 1 subject required additional intervention, which included balloon dilation, tracheobronchial stenting, and aortopexy to alleviate the obstruction. Mean follow-up time was 5.89 years. Conclusions: This is the largest series of children with absent tracheal rings who underwent slide tracheoplasty with long-term follow-up presented to date. Slide tracheoplasty is an effective surgical intervention for the treatment of absent tracheal or bronchial rings in infants and young children. [ABSTRACT FROM AUTHOR]

Biologic agents, monoclonal antibodies that target highly-specific molecular pathways of inflammation, are becoming integrated into care pathways for multiple disorders that are relevant in otolaryngology and allergy. These conditions share common inflammatory mechanisms of so-called Type 2 inflammation with dysregulation of immunoglobulin E production and eosinophil and mast cell degranulation leading to tissue damage. Biologic agents are now available for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, eosinophilic granulomatosis with polyangiitis (EGPA), atopic dermatitis (AD), and chronic spontaneous urticaria (CSU). This paper summarizes the diagnosis and management of these conditions and critically reviews the clinical trial data that has led to regulatory approval of biologic agents for these conditions. [ABSTRACT FROM AUTHOR]

Objectives: Assess the 2008‐2012 American and Canadian contribution to the world otolaryngology literature. Methods: All articles published from January 2008 to December 2012 in 8 otolaryngology journals were reviewed. Book reviews, letters, correspondence, and meeting abstracts were excluded. Nationality, author numbers, and study types were extracted. Nationality of the article was defined by the publishing department's country of origin. Articles were categorized into primary clinical research, primary basic science research, secondary research such as systematic reviews and meta‐analyses, and other articles that did not fit the aforementioned classifications. Articles originating from the United States, Canada, and the rest of the world were statistically compared using Mantel‐Haenszel Common Odds Ratio Estimate, Pearsons chi‐squared, and Fisher exact tests. Results: A total of 3635 articles published in the journals surveyed were analyzed. Canadian‐authored papers decreased from 12.8% in 2008‐2009 to 10.2% in 2011‐2012, whereas American‐authored papers increased from 27.9% in 2008‐2009 to 30.1% in 2011‐2012. These changes were statistically significant (P =. 031). Multiauthorship (≥5 authors) increased in Canadian papers (P =. 015), whereas this trend had not been observed in American papers (P =. 566). Study types from the United States and Canada had not significantly changed from 2008‐2009 to 2011‐2012 (P =. 137). Conclusions: There were significant changes in otolaryngology publishing trends in the United States and Canada. Increase in multiauthorship in Canadian‐authored papers possibly suggests increased collaboration with multi‐disciplines and decreased investigator productivity. [ABSTRACT FROM AUTHOR]

Objectives: Determine whether various techniques used to promote tympanic membrane (TM) perforation closure at the time of ventilation tube removal impact the likelihood of TM perforation healing in children. Methods: A retrospective chart review was conducted of 265 children (341 ears) who underwent tympanostomy tube removal at a tertiary care pediatric hospital between January 2010 and November 2013. Techniques performed at the time of ventilation tube removal included tube removal only, freshening the perforation edges, performing paper patch myringoplasty, or both freshening edges and paper patch myringoplasty. Results: The persistent TM perforation rate was 9.97% (34/341). Technique was not found to significantly influence the likelihood for the TM to heal (P =. 81), with 11/86 (12.7%) having persistent perforations with tube removal only, 6/62 (9.7%) with freshened perforation edges, 7/50 (14.0%) with paper patch myringoplasty and 10/109 (9.2%) with both edges freshened and paper patch myringoplasty. There was no significant interaction between technique and age, tube retention length, number of previous ventilation tubes placed, or type of tube removed. Additionally, no significant difference in TM perforation rate was observed for number of previous tympanostomy tubes, tube duration, previous adenoidectomy, or indication for tube removal. Factors associated with higher rates of persistent perforation included older age, longer‐acting ventilation tubes, and trisomy 21. Conclusions: There is no reduction in persistent TM perforation rate following ventilation tube removal if edges are freshened and/or a paper patch myringoplasty is performed. Increased pediatric age, longer‐acting tympanostomy tubes and history of trisomy 21 may negatively influence the likelihood of closure. [ABSTRACT FROM AUTHOR]