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ABSTRACT Background Methods Results Conclusions In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well‐differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low‐risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines.A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta‐analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines.We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology.Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre‐ATA 2015 era. [ABSTRACT FROM AUTHOR]

The sinonasal structures and their adjacent organs host several functions including vision, olfaction, nasal respiration and filtration, secretory immunity, facial expression, articulation, and oral deglutition. We reviewed the current evidence supporting functional preservation in sinonasal cancer treatment. Primary surgery with or without adjuvant modalities continues to be the standard of care for sinonasal cancer. Unfortunately, functional compromise remains a dominant negative feature of this approach. More recently, through advances in therapeutic techniques and improved understanding of the relevant tumor biology, treatments aimed at preserving function and cosmesis are emerging. The evidence for such progress involving minimal access surgery, surgical reconstruction for rehabilitation, new techniques in radiation therapy, inclusion of systemic and locally enhanced chemotherapy, and therapeutic agents based on molecular targets are highlighted. This multi‐prong approach bodes well for future patients with sinonasal cancer to undergo successful treatment that includes maximal preservation of associated functions. [ABSTRACT FROM AUTHOR]

Simple Summary: Local recurrences, isolated regional recurrences, and loco-regional recurrences are frequent after treatment for advanced stage head and neck squamous cell carcinoma. Salvage surgery may be possible in selected patients, taking into account the location and stage of the recurrent disease, patient age and comorbidities, tumor HPV status, and functional sequelae in relation to initial therapy. Results vary according to these parameters. Adjuvant treatments after salvage surgery are under investigation. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery. Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery. [ABSTRACT FROM AUTHOR]

Emergency department (ED) visits can be divided into urgent and non-urgent. A delay in seeking medical help, especially in urgent cases, can lead to fatal consequences, along with a higher rate of complications and morbidity. Coronavirus disease 2019 (COVID-19) pandemic spread led to restrictions and eventually quarantines. We investigated the impact of the COVID-19 spread and quarantine on ED visits rates comparing to parallel periods in preceding years (2013–2019). In addition, we compared this decrease to holidays and weekends, times in which a decrease in ED visits is seen. This was a descriptive retrospective study. Causes of ED referrals were divided into urgent and non-urgent, then into different subcategories including infectious, cardiac, etc. For the spring COVID-192020 quarantine period, a 56.3% decrease of mean ED visits per day was seen, as compared to preceding years (55.7% and 98.9% respectively). This decrease was also statistically evident when comparing the urgent and non-urgent causes separately and for all sub-categories. This pattern of decrease also showed statistical evidence of fewer ED visits during holidays for most comparisons, in which lower ED visit rates are expected. Significantly lower rates of ED visits were demonstrated during the COVID-19 quarantine period, as compared to preceding years and main holidays and weekends, a decrease that was also demonstrated for urgent life-threatening causes. Our findings can be used to inform a wide range of stakeholders, including regional planners, historians, sociologists, and international healthcare organizations. Healthcare providers should understand the reasons for this ED visit decline pattern, attempt to address patients' concerns, and increase awareness regarding alarming symptoms in urgent medical situations. • We investigated the impact of the COVID-19 spread and quarantine on emergency department (ED) visits rates. • For the COVID-19 quarantine period, a 56.3% decrease of mean ED visits per day was seen, as compared to preceding years. • This decrease was also evident when comparing the urgent and non-urgent causes separately and for all sub-categories. • Our findings can be used to inform a wide range of stakeholders, including international healthcare organizations. • Healthcare providers should understand the reasons for this ED visit decline and attempt to address patients concerns. [ABSTRACT FROM AUTHOR]

Vitamin D (VitD) deficiency has garnered significant attention in contemporary medical research. Although the canonical biological activity of VitD manifests itself mainly in the regulation of calcium-phosphorus metabolism, recent studies show that, thanks to the presence of numerous receptors, VitD may also play an important role in regulating the immune system. VitD deficiency has been demonstrated to impact autoimmune disease, coeliac disease, infections (including respiratory/COVID-19), and patients with cancer. Recent studies also show that VitD plays a significant role in autoimmune thyroid diseases (AITDs). Many studies have shown a correlation between low VitD levels and chronic autoimmune thyroiditis – Hashimoto thyroiditis (HT), Graves' disease (GD), and postpartum thyroiditis (PPT). This review article, therefore, describes the current state of knowledge on the role of VitD in AITDs, including HT, GD, and PTT. [ABSTRACT FROM AUTHOR]

Simple Summary: In non-well differentiated thyroid cancer, the rate of nodal involvement is variable and depends on the histology of the tumor. We aim to highlight the opinions of several experts from different parts of the world on the current management of the less common types of thyroid cancer to provide a consensus on the treatment of regional lymphatics for these entities. The rate of lymph node involvement is variable and depends on the histology of the tumor. Within undifferentiated tumors', there is an established consensus on the treatment of anaplastic carcinoma, medullary carcinoma and poorly differentiated carcinoma of the thyroid. However, treatment of other rarer tumors must be individualized, taking into account both the aggressiveness of the histology and the anatomical distribution of the disease. In general, prophylactic treatment of the neck is not indicated. Lymph node metastases in non-well differentiated thyroid cancer (non-WDTC) are common, both in the central compartment (levels VI and VII) and in the lateral neck (Levels II to V). Nodal metastases negatively affect prognosis and should be treated to maximize locoregional control while minimizing morbidity. In non-WDTC, the rate of nodal involvement is variable and depends on the histology of the tumor. For medullary thyroid carcinomas, poorly differentiated thyroid carcinomas, and anaplastic thyroid carcinomas, the high frequency of lymph node metastases makes central compartment dissection generally necessary. In mucoepidermoid carcinomas, malignant peripheral nerve sheath tumors, sarcomas, and malignant thyroid teratomas or thyroblastomas, central compartment dissection is less often necessary, as clinical lymphnode involvement is less common. We aim to summarize the medical literature and the opinions of several experts from different parts of the world on the current philosophy for managing the neck in less common types of thyroid cancer. [ABSTRACT FROM AUTHOR]

Objective: Nasal obstruction is a common complaint. The Nasal Obstruction Symptom Evaluation scale (NOSE) is a reliable validated tool used to assess the quality of life of patients with nasal obstruction. The purpose of this study is to validate the Hebrew version of the NOSE scale (He‐NOSE). Methods: A prospective instrument validation was conducted. The NOSE scale was translated primarily from English to Hebrew and then back from Hebrew to English according to the accepted guidelines of the cross‐cultural adaptation process. The study group included surgery candidates suffering from nasal obstruction due to a deviated nasal septum and/or inferior turbinate hypertrophy. The study group completed the validated He‐NOSE questionnaire twice prior to the surgery and once again, a month post‐surgery. A control group of individuals with no history of nasal complaints or surgeries was asked to complete the questionnaire once. Reliability, internal consistency, validity, and responsiveness to change of the He‐NOSE were evaluated. Results: Fifty‐three patients and 100 controls were included in this study. The scale showed excellent ability to discriminate between the study and the control group, exhibiting significantly lower scores in the control group (73.8 and 7 average scores respectively, p <.001). Good internal consistency (Cronbach's alpha.71 and.76) and test–retest reliability (Spearman rank correlation r =.752, p <.0001) were measured. Moreover, the scale revealed remarkable responsiveness to change (p <.00001). Conclusion: The translated and adapted He‐NOSE scale can be a useful tool to be applied in both clinical and research fields when assessing nasal obstruction. Level of evidence: N/A. [ABSTRACT FROM AUTHOR]

Objectives: The first Bethesda classification category of thyroid fine-needle aspiration biopsy (FNAB) is nondiagnostic (ND), which indicates that the specimen's cellularity is inadequate for evaluation. This work investigated the effect of needle diameter size on ND rates by comparing diagnostic outcomes of FNAB samples collected with 23-, 25-, and 27-gauge needles.Methods: This was a retrospective analysis of samples collected from patients undergoing FNAB between 2018 and 2021. It was conducted in an otolaryngology department in a university teaching hospital.Results: Of the 699 aspirations, 144, 335, and 220 were performed using 23-, 25-, and 27-gauge needles, respectively. ND rates increased significantly when using 27-gauge compared with 23- to 25-gauge needles (P = .002), and a significantly lower ND rate was found for the 25-gauge needle compared with the 27-gauge needle (P = .001). Furthermore, increased nodule size was associated with reduced ND rate (odds ratio, 0.801; 95% confidence interval, 0.691-0.929).Conclusions: The 25-gauge needles are superior to 27-gauge needles in reducing ND rates of thyroid nodule FNAB specimens. Future prospective studies should be performed to confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: Post-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis. Methods: In the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results: Diagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options. Conclusion: A basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment. [ABSTRACT FROM AUTHOR]

Objective: Parents of children with any chronic illness may experience increased anxiety and reduced health-related quality of life (QoL). Our objective was to evaluate the change in parental QoL before vs after tonsillectomy. Our hypothesis was that pediatric tonsil surgery with or without adenoidectomy would improve parental QoL. Study Design: A prospective cohort study. Setting: An otolaryngology department in a tertiary academic center. Methods: We enrolled parents of 79 children <5 years old. Adenotonsillectomy due to an obstructive airway indication was performed in 45 children. A group of 34 parents to healthy children served as a control group. Initially, we validated a modified version of the PAR-ENT-QoL questionnaire; then, we analyzed QoL parameters among parents of children with obstructive sleep-disordered breathing before and after surgical treatment. Results: We found significant differences between the QoL score before and after surgery (P =.003). The QoL score after surgery significantly improved and was even lower than that of the control group (P <.001). Conclusions: These results highlight the importance of timely diagnosis and treatment of children with obstructive sleep-disordered breathing, as this condition may affect not only the children themselves but also their caregivers. [ABSTRACT FROM AUTHOR]

It is important to define the accuracy of fine‐needle aspiration cytology (FNAC) in the diagnosis of Warthin tumor (WT). This systematic review and meta‐analysis evaluated the accuracy of FNAC in the diagnosis of WT in the parotid gland and WT growth rate. For determination of FNAC accuracy, 17 studies, encompassing 1710 cases, were included. Pulled random model estimates of sensitivity, specificity, PPV, and NPV were 93.7% (95%CI: 92.1, 95.3), 97.9% (95%CI: 97, 98.9), 93.3% (95%CI: 91.5, 95.1), and 97.4% (95%CI: 96.4, 98.4), respectively. FNAC is highly reliable for the diagnosis of WT of the parotid. The high PPV value suggests that patients with a cytological diagnosis of WT of the parotid may be assigned to active surveillance. [ABSTRACT FROM AUTHOR]

High frequency jet ventilationis a mechanical lung ventilation method which uses a relatively high flow usually through an open system. This work examined the effect of high-frequency jet ventilation on respiratory parameters of an intubated patient simulated using a high-frequency jet ventilator attached to a ventilation monitor for measurements of ventilation parameters. The series of experiments altered specific parameters each time (respiratory rate, inspiratory-expiratory (I:E) ratio, and inspiratory pressure), under different lung compliances. A reduction of minute ventilation was observed alongside a rise in respiratory rate, with low airway pressures over the entire range of lung compliances. In addition, an I:E ratio of 2:1 to 1:1; and the tidal and minute volumes were directly related to the inspiratory pressure over all compliance settings. To conclude, the respiratory mechanics in high-frequency jet ventilation are very different from those of conventional rate ventilation in a lung model. Further studies on patients and/or a biological model are needed to investigate pCO2 and end-tidal carbon-dioxide during high-frequency jet ventilation. [ABSTRACT FROM AUTHOR]