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Otitis media with effusion is one of the most commonly encountered diseases by otolaryngologists. Hearing loss is the most common symptom, particularly affecting academic performance in school-age children. Therefore, establishing an accurate diagnosis is crucial. The primary diagnostic method is an otoscopic ear examination. Tympanometry is the most frequently used technique for diagnosis. In this study, we aimed to compare the results of tympanometric examinations with intraoperative findings. Our study included a total of 126 patients with a diagnosis of chronic otitis media with effusion and a decision for surgery, comprising 224 ears that were followed by our clinic. All patients underwent at least one myringotomy. Ventilation tubes were inserted in cases of glue ear. Preoperative physical examination and tympanometry results were compared with intraoperative findings. Of the 126 patients, 81 were male. The mean age was 5.3 years (range: 2-15). Preoperatively, 135 ears exhibited Type B tympanogram, and 89 ears exhibited Type C tympanogram. The rate of tube insertion was statistically significant in cases with type B tympanogram. Additionally, the tube insertion rate was determined to be 32.5% in cases with Type C tympanograms. In conclusion, diagnosing effusive otitis media is a crucial matter. While physical examination is the most important diagnostic tool, it may sometimes be insufficient. Tympanometry is a highly useful method for improving the diagnostic rate of this condition. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of the otoscope. Also cited are the study of the gross and microscopic anatomy of the ear in mid-1800s, the works of Anton Freiherr von Troltsch on the state of otoscopy, the invention by German medical officer Friedrich Hofmann of a concave mirror for illumination, and the works of urologist Maximilian Carl-Friedrich Nitze and instrument maker Josef Leiter to develop an illuminated cystoscope.

Middle ear tumors are diverse, but relatively uncommon. The most frequent tumor in the middle ear is glomus tumor, followed by others such as schwannoma and cholesteatoma. We experienced a case of Mucosa‐associated lymphoid tissue hyperplasia as a middle ear tumor. The mass behind tympanic membrane appeared a hypervascular tumor, mimicking a glomus tumor, but the form of multiple separate masses in middle ear and mastoid cavity was the distinguishing feature that set it apart from a glomus tumor. Additionally, another characteristic was its tendency to easily shrink under pressure. This characteristic should be considered when encounter a hypervascular looking middle ear mass. Laryngoscope, 134:1894–1896, 2024 [ABSTRACT FROM AUTHOR]

Background: Within otologic surgery, a paucity of well-controlled studies assessing the use of systemic antibiotic to reduce surgical site infections exists. Moreover, discrepancies in wound classification of procedures challenge consensus in antimicrobial prescribing patterns. We sought to compare surgeons from two different health systems to examine how surgeons' prescribing habits compared to practice guidelines for numerous otologic procedures. Methods: An online questionnaire was distributed to 33 Canadian and 32 Austrian surgeons who regularly perform otologic surgery. Current systemic antibiotic prescribing habits for cochlear implantation, cholesteatoma surgery, stapes surgery, and tympanoplasty ± ossiculoplasty were collected. Results: Eighteen of 33 (54.5%) Canadian surgeons provided responses, while 18 of 32 (56.3%) of Austrian surgeons answered. Clear consistency with clinical practice guidelines exists for pre-operative antibiotics use in cochlear implant surgery and infected cholesteatoma surgery. However, for stapes surgery and tympanoplasty ± ossiculoplasty, consensus is lacking for both pre- and post-operative antibiotic prescribing habits. Notable differences between the two countries include post-operative antibiotics for cochlear implant surgery (Austria: 36.4%, Canada: 71.4%) and uninfected cholesteatoma surgery (Austria: 33.3%, Canada: 77.8%). Across all procedures, both induction and post-operative antibiotic administration was not significantly associated with surgeon seniority when stratified by five-year increments. Conclusion: The lack of consensus among each country's otologic surgeons underscores the uncertainty in wound classification and thus, adherence to clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Human temporal bones (HTBs) are invaluable resources for the study of otologic disorders and for evaluating novel treatment approaches. Given the high costs and technical expertise required to collect and process HTBs, there has been a decline in the number of otopathology laboratories. Our objective is to encourage ongoing study of HTBs by outlining the necessary steps to establish a pipeline for collection and processing of HTBs. In this methods manuscript, we: (1) provide the design of a temporal bone plug sawblade that can be used to collect specimens from autopsy donors; (2) establish that decalcification time can be dramatically reduced from 9 to 3 months if ethylenediaminetetraacetic acid is combined with microwave tissue processing and periodic bone trimming; (3) show that serial sections of relatively-rapidly decalcified HTBs can be successfully immunostained for key inner ear proteins; (4) demonstrate how to drill down a HTB to the otic capsule within a few hours so that subsequent decalcification time can be further reduced to only weeks. We include photographs and videos to facilitate rapid dissemination of the developed methods. Collected HTBs can be used for many purposes, including, but not limited to device testing, imaging studies, education, histopathology, and molecular studies. As new technology develops, it is imperative to continue studying HTBs to further our understanding of the cellular and molecular underpinnings of otologic disorders. [ABSTRACT FROM AUTHOR]

Objective: To review hearing and surgical outcomes after reconstructive middle ear surgery in class 4 congenital middle ear anomalies (CMEA), e.g., patients with oval- or round window atresia of dysplasia. Data sources: Pubmed/Medline, Embase and Cochrane library. Review methods: Articles containing data on hearing outcomes and complications after reconstructive ear surgery in class 4 anomalies were analyzed and critically appraised. The following data were included and reviewed: patient demographics, audiometric testing, surgical techniques, complications, revision surgeries and their outcomes. Risk of bias was determined, and GRADE certainty of evidence was assessed. Primary outcomes were postoperative air conduction thresholds (AC), change in AC, and success rates (closure of the ABG to within 20 dB), the occurrence of complications (most importantly sensorineural hearing loss) and the long-term stability of hearing results (> 6-month follow-up) and occurrence of recurrence of preoperative hearing loss. Results: Success rates varied from 12.5 to 75% at long-term follow-up with larger cohorts reporting success rates around 50%, mean postoperative gain in AC varied from 4.7 to 30 dB and − 8.6 to 23.6 dB at, respectively, short- and long-term follow-up. No postoperative change in hearing occurred in 0–33.3% of ears, and recurrence of hearing loss occurred in 0–66.7% of ears. SNHL occurred in a total of seven ears across all studies of which three experienced complete hearing loss. Conclusion: Reconstructive surgery can be an effective treatment option which should be considered in patients with very favorable baseline parameters, while also considering the substantial risk of recurrence of hearing loss, the possibility of unchanged hearing despite surgery and the rare occurrence of SNHL. Level of evidence: 2c. [ABSTRACT FROM AUTHOR]

Introduction The role of endoscopes in the ear, nose, and throat (ENT) field has been described since the 1980s; It started with endoscopic nasal surgeries, followed by otological and laryngological procedures, and, since then, it has experienced a rapid evolution. Endoscopes help otologists understand how to approach difficult areas of middle ear, as well as the physiology of middle ear cleft. Objectives Despite the introduction of endoscopes in the field of otology, microscopes are still widely used in clinics and in operation theaters either alone or with endoscopes. The present study, which was conducted amongst otologists in India, is on their experience with and knowledge of the use of the endoscope compared to microscopes. Methods A Google form-based questionnaire comprising 18 questions was developed and sent online to otologist all over the country. The final dataset included responses from 354 active otologists. Results Out of 354 participants, only 3% had more than 5 years of experience in endoscopic ear surgery (EES), and 16.1% had never worked with an endoscope. Endoscopes were used in clinics and in operation theaters by 74.9% of the participants. Conclusion There has been a rise in the acceptance and use of endoscopes among Indian otologists and otology surgeons in last few decades. [ABSTRACT FROM AUTHOR]

Copyright of Osmangazi Journal of Medicine / Osmangazi Tip Dergisi is the property of Eskisehir Osmangazi University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Exoscopes represent a promising alternative to conventional binocular microscopes (OM) in otology offering potential advantages such as enhanced ergonomics and a more compact device design. While previous research has demonstrated the effectiveness of exoscopes in various surgical specialties, their objective assessment in the field of otology remains limited. Therefore, this investigation aims to assess task‐based efficiency associated with exoscopes in the field of otology by use of simulated surgical models. Methods: A prospective cross‐over study design was used to compare an OM to an exoscope in otolaryngology residents and medical students. Participants performed five tasks on 3D‐printed ear models using both the exoscope and OM. Data collection included completion time, frequency of predefined errors, mental effort, and user experience. Subgroup analysis was performed based on level of experience. Results: Fourteen students and fifteen residents participated. Participants completed four of five tasks faster with the OM and there was no difference in number of errors committed. When separated by surgical experience, residents performed four of five tasks faster using the OM while students completed one of five tasks faster with the OM. Students committed more errors with the exoscope for one task with no difference in errors for residents. There was no difference in perceived difficulty performing tasks with either visualization system. Exit survey results showed more favorable opinions of the OM among residents and more favorable opinions of the exoscope among students. Conclusions: The exoscope permits successful performance in simulated otologic tasks. Task performance and user experience between operative microscopes and exoscopes differ based on level of surgical experience. Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background: During the cochlear implantation procedure, the receiver/stimulator (R/S) part of the implant is fixated to prevent postoperative device migration, which could have an adverse effect on the position of the electrode array in the cochlea. We aim to compare the migration rates of two fixation techniques, the bony recess versus the subperiosteal tight pocket without bony sutures. Methods and analysis: This single-blind randomized controlled trial will recruit a total of 112 primary cochlear implantation adult patients, eligible for implantation according to the current standard of practice. Randomization will be performed by an electronic data capture system Castor EDC, with participants block randomized to either bony recess or standard subperiosteal tight pocket in a 1:1 ratio, stratified by age. The primary outcome of this study is the R/S device migration rate; secondary outcomes include patient-experienced burden using the validated COMPASS questionnaire, electrode migration rate, electrode impedance values, speech perception scores, correlation between R/S migration, electrode array migration and patient complaints, assessment of complication rates, and validation of an implant position measurement method. Data will be collected at baseline, 1 week, 4 weeks, 8 weeks, 3 months, and 12 months after surgery. All data analyses will be conducted according to the intention-to-treat principle. Discussion: Cochlear implantation by means of creating a tight subperiosteal pocket without drilling a bony seat is a minimally invasive fixation technique with many advantages. However, the safety of this technique has not yet been proven with certainty. This is the first randomized controlled trial that directly compares the minimally invasive technique with the conventional method of drilling a bony seat. Trial registration: Netherlands Trial Register NL9698. Registered on 31 August 2021. [ABSTRACT FROM AUTHOR]

Introduction the ability to taste is among the life's finest pleasures and perception of taste can be altered by various disorders or therapeutic regimens as colds or dental procedures. Head trauma patients, patients on certain drugs such as phenylbutanone, carbamazepine and baclofen and patients with inflammatory diseases of the middle ear frequently complain about alterations in their ability to taste. So, assessment of gustatory sensitivity is the prerequisite for the correct diagnosis of taste dysfunction which uses taste strips impregnated with taste stimulants. Material and method in this prospective study, 40 patients were enrolled after assessment of history, general and local examination of ear and finally assessment of gustatory function was done according to Muller technique using taste strips. Results in present study out of 40 patients, 16 (40%) patients had COM squamous, 24 patients (60%) had COM mucosal. In the ipsilateral diseased ear (both COM squamous & mucosal) the mean taste score for various taste sensation was 11.65 ± 2.59. In the contralateral normal ear, the mean taste score was 15.42 ± 0.78. The difference between the two was found to be statistically significant (p < 0.0001). Conclusion a significant difference was obtained in taste scores between diseased (ipsilateral) and normal (contralateral) ears both overall and also when subtypes were compared. Thus, the present prospective study indicates that COM squamous as well as mucosal can induce taste dysfunction. [ABSTRACT FROM AUTHOR]

Ossicular chain defects secondary to Chronic otitis media most frequently involves the incudo-stapedial joint. This study observes the effect of incudo-stapedial joint reconstruction using conchal cartilage interposition graft on hearing of the patient. Fifty-three patients with chronic otitis media of inactive mucosal type with incudostapedial necrosis of less than half of long process of incus were posted for tympanoplasty with incudostapedial joint reconstruction using autologus conchal cartilage. Their hearing outcome was analysed by comparing the pre-operative and 12 weeks post-operative Pure Tone Audiogram. A statistically significant improvement is seen in air conduction by 14.66 dB after incudo-stapedial joint reconstruction using conchal cartilage (p value 0.0001), whereas improvement seen in bone conduction was statistically insignificant. 52 (98.1%) patients had ≤ 40 dB post-op AC and 1 (1.9%) had > 40 dB.. Conchal cartilage is an easy-to-harvest, biocompatible and cost effective graft material. It gives hearing results comparable to other materials. [ABSTRACT FROM AUTHOR]

Objective: To compare measured and perceived taste function before and after surgery of patients with chronic otitis media with cholesteatoma (OMCC) to patients without cholesteatoma (patients with chronic suppurative otitis media [CSOM] and patients with lateral skull base lesions [LSB]). Methods: This prospective cohort study included 29 patients undergoing surgery for unilateral OMCC. The chorda tympani nerve (CTN) was resected in 8 of these patients. Fourteen patients undergoing surgery for unilateral CSOM and 5 patients undergoing surgery for unilateral LSB (with CTN resection) served as the comparison group. Taste function was measured using taste strips on both sides of the tongue before surgery, 2 weeks postoperatively and 3 months postoperatively. The affected side of the tongue was compared to the unaffected side. A questionnaire on taste perception was completed at each visit. Results: Preoperatively, cholesteatoma patients showed higher taste strip scores than non-cholesteatoma patients, indicating a larger difference between the healthy and affected sides of the tongue. Despite this difference in measured taste function few cholesteatoma patients reported taste alteration before surgery (3/29 [10.3%]). Postoperatively, patients with CTN resection (OMCC patients with CTN resection and LSB patients) showed a decreased measured taste function. Subjectively, only approximately 20% of these patients reported taste alteration 3 months postoperatively. Conclusions: Before surgery, cholesteatoma patients displayed an impaired measured taste function compared to patients without cholesteatoma (CSOM, LSB). Subjectively this was often unnoticed. After surgery, despite removal of the CTN and consequent reduction of measured taste function, few patients reported taste alteration and subjective taste perception was seen to be improving. In regards to middle ear surgery, perceived taste function does not seem to reflect measured gustatory function. [ABSTRACT FROM AUTHOR]

Objective: Hearing loss (HL) is highly prevalent, yet underrecognized and underdiagnosed. Lack of standardized screening, awareness, cost, and access to hearing testing present barriers to HL identification. To facilitate prescreening and selection of patients who warrant audiometric evaluation, we developed a machine learning (ML) model to predict speech‐frequency pure‐tone average (PTA). Study Design: Cross‐sectional study. Setting: National Health and Nutrition Examination Survey (NHANES). Methods: The cohort included 8918 adults (≥20 years) who completed audiometric testing with NHANES (2012‐2018). The primary outcome measure was the prediction of better hearing ear speech‐frequency PTA. Relevant predictors included demographics, medical conditions, and subjective assessment of hearing. Supervised ML with a tree‐based architecture was used. Regression performance was determined by the mean absolute error (MAE) with binary classification assessed with area under the receiver operating characteristic curve (AUC). Results: Using the full set of predictors, the test set MAE between the ML‐predicted and actual PTA was 5.29 dB HL (95% confidence interval [CI]: 4.97‐5.61). The 5 most influential predictors of higher PTA were increased age, worse subjective hearing, male gender, increased body mass index, and history of smoking. The 5‐factor abbreviated model performed comparably to the extended feature set with MAE 5.36 (95% CI: 5.03‐5.69) and AUC for PTA > 25 dB HL of 0.92 (95% CI: 0.90‐0.94). Conclusion: The ML model was able to predict PTA with patient demographics, clinical factors, and subjective hearing status. ML‐based prediction may be used to identify individuals who could benefit most from audiometric evaluation. [ABSTRACT FROM AUTHOR]

Background Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by pulmonary, otological and sino-nasal manifestations. Well-defined clinical outcome measures are needed in such rare diseases research to improve follow-up and treatments. Pulmonary outcome measures have recently been described. The aim of this study was to identify ear and upper airway outcome measures that could be used for longitudinal follow-up of individuals with PCD. Methods A scoping review was performed by systematically searching MEDLINE, Embase and Cochrane Database of Systematic Reviews online databases for studies published from January 1996 to March 2022 that included at least 10 adult or paediatric PCD patients and reported ear and upper airway outcomes. Results 33 studies (1794 patients) were included. 10 ear and upper airway outcomes were reported. 17 studies reported audiometry, 16 reported otoscopic findings, and 13 reported rhinoscopic findings and sinus imaging. Health-related quality of life questionnaires were performed in seven studies. There was a high variability in definitions and measurement of outcomes between studies. Conclusions This scoping review highlights the lack of data regarding ear and upper airway outcomes in PCD. It also reports a high heterogeneity in outcome definitions or measures. We provide well-founded specific suggestions to standardise ear and upper airway outcome definitions and reporting for future PCD research studies. [ABSTRACT FROM AUTHOR]

Objective: Tinnitus is a common auditory symptom that negatively affects the quality of life of individuals. This study aimed to determine the validity and reliability of a Turkish version of the International Tinnitus Inventory (Tr-ITI) for both clinical and research purposes. ITI is a short, easily applicable self-report inventory to measure perceived tinnitus. Methods: The Turkish translation of the ITI and the Tinnitus Handicap Inventory (THI) were administered to 125 participants aged 19 to 76 with tinnitus complaints for over three months. A routine audiological evaluation was performed, and the psychoacoustic properties of tinnitus were determined. Confirmatory factor analysis (CFA) was performed to construct validity, Cronbach’s alpha coefficient was used for the reliability of internal consistency, and retests were administered to participants 15 days after the first measurement. Results: CFA and inter-item correlations confirmed the unifactorial model. Tr-ITI showed high internal consistency reliability (Cronbach’s alpha =0.909). All fit index values showed a good fit. Correlations between the total scores of Tr-ITI and THI were moderate (r=-0.620) and between retest scores were very high (r=0.993). Conclusion: The Tr-ITI is a valid, reliable, and practical tool for determining tinnitus severity and tinnitus complaints. [ABSTRACT FROM AUTHOR]

Objective: Tinnitus is a common auditory symptom that negatively affects the quality of life of individuals. This study aimed to determine the validity and reliability of a Turkish version of the International Tinnitus Inventory (Tr-ITI) for both clinical and research purposes. ITI is a short, easily applicable self-report inventory to measure perceived tinnitus. Methods: The Turkish translation of the ITI and the Tinnitus Handicap Inventory (THI) were administered to 125 participants aged 19 to 76 with tinnitus complaints for over three months. A routine audiological evaluation was performed, and the psychoacoustic properties of tinnitus were determined. Confirmatory factor analysis (CFA) was performed to construct validity, Cronbach's alpha coefficient was used for the reliability of internal consistency, and retests were administered to participants 15 days after the first measurement. Results: CFA and inter-item correlations confirmed the unifactorial model. Tr-ITI showed high internal consistency reliability (Cronbach's alpha =0.909). All fit index values showed a good fit. Correlations between the total scores of Tr-ITI and THI were moderate (r=-0.620) and between retest scores were very high (r=0.993). Conclusion: The Tr-ITI is a valid, reliable, and practical tool for determining tinnitus severity and tinnitus complaints. [ABSTRACT FROM AUTHOR]

Abstract Objectives Evaluate the relationship between cardiovascular disease (CVD) risk factors and cochlear function in African Americans. Methods Relationships between hearing loss, cochlear function, and CVD risk factors were assessed in a cross‐sectional analysis of 1106 Jackson Heart Study participants. Hearing loss was defined as puretone average (PTA0.5,1,2,4) > 15 dB HL. Distortion product otoacoustic emissions (DPOAEs) were collected for f2 = 1.0–8.0 kHz. Two amplitude averages were computed: DPOAElow (f2 ≤ 4 kHz) and DPOAEhigh (f2 ≥ 6 kHz). Based on major CVD risk factors (diabetes, current smoking, total cholesterol ≥240 mg/dL or treatment, and systolic blood pressure [BP]/diastolic BP ≥ 140/≥90 mmHg or treatment), four risk groups were created: 0, 1, 2, and ≥3 risk factors. Logistic regression estimated the odds of hearing loss and absent/reduced DPOAElow and DPOAEhigh by CVD risk status adjusting for age, sex, education, BMI, vertigo, and noise exposure. Results With multivariable adjustment, diabetes was associated with hearing loss (OR = 1.48 [95% CI: 1.04–2.10]). However, there was not a statistically significant relationship between CVD risk factors (individually or for overall risk) and DPOAEs. Conclusion Diabetes was associated with hearing loss. Neither individual CVD risk factors nor overall risk showed a relationship to cochlear dysfunction. Level of Evidence 2b.

We explore a case of Benign Paroxysmal Positional Vertigo in the context of Persistent Hypoglossal Artery (PHA) and bilateral Madelung Deformity (MD). PHA is associated with a raft of major adverse cardiovascular events. MD can result from manifold conditions such as Turner’s Syndrome and mesomelic dwarfism. In this case, the patient’s positive family history of MD across generations is suggestive of inherited mutation in the Short Stature Homeobox (SHOX) Gene. We discuss the putative impact of SHOX on the genesis of Benign Paroxysmal Positional Vertigo (BPPV) in a patient with PHA and bilateral MD.

Abstract Background Otolaryngology–head and neck surgical (OHNS) trainees’ operating exposure is supplemented by a combination of didactic teaching, textbook reading, and cadaveric dissections. Conventional teaching, however, may not adequately equip trainees with an understanding of complex visuospatial relationships of the middle ear. Both face and content validation were assessed of a novel three-dimensional (3D) photorealistic virtual ear simulation tool underwent face and content validation as an educational tool for OHNS trainees. Methods A three-dimensional mesh reconstruction of open access imaging was generated using geometric modeling, which underwent global illumination, subsurface scattering, and texturing to create photorealistic virtual reality (VR) ear models were created from open access imaging and comiled into a educational platform. This was compiled into an educational VR platform which was explored to validate the face and content validity questionnaires in a prospective manner. OHNS post-graduate trainees were recruited from University of Toronto and University of Calgary OHNS programs. Participation was on a voluntary basis. Results Total of 23 OHNS post-graduate trainees from the two universities were included in this study. The mean comfort level of otologic anatomy was rated 4.8 (± 2.2) out of 10. Senior residents possessed more otologic surgical experience (P

Objective: To assess the diagnostic agreement between smartphone-enabled otoscopy and rigid otoendoscopy in tympanic membrane and middle ear diseases. Methods: A cross-sectional study was carried out to analyze otoscopies in patients seen at a general otorhinolaryngology (ORL) outpatient clinic, from June to December 2019. Eighty-three images of patients obtained from otoscopies performed through a smartphone device and a rigid endoscope were included, recorded, and stored for further analysis. The images were first analyzed by an experienced otologist, who assigned his diagnostic impression (defined as the gold standard) on each of the images. After this analysis, the images were displayed to a group of secondary raters (an experienced otorhinolaryngologist, a second-year resident in ORL, and a general practitioner). A questionnaire was applied related to each image. Results: There was high agreement between the smartphone device and the otoendoscopy images for all professionals, with a Kappa coefficient of 0.97 (p

Key Clinical Message Congenital mastoid confined cholesteatoma is a very rare entity with only 30 reported cases worldwide. We describe the presentation and treatment of this condition in a 14‐year‐old boy, with maintenance of normal hearing and ear canal function.

Melanoma is one of the tumours whose incidence has increased the most in recent decades.Metastasis of the inner ear and cerebellopontine angle from melanoma are rare and only few cases of melanoma metastases with simultaneous bilateral involvement of the inner ear have been reported.We report the case of DM, a 52 years old man, who was admitted to our department for a rapidly worsening sensorineural hearing loss with bilateral tinnitus and postural instability. Seven years before, the patient was diagnosed with a stage III-B melanoma of the trunk treated with surgical excision and axillary lymph-nodes dissection. The following oncological follow-up resulted negative. Vestibular evaluation excluded vestibular neuritis, revealing instead an horizontal nystagmus on the left side, alteration of the right orbicularis oculi muscle with minimal lagophthalmos and gait anomalies. The CT-scan excluded a stroke. The MRI showed bilateral enhancing lesions at IACs, thickened appearance at the right VIII cranial nerve level with hyperintensity of the signal and a similar lesion at D1 spine level. A debulking surgery and biopsy with translabyrinthine access were planned.The histological report showed a BRAF mutated melanoma and for that reason the patient was referred to the oncology department to start immunotherapy treatment.

William Wilde, father of Oscar Wilde, made a significant contribution to ophthalmology and otology. Qualified as a surgeon. educated in statistics and showing sympathy for the Irish population, Wilde was appointed a Commissioner for the 1851 Census, which covered the time of the Irish Famine (1845–1852). Wilde, steeped in Irish mythology, used his knowledge to develop a close rapport with the Irish peasantry. However, his life was a paradox; he supported the British Government's approach to the Famine and at the same time he showed humanity to the Irish peasantry. In his personal life he was implicated in an abortive libel case involving a young female patient who had accused him of rape. Wilde lived as though he had two separate lives : on the one hand the successful surgeon, famine Commissioner and cataloguer of Irish antiquities, and the other a countryman and disciple of Irish mythology. Wilde was highly preceptive especially in his views on the recording of medical data and outcomes in clinical practice. We argue that Wilde was probably unmatched in the variety of his talents but was also perplexing in the various actions he took during his life and that indeed Wilde was an enigma. [ABSTRACT FROM AUTHOR]

Objective: Postoperative opioid prescriptions tend to exceed children's analgesic needs, but awareness of the opioid epidemic may have driven changes in prescribing behaviors. This study evaluated opioid prescribing patterns after major pediatric ear surgery. Methods: This study reviewed all cases of tympanoplasty, tympanomastoidectomy, mastoidectomy, cochlear implantation, otoplasty, and aural atresia repair at a pediatric hospital during 2010–2021. Regressions were conducted to identify opioid prescribing trends over time. Potential covariates were assessed. Returns to the system were reviewed as a balancing measure. Results: Even without a targeted protocol, opioid prescribing declined significantly. After prescribing peaked in 2012–2013, significant negative trends yielded lower rates of opioid prescriptions, fewer doses per prescription, smaller patient‐weight‐standardized dose sizes, and less variability (all p < 0.001). In 2012, 96.1% of patients received opioid prescriptions; the rate fell to 13.5% by 2021. For patients ages, 0–6, the annual rate of opioid prescriptions dropped from a maximum of 96.3% in 2012 to 0.0% in 2021. The annual average supply of doses per prescription decreased by 68% between 2013 and 2021, reducing the total days' supply to an evidence‐based 3.1 ± 1.6 days. Regressions did not detect changes in returns to the system. Pain‐related returns were rare (0.9%) and did not vary by opioid prescriptions (p = 0.37). Prescribing trends were closely correlated with a tonsillectomy‐focused protocol that our institution implemented in 2019. Conclusion: Surgeon‐driven opioid stewardship has improved with no resultant change in revisit rates. Procedure‐specific quality improvement interventions may have broader off‐target effects on prescribing behaviors. Level of Evidence: IV Laryngoscope, 133:1987–1992, 2023 [ABSTRACT FROM AUTHOR]

In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies.

Objective: This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. Study Design: Prospective cohort study. Setting: Single tertiary‐care facility. Methods: Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. Results: Eighty‐six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). Conclusion: The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery. [ABSTRACT FROM AUTHOR]

Objectives: Totally endoscopic ear surgery is becoming increasingly utilized in otologic practice. Although the well‐established microscope‐assisted tympanoplasty remains the most common technique to repair a tympanic membrane defect, the merits of endoscopic approaches have been well‐documented. This systematic review and meta‐analysis compares the outcomes of endoscopic to microscopic tympanoplasty incorporating only randomized trials. Study Design: Systematic review and meta‐analysis. Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Cochrane Library, and EMBASE was conducted. All randomized studies comparing endoscopic to microscopic tympanoplasty were collected according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines. Quality assessment was carried out utilizing the Risk of Bias 2. Results: The initial search identified 1711 studies, of which 9 met the inclusion criteria comprising of 540 patients (microscopic tympanoplasty 51.5%; endoscopic tympanoplasty 49.5%). The mean age was 32.5 years with a similar number of males (50.1%) and females (49.9%). Both endoscopic and microscopic groups had comparable outcomes with regards to graft success rate (RD 0.00; 95% confidence interval [CI], −0.04 to. 0.05; p = 0.87) and hearing improvement (MD 0.57 dB; 95% CI, −1.23 to 2.36; p = 0.54). A significantly shorter operative time was noted in the endoscopic group (MD, −24.73 min; 95% CI, −38.56 to −10.89; p = 0.0005). Conclusion: Our results, assimilating level 1 evidence, demonstrates that endoscopic and microscopic‐assisted type‐1 tympanoplasty have similar outcomes in both graft success and hearing improvement, with endoscopic approaches yielding a shorter operative time. Level of Evidence: 1 Laryngoscope, 133:1550–1557, 2023 [ABSTRACT FROM AUTHOR]

Misophonia, meaning "hatred of sound", is a proposed neurological condition in which certain sounds trigger emotional or physiological responses others may deem unreasonable. The studies on prevalence of misophonia show that almost 20% of college going students exhibit experience misophonia like symptoms worldwide. These studies help us understand that decreased tolerance towards certain sounds has a high prevalence rate. In a country like India, the diversity in terms of exposure to various levels of noise and traditional habits spans across different age groups, locations, socio-economic statuses, and communities. This study aims to establish the prevalence rate and severity of misophonia in college going-students of India and also an attempt to determine gender dominance. The total participants were 328 undergraduate students all over India, with diverse cultural, linguistic, and economic backgrounds. An online survey was conducted through Google forms, wherein the participants filled the self-rating Amsterdam Misophonia Scale and Misophonia Questionnaire. The results of the study showed that the prevalence of misophonia was approximately 15.85%, with a moderate to severe degree of misophonia. The results indicate that misophonia is highly prevalent in India and there is no gender dominance in experiencing misophonia. [ABSTRACT FROM AUTHOR]

In order to decrease medical errors and improve organized, targeted education pre- and postgraduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi's method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists' opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies. [ABSTRACT FROM AUTHOR]

Objective: To quantitatively compare the ergonomic risk of otologic surgeries performed with endoscopes and microscopes. Study Design: Observational cross‐sectional study. Setting: Operating room of a tertiary academic medical center. Methods: Intraoperative neck angles of otolaryngology attendings, fellows, and residents were assessed during 17 otologic surgeries using inertial measurement unit sensors. Sensors were attached midline between the shoulder blades and on the posterior scalp of participants and were calibrated just prior to beginning each case. Quaternion data were used to calculate neck angles during periods of active surgery. Results: Endoscopic and microscopic cases included similar percentages of time in high‐risk neck positions, 75% and 73%, respectively, according to a validated ergonomic risk assessment tool, the Rapid Upper Limb Assessment. However, microscopic cases included a higher percentage of time spent in extension (25%) compared to endoscopic cases (12%) (p <.001). When examining the magnitude of average flexion and extension angles, endoscopic and microscopic cases were not significantly different. Conclusion: Utilizing intraoperative sensor data, we found that both endoscopic and microscopic approaches in otologic surgery were associated with high‐risk neck angles, which can result in sustained neck strain. These results suggest that optimal ergonomics may be better achieved by the consistent application of basic ergonomic principles than by changing the technology in the operating room. [ABSTRACT FROM AUTHOR]

Background: The direct to audiology via ENT referral pathway was designed to enhance patient access to audiology services. The pathway is recommended in the Otolaryngology Head & Neck Surgery: a model of care for Ireland report, published in 2019. Aims: This study aimed to review the outcomes of all patients that attended our institution over the last seven years. Methods: A retrospective review of the direct to audiology referral service from March 2014 to December 2021 was conducted. Outcomes were defined by the pathway each patient took following attendance at the audiology clinic. Patients were either (i) discharged, (ii) referred for hearing aid(s) or (iii) identified as candidates for further diagnostic assessments, including a follow-up at the ENT outpatient clinic. Results: During the time frame, 419 patients were triaged to the pathway. The average wait time was 13 days. The average age was 53 years (range 16–96 years, SD = 6.1). Approximately 34% (n = 143) of all patients referred were discharged back to the GP by the audiologist, but 66% (n = 276) presented with 'red flags' and needed further investigation in the ENT clinic, with 30% (n = 73) ultimately requiring imaging studies. Over half (n = 254, 61%) were referred for hearing aids. Conclusion: The direct to audiology initiative has proven effective at reducing waiting times for ENT patients solely in need of audiological intervention. Approximately one-third of these referrals to the ENT service can be assessed comprehensively in the audiology clinic, thereby reducing the demand for ENT clinics, enhancing service provision and expediting onwards referral for amplification. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe a case series of previously undiagnosed granulomatosis with polyangiitis (GPA) patients who presented primarily with otological manifestations.MethodWe report a series of patients visited at a neurotology clinic who were eventually diagnosed with GPA based on their otologic complaints and had no prior knowledge of having this condition.ResultsIn this series, 10 (91%) patients presented with hearing loss (HL), more than half of which were bilateral (60%). Upon audiometric examination, all but 1 patient had mixed, conductive, or sensorineural HL. All patients presented with eustachian tube dysfunction (ETD), otitis media with effusion (OME), or both. Nasal endoscopy showed intranasal pathology in 3 (27%) patients. Otologic symptoms were improved in all patients after treatment with an average of 4 in-office follow-up appointments.ConclusionGPA should be included in the differential diagnosis of adults with unexplained mixed hearing loss, new onset serous effusion, or acute otitis media in the absence of a previous history of ETD. Laboratory tests (ie, anti-neutrophil cytoplasmic autoantibody, erythrocyte sedimentation rate, and C-reactive protein) along with a urinalysis can aid in screening these patients. In cases in which the index of suspicion is high, repeated testing could reduce the risk of false negative findings.

Significance Statement: Eustachian tube disorders are common outpatient otologic presentations that can present a diagnostic challenge due to overlapping symptoms. This article will focus on patulous Eustachian tube, how the symptoms can overlap with those of Eustachian tube dysfunction, and the diagnostic insight offered by a close inspection of the tympanic membrane. [ABSTRACT FROM AUTHOR]

Some patients with autoimmune disease will experience otologic symptoms, such as pain and hearing loss. We present a patient with ANCA-associated vasculitis who required surgery for a suspicious mastoid lesion associated with her disease.

Preoperative simulation using a three‐dimensional printer is effective to perform safe surgery by knowing the range limit of drilling in the temporal bone. Moreover, simulations using models are thought to be useful for education of young surgeon. [ABSTRACT FROM AUTHOR]

The aim of our study was to report rates of facial nerve palsy and residual tumor following surgical intervention and subsequent tumor recurrence in patients with endolymphatic sac tumors. A systematic literature review of preoperative assessment and surgical management is also included. Studies including patient/s affected by sporadic or von Hippel-Lindau disease related endolymphatic sac tumors, reporting levels of facial nerve function, residual and recurrence pathology following a surgical procedure, were considered. Data were combined for proportional meta-analysis, and the selected studies' methodological quality was also evaluated. Overall 34 papers, including 202 subjects (209 cases of endolymphatic sac tumors) were analyzed. Pooled proportion rate (95% CI) of overall facial nerve palsy was 39.7% (28.2-51.9) and residual tumor was 16.5% (10.3-23.7) after surgical procedure. Pooled proportion rate (95% CI) of tumor recurrence was 14.0% (9.7-19.3) during a mean follow-up period of 49.7 months (8-136). Our results showed that preoperative facial nerve function is impaired in almost 30% of patients with endolymphatic sac tumors. Surgical management of endolymphatic sac tumor may cause a worsening of facial nerve function in a low percentage of treated subjects. Residual and/or recurrence of endolymphatic sac tumors are not rare events, and follow-up strategies should be designed accordingly. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to gain in-depth feedback on patient perceptions of remote assessment in otology, to better inform the development of a telemedicine pathway for new otology referrals. Methods: A qualitative descriptive approach was employed to analyse semi-structured interviews from 14 patients seen in a routine otology clinic. Results: Patients were generally accepting of the proposed telemedicine pathway. Key themes included maintaining quality of care, adequate training for facilitators, reducing waiting times, appropriate actioning of clinic outcomes and anxiety surrounding the use of technology. Conclusions: Our proposed telemedicine pathway for new otology referrals is acceptable to patients, provided there is no compromise in the standard of their care versus a traditional pathway. These results further our understanding of remote assessment in otology from the patient perspective and may help to inform the development of such pathways outside of our centre. [ABSTRACT FROM AUTHOR]

Background: 3D-printed temporal bone models can potentially provide a cost-effective alternative to cadaver surgery that can be manufactured locally at the training department. The objective of this study was to create a cost-effective 3D-printed model suitable for mastoidectomy training using entry level and commercially available print technologies, enabling individuals, without prior experience on 3D-printing, to manufacture their own models for basic temporal bone training. Methods: Expert technical professionals and an experienced otosurgeon identified the best material for replicating the temporal bone and created a cost-effective printing routine for the model using entry-level print technologies. Eleven participants at a temporal bone dissection course evaluated the model using a questionnaire. Results: The 3D-printed temporal bone model was printed using a material extrusion 3D-printer with a heat resistant filament, reducing melting during drilling. After printing, a few simple post-processing steps were designed to replicate the dura, sigmoid sinus and facial nerve. Modifying the 3D-printer by installing a direct-drive and ruby nozzle resulted in more successful prints and less need for maintenance. Upon evaluation by otorhinolaryngology trainees, unanimous feedback was that the model provided a good introduction to the mastoidectomy procedure, and supplementing practice to cadaveric temporal bones. Conclusion: In-house production of a cost-effective 3D-printed model for temporal bone training is feasible and enables training institutions to manufacture their own models. Further, this work demonstrates the feasibility of creating new temporal bone models with anatomical variation to provide ample training opportunity. [ABSTRACT FROM AUTHOR]

Objective: To establish the relationship between endoscope temperatures and luminosity with a variety of light source types, endoscope ages, endoscope sizes, angles and operative distance in transcanal endoscopic ear surgery. Methods: Transcanal endoscopic ear surgery was simulated in an operating theatre using 7 mm plastic suction tubing coated in insulating tape. An ATP ET-959 thermometer was used to record temperatures, and a Trotec BF06 lux meter was used to measure luminosity. Luminosity and temperature recordings were taken at 0 mm and 5 mm from the endoscope tip. Results: Thermal energy transfer from operating endoscopes is greatest when: the light intensity is high, there is a light-emitting diode light source and the endoscope is touching the surface. Additionally, larger-diameter endoscopes, angled endoscopes and new endoscopes generated greater heat. Conclusion: It is recommended that operative light intensity is maintained at the lowest level possible, and that the surgeon avoids contact between patient tissues and the endoscope tip. [ABSTRACT FROM AUTHOR]

Objectives: To analyze trends in billing patterns, Medicare reimbursement, and practice-setting for otolaryngologists (ORLs) and other provider types performing in-office cerumen removal. Methods: This retrospective study included data on Medicare-billing providers from the Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of providers performing in-office cerumen removal, total sums and medians for Medicare reimbursements and services, and services per patient were gathered along with geographic distributions. Results: There have been near linear declines in number of general physicians and other provider types performing cerumen extractions with 42.6% and 40.7% declines, respectively, and near linear growth in number of ORLs and advanced practice providers (APPs) with 9.7% and 51.1% growth, respectively. At the median, general physicians, APPs, and other provider types have been billing for a similar and constant number of cerumen extractions per provider, while ORLs have seen a 10.6% increase. Total Medicare reimbursement to general physicians and other provider types has fallen 45.0% and 32.5%, respectively, and to ORLs and APPs has grown 16.9% and 103.4%, respectively. Compared to non-ORLs, ORLs tend to bill for cerumen extraction out of an urban setting rather than a rural setting (P <.001). Conclusions: General physicians and other provider types are increasingly referring cerumen disimpaction patients to ORL physicians and allowing APPs to perform these procedures, indicating a change in landscape of medical practice among these providers. General physicians may be filling a need in the rural setting, where there are fewer ORLs practicing. [ABSTRACT FROM AUTHOR]

Introduction: Intralabyrinthine schwannomas, including the intracochlear variety, are rare benign tumors. They can cause a number of symptoms and have the potential to grow to involve other critical structures of the inner ear and skull base. While surgical resection is feasible, there is typically permanent hearing dysfunction as a result of resection and subsequent fibrosis. Here, we present 2 cases of intracochlear schwannomas (ICS) that were successfully resected with simultaneous cochlear implant placement. Methods: Patient 1 presented with an intravestibulocochlear schwannoma. This patient underwent a translabyrinthine approach. Endoscopic assistance was used to dissect the tumor from the vestibule and basal turn of the cochlea, through an enlarged round window approach. A cochlear implant was placed via a round window cochleostomy. Patient 2 presented with an intracochlear schwannoma involving the basal and middle turns of the cochlea. The patient underwent a trans-otic approach for resection. A large portion of the cochlear promontory required unroofing for complete exposure of the tumor. A cochlear implant was then placed via a round window cochleostomy. Results: Upon cochlear implant activation, Patient 1's sound field thresholds using the implant were near the normal range of hearing, ranging from 25 to 50 dB HL from 250 to 6000 Hz. Patient 2's 6-month post-operative cochlear implant sound field testing ranged from 20 to 30 dB HL from 250 to 6000 Hz and speech recognition testing revealed 59% on AZ Bio sentences compared to 0% pre-operatively. Conclusion: Simultaneous cochlear implantation after resection of intracochlear schwannomas is safe and successful in restoring hearing. Attention to adequate exposure and endoscopic assistance, when required, allow for gross total resection while minimizing trauma to cochlear structures. In such cases, immediate cochlear implantation allows for hearing rehabilitation before likely cochlear fibrosis can occur. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes of telephone and face-to-face consultations for new otology referrals and discuss the wider use of telemedicine in otology. Methods: Retrospective cohort study including new adult otology referrals to our unit, sampled consecutively between March 2021 and May 2021, seen in either a face-to-face or telephone clinic. Primary outcome measure was the proportion of patients with a definitive management outcome (discharged or added to waiting list for treatment) versus the proportion of patients requiring follow-up for further assessment or review. Results: 150 new patients referred for a routine otology consultation (75 telephone, 75 face-to-face) were included. 53/75 patients (71%) undergoing a face-to-face consultation received a definitive outcome following initial review, versus 22/75 (29%) telephone patients (χ2 < 0.001, OR 5.8). 52/75 (69%) telephone patients were followed up face-to-face for examination. The mean (SD) number of appointments required to reach a definitive outcome was 1.22 (0.58) and 1.75 (0.73) in the face-to-face and telephone cohorts, respectively (p < 0.001). Conclusions: Telephone clinics in otology have played an important role as part of the COVID19 response. However, they are currently limited by a lack of clinical examination and audiometry. Remote assessment pathways in otology that incorporate asynchronous review of recorded examinations alongside audiometry, either conventional or boothless, may mitigate this problem; however, further research is required. [ABSTRACT FROM AUTHOR]

Introduction Recently, there have been significant advancements in transcanal endoscopic ear surgery (TEES). The combination of rigid and thin otoendoscopes with high-definition cameras enabled a less invasive transcanal access to the middle ear and a clearer view of the surgical field. Several surgeons have recently published studies about cholesteatoma resection via transcanal endoscopic surgery, even in cases where the disease has extended to the mastoid, requiring transcanal endoscopic mastoidectomy. Objectives To analyze the currently available literature on transcanal endoscopic inside-out mastoidectomy, and to determine its efficacy as a surgical technique by evaluating the disease's relapse/recurrence rate. Data Synthesis Initially, the titles and abstracts of articles identified were analyzed. At this stage, 117 articles were analyzed, 97 of which were excluded for not meeting the inclusion criteria. The 20 remaining articles were further evaluated. The articles were classified on the basis of five levels of scientific evidence. Final Comments The analysis of the studies showed that the transcanal endoscopic approach is effective in providing access to the attic or antrum, especially in cases of sclerotic mastoids. There was only one study with grade A recommendation, which showed the efficacy of endoscopic ear surgery in the treatment of cholesteatoma. Furthermore, there were three studies with grade B recommendation, showing less relapse/recurrence after TEES. More studies with grade A and B recommendations are needed to better evaluate the effectiveness of TEES, especially compared with that of traditional microscopic surgery. [ABSTRACT FROM AUTHOR]

Aims: Ascertain whether a demographic analysis of the archives of an annual national meeting head and neck section could reflect contemporary issues in our specialty and compare the results with available analysis from other ORL-HNS meetings. Materials and methods: A review of all accepted abstracts of Sylvester O'Halloran Symposium—H&N section, from 2005 to 2020. Results: ORL-HNS was responsible for 77% of the accepted abstracts. Presentations on H&N Malignancy were predominantly from ORL-HNS (84%), while Thyroid presentations were divided with General Surgery (45%). Medical students have appeared in recent years and produced 4% of papers at the last meeting while more junior presenters are participating with an increasing female preponderance (ranging from 7 to 53%). The overall publication rate was 27%, where male authors had a rate of 28% and females 22%. Similar papers published subsequent to the relevant meeting were identified from other institutions in 40% of presentations. Conclusion: This review of presentations at a surgical meeting provides an insight into contemporary issues involving our specialty and lays down markers or challenges for organisers and presenters alike. Presentations on H&N Malignancy have become almost exclusively ORL-HNS, while Thyroid presentations are becoming more valorised to General Surgery and Facial Plastics with our colleagues in Plastic Surgery and Maxillofacial. Our publication rate of 27% is similar to other ORL-HNS meetings. Approximately 10% are published over 5 years after the meeting but presenters should endeavour to publish earlier as others may usurp publication in up to 40% of presentations. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the relationship between cardiovascular disease (CVD) risk factors and cochlear function in African Americans. Methods: Relationships between hearing loss, cochlear function, and CVD risk factors were assessed in a cross‐sectional analysis of 1106 Jackson Heart Study participants. Hearing loss was defined as puretone average (PTA0.5,1,2,4) > 15 dB HL. Distortion product otoacoustic emissions (DPOAEs) were collected for f2 = 1.0–8.0 kHz. Two amplitude averages were computed: DPOAElow (f2 ≤ 4 kHz) and DPOAEhigh (f2 ≥ 6 kHz). Based on major CVD risk factors (diabetes, current smoking, total cholesterol ≥240 mg/dL or treatment, and systolic blood pressure [BP]/diastolic BP ≥ 140/≥90 mmHg or treatment), four risk groups were created: 0, 1, 2, and ≥3 risk factors. Logistic regression estimated the odds of hearing loss and absent/reduced DPOAElow and DPOAEhigh by CVD risk status adjusting for age, sex, education, BMI, vertigo, and noise exposure. Results: With multivariable adjustment, diabetes was associated with hearing loss (OR = 1.48 [95% CI: 1.04–2.10]). However, there was not a statistically significant relationship between CVD risk factors (individually or for overall risk) and DPOAEs. Conclusion: Diabetes was associated with hearing loss. Neither individual CVD risk factors nor overall risk showed a relationship to cochlear dysfunction. Level of Evidence: 2b. [ABSTRACT FROM AUTHOR]

Objective: Management of tympanic membrane perforations is varied. This study aimed to better understand current practice patterns in myringoplasty and type 1 tympanoplasty. Methods: An electronic questionnaire was distributed to American Academy of Otolaryngology – Head and Neck Surgery members. Practice patterns were compared in terms of fellowship training, practice length, practice setting, paediatric case frequency and total cases per year. Results: Of the 321 respondents, most were comprehensive otolaryngologists (60.4 per cent), in private practice (60.8 per cent), with a primarily adult practice (59.8 per cent). Fellowship training was the factor most associated with significant variations in management, including pre-operative antibiotic usage (p = 0.019), contraindications (p < 0.001), approach to traumatic perforations (p < 0.001), use of local anaesthesia (p < 0.001), graft material (p < 0.001), tympanoplasty technique (p = 0.003), endoscopic assistance (p < 0.001) and timing of post-operative audiology evaluation (p = 0.003). Conclusion: Subspecialty training appears to be the main variable associated with significant differences in peri-operative decision-making for surgical repair of tympanic membrane perforations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the results of cochlear implantation in subjects with neurofibromatosis type 2 (NF2) and bilateral vestibular schwannomas (VS). Study Design: Retrospective case series. Setting: University-based tertiary referral center. Subjects: Five subjects with NF2 and severe-to-profound sensorineural hearing loss. Intervention: Cochlear implantation. Main Outcome Measure: Surgical outcomes and audiometric performance after cochlear implantation. Results: Five subjects (3 female, 2 male) were included in the study. The mean age at the time of implantation was 54 years old (range 35-78 years). Follow-up after cochlear implantation averaged 38 months (range 21-106 months). In the 5 implanted ears, 2 had no prior treatment, 1 had undergone prior radiation therapy, 1 underwent prior microsurgical removal, and 1 underwent prior microsurgical removal with adjuvant radiation therapy. The mean ipsilateral VS dimensions at time of implantation were 14 mm × 7.2 mm × 6.1 mm (mediolateral × anteroposterior × craniocaudal). Following cochlear implant activation, all 5 subjects achieved sound awareness, open set speech recognition, and 4 continue to be daily users of the devices. Conclusion: Cochlear implantation is a viable hearing rehabilitation option for subjects with NF2 and severe-to-profound sensorineural hearing loss. All subjects reported benefit with their cochlear implant, including open set speech recognition, enhanced lip-reading skills and environmental awareness of sound. Four subjects continued to demonstrate improved open-set speech recognition at the time of their last evaluations. [ABSTRACT FROM AUTHOR]