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OBJECTIVE To determine the efficacy of various treatment modalities used for acute noise-induced hearing loss (aNIHL) from acute acoustic trauma (AAT) via a systematic review and meta-analysis. DATA SOURCES PubMed, Cochrane, and Scopus databases. STUDY SELECTION The scientific literature was searched up to October 2018 for articles evaluating hearing outcomes after treatment of aNIHL. DATA EXTRACTION The following were extracted: Oxford level of evidence, number of patients, mean age, time to presentation, source of noise exposure, method of treatment/intervention, baseline hearing threshold, posttreatment hearing threshold, hearing gain, proportion of patients with no recovery, partial recovery, or complete recovery, and treatment complications. DATA SYNTHESIS Sixteen studies with 932 patients met inclusion criteria for systematic review and four studies with 187 patients were included in the meta-analysis. CONCLUSIONS Treatment modalities identified were steroids, vascular agents, nootropics, antioxidants, vitamins, cell apoptosis inhibitors, and hyperbaric oxygen therapy. Meta-analysis demonstrated significant improvement in mean hearing threshold for patients with high-frequency hearing loss, those treated within 48 hours, and those receiving treatment with a nootropic agent. Significant heterogeneity was present in experimental design among included studies and many were of lower levels of evidence. More prospective, large scale, randomized, double-blinded, placebo-controlled clinical trials are required to determine optimal treatment regimens for patients suffering from aNIHL caused by AAT.

BACKGROUND There is a paucity of information regarding the incidence and survival of parotid malignancies over time. METHODS The Surveillance, Epidemiology, and End Results population-based cancer registry was queried for parotid malignancies from 1973 to 2015. RESULTS The age-adjusted incidence of parotid malignancies has increased by 58.1% (7.87-12.44 per 1 000 000). Analysis of histologic type revealed an increased annual percent change (APC) of acinar cell carcinoma (1.38) and squamous cell carcinoma (1.58), but decreased APC of adenoid cystic carcinoma (-1.63) and adenocarcinoma NOS (-0.86) (P

Objective Stapes surgery is technically challenging, yet its methodology is not standardized. We aim to elucidate preferences in stapes surgery among American Otological Society (AOS) otologists and determine if any common practice patterns exist. Study design Cross-sectional study via emailed questionnaire. Setting Surgery centers. Subjects and methods Members of the AOS were an emailed a survey to quantify variables including surgical volume, anesthetic preference, laser use, type of procedure, footplate sealing technique, antibiotic use, and trainee participation. Results Most otologists (71%) performed 2 to 5 stapes surgeries per month under general anesthesia (69%) with stapedotomy (71%) as the preferred procedure. Most (56%) used the rosette method of laser stapedotomy with manual pick debris removal for footplate fenestration. Either the handheld potassium titanyl phosphate (KTP) laser (40%) or handheld carbon dioxide (CO2) laser (33%) was used. The heat-activated memory hook (51%) was the preferred prosthesis. Footplate sealing method was variable, as was antibiotic use among respondents. Trainee participation was limited, as 42% of otologists allowed residents to place the prosthesis, and fewer allowed residents to crimp the prosthesis, and laser or drill the footplate. Surgeons with higher surgical volume (≥ 6 surgeries per month) demonstrated the following statistically significant correlations: footplate fenestration with laser in a rosette pattern and pick for debris removal (rs = −0.365, P = 0.014) and trainee participation with fellows only (rs = 0.341, P = 0.022). Conclusions Trends in various surgical decisions showed a lack of consensus in all aspects of stapes surgery.

Objective This study aims to explore and determine the effectiveness of current pharmacologic agents for the prevention of noise-induced hearing loss (NIHL) via a systematic review. Databases reviewed The PubMed, Scopus, ClinicalTrials.gov, and Cochrane Library databases were searched from inception through February 6, 2020. Methods Full-text, English-language articles detailing prospective randomized and nonrandomized clinical trials with pharmacological interventions administered to prevent NIHL were included in accordance with PRISMA guidelines. The detailed search terms are included in the Appendix, http://links.lww.com/MAO/B67. Results Eleven articles were included in this review with 701 patients receiving a pharmacologic prevention for various noise exposures. Various regimens included administration of alpha-lipoic acid, ambient oxygen, beta-carotene, carbogen, ebselen, Mg-aspartate, N-acetylcysteine, and vitamins C, E, and B12. A number of studies demonstrated statistically significant amelioration of NIHL with pharmacologic intervention. Two studies demonstrated significantly better hearing outcomes for pharmacological prophylaxis with carbogen or ebselen as compared with placebo for the 4 kHz frequency, where the noise-notch is most likely to be encountered. Given the considerable heterogeneity in agents and methodologies, however, it was not possible to conduct a meta-analysis. Conclusions While several heterogenous articles demonstrated promising results for Mg-aspartate, carbogen, vitamin B12, and alpha-lipoic acid, the clinical significance of these pharmaceuticals remains unclear. Initial data from this study alongside future clinical trials might potentially contribute to the generation of clinical practice guidelines to prevent NIHL. Level of evidence 2.

Advances in cancer prevention, screening and early detection, diagnosis, treatment, and care delivery have yielded significant improvements in survival for cancer patients and decreases in cancer-related treatment toxicity. However, these advances have been accompanied by an increasing financial burden to patient and their caregivers. Financial toxicity, which draws a parallel between the side effects of cancer treatment and the side effects of undue financial distress, is increasingly recognized as being common and a source of significant morbidity and decreased health-related quality of life for head and neck cancer (HNC) patients and their caregivers. This chapter will (1) define financial toxicity following cancer treatment, (2) estimate its incidence in HNC patients, (3) highlight key risk factors in HNC patients, (4) describe various tools for its measurement, (5) discuss the impact of financial toxicity on HNC patients, and (6) review resources on financial toxicity for patients and caregivers. Knowledge gaps and research opportunities to improve the delivery of patient-centered cancer care that is attentive to the complex issue of financial toxicity will be explored at the conclusion.

Background Diffuse Large B-Cell Lymphoma (DLBCL) of the major salivary glands is a rare high-grade malignancy that often presents with vague symptoms. This study aimed to evaluate its incidence and prognosis on a population level. Methods The Surveillance, Epidemiology, and End Results database was queried for cases of major salivary gland DLBCL. Results 896 patients had DLBCL affecting the parotid gland (78.3%) or submandibular gland (19.8%). The incidence was increasing at 1.5% (P = 0.005) per year from 1973 to 2016. 24.4% of patients underwent parotidectomy, 16% had biopsy, and the remaining provided no details of diagnostic method. Five-year disease-specific survival increased from 59.8% to 84.0%. Late-stage disease (HR = 1.7, P = 0.003) and female sex (HR = 2.1, P = 0.018) were associated with increased risk of mortality. Conclusion Despite the rising incidence of major salivary gland DLBCL, chemotherapy and radiation treatment has resulted in increasingly favorable survival outcomes. The otolaryngologist - head and neck surgeon continues to play a critical role in establishing the diagnosis of salivary gland DLBCL.

Objectives/hypothesis Carcinosarcomas represent a rare entity of mixed malignant tumors of the salivary gland with limited evidence regarding management strategies. We aim to demonstrate the incidence, prognostic factors, and conduct a survival analysis for this aggressive malignancy. Study design Retrospective database review. Methods The Surveillance, Epidemiology, and End Results database was queried for all cases of major salivary carcinosarcoma and its incidence from 1973 to 2015 to identify 66 patients. Results The incidence of this tumor was 0.02 cases per 1 million, with a rising number of absolute cases in the past 2 decades. The parotid gland was the most common site (78.8%) of involvement. The 5-year overall survival was 37% and 5-year disease-specific survival was 62%. Surgery was most common management strategy (95.5%), with total parotidectomy and facial nerve sacrifice procedures for those with parotid disease. Radiotherapy was commonly performed (75.8%) and chemotherapy use was rare (18.2%). Patients with distant metastasis had a greater than threefold increase in mortality, and those with total parotidectomy surgery had decreased mortality. Conclusions Carcinosarcomas of major salivary glands are extremely rare and highly aggressive tumors. We recommend prompt surgical management and postoperative radiation for this tumor with a poor prognosis. Level of evidence NA Laryngoscope, 130:E335-E339, 2020.

Purpose Identify variables that are independent predictors of survival in carcinoma ex pleomorphic adenoma (CXPA) of the major salivary glands using a population-based database and evaluate the incidence and management strategies for this rare malignancy. Materials and Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for all cases of major salivary gland CXPA from 1973 to 2015. Results Of the 619 patients identified, the parotid gland was the most common site of involvement (76.9%, 476/619). The reported incidence of CXPA has risen in the past decade (2005–2015, 0.24 to 0.63 per 1,000,000). The 2-year and 5-year disease-specific survival (DSS) rates were 90.3% and 80.4%, respectively. On univariate analysis, facial nerve sacrifice was not a statistically significant predictor of survival (HR = 1.213, 95% CI [0.588–2.058], P = 0.602). Patients with a tumor size >4 cm, multiple positive lymph nodes, and distant metastatic disease had a 2 to 4-fold statistically significant increase in mortality using a multivariate analysis. Statistical significance was not demonstrated in the DSS of patients who underwent partial versus total parotidectomy procedures. Conclusions CXPA is a rare salivary malignancy that has a reported increased incidence in the last decade. Tumor size >4 cm, multiple positive lymph nodes, and distant metastatic disease are predictors of disease-specific mortality. Further research should be conducted to improve early detection and survival strategies for this salivary cancer. Level of Evidence: 4.