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Objective: This study aimed to assess the safety and efficacy of endoscopic percutaneous dilatational tracheostomy (PDT) in obese and nonobese critically ill adults., Methods: A retrospective study of all cases of PDT performed at two academic health centers between 2016 and 2023 was conducted. Primary outcomes included peri- and postoperative complications stratified by both timing and severity. body mass index (BMI) data were stratified according to the World Health Organization classification (class I obesity defined as BMI ≥ 30, class II obesity ≥35 and <40, class 3 obesity ≥40)., Results: Totally 336 patients underwent a PDT, 279 of whom had available BMI data: 193 (69.2%) patients had a normal BMI, 56 (20.1%) had class I obesity, 15 (5.4%) class II obesity, and 15 (5.4%) class III obesity. The overall complication rates for the class I, II, and III obesity were 8.9%, 13.3%, and 13.3%, respectively. All procedures were successfully completed at the bedside (no conversions to an open approach), and there was no procedure-related mortality. The only accidental decannulation event was in a patient with class III obesity. There was no difference in overall complication rates between patients without obesity and patients with obesity (7.3% vs. 10.5%, respectively, p = 0.370)., Conclusion: This study significantly expands the current literature and represents one of the largest studies to date reporting on PDT in patients with obesity., Level of Evidence: 3 Laryngoscope, 134:5015-5020, 2024., (© 2024 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

We hereby present a rare case of laryngeal zoster presenting with unilateral odynophagia and hemifacial pain in an immunocompetent host. Visualization of the characteristic vesicles is challenging given their short-lived and at times delayed appearance; thus, laryngeal zoster may be a largely unrecognized cause of laryngitis and cranial neuropathies. Heightened awareness may improve prompt diagnosis, referral and initiation of antiviral therapy, while guiding patient counselling on the associated long-term sequelae such as voice and swallowing impairments, and post-herpetic neuralgia., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To present and evaluate the treatment of ciprofloxacin-resistant Pseudomonas mastoid cavity otorrhea with a ceftazidime thermosensitive poloxamer gel., Study Design: A retrospective clinical capsule report., Patients: Three patients diagnosed with ciprofloxacin-resistant Pseudomonas otorrhea in the setting of a previous canal-wall-down mastoidectomy between March 2019 and June 2023 visiting our tertiary care institution were retrospectively reviewed., Intervention: Application of a 2% ceftazidime thermosensitive poloxamer gel to mastoid cavity., Main Outcome Measures: No evidence of disease during microscopic inspection of the ear within a month of initial treatment or bacterial eradication on subsequent culture., Results: Two patients had complete resolution of symptoms and achieved a safe and dry ear after topical application of the hydrogel. The second patient had pseudomonal eradication on culture, but persistent otorrhea due to other multidrug-resistant bacteria and an anatomically unfavorable mastoid cavity, which ultimately resolved after revision surgery., Conclusions: This small case series suggests that topical treatment of mastoid cavity otorrhea with a 2% ceftazidime poloxomer gel is a potential therapeutic avenue in patients with ciprofloxacin-resistant Pseudomonas ., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Metastatic renal cell carcinoma to the thyroid is a rare yet aggressive histopathologic diagnosis, which may often be omitted from the initial clinical differential. This is in part due to the long latency period between the initial renal primary and appearance of metastatic disease, coupled with the diagnostic limitations of fine-needle aspiration biopsies. We herein present an interesting case of a metastatic clear-cell renal-cell carcinoma mimicking an aggressive primary thyroid neoplasm, 10 years after a nephrectomy for a renal primary, highlighting key diagnostic and management considerations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Recurrent and primary tracheoesophageal fistulas (TEFs) are a challenging surgical pathology to treat, as standard open surgical approaches are associated with high morbidity and mortality. As such, endoscopic modalities have gained interest as an alluring alternative, yet variable success rates have been reported in the literature. The aim of this study was to provide a contemporary update of the literature and describe our institutional experience with the bronchoscopic obliteration of recurrent and primary TEFs., Methods: Retrospective chart review of all pediatric patients having undergone endoscopic TEF repair at two pediatric academic centers in Montreal, Canada and Lille, France between January 1, 2008 to December 31, 2020., Results: 28 patients with TEFs (20 recurrent, 8 primary) underwent a total of 48 endoscopic procedures. TEF repair was performed under endoscopic guidance using various combinations of techniques, including fistula de-epithelialization (endoscopic brush, thulium laser, trichloroacetic acid-soaked pledgets or electrocautery), tissue adhesives, submucosal augmentation, esophageal clip and stenting. Successful closure was achieved in 16 patients (57 %), while 12 (43 %) required eventual open or thoracoscopic repair. The mean number of endoscopic procedures was 1.7. There were no major treatment-related complications such as pneumothorax, mediastinitis or death (mean follow-up 50.8 months)., Conclusions: Endoscopic repair of recurrent or primary TEFs is a valuable component of our therapeutic armamentarium and may contribute to decreased surgical morbidity in this complex patient population. Families should be counselled that endoscopic results may be more modest than with open or thoracoscopic approaches, and multiple procedures may be required., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

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Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To evaluate and compare perioperative outcomes of percutaneous bone-anchored hearing implant (BAHI) surgery in syndromic and nonsyndromic pediatric patients., Study Design: Retrospective cohort study., Setting: McGill University Health Centre in Montreal, Quebec, Canada., Patients: Forty-one pediatric patients (22 syndromic, 19 nonsyndromic) who underwent percutaneous BAHI surgery between March 2008 and April 2021., Intervention: Percutaneous BAHI surgery., Main Outcome Measures: Patient demographics (age at surgery, gender, implant laterality), operative information (American Society of Anesthesia [ASA] score, anesthesia type, surgical technique, implant/abutment characteristics), and postoperative outcomes (implant stability, soft tissue integrity, surgical revisions, implant failure)., Results: The most frequent syndromes among implanted patients were Treacher Collins (27.3%), Goldenhar (13.6%), Trisomy 21 (13.6%), and Nager (9.1%). Syndromic patients were more frequently given higher ASA scores: 2 ( p = 0.003) and 3 ( p = 0.014). All cases of implant extrusion were in syndromic patients: two posttraumatic and two failures to osseointegrate. Nine (40.9%) syndromic patients experienced a Holgers Grade 4 skin reaction at one of their postoperative follow-up visits as compared to 0% of nonsyndromic patients ( p < 0.001). Implant stability was similar between cohorts at all postoperative time-points, except for significantly greater nonsyndromic implant stability quotient scores at 16 weeks ( p = 0.027) and 31+ weeks ( p = 0.016)., Conclusions: Percutaneous BAHI surgery is a successful rehabilitation option in syndromic patients. However, it presents a relatively higher incidence of implant extrusion and severe postoperative skin reactions as compared to nonsyndromic patients. In light of these findings, syndromic patients may be great candidates for novel transcutaneous bone conduction implants., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

We hereby present the first-reported pediatric case of a hard palate neurovascular hamartoma in a male newborn, in which the diagnosis was established following an initial nondiagnostic biopsy, extensive radiological investigations, and eventual wide local excision. These benign lesions can easily be mistaken for malignant diagnoses, leading to increased parental and child anxiety as well as avoidable diagnostic and therapeutic interventions.

Objective: This study investigates the physical properties upon immersion of two gelatin sponges commonly used in otologic surgery., Background: Absorbable gelatin sponges are often used in middle ear surgery to achieve hemostasis and, perhaps more importantly, to provide a "scaffolding" to support ossicular chain and/or tympanic membrane reconstructions. Their rate of dissolution may therefore affect the success of tympanic membrane closure., Methods: An in vitro study was conducted to quantify the material changes of two absorbable gelatin sponges, a standard-density sponge and one with fewer collagen cross-linkages (low-density sponge). Volume loss (%) in 0.9% saline, 0.3% ciprofloxacin, and/or 0.1% dexamethasone as single-agent otic drops in a combination formulation was measured at 15-minute intervals for the first hour and at days 1, 3, and 5 postimmersion. Secondary end points included compressibility, porosity under microscopy, and infrared spectroscopy analysis., Results: The low-density sponge immersed in any of the three otic solutions showed a statistically significant greater volume loss at all time points when compared with the standard-density sponge (27.2% ± 5.4% vs. 15.4% ± 6.0% at 15 minutes and 44.8% ± 5.1% vs. 34.6% ± 2.9% at 5 days, p < 0.001). Interestingly, both sponges immersed in normal saline had lost almost half of their original volume after 15 minutes when compared with samples immersed in an otic solution (48.3% ± 4.6% vs. 21.3% ± 8.3%, respectively, p < 0.001)., Conclusion: The standard-density sponge immersed in an otic solution of ciprofloxacin, dexamethasone, or a combination formulation best maintained its structural integrity. Ancillary in vivo studies are required to assess the hemostatic properties, surgical outcomes, and middle ear synechiae of the above study conditions., Level of Evidence: Foundational evidence., Competing Interests: The authors acknowledge support from Canada Research Chair Foundation, McGill Engineering Undergraduate Student Masters Award (MEUSMA), Fonds de Recherche du Québec Nature et Technologies (FRQNT), and Quebec Centre for Advanced Materials (CQMF). The authors disclose no conflicts of interest., (Copyright © 2023, Otology & Neurotology, Inc.)

The incidence of all head and neck malignancies is rising worldwide, with carcinoma of the larynx constituting approximately 1% of all cancers. Early glottic cancer responds quite favorably to surgical intervention due to its early presentation, coupled with the low rate of regional and distant metastases. This article focuses on various approaches to the surgical treatment of early glottic cancer. Details include the clinical and radiological evaluation of laryngeal cancer, the goals of treatment, current surgical options for early disease, approach to surgical resection margins and management of nodal disease, and complications associated with each treatment modality., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Importance: Obesity has traditionally been described as a relative contraindication to percutaneous dilatational tracheostomy (PDT). Increased familiarity with the technique and use of bronchoscopy or real-time ultrasonography to enhance visualization have led many practitioners to expand the indication for PDT to patients historically deemed to have high risk of perioperative complications., Objective: To assess the reported complication rate of PDT in critically ill adults with obesity and compare it with that of open surgical tracheostomies (OSTs) in this patient population and with that of PDT in their counterparts without obesity., Data Sources: In this systematic review and meta-analysis, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy and obesity were included., Study Selection: Original investigations of critically ill adult patients (age ≥18 years) with obesity who underwent PDT that reported at least 1 complication of interest were included. Case reports or series with fewer than 5 patients were excluded, as were studies in a language other than English or French., Data Extraction and Synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were used, with independent extraction by multiple observers. Frequencies were reported for all dichotomous variables. Relative risks for complications were calculated using both fixed-effects and random-effects models in the meta-analysis., Main Outcomes and Measures: Main outcomes included mortality directly associated with the procedure, conversion to OST, and complications associated with the procedure (subclassified into life-threatening or non-life-threatening adverse events)., Results: Eighteen studies were included in the systematic review, comprising 1355 patients with obesity who underwent PDT. The PDT-related complication rate was 16.6% among patients with obesity overall (791 patients, 17 studies), most of which were non-life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies) were aborted or converted to an OST. A meta-analysis of 12 studies (N = 4212; 1078 with obesity and 3134 without obesity) showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity (risk ratio, 1.78; 95% CI, 1.38-2.28). A single study compared PDT with OST directly for critically ill adults with obesity; thus, the intended meta-analysis could not be performed in this subgroup., Conclusions and Relevance: The findings suggest that the rate of complications of PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.

Background: Oropharyngeal squamous cell carcinoma (OPSCC) patients are burdened by the effect of the disease process and treatment toxicities on organs important in everyday activities, such as breathing, speaking, eating, and drinking. There is a rise in OPSCC due to human papilloma virus (HPV)-associated OPSCC, affecting younger and healthier patients and with a better overall prognosis. Emphasis must be shared between oncologic outcomes and the effects on quality of life. While there have been efforts to study global and physical quality of life, the impact on psychosocial quality of life has not yet been specifically reviewed. Methods: A scoping review methodology was employed to explore the emotional, social, and mental quality of life in OPSCC patients and determine the impact of HPV status or treatment modalities. Results: Eighty-seven full-text articles were evaluated for eligibility. Fifteen articles met final inclusion criteria. The majority of the studies were conducted in the United States (n = 10) and study methodology was divided between cross-sectional (n = 6), prospective (n = 5), and retrospective studies (n = 4). Four psychosocial quality of life themes were explored: the impact on mental health and emotional wellbeing, social wellbeing and function, stress, and relationship and sexual behavior. Eighteen different patient-reported outcome measures were used, including both general head and neck oncology questionnaires and symptom-specific surveys. Conclusion: There is a paucity of research regarding the effect of OPSCC on patients' psychosocial quality of life. Learning more about this component of quality of life can guide outreach programs and multidisciplinary involvement in improving patient care.

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cervicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial., Objectives: This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges., Methods: A modified three-iterative Delphi method was used to establish expert recommendations on the diagnostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature., Setting: Multinational, multi-institutional, tertiary pediatric hospitals., Results: Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation., Conclusion: The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Objective: Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion., Methods: As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications., Results: Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting., Discussion: Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety., Implications for Practice: This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

The prevalence of oropharyngeal squamous cell carcinoma has been increasing in North America due to human papillomavirus-associated disease. It is molecularly distinct and differs from other head and neck cancers due to the young population and high survival rate. The treatment regimens currently in place cause significant long-term toxicities. Studies have transitioned from mortality-based outcomes to patient-reported outcomes assessing quality of life. There are many completed and ongoing trials investigating alternative therapy regimens or de-escalation strategies to minimize the negative secondary effects while maintaining overall survival and disease-free survival. The goal of this review is to discuss the most recent advancements within the field while summarizing and reviewing the available evidence.

Importance: Patient education and engagement is a pivotal component of surgical recovery. Ensuring proper patient education involves a thorough understanding of one's diagnosis and recovery plan, while reducing language and learning barriers to help patients make informed decisions and improve their hospital experience., Objective: To assess whether using an animated surgical guide will help patients who are undergoing head and neck surgery feel more satisfied with their surgery and recovery process., Design, Setting, and Participants: A randomized clinical trial was conducted between January and August 2020 at a single tertiary care academic center in Montreal, Canada. A consecutive sample of individuals who were undergoing any of the following surgical procedures was recruited: head and neck cancer resection with or without reconstruction, parotidectomy, thyroidectomy, parathyroidectomy, laryngectomy, or transoral robotic resection. The treating team was masked to group allocation, while study participants in the nonintervention group were unaware of the multimedia platform to avoid introducing bias in their survey responses., Interventions: Patients were randomly allocated to either the treatment arm, in which they obtained access to a multimedia patient education platform, or the control arm, in which they received traditional patient education methods via clinical visits., Main Outcomes and Measures: Primary analysis compared patient satisfaction scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire INFO 25, a validated questionnaire on the perceived quality of information received by patients with cancer (possible scores ranging from 20 to 80)., Results: A total of 100 patients (50 in each arm; 63 women [63%]; 6 African American [6%, 12 Hispanic/Latino [12%], 11 Middle Eastern [11%], and 78 White [78%] individuals) completed the preintervention and postintervention questionnaires. In those who received access to the patient education platform, there was an 11.3-point (Cohen d = 1.02; control group score, 61.1 of 80; treatment group score, 72.4 of 80) difference of greater postoperative satisfaction scores at 1 month. While both groups felt that they received an adequate amount of information concerning their disease process, patients in the treatment arm had significantly better satisfaction with information concerning their medical tests, treatments, and other services., Conclusions and Relevance: This randomized clinical trial of patients undergoing head and neck cancer treatment demonstrates that multimedia patient education platforms may enhance current traditional methods, providing complementary information on patients' treatment plans and recovery process, mental health, family life, and supplementary services. Further research is currently underway to confirm whether this platform will lead to decreased hospital stay, shorter complication rates, and long-term effects., Trial Registration: ClinicalTrials.gov Identifier: NCT04048538.

Objective  The continually evolving coronavirus disease 2019 (COVID-19) pandemic has created a dire need for rapid reorganization of health care delivery within surgical services. Ensuing initial reports of high infection rates following endoscopic sinus and skull base surgery, various expert and societal guidelines have emerged. We hereby provide a scoping review of the available literature on endoscopic sinus and skull base surgery, exploring both the risk of aerosolization and expert recommendations on surgical management during the pandemic. Methods  A literature search of the PubMed database was performed up until May 9th, 2020. Additionally, websites and published statements from otolaryngology associations were searched for recommendations. This scoping review followed the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews. Results  A total of 29 peer-reviewed publications and statements from expert recommendations or professional associations were included. Current expert guidance relies mainly on scarce, anecdotal evidence, and two cadaveric studies, which have demonstrated potential aerosolization during transnasal surgery. General consensus exists for delaying surgery when possible, ascertaining COVID-19 status preoperatively and donning of adequate personal protective equipment by all operating room staff (including at minimum an N95 mask). Cold, nonpowered surgical instruments are deemed the safest, while thermal instruments (electrocautery and laser) and high-speed drills should be minimized. Conflicting recommendations emerge for use of microdebriders. Conclusion  Endoscopic sinus and skull base surgery impart a potential risk of aerosolization. Hence, surgical indications, protective measures for health care workers, and surgical instrumentation must be adapted accordingly in the COVID-19 context., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Background: Although the pathogenesis and epidemiology of endemic Burkitt lymphoma (bl) have been extensively studied, the epidemiologic landscape of sporadic and immunodeficiency-associated bl in North America remains poorly understood., Methods: We used 3 distinct population-based cancer registries to retrospectively study bl incidence and mortality in Canada. Data for patient sex; age at the time of diagnosis; and reporting province, city, and forward sortation area (fsa, the first three characters of a postal code) were analyzed., Results: During 1992-2010, 1420 patients with bl in Canada were identified (incidence rate: 2.40 cases per million patient-years), of which 71.1% were male patients. Mean age at diagnosis was 55.5 ± 20.8 years. A bimodal incidence by age distribution was seen in both sexes, with pediatric- and adult-onset peaks. An analysis based on fsas identified select communities with statistically higher rates of adult bl. Several of those fsas were located within the 3 major metropolitan areas (Montreal, Vancouver, Toronto) and within self-identified lgbtq communities. The fsas with a higher socioeconomic status score were associated with lower rates of bl., Conclusions: Current results highlight the geographic and historic pattern of bl in Canada. The human immunodeficiency virus remains an important risk factor for adult bl., Competing Interests: CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none., (2020 Multimed Inc.)

Background: Suboptimal pain management is a common, yet largely unrecognized, problem in the postsurgical patient population. Current treatment protocols heavily rely on opioid use and, though generally effective in providing pain relief, are associated with multiple side effects. The present systematic review aims to offer plastic surgeons insight into the current state of literature on prolonged local anesthetic wound infusion regimens, evaluating both their efficacy in lowering pain scores and the potential opioid-sparing effect., Methods: A comprehensive literature search of the Medline, Embase, and Cochrane Library databases was performed to identify relevant studies published between 1980 and December 2017 evaluating the use of prolonged local anesthetic wound infusion for postoperative pain management in plastic surgery., Results: A total of 28 articles were selected, including 3904 patients. The overall infection rate in all patients treated with postsurgical local anesthetic wound infiltration was 0.28% (7/2536). There were no reported cases of systemic toxicity. An opioid-sparing effect was found in 92% (12/13) of studies when compared to an active comparator and 88% (7/8) of those comparing to placebo. Pain scores were decreased in 90% (9/10) of studies comparing wound infiltration to narcotic-based regimens and in 67% (6/9) of those comparing to placebo., Conclusions: Continuous or intermittent wound infusion is safe and effective in reducing pain scores and opioid consumption in plastic surgery. Though the overall pain-lowering effect appears to be modest, ease of catheter insertion and patient satisfaction make this technique an alluring alternative to more validated approaches such as neuraxial or peripheral nerve blocks.

Medulloblastoma is the most common pediatric malignant brain tumor and carries a relatively grim prognosis despite recent advances in multimodality therapy. Delays in diagnosis and treatment initiation may contribute to worst outcomes. Signs of increased intracranial pressure and ataxia are known presentations of posterior fossa tumors, but sensorineural hearing loss (SNHL) is a seldom reported symptom. We report the case of a 2-year-old girl who had progressive unilateral SNHL since birth, which was later found to have a posterior fossa medulloblastoma when a head magnetic resonance imaging was ordered following subsequent progression to bilateral hearing impair. We further report our review of 17 additional cases of medulloblastoma presenting with SNHL and their associated head and neck findings. The present study provides insight into the current state of the literature on this rare symptom of a commonly encountered diagnosis, while highlighting the need to consider dedicated brain imaging in pediatric unilateral SNHL when a syndromic etiology or inner ear anomaly is not readily identified on initial investigations., (Copyright © 2019 Elsevier B.V. All rights reserved.)