Search

Introduction: Peritonsillar abscesses form between the tonsillar capsule, the superior constrictor, and palatopharyngeus muscles. Physicians traditionally make this diagnosis clinically; however, ultrasound allows clinicians to further identify and differentiate between peritonsillitis, peritonsillar abscess, and phlegmon formation. By increasing both the sensitivity and specificity, ultrasound improves the diagnostic accuracy for patients with peritonsillar abscesses. This case demonstrates the utilization of ultrasound in peritonsillar abscesses and the application of point-of-care ultrasound (POCUS) in identifying complications of procedures used for treatment in the emergency department (ED).Case Report: A 19-year-old male presented to the ED with complaints of severe sore throat and fever for the prior five days. A POCUS using an endocavitary probe with sterile cover demonstrated hypoechoic debris with a “swirl sign.” Ultrasound was used to successfully guide needle aspiration by using in-plane needle guidance. The patient had significant bleeding after needle aspiration, and repeat POCUS clearly identified a new pocket of blood that had formed and was contained in the soft tissue. We monitored the size of the hematoma in real time with ultrasound to ensure the hematoma had no rapid expansion and was stable.Conclusion: Among the differential diagnoses for sore throat, the diagnosis of peritonsillar abscess is particularly concerning as it is both common and generally requires swift intervention. Presentations can range from a mild infection to a life-threatening emergency with potential airway compromise. The two primary avenues for treatment include either needle aspiration or incision and drainage. Ultrasound can successfully identify the abscess and other landmarks for safe and successful drainage, as well as early identification of complications.

Otolaryngologists frequently serve as the first touchpoint for patients presenting with dermatologic conditions of the head and neck. This study aims to identify and quantify gaps in dermatologic training among otolaryngology residents, and to assess their diagnostic accuracy in comparison to dermatology residents. It comprised 14 multiple-choice questions focused on common dermatologic diagnoses related to the head and neck. Sixty-one dermatology and 36 otolaryngology residents participated in the study. Dermatology residents significantly outperformed otolaryngology residents, with average scores of 90% (SD = 8) compared to 71% (SD = 10) (P

Background: Published best‐practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines. Aims: To provide an up‐to‐date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech–language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs). Methods & Procedures: ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis. Outcomes & Results: Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory–perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory–perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs). Conclusions & Implications: Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis. WHAT THIS PAPER ADDS: What is already known on the subject: Best‐practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni‐disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge: This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work?: This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced‐based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best‐practice guidelines. [ABSTRACT FROM AUTHOR]

Objective: Extended reality (XR) has increasing usage in medicine, especially surgical fields, but the scope of applications is largely limited to intraoperative navigation. The aim of this scoping review is to evaluate all the available literature on how XR technologies have been applied to otolaryngology—head and neck surgery (OHNS) beyond the operating room for applications such as patient education and interdisciplinary communication. Review Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we systematically searched PubMed and Scopus. Studies were reviewed without temporal restriction. Inclusion criteria comprised English-language, peer-review papers or conference abstracts studying XR technologies for non-operative uses such as patient education, physician training, or interdisciplinary preoperative planning in the field of OHNS. Results: Database searching initially identified 1607 records. After filtering for duplicates, screening for relevance, and applying the inclusion criteria, 10 studies were ultimately included. This study identifies gaps in the existing literature and describes future applications and key areas of research. XR is a novel strategy for increasing patients' comprehension of their procedures and can facilitate improved communication and planning amongst a multidisciplinary surgical team during preoperative discussions. However, the existing literature is small in scale and has low statistical power for demonstrating clinical benefits. Conclusions: More robust studies are required to determine the true value of implementing XR. XR is a promising new technology with potential to advance education and patient care in OHNS. Ongoing research will continue to optimize the use of XR technology, ensuring safe and effective integration into clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. Methods: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. Results: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. Conclusion: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the accuracy of information provided by ChatGPT-4o to patients about tracheotomy. Methods: Twenty common questions of patients about tracheotomy were presented to ChatGPT-4o twice (7-day intervals). The accuracy, clarity, relevance, completeness, referencing, and usefulness of responses were assessed by a board-certified otolaryngologist and a board-certified intensive care unit practitioner with the Quality Analysis of Medical Artificial Intelligence (QAMAI) tool. The interrater reliability and the stability of the ChatGPT-4o responses were evaluated with intraclass correlation coefficient (ICC) and Pearson correlation analysis. Results: The total scores of QAMAI were 22.85 ± 4.75 for the intensive care practitioner and 21.45 ± 3.95 for the otolaryngologist, which consists of moderate-to-high accuracy. The otolaryngologist and the ICU practitioner reported high ICC (0.807; 95%CI: 0.655–0.911). The highest QAMAI scores have been found for clarity and completeness of explanations. The QAMAI scores for the accuracy of the information and the referencing were the lowest. The information related to the post-laryngectomy tracheostomy remains incomplete or erroneous. ChatGPT-4o did not provide references for their responses. The stability analysis reported high stability in regenerated questions. Conclusion: The accuracy of ChatGPT-4o is moderate-to-high in providing information related to the tracheotomy. However, patients using ChatGPT-4o need to be cautious about the information related to tracheotomy care, steps, and the differences between temporary and permanent tracheotomies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the platelet-rich plasma (PRP) effectiveness in patients with a long-lasting postviral olfactory dysfunction (LPOD). Methods: Forty-three consecutive patients with a long-lasting postviral OD were prospectively recruited. The injection of 1 mL of PRP was carried out in both olfactory clefts. The pre- to 6-month post-PRP injection change in olfaction was assessed with the olfactory disorder questionnaire (ODQ) and the threshold, discrimination, and identification (TDI) tests. Results: Forty-three patients received bilateral PRP injections (24 females). The mean age of patients was 58.9 ± 16.8 years. The mean duration of LPOD was 8.7 years. The pre to 6-month post-injection mean TDI significantly improved from 10.3 ± 10.2 to 20.12 ± 12.07 (p = 0.001). The mean ODQ significantly decreased from 29.8 ± 13.0 to 23.4 ± 11.3 (p = 0.013). The average change of the TDI and the ODQ were 9.8 and 6.4, respectively. Age was inversely associated with the 6-month threshold score. Conclusion: PRP appears to be a promising therapeutic strategy for long-lasting postviral OD. Our findings support the conduction of controlled randomized trial in this population of patients. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) patients often have dysphagia following surgical and/or chemoradiation treatment, which can lead to reduced quality of life. Some patients suffer from decreased tongue strength and mobility that may cause discomfort and difficulty with swallowing. Our group has developed a patented genioglossus muscle strength trainer (GMST) to increase tongue protrusive force that has been used in patients with sleep apnea. We hypothesized that the GMST device would increase tongue strength in the HNC population. Methods: We conducted an IRB approved, non-randomized, interventional clinical trial of HNC patients with dysphagia to determine the effect of GMST on tongue strength. Our secondary objective was to assess dysphagia quality of life, as determined by questionnaires. Genioglossus muscle strength measurements (measured in Newtons, N) and dysphagia quality of life scores (SWAL-QoL questionnaire) were obtained from enrolled patients at baseline and following 4 weeks of intervention. Treatment was at-home GMST exercise regimen 3 times daily, 5 days per week. Compliance was assessed via review of training logs. Two-sided paired t -tests at significance level α =.05 were performed to assess difference in mean GG muscle strength pre- and post-treatment. Results: Out of 10 patients initially enrolled, 7 patients completed the trial. Eighty-six percent were male and the average age was 60. About 5 patients had surgery plus adjuvant radiation and 2 patients had primary radiation. All patients had baseline dysphagia as determined by patient complaint and/or objective measurement (prior modified barium swallow). No adverse events were reported. We observed a statistically significant increase in genioglossus muscle strength (mean change: 4.0 N, 95% CI 1.1-6.9, P =.015) after 4 weeks of treatment. Patients reported reduced swallowing burden and feeling of stigma around eating based on SWAL-QoL results. Conclusions: Our data suggest that protrusive tongue-training exercises utilizing a novel tongue trainer device is well-tolerated and increases genioglossus muscle strength in treated HNC patients complaining of dysphagia. Patient-reported outcomes based on the SWAL-QoL survey indicate improvements in quality-of-life post-treatment, although our results are limited by small sample size. Larger studies are needed to see if this device could have clinically meaningful results for this difficult-to-treat patient population. [ABSTRACT FROM AUTHOR]

Introduction: This quality improvement initiative is a continued pursuit to optimize outcomes by iteratively improving our opioid sparing anesthesia protocol for tonsillectomy with or without adenoidectomy at our pediatric ambulatory surgical center through data driven Plan‐Do‐Study‐Act cycles. Methods: From 1/2015 through 12/2023, our standardized tonsillectomy protocol underwent nine procedure‐specific perioperative Plan‐Do‐Study‐Act cycles, three procedure‐specific postoperative prescription Plan‐Do‐Study‐Act cycles, and four general ambulatory surgical center enhanced recovery Plan‐Do‐Study‐Act cycles. We analyzed data from the medical record using statistical process control charts. The primary outcome measure was the percent of patients requiring intravenous opioid in the post anesthesia care unit. Secondary outcomes included maximum post anesthesia care unit pain score, the percent of patients requiring treatment for nausea and/or vomiting in the post anesthesia care unit, and the number of postoperative opioid prescription dosages. Balancing measures were average post anesthesia care unit length of stay, percent of patients with prolonged Post Anesthesia Care Unit length of stay (>120 min), and 30‐day reoperation rate. Results: A total of 5654 tonsillectomy with or without adenoidectomy cases were performed at our ambulatory surgical center from 2015 to 2023. The incidence of intravenous opioid administered in the post anesthesia care unit initially rose with opioid free anesthesia launch, but subsequently decreased below the target of 10%. Maximum post anesthesia care unit pain scores rose from mean 3.6 to 4.5, but subsequently returned to the baseline of 3.5, while the incidence of postoperative nausea and/or vomiting improved. The average post anesthesia care unit length of stay increased by 10 min with opioid free anesthesia; however, prolonged post anesthesia care unit stay and 30‐day reoperation rates were unchanged. Conclusions: The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay. [ABSTRACT FROM AUTHOR]

Background: Acute rhinosinusitis (ARS) is one of the most encountered conditions in primary care and otolaryngology clinics. However, little is known about how antibiotic prescription practices following a diagnosis of ARS compare to guidelines set forth by the American Academy of Otolaryngology in 2015. Objective: To investigate the epidemiology of ARS and the corresponding antibiotic prescribing practices by physicians and compare to published guidelines. Methods: Using the TriNetX Live database, we identified all patients diagnosed with ARS using the ICD10 code J01 between April 2015 and December 2022 across the state of Tennessee. After investigating the demographics of this cohort, we compared the first prescribed antibiotic within one day of ARS diagnosis to published guidelines. Antibiotics were grouped into their respective classes. Results: Of 81 310 patients diagnosed with ARS identified in the specified time frame, 66% were Female, 49% were African American, 44% were White, and the mean age was 47 ± 20 years. The six most common initial antibiotics prescribed for ARS were erythromycins/macrolides [14 609 (25.8%)], amoxicillin/clavulanate [14 322 (25.3%)], amoxicillin [9300 (16.4%)], third generation cephalosporins [7733 (13.6%)], quinolones [3648 (6.4%)] and tetracyclines [2235 (3.9%)]. Of this cohort, 56 719 patients (69.8%) of patients were prescribed an antibiotic within one day of diagnosis. Conclusion: Despite published guidelines recommending amoxicillin with or without clavulanic acid as first-line treatment for ARS, only 42.2% of prescribed antibiotics followed this guideline in our cohort. While accounting for patients with penicillin allergy, the second-most represented antibiotics were erythromycins/macrolides, which are specifically recommended against due to high rates of S. Pneumonia e resistance. Our results suggest that further investigation into the causes of erythromycin/macrolide prescriptions as first line treatment for ARS and practices at other institutions should be conducted. In addition, building awareness around published ARS guidelines for physicians may be useful in improving antibiotic stewardship in treatment of ARS. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU 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.)

Background: While other otolaryngology subspecialties have established female authorship trends, there is no comprehensive study within head and neck surgery (HNS). Methods: Five researchers recorded the gender identity of first and senior authors from HNS subspecialty papers (head and neck oncology, endocrine surgery, salivary gland pathology, and microsurgery) derived from 10 journals in otolaryngology and oncology in the years 2013, 2016, 2019, and 2022. Results: From 3457 articles, 6901 unique author identities were analyzed. Female authors represented 32% (N = 1103) of first authors and 20% (N = 690) of senior authors. Female authors were less likely to publish in microvascular and reconstructive surgery. Senior female authors were more likely to publish in higher impact journals than male senior authors, and first female authors had an increased likelihood of funding compared to their male counterparts. Conclusions: While female authors remain underrepresented in certain literature, we illustrate promising trends in productivity, funding allocation, and impact. [ABSTRACT FROM AUTHOR]

Objective: (1) Describe short and long‐term opioid prescribing patterns and variation after common otolaryngologic procedures and (2) assess risk factors for chronic opioid use in this cohort. Study Design: Retrospective cohort. Setting: Optum's deidentified Integrated Claims‐Clinical data set. Methods: An adult cohort of patients undergoing common otolaryngology procedures from 2010 to 2017 was identified. Associations between procedure and other covariates with any initial opioid prescription and continuous opioid prescriptions were assessed with multivariable modeling. Opioid use was defined as continuous if a new prescription was filled within 30 days of the previous prescription. A time‐to‐event analysis assessed continuous prescriptions from the index procedure to end of the last continuous opioid prescription. Results: Among a cohort of 19,819 patients undergoing predominately laryngoscopy procedures (12,721, 64.2%), 2585 (13.0%) received an opioid prescription with variation in receiving a prescription, daily dose, and total initially prescribed dose varying by procedure, patient demographics, provider characteristics, and facility type. Opioids were prescribed most frequently after tonsillectomy (45.4%) and least frequently after laryngoscopy with interventions (3.9%), which persisted in the multivariable models. Overall rates of continuous use at 180 and 360 days were 0.48% and 0.27%, respectively. Among patients receiving an initial opioid prescription, maintaining continuous prescriptions was associated with tonsillectomy procedures, age (adjusted hazard ratio [aHR]: 0.997 per year, 95% confidence interval [CI]: 0.993‐0.999), opioid prescriptions 6 months preprocedure (aHR: 0.42, 95% CI: 0.37‐0.47), and nonotolaryngology initial prescribers (aHRs: <1, P <.05). Conclusion: There is substantial variation in initial prescribing practices and continuous opioid prescriptions after common Otolaryngology procedures, but the overall rate of maintaining a continuous prescription starting after these procedures is very low. Level of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patients' satisfaction with opioid versus opioid‐sparing postoperative analgesia in patients undergoing outpatient head and neck surgery. Study Design: Prospective randomized trial. Setting: Tertiary care academic hospital. Methods: Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First‐ and second‐line medications were the following by group (1) Hydrocodone‐acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone‐acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction. Results: One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0‐10, [7.7, 8.3, 8.5, P =.46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P =.978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P =.682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups. Conclusion: In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid‐sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient's perception of care. [ABSTRACT FROM AUTHOR]

Background Foreign bodies (FBs) in the ears and nose are common presentations among paediatric patients, necessitating prompt and appropriate management to avoid potential complications. Objective This article presents a standardised approach for FB retrieval based on local clinical data from a tertiary paediatric centre, addressing the challenges of identifying patients requiring specialist referral. Discussion The approach involves a detailed initial consultation and succinct examination to determine the most suitable retrieval method. Patient preparation and equipment availability are key to successful outcomes. A combination of microsuction and alligator forceps with adequate illumination is strongly recommended, along with various adjunct tools commonly available. Urgent referral to otorhinolaryngology is indicated for button batteries and previous failed attempts. This comprehensive approach seeks to achieve successful FB removal and optimise patient outcomes in both community and hospital settings. [ABSTRACT FROM AUTHOR]

Background: Usually non-pathogenic in immunocompetent individuals, mucormycosis is an aggressive, angio-invasive fungus. It is a rare, opportunistic infection belonging to the zygomycete family. The second wave of COVID-19 saw the emergence of a more dangerous and a potentially deadly invasive fungal sinusitis evolving in rhino-cerebral mucormycosis thus compounding and complicating the pandemic. Alarming and exponential rise in the number of cases of rhino-cerebral mucormycosis in India versus the rest of the world when the treatment protocols essentially remained the same needs to be probed scientifically along with its prompt management. Here an attempt has been made to explore this in the study of 50 cases of rhino-cerebral mucormycosis. This study aims to explore the cause and extension of the disease along with its treatment and outcome in 50 cases of post COVID rhino-cerebral mucormycosis. Results: This is a retrospective cohort study conducted on 50 patients with post COVID-19 invasive mucormycosis of the paranasal sinuses with extension to surrounding structure visiting Otorhinolaryngology department at Acharya Vinoba Bhave Rural Hospital, Wardha. Among 50 patients, 86% males in 4th to 7th decade with mean age of 51.08 years. Large majority had mild–moderate severity on high-resolution computed tomography thorax with 84% having uncontrolled diabetes and 18% newly diagnosed diabetic cases. Seventy-two percent had history of steroid intake for COVID-19 management. Maxillary sinus was most commonly involved sinus in 94% cases while 32% had commonest extra nasal spread hard palate. Seventy-eight percent of the post operated mucormycosis cases are alive with no recurrence, 8% are alive and had recurrence of the disease while 14% resulted in death. Conclusion: Effective management and control of the infection can be achieved with the use of strong antibiotics, oral or systemic antifungal drugs, extensive surgical excision of diseased tissue, and addressing underlying risk factors can effectively manage and control the infection. This approach results in positive outcomes and reduced morbidity compared to the time prior to the COVID-19 pandemic including cases with extensive disease. [ABSTRACT FROM AUTHOR]

Objectives: While flipped classroom instruction has repeatedly shown efficacy in undergraduate medical education, evidence for its utility in procedural domains remains sparse. This holds particular significance for surgical subspecialties such as otolaryngology, which have limited time in undergraduate medical curricula. We designed a novel airway management skills simulation course with a flipped classroom approach and evaluated its efficacy in a pilot study. Methods: A simulation course was designed to provide instruction in seven airway management skills: bag valve mask ventilation, laryngoscopy, intubation, cricothyroidotomy, tracheotomy, and tracheostomy care. Publicly available YouTube videos were selected as pre-learning materials. Participating students completed surveys before the pre-learning assignment and after completion of the simulation center workshop. Results: Sixteen students participated in the workshop, and data was collected from 14 participants. Learners reported significant improvements in knowledge regarding all covered skills except tracheotomy; mean self-rated knowledge improved from 2.9 to 5.8 (p < 0.001) on a scale from 0 to 10. Significant increases in self-reported confidence in performing all seven skills were also observed, with an overall increase from 1.1 to 5.7 (p < 0.001). Students also rated all elements of the workshop highly, including a prevailing belief that the pre-learning materials markedly enhanced their learning. Conclusion: Our novel framework for skills-based education using a flipped classroom approach demonstrated remarkable efficacy in improving learner knowledge and self-reported confidence regarding airway management skills. This educational design, including the use of high-quality, publicly available pre-learning videos, has significant implications for undergraduate medical education in surgical subspecialties. [ABSTRACT FROM AUTHOR]

Objective: To review the current literature about surgical treatments of pediatric bilateral vocal fold paralysis (PBVFP). Methods: A systematic review of the current literature in PubMed, Scopus, and Cochrane Library regarding etiologies and management of PBVFP was performed until November 2023 according to PRISMA statements. Quality assessment was assessed with Methodological Index for Non-Randomized Studies (MINORS) tool. Results: Of the 211 screened articles, 26 were included accounting for 320 patients. The etiologies included idiopathic (42.2%), congenital (19.7%), neurological (16.9%), or post-surgical (9.5%) pediatric bilateral vocal cord paralysis (PBVCP). Patients were decannulated in 76.7% of cases without laryngeal procedure. Decannulation was achieved in 84.6%, 66.6%, 83.3%, 80.0%, and 62.5% of cases of laterofixation of the vocal fold, cricoid split approaches, partial or total arytenoidectomy, uni- or bilateral transverse cordotomy, and selective laryngeal reinnervation, respectively. Dyspnea/stridor relief, swallowing, or voice quality outcomes were used in some studies, which reported conflicting results. Revision and complications varied between studies, with complications mainly involving edema, granuloma, or aspirations. Revision was required in 6.4%, 12.9%, and 40.0% of cases that underwent laterofixation of the vocal fold, arytenoidectomy, and cricoid split procedures, respectively. There was substantial heterogeneity across studies in inclusion criteria, procedures, and outcomes. Conclusion: The management of PBVFP may involve several temporary or permanent surgical procedures that are associated with overall subjective improvements of symptoms, and laryngeal findings. The retrospective design of studies, the small number of cohorts, the lack of objective outcomes, and the differences between teams regarding procedure timing and features limit drawing reliable conclusions about the superiority of one technique over others. [ABSTRACT FROM AUTHOR]

Objective: The surgical strategy of cholesteatomas is still controversial. This study aimed to compare the hearing improvement and determine the prognostic factors between endoscopic and microscopic ear surgery for attic cholesteatoma via a multicenter retrospective study. Methods: This retrospective study included 169 patients with attic cholesteatoma who received endoscopic ear surgery (EES) or microscopic ear surgery (MES) from 12 otorhinolaryngology centers. Hearing improvement between EES and MES was evaluated, including the postoperative pure tone average (PTA) and air-bone gap (A-B Gap), as well as the hearing threshold across the low-, mid-, and high-frequency. The success rate of grafts was collected. Linear regression was performed to access the prognostic value of preoperative PTA and A-B Gap. Patients were followed up for at least 3 years. Results: The graft success rate of EES was 89.66% (78/87) versus 80.49% (66/82) for MES. The postoperative PTA and A-B Gap demonstrated significant improvement in EES compared to MES (Post-PTA: t = 3.281, P =.001; Post-A-B Gap: t = 2.197, P =.029). In the EES group, there were 59 ears (67.82%) with a postoperative A-B Gap ≤20 dB HL, which revealed a higher rate of successful hearing outcomes in EES as opposed to MES (χ2 = 9.904, P =.019). There were significantly better hearing improvement, shorter surgical times, and lower hospital stays in EES for epitympanic cholesteatoma without stapes superstructure involvement. The preoperative AC ≤79 dB and/or preoperative A-B Gap ≤52 dB was associated with a better prognosis in EES for epitympanic cholesteatoma with stapes superstructure involvement. Conclusions: EES showed higher graft success rate, better hearing improvement, shorter surgical times and hospital stays for attic cholesteatoma, particularly without stapes superstructure involvement. The range of preoperative PTA and A-B Gap have shown the prognostic value, which maybe a favorable surgical indication for EES or MES. [ABSTRACT FROM AUTHOR]

Importance: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with significant quality of life impairments. There is a need to implement outcome-based metrics to evaluate the outcomes of CRS treatment with endoscopic sinus surgery or biologics. Objective: We aimed to understand Canadian otolaryngologists' opinions on patient-related outcome measures (PROM) for CRS and identify potential barriers to implementation. Design: Qualitative research. Setting and Participants: A cross-sectional survey was distributed via the Canadian Society of Otolaryngology-Head and Neck Surgery and direct emailing. Measures: Participants' demographics, practice information, and opinions on PROM were collected. Results: Of 346 (23%) Canadian otolaryngologists, 78 responded to the survey (26 rhinology fellowship–trained, 51 non-fellowship-trained, and 1 missing data). Thirty-eight responded that they collect PROM (69% with fellowship-trained, 39% non-fellowship-trained, P =.029). Regarding opinions on PROM, 74% of respondents agreed that it helps patients report their symptoms, 42% agreed that it improves the efficiency of the patient encounter, 54% agreed that it is easy for patients to understand, 62% agreed that it improves management and monitoring of clinical outcomes, and 71% disagreed that PROM is not helpful. Fellowship-trained otolaryngologists were 4 times more likely to agree that PROM improves management and monitoring of clinical outcomes (P =.014), and no other differences in opinions were significant. The most-frequently-identified barriers to PROM usage were lack of time for 67% of respondents, difficulty integrating into clinical workflow for 64%, and lack of integration into the electronic medical record for 47%. If these barriers were addressed, 86% of respondents said they would use PROM in their practice. Conclusions and Relevance: Despite the low uptake of PROM among otolaryngologists without rhinology fellowship, opinions were generally favorable. We identified barriers that, if addressed, may increase their use in clinical practice. As resource-limited therapies such as biologics become more prevalent in CRS management, PROM may find more applications in shared clinical decision making. [ABSTRACT FROM AUTHOR]

Introduction: In pediatric tonsillectomy management, the consistent tracking of surgical outcomes and adherence to guidelines are vital. This study explores how a surgical dashboard can serve as a tool in research analysis, translating AAO‐HNSF guidelines into measurable performance improvements. Methods: Using a prospective registry from three pediatric hospitals, a Tableau dashboard was constructed to graphically visualize key demographic and postoperative outcomes (including intensive care unit [ICU] utilization, 30‐day emergency department (ED) visits, and postoperative bleed rates) in children undergoing tonsillectomy from 2020 to 2024. From the dashboard data, a retrospective cohort study analyzing 6767 tonsillectomies was conducted from January 2, 2020, to June 20, 2023. Patients were categorized into low‐risk, OSA‐only (by ICD‐10 codes), and high‐risk groups based on comorbidities. Logistic regression identified factors influencing ED revisits and unplanned nursing calls. Three quality initiatives were assessed: preoperative school absence notes, perioperative dexamethasone recording, and post‐tonsillectomy parental education. Results: A total of 2122 (31%) were low‐risk, 2648 (39%) were OSA‐only, and 1997 (30%) high risk. Risk factors that increased the likelihood of ED visits were high‐risk comorbidities (OR = 1.46; 95% CI = 1.24–1.74; p < 0.001) and older age (OR = 1.05; 95% CI = 1.03–1.08; p < 0.001). Risk factors that increased the likelihood of an unplanned nursing communication were high‐risk comorbidities (OR = 1.53; 95% CI = 1.34–1.75; p < 0.001), older age (OR = 1.03, 95% CI = 1.01–1.04; p = 0.001), and Medicaid insurance (OR = 1.25; 95% CI = 1.09–1.43; p = 0.002). Postoperative bleed control was generally comparable between the groups, at 2.8% (low risk), 2.7% (OSA), 3.2 (high risk) (p = 0.651). Conclusion: The dashboard aided in data collection, data visualization, and data analysis of quality improvement initiatives, effectively translating guidelines into tangible measures to enhance care. Level of evidence: NA. [ABSTRACT FROM AUTHOR]

The article examines the ethical considerations of introducing school-based hearing and vision screening programs in Samoa and the Pacific Islands. Topics discussed include the importance of early detection of hearing and vision impairments, the use of mobile technology in low-resource settings, and the collaboration needed among healthcare and educational stakeholders to ensure effective program implementation.

This systematic literature review aims to study the role and impact of artificial intelligence (AI) in transforming Ear, Nose, and Throat (ENT) healthcare. It aims to compare and analyse literature that applied AI algorithms for ENT disease prediction and detection based on their effectiveness, methods, dataset, and performance. We have also discussed ENT specialists' challenges and AI's role in solving them. This review also discusses the challenges faced by AI researchers. This systematic review was completed using PRISMA guidelines. Data was extracted from several reputable digital databases, including PubMed, Medline, SpringerLink, Elsevier, Google Scholar, ScienceDirect, and IEEExplore. The search criteria included studies recently published between 2018 and 2024 related to the application of AI for ENT healthcare. After removing duplicate studies and quality assessments, we reviewed eligible articles and responded to the research questions. This review aims to provide a comprehensive overview of the current state of AI applications in ENT healthcare. Among the 3257 unique studies, 27 were selected as primary studies. About 62.5% of the included studies were effective in providing disease predictions. We found that Pretrained DL models are more in application than CNN algorithms when employed for ENT disease predictions. The accuracy of models ranged between 75 and 97%. We also observed the effectiveness of conversational AI models such as ChatGPT in the ENT discipline. The research in AI for ENT is advancing rapidly. Most of the models have achieved accuracy above 90%. However, the lack of good-quality data and data variability limits the overall ability of AI models to perform better for ENT disease prediction. Further research needs to be conducted while considering factors such as external validation and the issue of class imbalance. [ABSTRACT FROM AUTHOR]

Epiphora is an annoying symptom, embarrassing the patient both socially and functionally. The two widely accepted treatment modalities of epiphora resulting from obstruction of the nasolacrimal ductus are external and endoscopic dacryocystorhinostomy (DCR). To compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent prospectively and to compare the outcome of endonasal endoscopic dacryocystorhinostomy with stent and without stent with external dacryocystorhinostomy retrospectively. This retrospective and prospective clinical interventional study was done in the Department of Otorhinolaryngology and Institute of Ophthalmology, Jawaharlal Nehru Medical College, A.M.U., Aligarh from July 2012 to September 2017. 110 patients of epiphora participated in the study and were divided into three groups: Group I: Endoscopic endonasal dacryocystorhinostomy with stent. Group II: Endoscopic endonasal dacryocystorhinostomy without stent. Group III: External dacryocystorhinostomy. Out of them 60 patients were for Endoscopic dacryocystorhinostomy (30 patients with stent and 30 patients without stent) and 50 patients were for External dacryocystorhinostomy. 71 (65%) were females while 39 (35%) were males (p < 0.05) with age ranging from ranging 8–60 years (mean 34.96 years) with predominance of symptoms in left eye (p < 0.01). A lower complication rate was observed in the endoscopic group, with minimal morbidity and shorter operative time compared with the external approach. Follow up was done at postoperative day 1st and 7th, at 2 weeks, 4 weeks and 3 months for assessing complications of operation, symptomatic relief of epiphora and syringing for anatomical patency. In our study, Success rate was 93.30% in Group I and 96.60% in Group II while 90% in group III. The avoidance of a cutaneous scar has been a strong impetus to further the success and improve outcomes of endonasal DCR. Endonasal DCR without stent has lesser incidence of post-operative fibrosis and higher patient's acceptance. [ABSTRACT FROM AUTHOR]

Background: Choanal atresia is a congenital anomaly characterized by an absence of the nasal choanae due to Failure to recanalize the nasal fossae during embryogenesis. Instances involving unilateral Choanal atresia may go unidentified for extended periods. Bilateral choanal atresia presenting in adulthood is an infrequent occurrence. Case Presentation: A case of bilateral choanal atresia in a female 24-year-old presenting to our otolaryngology department's out clinics with long-standing nasal obstruction, mouth breathing, and anosmia. She underwent endoscopic choanoplasty to reestablish patency of the posterior choana. Follow-up after one month revealed patent posterior choana. Conclusion: Bilateral choanal atresia requires early surgical intervention in infants for survival. Adult presentations are rare. Nasal endoscopy and CT help determine the surgical approach. Endoscopic trans-nasal Chonaolplasty is typically the standard treatment. [ABSTRACT FROM AUTHOR]

Choristomas are aggregates of microscopically normal tissues in aberrant locations. They can be cartilage, bone, glial tissue, salivary gland, and thyroid tissue. Cartilaginous choristomas of the oral cavity are rare and occur most commonly on the tongue and less often in sites such as the soft palate and gingiva. We report two cases of cartilaginous choristoma in young females presenting with recurrent tonsillitis. Histopathological examination showed the presence of mature island of hyaline cartilage surrounded by lymphoid hyperplasia. Level of Evidence: Level 4 [ABSTRACT FROM AUTHOR]

Study Background and Aims: There are marked barriers to research and publishing for low- and middle- income country (LMIC) ENT researchers. This could be reflected in LMIC journal characteristics and research, which has never been investigated. We aim to characterize differences in the number, geographic distribution, publishing costs, reach, number of articles, citations, and impact factors of high-income country (HIC) journals compared to LMIC journals. Methods: We included journals listed under the category "Otorhinolaryngology' in three major journal databases. From journal websites, we collected data related to financial model, waiver policy, access, and distribution. Additionally, from the Clarivate Journal Citation Reports 2022, we collected the following journal metrics: total articles, total citations, journal citation indicator, journal impact factor (JIF), 5-year JIF, and JIF without self cites. Results: 79.7% HIC journals offered English editing services, compared with 25.0% of LMIC journals. Additionally, 40.0% of HIC journals are solely open access compared with 92.0% in LMICs. Lower journal metrics were seen in LMIC journals, including 2022 mean total articles (107 HICs vs. 60 LMICs), total citations (4296 vs. 751), journal citation indicator (0.88 vs. 0.35), and journal impact factor (12.68 vs. 0.82). Conclusion: We have identified substantial differences in the distribution, English editing services, and journal metrics of HIC journals compared to LMIC journals. These may point to potential barriers to publishing and research access for those in LMICs. To support LMIC research, future work should evaluate opportunities to increase the number of ENT journals in LMICs, expand open access publishing, improve access to language services, and increase LMIC research impact. [ABSTRACT FROM AUTHOR]

Objectives: Tinnitus is a phantom sound sensation without an external sound source. Due to its subjective and multifaceted nature it is measured using multi-item self-reported instruments. Many well-validated tinnitus-related questionnaires are available for clinical practice and scientific research, but so far no attention has been paid to their measurement invariance. The study aimed to examine measurement invariance of the Tinnitus Handicap Inventory with regard to gender and hearing impairment, and to identify the items that show differential item functioning (DIF) across the groups. Design: This is a retrospective study using medical data from patients with tinnitus. They completed the Tinnitus Handicap Inventory (THI) and underwent pure-tone audiometry. Study sample: 1106 adult patients with tinnitus (554 women and 552 men; 320 with normal hearing and 786 with hearing loss), aged 19–84 years. Results: In the analysis, multi-group confirmatory factor analysis, hybrid ordinal logistic regression, Kernel smoothing in Item Response Theory, and lasso regression were applied. Measurement invariance was demonstrated across gender, but across hearing status the measurement was non-invariant. Five items were found to have DIF. Conclusions: Researchers and clinicians should be aware of the potential risk of response bias when tinnitus severity is evaluated. [ABSTRACT FROM AUTHOR]

Purpose: Sinonasal mucoceles (SM) are benign, expansive neoformations which require surgical marsupialization to prevent severe complications. The present study reports the larger case history ever published: a 28-years expertise in the surgical management of SM. Methods: A retrospective study was conducted on patients surgically treated for SM at the Departments of Otorhinolaryngology of Varese and Pavia, between 1994 and 2022. Results: 398 patients were reported. An endoscopic endonasal marsupialization of SM was performed in 92,5% of cases. 7% of patients underwent a combined approach while 0,5% required an exclusive open surgery. The average follow-up after surgery was 10–60 months. SM overall recurrence was observed in 11,4% of cases. Conclusion: Endonasal endoscopic SM marsupialization is a feasible technique which allows the preservation of the anatomy and physiology avoiding the surgical invasiveness of the external approaches. The well-established surgical expertise in the endonasal endoscopy together with technological improvements widened the indication range of the exclusive endoscopic technique over the traditional open surgery. [ABSTRACT FROM AUTHOR]

Purpose: To explore utilization and efficacy of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in different sub-specialties of otolaryngology. Methods: A systematic search was performed using Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Clinicaltrials.gov, Scopus, and Google Scholar up to March 2024. English language randomized controlled trials with original data evaluating the use of PRP and PRF in various surgical and non-surgical procedures related to otolaryngologic sub-specialties. Dataset was limited to randomized controlled trials (RCTs) to have the best quality of evidence and possible recommendation. Results: Our database search resulted in 591 manuscripts. Four hundred twenty-six studies were primarily excluded after reviewing the title and abstract. The remaining 165 articles were studied completely, and 51 articles met the inclusion criteria. All the studies were RCTs and dated from 2001 to 2024. They included 19 studies related to otology, 10 studies related to rhinology, 7 studies related to facial plastic surgery, 6 studies related to head and neck surgery, 3 studies related to general otolaryngology, 3 studies related to pediatrics, 2 studies related to laryngology, and 1 study related to sleep medicine. Conclusion: PRP and PRF are safe, easy to use, and potentially effective treatment options for multiple otolaryngology pathologies. As an autologous material, there is no risk of immune reaction, and thus has been selected as a viable treatment option by many otolaryngologists. Larger studies would be helpful to confirm efficacy and allow for optimized patient selection for this treatment option. [ABSTRACT FROM AUTHOR]

This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing proportion are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea (OSA), so judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities, and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including recent advances in ENT surgery that have an impact on the anaesthetist. [ABSTRACT FROM AUTHOR]

Objectives: Understanding the strengths and weaknesses of chatbots as a source of patient information is critical for providers in the rising artificial intelligence landscape. This study is the first to quantitatively analyze and compare four of the most used chatbots available regarding treatments of common pathologies in rhinology. Methods: The treatment of epistaxis, chronic sinusitis, sinus infection, allergic rhinitis, allergies, and nasal polyps was asked to chatbots ChatGPT, ChatGPT Plus, Google Bard, and Microsoft Bing in May 2023. Individual responses were analyzed by reviewers for readability, quality, understandability, and actionability using validated scoring metrics. Accuracy and comprehensiveness were evaluated for each response by two experts in rhinology. Results: ChatGPT, Plus, Bard, and Bing had FRE readability scores of 33.17, 35.93, 46.50, and 46.32, respectively, indicating higher readability for Bard and Bing compared to ChatGPT (p = 0.003, p = 0.008) and Plus (p = 0.025, p = 0.048). ChatGPT, Plus, and Bard had mean DISCERN quality scores of 20.42, 20.89, and 20.61, respectively, which was higher than the score for Bing of 16.97 (p < 0.001). For understandability, ChatGPT and Bing had PEMAT scores of 76.67 and 66.61, respectively, which were lower than both Plus at 92.00 (p < 0.001, p < 0.001) and Bard at 92.67 (p < 0.001, p < 0.001). ChatGPT Plus had an accuracy score of 4.39 which was higher than ChatGPT (3.97, p = 0.118), Bard (3.72, p = 0.002), and Bing (3.19, p < 0.001). Conclusion: On aggregate of the tested domains, our results suggest ChatGPT Plus and Google Bard are currently the most patient‐friendly chatbots for the treatment of common pathologies in rhinology. Level of Evidence: N/A Laryngoscope, 134:4225–4231, 2024 [ABSTRACT FROM AUTHOR]

Objective: To investigate the consistency of Chatbot Generative Pretrained Transformer (ChatGPT)‐4 in the analysis of clinical pictures of common laryngological conditions. Study Design: Prospective uncontrolled study. Setting: Multicenter study. Methods: Patient history and clinical videolaryngostroboscopic images were presented to ChatGPT‐4 for differential diagnoses, management, and treatment(s). ChatGPT‐4 responses were assessed by 3 blinded laryngologists with the artificial intelligence performance instrument (AIPI). The complexity of cases and the consistency between practitioners and ChatGPT‐4 for interpreting clinical images were evaluated with a 5‐point Likert Scale. The intraclass correlation coefficient (ICC) was used to measure the strength of interrater agreement. Results: Forty patients with a mean complexity score of 2.60 ± 1.15. were included. The mean consistency score for ChatGPT‐4 image interpretation was 2.46 ± 1.42. ChatGPT‐4 perfectly analyzed the clinical images in 6 cases (15%; 5/5), while the consistency between GPT‐4 and judges was high in 5 cases (12.5%; 4/5). Judges reported an ICC of 0.965 for the consistency score (P =.001). ChatGPT‐4 erroneously documented vocal fold irregularity (mass or lesion), glottic insufficiency, and vocal cord paralysis in 21 (52.5%), 2 (0.05%), and 5 (12.5%) cases, respectively. ChatGPT‐4 and practitioners indicated 153 and 63 additional examinations, respectively (P =.001). The ChatGPT‐4 primary diagnosis was correct in 20.0% to 25.0% of cases. The clinical image consistency score was significantly associated with the AIPI score (rs = 0.830; P =.001). Conclusion: The ChatGPT‐4 is more efficient in primary diagnosis, rather than in the image analysis, selecting the most adequate additional examinations and treatments. [ABSTRACT FROM AUTHOR]

Objective: To investigate the minimum therapeutic duration for patients with primary laryngopharyngeal reflux disease (LPRD) through the evaluation of symptom changes at multiple time points. Study Design: Prospective uncontrolled. Setting: University medical center. Methods: Patients with LPRD at the 24‐hour hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring were recruited from the European Reflux Clinic. Depending on the type of LPRD, patients were treated with a combination of proton‐pump inhibitors, alginate, or magaldrate. Symptoms were evaluated with the reflux symptom score (RSS) at baseline and throughout treatment (1‐, 3‐, 6‐, and 9‐month posttreatment). The most appropriate therapeutic duration was determined using the RSS changes. Signs were evaluated with the reflux sign assessment. Results: A total of 159 patients completed the study. The mean age was 49.9 ± 15.7 years. At 1‐month posttreatment, 97 patients (61.0%) were considered as early responders to treatment, and the treatment was stopped for 52 patients (32.7%). Of the 62 early nonresponders, 34 patients (21.4%) reached responded to treatment after 3 to 9 months. The cumulative therapeutic success rate at 1‐month posttreatment (61.0%) progressively increased to reach a range of 82.4% to 99.3% at 9‐month posttreatment. The RSS mainly decreased in the first month of treatment in early responders. In early nonresponders, RSS progressively decreased throughout the 9‐month treatment period. The baseline severity of RSS is a strong predictor of therapeutic response. Conclusion: A therapeutic regimen of 1 month can be sufficient to treat one third of LPRD patients. The early nonresponders may require 3 to 9 months of treatment. [ABSTRACT FROM AUTHOR]

Objective: The recent surge in popularity of large language models (LLMs), such as ChatGPT, has showcased their proficiency in medical examinations and potential applications in health care. However, LLMs possess inherent limitations, including inconsistent accuracy, specific prompting requirements, and the risk of generating harmful hallucinations. A domain‐specific model might address these limitations effectively. Study Design: Developmental design. Setting: Virtual. Methods: Otolaryngology–head and neck surgery (OHNS) relevant data were systematically gathered from open‐access Internet sources and indexed into a knowledge database. We leveraged Retrieval‐Augmented Language Modeling to recall this information and utilized it for pretraining, which was then integrated into ChatGPT4.0, creating an OHNS‐specific knowledge question & answer platform known as ChatENT. The model is further tested on different types of questions. Results: ChatENT showed enhanced performance in the analysis and interpretation of OHNS information, outperforming ChatGPT4.0 in both the Canadian Royal College OHNS sample examination questions challenge and the US board practice questions challenge, with a 58.4% and 26.0% error reduction, respectively. ChatENT generated fewer hallucinations and demonstrated greater consistency. Conclusion: To the best of our knowledge, ChatENT is the first specialty‐specific knowledge retrieval artificial intelligence in the medical field that utilizes the latest LLM. It appears to have considerable promise in areas such as medical education, patient education, and clinical decision support. The model has demonstrated the capacity to overcome the limitations of existing LLMs, thereby signaling a future of more precise, safe, and user‐friendly applications in the realm of OHNS and other medical fields. [ABSTRACT FROM AUTHOR]

Objective: To determine whether certain groups of otolaryngologists (ORLs) are treating cohorts of patients with more comorbidities. Study Design: Cross‐sectional population‐based analysis. Setting: 2019 Medicare Provider Utilization and Payment Dataset. Methods: Each ORL's average Medicare hierarchical condition category (HCC) risk score, a comorbidity index calculated from a patient's comorbidities, was collected. These were stratified and compared by various physician characteristics, including practice region and rurality, years in practice, gender, subspecialty, and setting (academic vs community). Results: Among 8959 ORLs, the mean HCC risk score for Medicare patients was 1.35 ± 0.35. On univariate analysis, ORLs practicing in urban (compared to rural), ORLs in academic settings (compared to community), and early career ORLs all had a patient population with a higher HCC risk score (P <.001 for all). On multivariate analysis controlling for gender, rurality, graduation year, and region, rural setting was associated with decreased odds of having a high‐risk patient population (odds ratio: 0.58 [95% confidence interval, CI: 0.48‐0.71]; P <.001), while those more recently graduated has an increased risk (2000‐2009: 1.41 [1.01‐1.96], P =.046; 2010‐2015: 2.30 [1.63‐3.25], P <.001). In a separate subgroup analysis, subspecialty differences were seen and community setting was associated with decreased odds of having a high‐risk patient population (0.36 [0.23‐0.55]; P <.001). Conclusion: There is variability in patient comorbidity profiles among ORLs, with those in urban settings, those more recently graduated, and those in academic settings treating a group with more comorbidities. As the comorbidity burden may increase the cost of practice and complications, these findings may have important implications for health inequity. [ABSTRACT FROM AUTHOR]

Background: In Cameroon, the COVID-19 disease has demonstrated shortcomings in preventing nosocomial infections at both collective and individual levels. This study aimed to identify practice changes in ENT outpatient consultations in Cameroon inducted by the COVID-19 pandemic. Methods: This was a descriptive cross-sectional study that took place in March 2024. A Google Form was submitted to ENT practitioners online across Cameroon. It consisted of 20 questions grouped into socio-professional and clinical data. Results: Sixty-four practitioners responded to the questionnaire. The average age of respondents was 36, with extremes of 31 and 70. The sex ratio was 0.35 in favor of women. In terms of experience, 47.7% had been practicing for less than 10 years. A total of 91.3% practiced in public health facilities. Before the COVID-19 outbreak, attitudes towards respiratory diseases were as follows: wearing of masks by suspected patients (4.3%), information posters in waiting rooms (13%), constant use of disinfectant gel (26.1%), wearing of masks by practitioners (0%), wearing of gloves (54.5%), wearing of gowns (87%), constant hand hygiene after each consultation (26.1%), and regular surface hygiene (30.4%). All precautions were improved after 4 years of the pandemic except wearing eye protection. Conclusion: ENT practice has been strongly impacted by the COVID-19 pandemic, and many measures still need to be taken to improve infection control in hospitals in Cameroon. [ABSTRACT FROM AUTHOR]

Background: Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care. Methods: This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Results: There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care. Conclusions: This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is the preferred method for managing critically ill patients requiring prolonged mechanical ventilation. We aimed to compare the safety of PDT performed by intensivists versus surgeons. Methods: This retrospective, single center, cohort study included all the patients who underwent PDT from 2014 to 2023. Propensity score matching was performed to adjust the imbalances of covariates between the groups. The primary outcome was the occurrence of early complications after PDT. Secondary outcomes were the development of late complications of PDT and mortality directly related to tracheostomy. Results: 1685 consecutive patients with critical illness were included in the analysis. Of these, 1396 (82.8%) PDTs were performed by surgeons and 289 (17.2%) by intensivists with background residency training in internal medicine. Early complications were reported in 80 (5.7%) of the patients in the surgeon group and in 13 (4.5%) patients in the intensivist group (p = 0.40). Minor hemorrhage was the most common early complication. Secondary outcomes were comparable in both groups. In a propensity score‐matched cohort, the findings remained consistent. Conclusions: This study suggests that PDT can be performed by intensivists, as well as surgeons, with the same safety profile. Our findings underscore the importance of incorporating PDT into the intensive care unit (ICU) training syllabus, ensuring the procedure is readily accessible with reliance on the expertise of ICU staff. [ABSTRACT FROM AUTHOR]

Objectives: Otolaryngology (ENT) plays a crucial role in healthcare, yet undergraduate education in the United Kingdom has historically not reflected this. This study aimed to assess the delivery of ENT education, focusing on teaching methods, clinical placements, and assessment practices. Methods: An online questionnaire was distributed to medical students. Data were collected via Qualtrics from 5 August 2023 to 17 October 2023. Results: Forty medical schools were involved. Thirty-seven schools had compulsory ENT teaching however 20 per cent lack an ENT placement. Clinical placements varied, with an average length of 7.3 days. Assessment of ENT knowledge included Objective, Structures, Clinical Examination stations (90 per cent) and written exams (80 per cent). Conclusion: The study highlights persistent gaps in ENT education. Deficiencies in clinical exposure and lack of alignment with national guidelines indicate the need for improvement. As the Medical Licensing Assessment approaches, standardising assessments may address disparities but should be accompanied by comprehensive changes in teaching methods and placements. [ABSTRACT FROM AUTHOR]

Background: Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic. Method: The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed. Results: In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity. Conclusion: Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance. [ABSTRACT FROM AUTHOR]

Inflammatory myofibroblastic tumors (IMTs) are one of the most complex and rare neoplasms that have been discovered, with varying behavior in different cases. They mostly arise in the thoracic and abdominal cavity, the lungs, retroperitoneum, and extremities. They can also be detected in the head and neck area. IMTs have no age or gender preference which makes them tougher to anticipate. Head and neck IMTs are benign neoplasms with locally aggressive behavior and a low risk of metastatic spread. They have an unknown etiology, and they resemble malignant lesions radiologically. In this case report, we will review the case of a 40-year-old woman with an unusual IMT in the maxillary sinus that presented as a challenge in diagnosis and management. [ABSTRACT FROM AUTHOR]

Purpose: Smoking is not only one of the main risk factors for the development of most malignant and numerous benign ENT tumours but also has an important influence on therapy and prognosis. Even quitting smoking at the time of diagnosis significantly reduces mortality. Patients have a particularly strong desire to stop smoking when they are diagnosed. The present study investigated to what extent patients were aware of the relationships between smoking and the development and prognosis of tumours and how much information and smoking cessation support they were offered by physicians. Methods: A total of 194 patients (74.7% male, 62.0 ±10.6 a) with malignant primary ENT tumours, pre-cancerous tumours, Reinke's oedema and salivary gland tumours were interviewed. Results: 22.7% were nonsmokers, 49.5% were cigarette smokers and 27.8% were ex-smokers. A total of 57.0% of the smokers said they would have quit before the onset of the disease if they had known about the association. Forty-one percent did not receive information about the association between smoking and the development of their disease, while 45.5% did not receive information about the relationship with their prognosis. The provision of information lasted less than 5 min for 40.4% of the patients and more than 10 min for only 13.5%. In total, 50.7% of the patients were directly requested not to smoke. A total of 7.7% received offers of smoking cessation support from otolaryngologists and 18.2% received such offers from family physicians. Conclusions: There is a pronounced need for improvements in the provision of medical information about the health risks associated with smoking and offers to support patient efforts to stop smoking. In particular, the appointment during which the diagnosis is communicated to the patient should be considered a 'teachable moment' that can lead to smoking cessation. [ABSTRACT FROM AUTHOR]

This study is a randomized controlled interventional study aimed to determine the effect of preoperative brochure‐assisted education on surgical fear and anxiety in patients scheduled for septorhinoplasty surgery. The study was conducted between May 2022 and February 2023 in the Otorhinolaryngology services and clinics of a training and research hospital in the southern region of Turkey. The study included 61 patients, with 29 in the education group and 32 in the control group. All patients received routine nursing care before surgery, with the education group receiving additional education through an informative brochure. The data were collected using the "Personal Information Form", "Surgical Fear Questionnaire", and "Surgical Anxiety Questionnaire". There was no significant difference in the mean scores of surgical fear between the groups on the morning of the surgery (p > 0.05). However, a significant difference was found in the mean scores of surgical anxiety between the groups (p < 0.05). In conclusion, patients in the education group who received preoperative brochure‐assisted education had lower anxiety compared with the control group. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to compare voice outcomes in open partial horizontal laryngectomy vs. total laryngectomy (TL) with voice prosthesis. Methods: In this retrospective monocentric study patients undergoing OPHL or TL with voice prosthesis were enrolled during the usual oncological follow-up consultations at the Otolaryngology and Audiology Unit of a University Hospital in the period between July 2022 and June 2023. Acoustic analysis (F0, HNR, NHR), maximum phonation time, I-SECEL and INFV0 scale were used to assess voice outcome. Results: Forty-three patients were enrolled. Voices of patients undergoing LT were better in quality of voice (V0) at INFV0 scale. The scores in I-SECEL and acoustic analysis were comparable. Conclusions: Voice quality could be slight better in patients undergoing TL with voice prosthesis than those undergoing OPHL. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether a gap year for either research or a master's degree is associated with interview offers or match outcomes among otolaryngology applicants. Methods: Using the Texas Seeking Transparency in Application to Residency (Texas STAR) database, we conducted a cross-sectional analysis of otolaryngology applicants from 2018 to 2022. Applicants were stratified based on the presence and type of gap year during medical school. Applicant characteristics, signaling, research productivity, and application costs were analyzed, with primary outcomes including number of interview offers and match status. Results: Among 564 otolaryngology applicant respondents to the Texas STAR survey, 160 (28%) reported a gap year, including 64 (40%) applicants participating in a research year, 65 (41%) completing a Master of Public Health or Science (MPH and MSc), and 31 (19%) completing a Master of Business Administration, Education, or other degree (MBA and MEd). Gap-year applicants who completed a research year or MPH/MSc degree received more interview offers (P <.01) than MBA, MEd applicants, or those without a gap year. Applicants with a research year had the most publications, oral presentations, abstracts, posters, and research experiences (all P <.01). When controlling for USMLE scores, clerkship honors, and applications submitted, applicants completing a research year or an MPH/MSc-degree received increased interview offers (P <.01). No significant differences were seen in expenditures or match rates. Conclusions: Research and MPH/MSc gap years were associated with increased residency interview offers but not increased match success. Further longitudinal studies are needed to assess how yearlong experiences affect long-term career outcomes. [ABSTRACT FROM AUTHOR]

Cone beam computed tomography (CBCT) frequently captures unexpected structural abnormalities unrelated to the original intent of the diagnostic test. Once identified by dentists, these findings often require appropriate clinical referral for further investigation. This study reviewed recent literature using a comprehensive search to identify and curate common CBCT incidental findings (1Fs). Studies were included if they reported CBCT IFs and included more than 10 cases. The review included 16 primary studies in addition to 4 studies described in recent relevant systematic reviews. A total of 51 descriptive terms used to describe key IFs across studies were identified, and terms were organized semantically into 15 core finding categories. Recommendations for management and referral acuity were derived from otolaryngologic clinical practice guidelines and input from practicing otolaryngologists, and the results were integrated into a clinical management algorithm for acuity of referral. This comprehensive review offers practical recommendations to facilitate appropriate clinical management of CBCT IFs via otolaryngologic referral. [ABSTRACT FROM AUTHOR]