Importance:Diagnosis of pediatric ankyloglossia and other oral ties is increasing in part due to social media, leading to more frenotomies and excess medicalization of often normal anatomy. Objective:To assess the accuracy and readability of social media content on pediatric ankyloglossia and other oral ties. Design, Setting, and Participants:In this cross-sectional study, the top 200 posts on an image-based social media platform tagged with #tonguetie, #liptie, or #buccaltie were collected using a de novo account on March 27, 2023. Post metadata and caption and content text were extracted. Main Outcomes and Measures:Misinformation was judged by a 30-point scoring sheet based on clinical practice guidelines and expert consensus that was developed by 3 fellowship-trained pediatric otolaryngologist-head and neck surgeons. Readability was assessed using the Flesch-Kincaid Grade Level, Flesch Reading Ease, and Simple Measure of Gobbledygook scales. Quality was scored using the JAMA Benchmark Criteria. Results:After removing duplicates and irrelevant content, 71 unique posts from 68 unique accounts were included in the analysis. Business and practice accounts made up most of the account types (60 [84.5%]) compared with individual and personal accounts (11 [15.5%]). Most accounts (49 [69.0%]) were run by individuals who self-identified as health care practitioners, and 21 posts (29.6%) originated from accounts of individuals who self-identified as International Board Certified Lactation Consultants (IBCLCs). On average, the content corresponded to a ninth-grade reading level per Flesch-Kincaid Grade Level. Quality of posts as rated by the JAMA Benchmark Criteria corresponded to a median score of 3.0 (IQR, 2.0-4.0). Of the 71 posts, only 8 (11.3%) contained no misinformation. There was a significant difference in misinformation prevalence between accounts run by IBCLCs vs non-IBCLCs, with posts from IBCLCs less likely to contain over 50% misinformation (odds ratio, 0.22; 95% CI, 0.06-0.81), compared with posts from non-IBCLCs. Conclusions and Relevance:This study found a high frequency of misinformation in social media content on ankyloglossia. Most content was generated by self-identified health care practitioners but not physicians. Furthermore, the grade level of the content reviewed was above that recommended for the public. As the public increasingly looks to social media for medical information, health care practitioners should correct medical misinformation.

Due to resource restrictions related to the COVID-19 pandemic, many pediatric patients are facing substantial delays for surgery, potentially resulting in additional distress for caregivers. We aimed to assess the experiences and psychosocial distress of parents during COVID-19 as they relate to the pandemic, waiting for surgery, and the combined effects of both events. The was a cross-sectional qualitative study. Parents with children who faced treatment delays during the initial wave of the COVID-19 pandemic for elective, non-emergent procedures across a variety of surgical specialties were recruited. Semi-structured telephone interviews and thematic analysis were utilized. Thematic saturation was reached with eighteen participants. Four themes were identified: coping with COVID-19, distress levels, quality and nature of communication with the surgical team, and the experience of COVID-19 related hospital restrictions. Participants reported varying levels of distress due to the delay in surgery, such as the fear of developmental delay or disease progression for their child. They also indicated their own physical and mental health had been impacted by emotional distress related to both COVID-19 and delays in treatment. Most participants experienced the COVID-19-related hospital restrictions as distressing. This related predominantly to limiting in-hospital caregivers to only one caregiver. Participants were found to have substantial levels of psychosocial distress. Targeted social and emotional support may be helpful in reducing parental distress as the pandemic timeframe continues. Within the limits of individual health systems, reducing restrictions to the number of allowed care givers may help allay distress felt by parents.

Paradoxical vocal fold motion (PVFM) can occur at any stage of amyotrophic lateral sclerosis (ALS). PVFM results in glottic narrowing or complete blockage of airway in ALS patients, which eventually leads to respiratory insufficiency and sudden death. ALS typically presents initially with weakness of hands and bulbar musculature. Rarely, hoarseness is the initial symptom in ALS. This is a case report of how PVFM presents initially with hoarseness as a first symptom of ALS.

Background Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Methods A retrospective cohort analysis of patients with WDTC ( n = 584 ) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. Results Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group ( p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group ( p < 0.05 ). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. Conclusions TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients. Graphical abstract

Lymphoma originating from the middle ear is rare. The diagnosis of lymphoma as with other cancers of the temporal bone is often made late, and this has a negative implication on the treatment and prognosis of the condition. The delay of diagnosis is mainly due to the similar presentation shared with other benign conditions of the middle ear. We present a case of a 62-year-old man who was treated as a case of chronic otitis media for a period of time before presenting with advanced symptoms; a final diagnosis of lymphoma of the middle ear was given. Other similar cases in the literature are discussed and reviewed. Severe and persistent symptoms of the middle ear should raise red flags and warrant detailed investigations.