BACKGROUND:Chronic rhinitis (CR) is inflammation of the nasal mucosa, causing a multitude of symptoms. Temperature-controlled radiofrequency neurolysis (RFN) of the posterior nasal nerve (PNN) is a treatment for CR. In allergic rhinitis (AR), Type 2 cytokines are drivers of symptom severity. This study explores whether RFN's symptomatic improvements are linked to changes in nasal airflow and local cytokine levels. METHODS:This prospective, single-arm study was conducted at the Texas Sinus Institute at The University of Texas Health Science Center at Houston. Patients with ≥6 months of CR symptoms, a reflective total nasal symptom score (rTNSS) ≥6, and refractory to medical management were included. Follow-ups occurred at 4 and 12 weeks, with the primary endpoint at 12 weeks. Symptom improvement, peak nasal inspiratory flow (PNIF) and cytokine changes were assessed. RESULTS:Seventeen patients were enrolled with 15 patients undergoing the treatment. The procedure was well tolerated with no major adverse events. The rTNSS improved from a median of 7.5 to 4 at 12 weeks (P < .01). Median NOSE scores improved from 52.5 to 17.5 at week 12 (P < .05). Minimal clinically important differences (MCID) were achieved by 67% of patients for rTNSS and 50% for NOSE. There were no significant changes in PNIF. Patient-level change in IL-10 was significantly associated with improvement in NOSE score (r = -.70, P = .011). CONCLUSIONS:RFN of the PNN is a safe, effective in-office treatment for CR. While PNIF and group-level cytokines were not consistent indicators of improvement, the correlation between IL-10 and symptom relief suggests a potential link between neural ablation and the local mucosal microenvironment. This investigation shows the feasibility of cytokine monitoring to further investigate the mechanisms of rhinitis treatment.

BACKGROUND:The standard-of-care for advanced periauricular cutaneous squamous cell carcinoma (pCSCC) is surgery and adjuvant radiation therapy. Neoadjuvant immunotherapy recently demonstrated high pathologic response rates in patients with resectable pCSCC. METHODS:This retrospective review was conducted at a tertiary cancer center and included patients with pathologically confirmed pCSCC within the periauricular area treated with curative-intent surgery with or without neoadjuvant immunotherapy from 2005 to 2025. Patients who received neoadjuvant immunotherapy followed by surgery were age- and stage-matched to those who underwent upfront surgery. The primary outcomes were event-free survival (EFS) and overall survival (OS), estimated using the Kaplan-Meier method. RESULTS:The study included 85 patients. Twenty-four (28.2%) of whom received neoadjuvant immunotherapy and 61 (71.7%) underwent upfront surgery. The two cohorts had no differences in staging or disease burden at presentation. Forty-eight patients presented with recurrent disease, equally distributed among the groups (57% vs. 54%, p > 0.05). Patients receiving neoadjuvant immunotherapy had longer median EFS than those undergoing upfront surgery (5.9 vs. 3.4 years; hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.13-0.84; p = 0.02). Specifically, EFS at 2 years was 87% in the neoadjuvant group compared with 55% in the upfront surgery group (p < 0.05). Median OS was also longer in the neoadjuvant group (not met vs. 4.4 years; HR, 0.32; 95% CI, 0.11-0.90; p = 0.031). CONCLUSIONS:Neoadjuvant immunotherapy improved survival outcomes in patients with advanced resectable pCSCC. These findings underscore the importance of including this patient population in upcoming randomized trials.

Introduction: Although surgical navigation is commonly used in rhinologic surgery, data on real world performance are sparse because of difficulties in collecting measurements for target registration error (TRE). Despite publications showing submillimeter TRE, surgeons do report TRE of >3 mm. We describe a novel method for assessing TRE during surgery and report findings with this technique. Methods: The TruDi navigation system (Acclarent, Irving, CA) was registered using a contour-based protocol. The surgeon estimated target registration error (e-TRE) at up to 8 points (anatomic regions of interest [ROI]) during endoscopic sinus surgery (ESS). System logs were used to simulate the localization for quantitative assessment of TRE (q-TRE). Results: We performed 98 localizations in 20 patients. The ROI in the sinuses were ethmoid (33 sites), maxillary (28 sites), frontal (17 sites), and sphenoid (22 sites). For localizations, mean qTRE and eTRE were 0.93 and 0.84 mm (P = .56). Notably, 80% of qTRE and 81% of eTRE were 1 mm or less. Mean qTRE and eTRE were less for attending-performed registrations at the maxillary, frontal and sphenoid. Conclusion: Surgical navigation accuracy, as measured by qTRE and eTRE, approaches 1 mm or better at all sinus sites in a real-world setting for 80% of localizations. The qTRE method provides a unique approach for assessing TRE. Surgeons underestimate TRE (overstate navigation accuracy), but this difference does not seem to be statistically significant. Registration performed by trainees yields higher TRE than registration performed by attendings. These data may be used to guide navigation optimization.

Introduction: In March 2020, the World Health Organization declared COVID-19 a pandemic, initiating stay-at-home orders which delayed cancer care and screening. The impact on head and neck cancer care in pop-ulations at risk has yet to be elucidated. The objective of this investigation is to evaluate how the presentation, diagnosis, and treatment of head and neck squamous cell carcinoma cancer patients at a county hospital were affected by the pandemic.Methods: A retrospective review of patients with head and neck squamous cell carcinoma that were diagnosed at a county hospital 365 days before and after stay-at-home orders were initiated. The primary outcomes were duration between diagnosis from imaging and initiation of treatment. Secondary outcomes included mortality, stage, nodal status, and distant metastasis at presentation.Results: There was a total of 105 diagnoses. Sixty-five (62 %) head and neck squamous cell carcinoma diagnoses were diagnosed before the stay-at-home orders were initiated, and 40 (38 %) after. Eighty percent (32/40) of diagnoses presenting after had stage IV disease compared to 58 % (38/65) in those before (p < 0.05). A higher percentage of patients who presented later had a >30-day delay to biopsy (43 % v. 20 %, OR: 3.0, p < 0.05). This difference was exacerbated by those with laryngeal, oral cavity, or oropharyngeal cancer (45 % v. 15 %, OR: 4.5, p < 0.05). There was a larger delay from diagnosis to treatment after the orders were initiated (68 v. 53, p < 0.05) however there was no difference in one-year mortality (25 % v. 23 %, p > 0.05). This investigation found a 14 % loss to follow-up.Conclusions and relevance: In this cohort of head and neck squamous cell carcinoma diagnoses at a county hospital, those diagnosed after the stay-at-home orders were initiated presented with more advanced disease. They also had more delays in diagnosis and initiation of treatment. There was no difference in one-year mortality rates between the two groups however there was a significant loss to follow-up, limiting prognostication. These findings serve to better prepare healthcare providers to implement optimized care during future shutdowns related to public health crises.

BACKGROUND:Hyperostosis is a common radiographic feature of inverted papilloma (IP) tumor origin on computed tomography (CT). Herein, we developed a machine learning (ML) model capable of analyzing CT images and identifying IP attachment sites. METHODS:A retrospective review of patients treated for IP at our institution was performed. The tumor attachment site was manually segmented on CT scans by the operating surgeon. We used a nnU-Net model, a state-of-the-art deep learning-based segmentation algorithm that automatically configures image preprocessing, network architecture, training, and post-processing to identify the IP attachment site. The model was trained and evaluated using a 5-fold cross validation, where each iteration split the data into train/validation/test to avoid chances of overfitting. The attachment site was classified as either 'identified or 'not identified' using the nnU-Net model output and the Sørensen-Dice coefficient (Dice) was used to further evaluate the segmentation performance of each subject. RESULTS:A total of 58 subjects met enrollment criteria. The algorithm identified the attachment site in 55.2 % (n = 32) of patients with an average dice score (+/-SD) of 0.34 (+/- 0.24). In the univariate analysis, the algorithm performed better for attachment sites within the maxillary sinus (OR 4.0; p < 0.05) and performed worse during revision surgery (OR 0.13; p < 0.05). Multivariate logistic regression analysis confirmed these associations for maxillary attachment site (OR 4.6; p < 0.05) and revision surgery (OR 0.11; p < 0.05). CONCLUSION:A state-of-the-art ML model successfully identified the attachment site of IP with a high degree of fidelity in select cases, but requires larger sample sizes and more diverse datasets to become reliably integrated into clinical practice.

ObjectivesTo depict the current state of global surgery opportunities in United States ACGME‐approved Otolaryngology residency programs and compare the characteristics of programs with and without these opportunities.MethodsIn this cross‐sectional analysis, websites of ACGME‐accredited Otolaryngology residency programs were analyzed for information on program size, rank, age, and geographic region as obtained through the Doximity platform in 2023. Additional parameters were obtained for programs listing global surgery opportunities such as funding, faculty oversight, location/region, focus, and relationship to the community served. Data were tabulated and analyzed in Microsoft Excel and Stata.ResultsOf the 131 ACGME‐accredited Otolaryngology residency programs, 26 (20%) of programs advertised a global surgery opportunity. Nine (35%) of these promoted funding, 15 (58%) offered a clinical focus, one (4%) offered a research focus, and 10 (38%) offered a combined approach. The Midwest region had the most programs with global surgery opportunities (n = 8, 31%). Less than half (42%) of programs had an established partnership with local partners within low and middle‐income countries (LMICs). When comparing programs, the average Doximity rank, average program age, and average program size of programs that offered global surgery opportunities was significantly higher than those that did not (37.2 vs. 71.5, 54 vs. 41, 19.5 vs. 13.7; all p < 0.05).ConclusionsApproximately one‐fifth of Otolaryngology training programs have a global surgery opportunity. Programs that offer these opportunities had a higher Doximity ranking, older program age, and a larger trainee cohort. These results highlight potential areas for expanding global surgery opportunities in academic institutions.Level of EvidenceN/A Laryngoscope, 2024

ObjectivesTransoral robotic surgery (TORS) is an effective technique for patients with oropharyngeal malignancies. Recent advancements have allowed for the use of the Single Port (SP) system from Intuitive Surgical. Here, we present the first documented case series describing the parameters and techniques used to treat patients with parapharyngeal space (PPS) tumors using the da Vinci SP robotic system from Intuitive Surgical.Materials and MethodsTwo patients treated with the da Vinci SP platform at Houston Methodist Hospital for PPS tumors were identified. Their preoperative, operative, and postoperative courses and the operative setup and techniques were documented.ResultsThe two patients experienced a favorable operative and post-operative course, for which pathology revealed pleomorphic adenomas in both cases. One patient experienced a recurrence of her tumor 12 months postoperatively, which was managed with adjuvant radiotherapy and revision surgery. Both patients are disease-free at 6 and 3 months after treatment concluded.ConclusionSP TORS is a novel and safe approach for addressing benign PPS tumors and should be considered for these patients. Further research should provide further information on the benefit of this approach compared to standard operative techniques.

Cases of delayed osteoradionecrosis (ORN) of the anterior skull base have unique management considerations. A 59-year-old woman with a history of basaloid squamous cell carcinoma of the sinonasal cavity with intracranial extension through the anterior skull base developed delayed radiation sequelae of anterior skull base ORN. She underwent an initial endoscopic resection in 2011 with persistent disease that required an anterior craniofacial resection with left medial maxillectomy in 2012. She had a radiologic gross total resection with microscopic residual disease at the histologic margins prompting adjuvant chemoradiotherapy to target volume doses of 66 to 70 Gy with concurrent cisplatin chemotherapy. She subsequently developed an intracranial abscess in 2021 along the anterior skull base that required a craniotomy and endoscopic debridement. Despite aggressive surgical and medical therapy, she had persistent intracranial infections and evidence of skull base ORN. She ultimately underwent a combined open bifrontal craniotomy and endoscopic resection of the necrotic frontal bone and dura followed by an anterolateral thigh free flap reconstruction with titanium mesh cranioplasty. The patient recovered well from a microvascular free-tissue reconstruction without concern for cerebrospinal fluid leak. Anterior skull base reconstruction with free tissue transfer is a commonly utilized method for oncologic resections. Here, an anterolateral free flap was effectively used to treat an anterior skull base defect secondary to a rare indication of skull base ORN.

OBJECTIVE:Type 1 Thyroplasty is a well-established procedure used for medializing an immobile vocal fold. Silastic and Gore-Tex are the two most common materials used to accomplish this, but comparative data on their relative efficacy are scarce. We sought to compare outcomes between Silastic and Gore-Tex implants via systematic review and meta-analysis for unilateral vocal fold immobility. METHODS:We collected available data from PubMed, Embase, and Web of Science on demographics, maximum phonation time (MPT), voice handicap index (VHI-10/30) score, and any other relevant metrics encountered before comparatively evaluating differences in outcomes. RESULTS:The search yielded 1,534 records with 55 manuscripts ultimately included. There were 41 unique studies that utilized Silastic for a total of 1038 patients. There were 13 unique studies that utilized Gore-Tex for a total of 245 patients. The pooled mean increase in MPT for Silastic patients was 7.8 s (+1.3 SMD) compared with 5.7 s for Gore-Tex (+1.6 SMD). There was significant publication bias present in both analyses. The pooled mean change in VHI-30 with Silastic was -45.4 (62.2%, -2.09 SMD) compared with -51.6 (73.5%, -1.1 SMD) with Gore-Tex. The pooled mean change in VHI-10 with Silastic was -15.6 (54%, -0.46 SMD) compared with -11.6 (43%, -0.86 SMD) with Gore-Tex. There was no significant publication bias present in VHI outcomes. CONCLUSIONS:Silicone and Gore-Tex implants provide adequate and comparable results in TT1. The data supporting this conclusion are limited by follow-up, diversity in outcomes, limited data availability, and publication bias. Future research should be dedicated to comparing implants in a well-randomized environment. Laryngoscope, 135:1236-1247, 2025.

PurposeOral mucositis affects 90% of patients receiving chemotherapy or radiation for head and neck malignancies. Many patients use the internet to learn about their condition and treatments; however, the quality of online resources is not guaranteed. Our objective was to determine the most common Google searches related to "oral mucositis" and assess the quality and readability of available resources compared to ChatGPT-generated responses.MethodsData related to Google searches for "oral mucositis" were analyzed. People Also Ask (PAA) questions (generated by Google) related to searches for "oral mucositis" were documented. Google resources were rated on quality, understandability, ease of reading, and reading grade level using the Journal of the American Medical Association benchmark criteria, Patient Education Materials Assessment Tool, Flesch Reading Ease Score, and Flesh-Kincaid Grade Level, respectively. ChatGPT-generated responses to the most popular PAA questions were rated using identical metrics.ResultsGoogle search popularity for "oral mucositis" has significantly increased since 2004. 78% of the Google resources answered the associated PAA question, and 6% met the criteria for universal readability. 100% of the ChatGPT-generated responses answered the prompt, and 20% met the criteria for universal readability when asked to write for the appropriate audience.ConclusionMost resources provided by Google do not meet the criteria for universal readability. When prompted specifically, ChatGPT-generated responses were consistently more readable than Google resources. After verification of accuracy by healthcare professionals, ChatGPT could be a reasonable alternative to generate universally readable patient education resources.

OBJECTIVE:The PN Naloxone Nasal Swab (Pocket Naloxone Corp., Bethesda, MD) is a swab optimized for drug delivery and intended for use by non-medical personnel for the emergency treatment of opioid overdose. The aim of this study (PNC-20-003) is to determine the safety of this nasal swab in a real-world environment. METHODS:This was a single-institution, quantitative-qualitative prospective trial performed at an outpatient clinic. Patients with normal or abnormal nasal structure were recruited. A non-medically trained individual placed the nasal (soaked in fluorescein dye) on each side of the patient's nose. Endoscopy with recording was performed before and after swab placement. An independent reviewer rated degree of staining, mucosal bleeding, and trauma at nasal subsites. RESULTS:Videos from 32 nasal cavities (16 participants) were reviewed. All cavities had high intensity staining at the septum and the inferior turbinate. No patients had staining within the middle meatus, agger nasi, or olfactory regions. In patients with normal anatomy, obstructive nasal anatomy or prior nasal surgery, all cavities had staining near the nasal septum. Only 7 cavities (22 %) had minor bleeding defined as ooze that stopped in 1-2min, and 3 (9 %) had minor trauma defined as mucosal disruption less than 5mm. There were no significant differences in comparing pre- and post-swab nasal cavity, trauma, or bleeding exams. CONCLUSIONS:These study results showed that this swab is atraumatic to the nasal mucosal membranes when administered by non-medical personnel. Analysis suggests contact with targeted sites for drug absorption regardless of anatomy.

The opioid epidemic continues to concern the CDC and public health officials but recent trends in opioid prescribing rates following common pediatric otolaryngology surgeries are unexplored. This retrospective cohort study queried the TriNetX Research database from January 1, 2010, through December 31, 2023, for pediatric patients who underwent tonsillectomy and/or adenoidectomy and received oral opioids within 5 days of surgery. Prescription trends from 2010 to 2017 were compared to 2022 to 2023, after the publication of multiple clinical practice guidelines (CPGs). Of 286,572 surgeries, 29% of patients received postoperative opioids. Comparing the 2 time periods, a significant decrease was observed in the risk of postoperative opioid prescriptions following 2022 (RR 0.87, CI95% 0.86-0.88). Prescribing rates decreased between 2018 and 2023 from 34% to 24%. Publication of CPGs were associated with a decrease in opioid prescribing rates and may have contributed to an encouraging trend in opioid stewardship.

Crimean-Congo haemorrhagic fever (CCHF) is the most prevalent human tick-borne viral disease, with a reported case fatality rate of 30 % or higher. The virus contains a tri-segmented, negative-sense RNA genome consisting of the small (S), medium (M) and large (L) segments encoding respectively the nucleoprotein (NP), the glycoproteins precursor (GPC) and the viral RNA-dependent RNA polymerase (RDRP). CCHFV is one of the most genetically diverse arboviruses, with seven distinct lineages named after the region they were first reported in and based on S segment phylogenetic analysis.Due to the high genetic divergence of the virus, a single targeted tiling PCR strategy to enrich for viral nucleic acids prior to sequencing is difficult to develop, and previously we have developed and validated a tiling PCR enrichment method for the Europe 1 genetic lineage.We have developed a targeted, probe hybridisation capture method and validated its performance on clinical as well as cell-cultured material of CCHFV from different genetic lineages, including Europe 1, Europe 2, Africa 2 and Africa 3. The method produced over 95 % reference coverages with at least 10x sequencing depth. While we were only able to recover a single complete genome sequence from the tested Europe 1 clinical samples with the capture hybridisation protocol, the data provides evidence of its applicability to different CCHFV genetic lineages.CCHFV is an important tick-borne human pathogen with wide geographical distribution. Environmental as well as anthropogenic factors are causing increased CCHFV transmission. Development of strategies to recover CCHFV sequences from genetically diverse lineages of the virus is of paramount importance to monitor the presence of the virus in new areas, and in public health responses for CCHFV molecular surveillance to rapidly detect, diagnose and characterise currently circulating strains.

OBJECTIVES:To depict the novel use of steroid-eluting stents in the treatment of choanal atresia (CA) restenosis and subglottic stenosis (SGS).METHODS:A retrospective chart review of three pediatric patients, one with CA and two with SGS, treated with mometasone furoate eluting mini stents (PROPEL) was performed. Patients were evaluated for restenosis and adverse events between one to twelve months postoperatively.RESULTS:Postoperatively, patient one with CA showed no signs of restenosis and required no further intervention. Patient two with SGS demonstrated an open subglottic lumen with no signs of restenosis as well as improved phonation following his planned serial procedures. Post-operatively, patient three with SGS exhibited no restenosis of the subglottic lumen, tolerated intermittent tracheostomy capping, and demonstrated improved phonation.CONCLUSION:In this case series, we outline successful treatments for the management of CA restenosis and SGS with mometasone furoate-eluting stents. To our knowledge, this is the first reported application of this treatment in pediatric patients with CA restenosis and the second reported application in pediatric patients with SGS.

The Covid-19 pandemic led to a reduction of in-person, guided mentorship due to social distancing and an emphasis on virtual meetings. The effect of these changes on medical students’ experiences and specialty choice has yet to be studied in a large-scale manner. To determine the perspective of third- and fourth-year medical students regarding the impact of the COVID-19 pandemic on mentorship. The authors distributed a modified Likert scale questionnaire (score: 1–10) to assess responses. Third- and fourth-year medical students at two large US allopathic medical schools. Responses to each survey item were analyzed to characterize the impact of the COVID-19 pandemic on mentorship relationships in medical school. A score of 1–5 was considered “disagree” and a score of 6–10 was considered “agree.” A total of 144 responses were collected with a response rate of 16.2

Parathyroid cysts (PC) are infrequently encountered and characterize less than 1% of all head and neck masses. When present, PCs may present as a palpable neck mass and lead to hypercalcemia and rarely respiratory depression. Furthermore, the diagnostics of PCs is difficult as they can masquerade as a thyroid or mediastinal mass given their proximity. PCs are theorized to be a progression of parathyroid adenomas and often routine surgical excision is sufficient for cure. To our knowledge, there is no documented report of a patient with an infected parathyroid cyst that led to severe dyspnea. This case describes our experience of a patient with an infected parathyroid cyst presenting as hypercalcemia and airway obstruction.

Biologic therapy is a promising treatment for severe chronic rhinosinusitis (CRS). However, the expenses associated are extensive and the cost utility of this treatment paradigm has not been established. As such, understanding whether biologic therapy is cost-efficacious for all CRS patients is of utmost importance. Biologic therapy is a safe and effective treatment modality for severe CRS patients. The available published cost analysis suggests that biologic therapy is not cost-effective compared to surgery. However, there is limited evaluation of the cost-efficaciousness of biologic therapy. Most CRS patients respond to current standard of care. As such, biologic therapy should not be offered to patients in the initial treatment of CRS. However, future research should focus on pinpointing severe CRS patients that would benefit from biologic therapy.