Sarcopenic dysphagia is a significant concern in head and neck cancer (HNC) patients and contributes to malnutrition, aspiration pneumonia and poor clinical outcomes. Although tongue strength (TS) and swallowing muscle mass (SwMM) are central components of swallowing physiology, their relationship in HNC patients remains unclear. This study investigated the association between SwMM and TS and tongue endurance in HNC patients. This prospective cross-sectional study was conducted at the University Medical Center Groningen between February 2023 and April 2025. Fifty-three patients with primary mucosal HNC were included before treatment. SwMM was quantified on contrast-enhanced CT scans using the mid-sagittal tongue complex muscle (TCM) area as a proxy for SwMM volume. TS and tongue endurance were measured with the Iowa Oral Performance Instrument. Associations were evaluated using Pearson and Spearman correlation analyses and univariable and multivariable linear regression adjusted for age, sex, and nutritional status. SwMM was not significantly correlated with maximum TS at the anterior or posterior positions (r = 0.080 and r = 0.048, respectively; both p > 0.05), nor with tongue endurance (r= − 0.043 and r= − 0.004, respectively; both p > 0.05). Regression analyses confirmed that SwMM was not significantly associated with tongue performance, including in adjusted multivariable models. SwMM and tongue muscle performance represent distinct physiological domains in untreated HNC patients. The mid-sagittal TCM area, as a proxy for SwMM, was not associated with tongue pressure capacity, suggesting that TS alone may overlook lower SwMM. CT-based SwMM assessment is feasible but should complement functional assessments for a comprehensive evaluation of sarcopenic dysphagia.

OBJECTIVES:Detection of local recurrences after (chemo)radiotherapy (C)RT for head and neck squamous cell carcinoma (HNSCC) is challenging due to post-treatment mucosal changes. This study assessed the added diagnostic value of narrow band imaging (NBI) compared to white light imaging (WLI) during rigid endoscopy under general anaesthesia for recurrence detection. A secondary aim was to assess NBI's ability to detect tumour extension surrounding the suspected carcinoma, which remained undetected by WLI. DESIGN:Prospective randomised controlled trial with 1:1 block randomisation. SETTING:Single tertiary referral centre. PARTICIPANTS:Ninety-four patients with a suspected local recurrence after (C)RT, randomised to WLI (n = 47) or WLI+NBI (n = 47). MAIN OUTCOME MEASURES:Sensitivity, specificity, predictive values and survival outcomes, with histopathology as reference standard. RESULTS:A recurrence was histopathologically confirmed in 36 patients (38%). Surgeons judged lesions as highly suspected of malignancy in 48 patients (51%): 24 (50%) in each group. WLI yielded sensitivity 84.2%, specificity 71.4%, PPV 66.7%, and NPV 87.0%. WLI+NBI showed slightly lower sensitivity (75.0%) and specificity (66.7%), with PPV 62.5% and NPV 78.3%. Identification of Ni type V lesions alone significantly improved specificity, PPV and accuracy. No differences in disease-specific or overall survival were found between groups. CONCLUSION:In previously irradiated patients, NBI provides marginal additional diagnostic value over WLI in detecting local recurrence of HNSCC. Isolated use of Ni type V as a malignancy marker improves specificity, PPV and accuracy.

Background/Objectives: Supraglottic and hypopharyngeal carcinomas are aggressive malignancies that are often diagnosed at advanced stages. Timely recognition of these malignancies is influenced by many factors, such as endoscope quality and experience. This study evaluated the potential of artificial intelligence (AI) to support real-time detection and classification of such lesions during flexible endoscopy in the outpatient clinic. Methods: A previously developed deep learning (DL) algorithm was extended from a glottic lesion model to the unified localization and classification of glottic, supraglottic, and hypopharyngeal lesions during flexible endoscopy. Lesion frames were extracted from endoscopy videos obtained at two head and neck oncology centers and one secondary referral center between 2012 and 2024. These frames were annotated and labeled based on histopathological or clinically confirmed reference diagnoses. The primary outcome was the unified model's performance in detection of lesions per frame. After training (70% of data), the positive predictive value (precision) and sensitivity (recall) of this model were calculated on an independent test set (30% of data), stratified by subsite and tumor (T-) classification. Secondly, the model's binary classification performance (benign or malignant) was evaluated. Results: From 490 supraglottic and hypopharyngeal endoscopy videos, 40,059 frames with a benign or malignant lesion were extracted and added to the 56,036 glottic lesion frames in the database, comprising 1336 lesion videos and 123 healthy control videos (total n = 1459). On the test set, the model achieved a detection precision of 92.1% (95% CI: 90.9-93.2) and a recall of 73.3% (95% CI: 69.8-76.6). Detection performance increased with higher T-stage. Among correctly detected lesion instances in a malignancy-dominated test set (65.3% of lesion instances), sensitivity for malignancy detection was 94.3% (95% CI: 91.8-96.5). Combined end-to-end performance for correct malignant lesion detection and classification was estimated at 69.1% (object-level recall 73.3% × classification sensitivity 94.3%). Evaluation of 33 lesion-free videos demonstrated a mean frame-level specificity of 46.6% and a median of 19 false positive detections per video. Conclusions: This is the first study to report a DL model for real-time endoscopic detection and classification of benign and malignant laryngeal and pharyngeal lesions. The developed model showed promising lesion detection and cancer classification performance in the evaluated test set. T1 tumor detection remains an important limitation, particularly because early-stage detection is a primary aim of AI-assisted endoscopy. Further model testing is required in real-world lesion prevalence settings, where external validation and clinical usability should be investigated.

Purpose Sarcopenia, characterized by loss of skeletal muscle mass (SMM) and strength, often leads to dysphagia in the elderly. This condition can also worsen treatment outcomes in head and neck cancer (HNC) patients, who are susceptible to swallowing difficulties. This study aimed to establish the correlation between swallowing muscle mass (SwMM) and SMM in HNC patients. Methods Data from 157 HNC patients in the OncoLifeS biobank of the University Medical Center Groningen were analyzed using pre-treatment neck CT scans. The SwMM was assessed by the cross-sectional area (CSA) of the tongue complex muscles (TCM), and SMM was indicated by the skeletal muscle index (SMI), calculated from corrected CSA at the third lumbar vertebra (L3). Correlations between SwMM and SMM were analyzed using Pearson or Spearman tests, and multivariable linear regression with SMI as dependent variable was performed. Results SwMM was moderately correlated with SMI ( r = 0.600, p < 0.001), CSA at C3 ( r = 0.538, p < 0.001), and CSA at L3 ( r = 0.651, p < 0.001). The CSA at C3 strongly correlated with SMI ( r = 0.871, p < 0.001). In multivariable regression analysis, age, sex, and weight were strong predictors of SMI, while the TCM area was a less robust predictor ( p = 0.059). Models with CSA at C3 and L3 showed all variables as significant predictors ( p < 0.001). Conclusions Although SwMM was significantly correlated with SMI and holds clinical utility, it is not strong enough to be considered interchangeably with C3 for predicting SMI, suggesting that swallowing muscles represent a different entity than skeletal muscles and not reflect accurately the general muscle mass.

Background and purpose: In the Netherlands, care for head and neck cancer (HNC) is centralised in head and neck oncology centres (HNOCs). Follow-up after treatment requires frequent visits that can burden patients and providers. Telemedicine, through remote evaluation of laryngopharyngoscopy videos recorded at local hospitals, may offer a feasible alternative. This study protocol describes the aim to assess patient satisfaction and safety with telemedicine follow-up after treatment of (pre-)malignant glottic lesions, including severe dysplasia, carcinoma-in-situ and T1 squamous cell carcinoma, conducted at one HNOC and participating general hospitals. Methods and analysis: As a non-blinded, randomised controlled trial, 90 patients with a one-way travel time by car of over 45 min to the HNOC will be allocated to the intervention group (follow-up by an Ear, Nose and Throat surgeon at a nearby participating hospital) or the control group (standard follow-up at the HNOC). All patients undergo guideline-based care. In the intervention group, laryngopharyngoscopy recordings will be remotely reviewed by HNOC specialists on the same day. Surveys will be fulfilled at baseline, 6 and 12 months. The primary outcome is overall patient satisfaction using a 0–10 numeric rating scale at 12 months follow-up. Secondary outcomes are safety, quality of life, fear of recurrence, travel time and carbon-dioxide emission. Safety will be assessed through recurrence, complications, re-referral and survival. Between-group and within-group comparisons will be performed to evaluate differences in outcomes, using appropriate statistical methods based on data distribution. Ethics and dissemination: This study explores regional collaboration and sustainable follow-up for HNC patients. The ethics board approved the protocol (M23.325004). The authors commit to publishing the findings.

BACKGROUND/OBJECTIVES:SNMM is a rare and aggressive malignancy with a poor prognosis. The current staging systems fail to adequately stratify patient risk. This study aimed to evaluate the prognostic impact of tumor location and extension on overall survival (OS) in SNMM. METHODS:A systematic literature search of Medline, Web of Science, and Embase was performed to identify studies assessing the prognostic significance of tumor location and extension. Study quality was evaluated using the Quality in Prognosis Studies (QUIPS-2) tool. Meta-analyses were conducted to calculate pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Eligible studies included primary SNMM reporting tumor location/extension and survival; observational designs (case series ≥ 5 patients) were eligible with no language restrictions. Searches covered MEDLINE, Web of Science, and Embase and were last updated on 10 Jan 2025; reference lists were also screened. RESULTS:Thirty-four studies were included in the systematic review, of which ten met criteria for meta-analysis. Tumors located in the paranasal sinuses (HR = 2.89, 95% CI: 1.63-5.14) and those with orbital involvement (HR = 1.92, 95% CI: 1.34-2.73) were associated with significantly poorer OS. Maxillary and ethmoid sinus involvement showed no statistically significant difference compared with nasal cavity tumors. CONCLUSIONS:Tumor location and extension are significant prognostic indicators in SNMM. Patients with paranasal sinus tumors or orbital invasion have worse outcomes, supporting inclusion of these factors in future staging systems for better clinical decision-making. Limitations include the observational nature of the evidence, heterogeneity across definitions and analyses, and underpowered publication-bias tests; certainty of evidence was not formally graded.

OBJECTIVE:This study evaluated outcomes of stapes surgery in otosclerosis patients by assessing audiometric results and health-related quality of life (HRQOL) using the Dutch Stapesplasty Outcome Test-25 (SPOT-25) questionnaire. Additionally, the role of SPOT-25 in preoperative decision-making and as a follow-up tool was explored. STUDY DESIGN:A prospective, multicenter cohort study. SETTING:One tertiary academic medical center and 3 secondary referral centers. METHODS:Data from 115 adult patients undergoing primary stapes surgery was analyzed. Audiometric outcomes were measured using pure-tone audiometry results and word recognition score (WRS). HRQOL was assessed using SPOT-25, Glasgow Health Status Questionnaire, and Glasgow Benefit Inventory. Pre- and postoperative outcomes were compared, and correlations between pure-tone audiometry results, WRS, and HRQOL were analyzed. Outcomes were compared between patients receiving 0.4 and 0.6 mm diameter pistons, and the impact of preoperative pure-tone audiometry results was analyzed. RESULTS:Significant postoperative improvements were observed in all audiometric measures (mean air conduction gain of 22 dB and air-bone gap (ABG) improvement of 18 dB). HRQOL also improved significantly (mean SPOT-25 score improved from 48 to 27). The 0.6 mm piston group had a significantly smaller postoperative ABG than the 0.4 mm group. Patients with a preoperative ABG ≤ 15 dB had a mean SPOT-25 gain of 19 (SD 22), whereas those with a preoperative ABG > 15 dB had a gain of 21 (SD 18). CONCLUSION:Stapes surgery significantly improves hearing and HRQOL. The SPOT-25 is a valuable tool for evaluating HRQOL and may assist in preoperative decision-making in patients with varying hearing impairments. LEVEL OF EVIDENCE:III.

To translate and culturally adapt the SPOT-25 to the Dutch language and validate the Dutch SPOT-25 in a Dutch population of otosclerosis patients undergoing primary stapes surgery. A multicenter prospective validation study was performed between November 2018 and May 2024. The translation into Dutch and validation process of the SPOT-25 was performed according to the COSMIN guidelines. Patients were asked to complete the SPOT-25 and Glasgow Health Status Questionnaire (GHSQ) preoperatively, the SPOT-25, GHSQ and Glasgow Benefit Inventory six to eight weeks postoperatively and the SPOT-25 eight to ten weeks postoperatively. Healthy controls were asked to complete the translated SPOT-25 once. Preoperative and postoperative audiometric results were also obtained. The evaluated measurement properties included construct validity, measurement invariance, discriminative validity, reliability and responsiveness of the translated SPOT-25. Hundred and fifteen patients and 50 healthy controls were analyzed. Analyses of the translated SPOT-25 showed adequate construct validity, discriminative validity, reliability and responsiveness. The SPOT-25 scores were strongly correlated with the GHSQ score. The internal consistency and test–retest reliability were good as Cronbach’s alpha and intraclass correlation coefficients were higher than 0.70. The four-factor model fitted best in our population of otosclerosis patients; however the results indicated a mediocre fit between the model and the data. The Dutch SPOT-25 showed good validity, reliability and responsiveness and can be implemented as an additional outcome measure to improve otosclerosis research and clinical practice.

OBJECTIVE:The primary objective of this study was to test an in-house developed and 3D-printed endoscopic middle ear surgery trainer (EEST) that replicates patient-specific external auditory canal (OEAC) anatomy. The trainer is designed to train ENT residents and surgeons in navigating OEAC anatomic variability and to improve hand-eye coordination. METHODS:The EEST was designed using segmentations from temporal bone imaging from a human cadaveric head. Five 3D-printed models were created using photopolymer resin, incorporating gradual augmentations to the scutum and the bulge of the anterior bony wall. A single surgeon performed surgical procedures on these models and documented his experience. In addition, 3 surgeons and 2 experienced residents tested one model and completed a content and face validity questionnaire. RESULTS:In this pilot study, an experienced ENT surgeon successfully completed surgical tasks in all 5 EEST models. Scutum resection was required in 4 simulations. The EEST demonstrated an overall mean Likert scale rating of 3.9 (SD=0.4) on face validity and a content validity rating of 4.5 (SD=0.3) when tested by three surgeons and 2 residents. CONCLUSION:This study offers a valuable start for further development of an affordable, 3D-printed, patient-specific, surgical trainer for endoscopic middle ear surgery.

AbstractObjectiveThe primary aim of this study was to investigate the accuracy of a semi‐automatic algorithm in assessing the feasibility and complexity of endoscopic stapes surgery preoperatively.MethodsA semi‐automatic algorithm was developed to simulate endoscopic stapes surgery in 3D. To test the accuracy of the algorithm, five fresh‐frozen cadaveric heads (ten ears) were used. Each head was CT‐scanned, followed by segmentation and 3D reconstruction of the bones including the ear canal, middle ear, and ossicular chain. Two interventions were tested on each ear. Initially, the algorithm was digitally employed to simulate the endoscopic ear surgery. Subsequently, the actual endoscopic ear surgery was performed. Primary outcomes for each intervention included the amount of scutum removal (postoperative 3D model subtracted from preoperative 3D model), visibility of important landmarks, feasibility score, and a complexity questionnaire. Finally, the outcomes of the pre‐operative planning and the actual procedure were directly compared to evaluate the algorithm's accuracy and usability.ResultsThe preoperative planning method achieved an accuracy rate of 70% in predicting the need for scutum removal. The mean volume of the removed scutum was 0.5 mm3. Endoscopic surgery was feasible in all ten ears, with all relevant anatomical landmarks adequately visualized as estimated by the preoperative planning algorithm.ConclusionPreoperative planning models can assist ENT surgeons in evaluating the feasibility and complexity of endoscopic stapes surgery. With adequate training and testing on clinical cases, these models can significantly improve their predictive accuracy and thereby improve patient outcomes.

In the rising and frail head and neck cancer (HNC) population, geriatric assessments are crucial. Frail HNC patients often experience dysphagia. The coexistence of dysphagia and frailty presents complex health challenges, however, there is limited evidence on the prognostic value of frailty on post-treatment dysphagia. This study explores the relationship between pre-treatment frailty status and post-treatment dysphagia in HNC patients. A retrospective data analysis from the OncoLifeS data-biobank at the University Medical Center Groningen of 242 patients diagnosed with HNC between 2014 and 2016. The study involved several physical, functional and psychological pre-treatment geriatric assessments, and frailty screening using the Groningen Frailty Indicator (GFI) and the Geriatric-8 screening tool (G8). Outcome measures were swallowing-related quality of life (HNSW-QoL) and toxicity-related dysphagia evaluations (CTCAE-D) at 3, 6, 12 and 24 months. Linear mixed-effects models assessed factors associated with HNSW-QoL and CTCAE-D. Frail patients consistently reported worse HNSW-QoL and CTCAE-D than non-frail patients over time, with symptoms increasing at 3 months, but gradually decreasing by 24 months. Frailty status (G8 or GFI) was a significant predictor for lower HNSW-QoL (β = 11.770 and 10.936, both p < 0.001), and lower CTCAE-D (β = 0.245, p = 0.058; β = 0.331, p = 0.019), respectively. In this study, frailty was found to be associated with a worse of swallowing-related quality of life, and with increased toxicity-related dysphagia. These findings provide insights for the identification of HNC patients at higher risk of post-treatment swallowing-related issues, and offer opportunities for optimizing their post-treatment swallowing outcomes.

Purpose To evaluate the effect of piston diameter in patients undergoing primary stapes surgery on audiometric results and postoperative complications. Methods A retrospective single-center cohort study was performed. Adult patients who underwent primary stapes surgery between January 2013 and April 2022 and received a 0.4-mm-diameter piston or a 0.6-mm-diameter piston were included. The primary and secondary outcomes were pre- and postoperative pure-tone audiometry, pre- and postoperative speech audiometry, postoperative complications, intraoperative anatomical difficulties, and the need for revision stapes surgery. The pure-tone audiometry included air conduction, bone conduction, and air–bone gap averaged over 0.5, 1, 2 and 3 kHz. Results In total, 280 otosclerosis patients who underwent 321 primary stapes surgeries were included. The audiometric outcomes were significantly better in the 0.6 mm group compared to the 0.4 mm group in terms of gain in air conduction (median = 24 and 20 dB, respectively), postoperative air–bone gap (median = 7.5 and 9.4 dB, respectively), gain in air–bone gap (median = 20.0 and 18.1 dB, respectively), air–bone gap closure to 10 dB or less (75% and 59%, respectively) and 100% speech reception (median = 75 and 80 dB, respectively). We found no statistically significant difference in postoperative dizziness, postoperative complications and the need for revision stapes surgery between the 0.4 and 0.6 mm group. The incidence of anatomical difficulties was higher in the 0.4 mm group. Conclusion The use of a 0.6-mm-diameter piston during stapes surgery seems to provide better audiometric results compared to a 0.4-mm-diameter piston, and should be the preferred piston size in otosclerosis surgery. We found no statistically significant difference in postoperative complications between the 0.4- and 0.6-mm-diameter piston. Based on the results, we recommend always using a 0.6-mm-diameter piston during primary stapes surgery unless anatomical difficulties do not allow it.

Objective To investigate the assumption that day-case cochlear implantation is associated with lower costs, compared to inpatient cochlear implantation, while maintaining equal quality of life (QoL) and hearing outcomes, for the Dutch healthcare setting. Study design A single-center, non-blinded, randomized controlled trial in a tertiary referral center. Methods Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group (i.e., one night admission). We performed an intention-to-treat evaluation of the difference of the total health care-related costs, hospital and out of hospital costs, between day-case and inpatient cochlear implantation, from a hospital and patient perspective over the course of one year. Audiometric outcomes, assessed using CVC scores, and QoL, assessed using the EQ-5D and HUI3 questionnaires, were taken into account. Results There were two drop-outs. The total health care-related costs were €41,828 in the inpatient group ( n = 14) and €42,710 in the day-case group ( n = 14). The mean postoperative hospital stay was 1.2 days (mean costs of €1,069) in the inpatient group and 0.7 days (mean costs of €701) for the day-case group. There were no statistically significant differences in postoperative hospital and out of hospital costs. The QoL at 2 months and 1 year postoperative, measured by the EQ-5D index value and HUI3 showed no statistically significant difference. The EQ-5D VAS score measured at 1 year postoperatively was statistically significantly higher in the inpatient group (84/100) than in the day-case group (65/100). There were no differences in postoperative complications, objective hearing outcomes, and number of postoperative hospital and out of hospital visits. Conclusion A day-case approach to cochlear implant surgery does not result in a statistically significant reduction of health care-related costs compared to an inpatient approach and does not affect the surgical outcome (complications and objective hearing measurements), QoL, and postoperative course (number of postoperative hospital and out of hospital visits). Level of evidence 1.

Transoral Robotic Surgery (TORS) is utilized for treating various malignancies, such as early-stage oropharyngeal cancer and lymph node metastasis of an unknown primary tumor (CUP), and also benign conditions, like obstructive sleep apnea (OSA) and chronic lingual tonsillitis. However, the success and failure of TORS have not been analyzed to date. In this retrospective observational multicenter cohort study, we evaluated patients treated with TORS using the da Vinci surgical system. Success criteria were defined as identification of the primary tumor for CUP, >2 mm resection margin for malignant conditions, and improvement on respiratory polygraphy and tonsillitis complaints for benign conditions. A total of 220 interventions in 211 patients were included. We identified predictors of success, such as low comorbidity status ACE-27, positive P16 status, and lower age for CUP, and female gender and OSA severity for benign conditions. For other malignancies, no predictors for success were found. Predictors of failure based on postoperative complications included high comorbidity scores (ASA) and anticoagulant use, and for postoperative pain, younger age and female gender were identified. This study provides valuable insights into the outcomes and predictors of success and failure in TORS procedures across various conditions and may also help in patient selection and counseling.

Purpose Diagnostic endoscopy with biopsy under general anesthesia (DE-GA) is still considered as the established standard to assess laryngopharyngeal cancer patients. Office-based flexible laryngoscopic biopsy (FLB) offers an alternative, but the effect on oncological outcome remains uncertain. Therefore, the diagnostic process and survival of patients undergoing FLB, compared to those undergoing DE-GA were evaluated. Methods Patients suspected of laryngopharyngeal cancer who underwent FLB were evaluated. Patients with FLB-confirmed squamous cell carcinoma (SCC) were matched with DE-GA patients based on tumor site, T-classification, N-classification, age, and p16 overexpression. Time from first visit to diagnosis (FVD), time to treatment interval (TTI), disease-specific survival (DSS) and overall survival (OS) were analyzed. Results FLB yielded a definitive diagnosis in 155/164 (95 %) patients. No complications were observed. Ninety-eight of the 124 patients in which FLB revealed a SCC received curative treatment and were compared with 98 matched patients who underwent DE-GA. Median FVD interval was 6 days after FLB and 15 days after DE-GA (p < 0.001). Median TTI interval (FLB: 28 days, DE-GA: 28 days) was equal (p = 0.91). Oncological outcomes were comparable (p > 0.05) between FLB (OS: 2-yr: 76 %, 5-yr: 42 %; DSS: 2-yr: 86 %, 5-yr: 85 %) and DE-GA groups (OS: 2-yr: 76 %, 5-yr: 50 %; DSS: 2-yr: 81 %, 5-yr: 79 %). Conclusion FLB in the outpatient setting demonstrates a high diagnostic accuracy, is safe, accelerates the diagnostic process and has no negative effects on clinical outcome compared to DE-GA. Therefore, FLB should be considered as the standard diagnostic procedure in patients suspected of laryngopharyngeal cancer.

OBJECTIVE:To evaluate the difference in overall, hospital, and out-of-hospital cost difference of day-case stapes surgery, compared with inpatient stapes surgery, while maintaining equal hearing outcomes and quality of life (QoL). STUDY DESIGN:A single-center, nonblinded, randomized controlled trial in a tertiary referral center. METHODS:A total of 112 adult patients planned for primary or revision stapes surgery for clinically suspected otosclerosis were randomly assigned to either the day-case or inpatient treatment group. An evaluation was performed of the difference in total health care-related costs (hospital and out-of-hospital costs) from a hospital and patient perspective over the course of 1 year. Audiometric measurements included pure-tone audiometric measurements and speech audiometry measured at 2 months and 1 year postoperatively. QoL was assessed at 3 months and 1 year postoperatively, using the EQ-5D and HUI3 questionnaires. RESULTS:A total of 109 cases (100 patients) were analyzed due to three dropouts. The total health care-related costs were €16,586 in the inpatient group (n = 54) and €16,904 in the day-case group (n = 55). The mean postoperative hospital stay was 0.9 days (mean costs of €854) in the inpatient group and 0.5 days (mean costs of €561) in the day-case group (both mean differences statistically significant), with a crossover rate from day-case to the inpatient group of 36% (n = 20) and a crossover rate from inpatient to the day-case group of 11% (n = 6). There were no differences in postoperative complications and objective hearing outcomes. Besides an increased number (0.2) of postoperative telephone consultations in the day-case group, there were no statistically significant differences in postoperative hospital and out-of-hospital costs or visits. The QoL showed no statistically significant differences. CONCLUSION:A day-case approach in primary or revision stapes surgery does not result in a statistically significant reduction of health care-related hospital and out-of-hospital costs compared with an inpatient approach. It also does not affect the surgical outcome (objective audiometric measurements and complication rate), QoL, and postoperative course (number of postoperative hospital and out-of-hospital visits).Level of evidence: 1.

BACKGROUND:Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass. METHODS:Data from 10 head and neck cancer patients were collected from the Oncological Life Study data-biobank of the University Medical Center Groningen. The pharyngeal constrictor, genioglossus, mylohyoid and geniohyoid complex muscles, as well as the tongue complex muscles, were delineated manually on routinely performed head and neck computed tomography scans. Axial and sagittal planes were used for volume and area measurements, respectively. Muscle density measurements were performed with and without Hounsfield unit thresholding. Correlations were assessed by Pearson correlation coefficients, and interobserver reliability was measured using intra-class correlation coefficients (ICCs). RESULTS:Significant differences were observed between sagittal area measurements with and without Hounsfield unit thresholds for pharyngeal constrictor, tongue complex and the sum of the swallowing muscles (t > 6; P-value < 0.001). Stronger correlations emerged without Hounsfield unit thresholding. Strong positive and significant correlations were found between the total swallowing muscle mass volume and the sagittal area of the tongue complex muscles (r = 0.87, P-value < 0.05) and the sum of the sagittal areas of the pharyngeal constrictor and tongue complex muscles (r = 0.85, P-value < 0.05). The use of the Hounsfield unit threshold weakened correlations. Interobserver reliability was assessed and found to be fair to good for the pharyngeal constrictor muscle (ICC = 0.68, P-value < 0.05), excellent for the tongue complex muscles (ICC = 0.98, P-value < 0.05) and excellent for the total swallowing muscle area (ICC = 0.96, P-value < 0.05). CONCLUSIONS:Single-slice delineation of the sagittal area of tongue complex muscle and pharyngeal constrictor muscle is a promising, fast, simple and clinically applicable method for measuring the total volume of the swallowing muscle mass in head and neck cancer patients without Hounsfield unit thresholding. These advancements and findings would help in the early and accurate diagnosis of definitive sarcopenic dysphagia.

Objective To investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation. Study design A single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center. Methods Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year. Results Overall quality of life measured by the HUI3 was equal between the day-case ( n = 14) and inpatient group ( n = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting ( n = 1), drowsiness ( n = 1), late scheduled surgery ( n = 2), social reasons ( n = 1), or due to an unclear reason ( n = 1). No patients required readmission. Conclusion We found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery. Level of evidence 1.

Objective:What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests? Data Sources:PubMed Medline, Elseviers's Embase, and the six databases of Cochrane Library. Methods:We conducted a systematic search on December 20, 2022, consisting of synonyms for EGM. We considered randomized controlled trials and observational studies with original data for inclusion if they included adults who underwent electrogustometry. Articles were excluded if no analysis regarding validity, reliability, or diagnostic accuracy had been performed or if these analyses could not be performed with the published data. Results:Nineteen articles discussing 18 studies were included for data extraction. The included studies carry a high risk of bias. Overall, the association between a variety of reference taste tests and EGM was moderate or weak with correlation coefficients ranging from -0.51 to 0.40 with one outlier of -0.74 found in one study correlating EGM and taste solutions. Test-retest reliability was good with reported correlation coefficients between 0.78 and 1.0. The sensitivity, specificity, PPV, and NPV of EGM in identifying abnormal taste function varied widely between the four studies on diagnostic accuracy. Conclusion:The included studies in this review lack the required standards regarding study design to draw firm conclusions about the validity, reliability, and diagnostic accuracy of the EGM. Future research is needed to assess these measurement properties. Based on the reported results, we would not recommend using the EGM as a screening test for taste disturbance in clinical practice. Level of Evidence:NA.