OBJECTIVES:To describe and analyze the trends of pediatric sinusitis cases from 2018 to 2022 across the country utilizing the Pediatric Hospital Information System (PHIS) database focusing on volumes, socioeconomics, and severity of cases.STUDY DESIGN:Retrospective Cohort Study.METHODS:A retrospective cohort study using the Pediatric Health Information System (PHIS) database, which consists of 50 children's hospitals was performed. Regions were defined according to PHIS guidelines. We evaluated percentage of sinusitis cases demographic and socioeconomic information and subgrouped by region throughout 2018-2022.RESULTS:In all regions there were a greater number of sinusitis cases post-COVID compared to pre-COVID, with notable increases in major and extreme severity. The years 2020 and 2021 saw a decrease in total sinusitis cases in all locations. Both surgical intervention and severity of sinusitis were significant factors affecting length of stay. Age and severity were the most significant predictors regarding the odds of having sinus surgery. Age and insurance type were significant predictors of severity, with increasing age and government insurance associated with higher odds of major or extreme severity of sinusitis.CONCLUSIONS:There appears to be a trend of both increased number and worsening severity of acute sinusitis cases in the post-COVID era compared to pre-COVID. There was a decrease in cases in 2020-2021 during the pandemic, consistent with trends of other communicable diseases.

Objectives Surgical fires, particularly within Otolaryngology, remain a surprisingly frequent and devastating complication of laser‐related surgery in the oropharynx and airway; Current estimates suggest anywhere from 200 to 600 surgical fires per year in the United States, with 20%–30% of these occurring as a complication of laser surgery and 90%–95% of these occurring in the head and neck region. Unfortunately, the complications of laser surgery in the airway may include respiratory failure, airway burns with stenosis, and may result in mortality. The most commonly utilized endotracheal tube for protection against inadvertent laser strikes, the Laser‐Shield II tube (Medtronic), was removed from the commercial marketplace in 2016 after cases of airway fires were reported as a result of feature deficiencies in the product (FDA MAUDE Database review). Since the demise of the Laser‐Shield II tube, alternatives such as the Mallinckrodt laser tube and handmade reinforced tubes have been utilized, although shortcomings in design and features have made these options less appealing to practicing Otolaryngologists. Creating a laser‐safe endotracheal tube is critical for safe upper airway surgery. This paper evaluates new technologies, materials, and technical innovations in endotracheal tubes that may advance patient safety in laser‐assisted Otolaryngology procedures. Study Type This paper evaluates new technologies, materials, and technical innovations in endotracheal tubes that may advance patient safety in laser‐assisted Otolaryngology procedures. Methods First, this article reviews the background of laser surgery in Otolaryngology and the consequent risk of surgical fire with resultant development of laser‐resistant endotracheal tubes and commercial availability. Next, a review of claims and national database review of product failures related to previous laser‐resistant endotracheal tubes is performed through the FDA MAUDE database. This includes an evaluation of cases: review of techniques in laser airway surgery including spontaneous ventilation, decreased O 2 concentration, currently available endotracheal tubes including “handmade” fixes for perceived safety risks, and determination of failure points for previous laser‐resistant endotracheal tubes. Third, the paper reviews the requested features of an “ideal” laser‐resistant endotracheal tube. Finally, the paper reviews failure testing from an initial, unsuccessful attempt at material development and the consequent development of alternative technologies that address failure points from previous endotracheal tubes and addresses requested features with a detailed analysis of FDA‐approval required testing. Extensive lab testing of the new tube predicts a significant reduction of risk in vivo with inability to perforate the shaft or cuff of the tubes under standard working conditions. Results While no iteration of a laser‐resistant endotracheal tube is entirely laser safe, advances in technology can improve the safety profile of these devices. The new tube contains a double cuff, a soft and flexible shaft to minimize laryngeal insertion trauma, a smooth external surface, a tight‐to‐shaft balloon, and methylene blue dye in the cuff to alert the user to inadvertent penetration. These characteristics were the most requested by laryngologists in the development of a new laser‐resistant tube. The newest endotracheal tube brings the features most requested by Otolaryngologists in a laser‐resistant tube, and improves the safety profile over previous tubes. Conclusion Development of a new endotracheal tube represents an advancement in safety for the Otolaryngologist in laser airway surgery. Understanding the previous history and the science behind surgical fire formation is essential in advancing safety for patients in the future. Level of Evidence N/A Laryngoscope , 2024

Background Robotic-assisted surgery is increasingly used in pediatric otolaryngology, offering potential benefits like improved cosmetic outcomes. However, challenges such as longer operative times, higher costs, and a steep learning curve remain. Objectives This systematic review and meta-analysis assess whether robotic-assisted surgery offers advantages in operative time, complication rates, hospital stay, and cosmetic outcomes compared to traditional methods in pediatric patients. Methods A literature search identified 20 studies, with six focused on thyroidectomy. Data on operative time, complications, hospital stay, and cosmetic outcomes were extracted and analyzed. Results No significant differences in operative time or complications were found for robotic-assisted thyroidectomy, but it showed superior cosmetic outcomes and, in some cases, shorter hospital stays. Additional analyses suggested feasibility and functional benefits of other robotic procedures. Conclusions Robotic-assisted surgery in pediatric otolaryngology is as safe and efficient as traditional methods, with added cosmetic and functional benefits. Further large-scale trials are needed.

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

Introduction: Non-tuberculous mycobacterial (NTM) infection commonly manifests as subacute or chronic cer-vicofacial lymphadenitis in immunocompetent children. The optimal management of this pathology remains controversial. Objectives: This international consensus guideline aims to understand the practice patterns for NTM cervicofacial lymphadenitis and to address the primary diagnostic and management challenges.Methods: A modified three-iterative Delphi method was used to establish expert recommendations on the diag-nostic considerations, expectant or medical management, and operative considerations. The recommendations herein are derived from current expert consensus and critical review of the literature. Setting: Multinational, multi-institutional, tertiary pediatric hospitals. Results: Consensus recommendations include diagnostic work-up, goals of treatment and management options including surgery, prolonged antibiotic therapy and observation. Conclusion: The recommendations formulated in this International Pediatric Otolaryngology Group (IPOG) consensus statement on the diagnosis and management of patients with NTM lymphadenitis are aimed at improving patient care and promoting future hypothesis generation.

Background: The Occupational Safety and Health Administration (OSHA) considers acoustic exposure of 90 decibels (dB) an occupational risk for noise-induced hearing loss. Pediatric healthcare clinicians are exposed to considerable noise especially during invasive procedures, predisposing them to noise-induced hearing loss, increased work-related stress, and increased complications associated with intense noise exposure. While there has been extensive research in noise exposure in dentistry, to date there has been no research on noise exposure in the pediatric otolaryngology clinic setting. The objective of this study is to quantify the degree of noise exposure that pediatric otolaryngologists encounter in the clinical setting.Methods: A sound survey was performed of 420 pediatric otolaryngology clinic visits within a single-institution tertiary care facility from January 2022 to March 2022, with a total of 409 visits included. At each visit, noise was measured using a calibrated National Institute for Occupational Safety and Health (NIOSH) Sound Meter application, an iPad, and a microphone. The Equivalent Continuous Sound Pressure Level (LAeq), peak sound pressure level (SPL), C-weighted peak noise level (LCpeak), and the 8-hour time-weighted average (TWA) sound level were recorded.Results: The average LAeq was 61.1 dB, the median LAeq was 60.3 dB, and the average peak SPL was 80.5 dB. Only 0.5 % of visits reached an LAeq above 80 dB, however, 51 % were above 60 dB and 99 % were above 45 dB. No clinicians were exposed to noise exceeding established limits of safety. Patients younger than ten years old (p < 0.001) and those who underwent procedures such as cerumen removal (p < 0.001) elicited higher ranges of elevated noise. Multivariate analysis confirmed that increased age decreased acoustic exposure while procedures increased acoustic exposure.Conclusions: The results of this study suggest that pediatric otolaryngology clinicians do not exceed hazardous noise limit exposure. However, they are exposed to levels above those which have been linked to stress, poor productivity, and stress-related disorders. This analysis also reports that patients who are younger and those that undergo procedures, specifically cerumen removal, tend to expose their providers to the highest levels of noise. This is the first study examining noise exposure in pediatric otolaryngology, and further research should evaluate the risks of noise exposure in this environment.

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BACKGROUND:Alcohol-based skin preparations were first approved for surgical use in 1998 and have since become standard in most surgical fields. The purpose of this report is to examine incidence of surgical fires because of alcohol-based skin preparation and to understand how approval and regulation of alcohol-based skin preparations impacted trends in fires over time. METHODS:We identified all reported surgical fires resulting in patient or staff harm from 1991 through 2020 reported to the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database. We examined incidence of fires because of these preparations, trends after approval and regulation, and common causes. RESULTS:We identified 674 reports of surgical fires resulting in harm to patients and surgical personnel, in which 84 involved an alcohol-based preparation. The time-adjusted model shows that from 1996 through 2006, there was a 26.4% increase in fires followed by a 9.7% decrease from 2007 to 2020. The decrease in fires was most rapid for head and neck and upper aerodigestive tract surgeries. Qualitative content analysis revealed improper surgical site preparation as well as close proximity of surgical sites to an oxygen source as the most common causes of fires. CONCLUSION:Since FDA approval, alcohol-based preparation solutions have been associated with a significant percentage of surgical fires. Warning label updates from 2006 to 2012 coupled with increased awareness efforts of associated risks of alcohol-based surgical solutions likely contributed to the decrease in fires. Improper surgical site preparation technique and close proximity of surgical sites to oxygen continue to be risk factors for fires. LEVEL OF EVIDENCE:4 Laryngoscope, 134:607-613, 2024.

Background: Despite fire prevention protocols and perioperative staff training, surgical fires continue to cause patient harm, disability, and death.Methods: We identified surgical fires that were reported to the Food and Drug Administration's Manu-facturer and User Facility Device Experience database between 2000 and 2020 that resulted in patient or surgical personnel harm. Quantitative and descriptive content analyses were performed on free-text responses to identify contributing factors of surgical fire patient and personnel harm events.Results: We identified 565 surgical fire events resulting in patient or surgical personnel harm over a 20-year study period (median 25 events/year; range, 8-53). Surgical fires were significantly more likely to occur during upper aerodigestive tract (unadjusted odds ratio 15.96; 95% confidence interval, 11.93-21.34) and head and neck (unadjusted odds ratio 5.47; confidence interval 4.14-7.22) procedures compared with abdomen and pelvis procedures. Upper aerodigestive tract and head and neck procedures had the highest incidence of life-threatening injury (41% and 21%, respectively). An electrosurgical device was the ignition source in 82% of events. Content analysis revealed 7 common categories identified as root causes of surgical fires: preparation of surgical site (n = 55, 29%); device malfunction (n = 51, 26%), surgical accident (n = 47, 24%), medical judgement (n = 44 reports, 23%), equipment care and handling (n = 18, 9%), patient factors (n = 10, 5%), and communication (n = 3, 2%).Conclusion: Surgical fires resulting in harm to patient and surgical personnel continue to occur. The common themes identified in this study will prepare and empower surgeons and surgical personnel to prevent surgical fires in the future.(c) 2022 Elsevier Inc. All rights reserved.

Otolaryngology–Head and Neck SurgeryVolume 166, Issue 4 p. 652-656 Ethics in Practice When Should Patients Receive Mask Exemptions During the COVID-19 Pandemic? Ethics in Practice: Point-Counterpoint Michael J. Brenner MD, Corresponding Author Michael J. Brenner MD [email protected] Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USAMichael J. Brenner, MD, University of Michigan Medical School, 1500 East Medical Center Drive / 1903 Taubman Center SPC 5312, Ann Arbor, MI 48104, USA Email: [email protected]Search for more papers by this authorIna Roy-Faderman MD, PhD, Ina Roy-Faderman MD, PhD School of History, Philosophy and Religion, Oregon State University, Corvallis, Oregon, USASearch for more papers by this authorSoham Roy MD, Soham Roy MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USASearch for more papers by this authorNosayaba Osazuwa-Peters PhD, MPH, Nosayaba Osazuwa-Peters PhD, MPH Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USASearch for more papers by this authorRobert K. Jackler MD, Robert K. Jackler MD Departments of Otolaryngology–Head and Neck Surgery and Neurosurgery, School of Medicine, Stanford University, Stanford, California, USASearch for more papers by this authorG. Richard Holt MD, MSE, MPH, G. Richard Holt MD, MSE, MPH Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this author Michael J. Brenner MD, Corresponding Author Michael J. Brenner MD [email protected] Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USAMichael J. Brenner, MD, University of Michigan Medical School, 1500 East Medical Center Drive / 1903 Taubman Center SPC 5312, Ann Arbor, MI 48104, USA Email: [email protected]Search for more papers by this authorIna Roy-Faderman MD, PhD, Ina Roy-Faderman MD, PhD School of History, Philosophy and Religion, Oregon State University, Corvallis, Oregon, USASearch for more papers by this authorSoham Roy MD, Soham Roy MD Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, Children's Memorial Hermann Hospital, Houston, Texas, USASearch for more papers by this authorNosayaba Osazuwa-Peters PhD, MPH, Nosayaba Osazuwa-Peters PhD, MPH Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USASearch for more papers by this authorRobert K. Jackler MD, Robert K. Jackler MD Departments of Otolaryngology–Head and Neck Surgery and Neurosurgery, School of Medicine, Stanford University, Stanford, California, USASearch for more papers by this authorG. Richard Holt MD, MSE, MPH, G. Richard Holt MD, MSE, MPH Department of Otolaryngology–Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USASearch for more papers by this author First published: 06 July 2021 https://doi.org/10.1177/01945998211031447Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Prather KA, Wang CC, Schooley RT. Reducing transmission of SARS-CoV-2. Science. 2020; 368(6498): 1422–1424. 10.1126/science.abc6197 CASPubMedWeb of Science®Google Scholar 2Chan NC, Li K, Hirsh J. Peripheral oxygen saturation in older persons wearing nonmedical face masks in community settings. JAMA. 2020; 324(22): 2323–2324. 10.1001/jama.2020.21905 CASPubMedWeb of Science®Google Scholar 3Asimakopoulou K, Hoorens V, Speed E, et al. Comparative optimism about infection and recovery from COVID-19: implications for adherence with lockdown advice. Health Expect. 2020; 23(6): 1502–1511. 10.1111/hex.13134 PubMedWeb of Science®Google Scholar 4Rubin R. As their numbers grow, COVID-19 "long haulers" stump experts. JAMA. 2020; 324(14): 1381–1383. 10.1001/jama.2020.17709 CASPubMedWeb of Science®Google Scholar 5Pizzo PA, Spiegel D, Mello MM. When physicians engage in practices that threaten the nation's health. JAMA. 2021; 325(8): 723–724. 10.1001/jama.2021.0122 PubMedWeb of Science®Google Scholar 6 Editors. Dying in a leadership vacuum. N Engl J Med. 2020; 383(15): 1479–1480. 10.1056/NEJMe2029812 Google Scholar 7Arnold C. Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History. St Martin's Publishing Group; 2020. Google Scholar 8Kal EC, Young WR, Ellmers TJ. Face masks, vision, and risk of falls. BMJ. 2020; 371: m4133. 10.1136/bmj.m4133 PubMedGoogle Scholar 9Pfattheicher S, Nockur L, Bohm R, Sassenrath C, Petersen MB. The emotional path to action: empathy promotes physical distancing and wearing of face masks during the COVID-19 pandemic. Psychol Sci. 2020; 31(11): 1363–1373. 10.1177/0956797620964422 PubMedWeb of Science®Google Scholar 10Dorfman D, Raz M. Mask exemptions during the COVID-19 pandemic—a new frontier for clinicians. 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Floating Harbor Syndrome (FHS) is a rare genetic disease with few reports detailing its potential otologic manifestations. The objective of this paper is to discuss two FHS patients with otologic manifestations. The first patient presented with delayed speech, middle ear effusions and conductive hearing loss (CHL) in addition to abnormal tympanograms. Her hearing improved after routine tympanostomy tube placement. The second patient presented with cleft palate, retracted ear drums and bilateral tympanic membrane who required multiple sets of T-tubes and eventually developed tympanic membrane perforations. She ultimately required hearing aids, however her speech and language development improved dramatically with time.

Objectives: Adenotonsillectomy (T&A) is one of the most common surgical procedures performed in the United States. Several studies have defined the safety of laryngeal mask airway (LMA) during this surgery, and conflicting evidence exists describing the role it plays in reducing intraoperative times. Our objective is to describe the role LMA and operating on a stretcher have on reducing intraoperative time during pediatric T&A. Methods: This is a retrospective review between October 2017 and January 2020. We included patients between the ages of 4-18 years old undergoing T&A. We excluded medically complex patients with chromosomal, craniofacial, and metabolic abnormalities, patients with cerebral palsy, and those who were tracheostomy dependent. Patient demographics included surgical indication, age, sex, obesity, use of preoperative midazolam, type of airway used, use of traditional operating room (OR) bed versus transport stretcher, surgeon type, and intraoperative times. Data was analyzed with univariate t-test and multivariate linear regression. Results: One hundred seventy-nine patients were included with an average age of 7.2 years. LMA and stretcher were used on 46.4% and 40.2% of patients, respectively. On multivariate linear regression LMA reduced emergence time by 4.4 min (p < 0.001, 95% CI -6.7 to -2.1) and transport stretcher reduced induction time by 2.5 min (p = 0.04, 95% CI -4.9 to -0.1). Use of LMA and stretcher did not have a statistically significant difference on actual procedure time. Conclusion: Our study further supports the role LMA has in reducing intraoperative times in addition to describing a novel method of reducing intraoperative time by operating on a transport stretcher for healthy children undergoing T&A. Level of evidence: 3.

Background Neuroblastic tumors arise from primitive sympathetic ganglion cells and are the most common extracranial solid tumor of childhood. Ganglioneuroma is the most well-differentiated, benign subtype and comprises less than 1% of all soft tissue tumors. One to 5% of these occur in the head and neck, including the parapharyngeal space. It is uncommon to find a physically detectable, neoplastic parapharyngeal space mass in a child. Case report A 7-year-old boy presented with a painless left neck mass. Imaging revealed a 2.6 × 2.7 × 6.1 cm left parapharyngeal space mass. Fine-needle aspiration suggested a ganglioneuroma. The patient developed compressive symptoms, notably pain, thus the decision was made to surgically resect. The tumor was excised transcervically, preserving the great vessels, phrenic and cranial nerves. Postoperatively, the patient developed a mild ipsilateral Horner’s syndrome, suggesting the mass to be a ganglioneuroma of the sympathetic chain. Conclusions Cervical ganglioneuromas typically present as slow-growing masses that cause compressive symptoms or are found incidentally. Resection is reserved for those with significant symptoms and is often complicated by Horner’s syndrome. In the review of literature, there are 23 reported cases of ganglioneuroma in the head/neck with a median age of 17 years. Eight of these occurred in the para/retropharyngeal spaces. Of these, five presented as an asymptomatic neck mass, two presented with compressive symptoms, and one was discovered incidentally. It is important to consider ganglioneuroma in the workup of pediatric neck masses, even in young children. Asymptomatic masses should be monitored for symptomatic transformation, and excision should be considered.

Objectives/hypothesis: To determine the effects of the COVID-19 pandemic on Adenotonsillectomies (TA), Tonsil Related Cases (TC), and Peritonsillar Abscess (PTA) Trends. Study design: Retrospective Cohort Study.Methods: This is a retrospective cohort study using the Pediatric Health Information System (R) (PHIS) database, which consists of 51 children's hospitals. Regions were defined according to PHIS rules with at least five children's hospitals per region. We compared monthly total TA, TC, TC as a proportion of all hospital visits, and PTA from all encounters at each hospital from January 1, 2019, through December 31, 2021.Results: Compared to 2019, April 2020 saw mean TC drop significantly from 371.62 to 68.37 (p < 0.001). Interestingly, June, September, and December 2020 had significantly higher mean TC compared to 2019. TC as a proportion of all hospital visits decreased significantly throughout the majority of 2021. Similarly, TA significantly decreased during 2020 and 2021 across all regions in the US, starting in March 2020 and this reduction in TA extended through the end of 2021 without any signs of recovery. PTA rates did not change significantly over the three years.Conclusions: The pandemic-plagued 2020 saw a noticeable decrease in overall TC and TA but then rebounded quickly to even higher than pre-pandemic levels. However, this rebound halted for the majority of 2021 and subsequently decreased to lower than pre-pandemic levels, which differs from other communicable pathologies such as otitis media which decreased initially then recovered to pre-pandemic levels by Summer of 2021.

• Hemangiomas of the submandibular gland are a rare phenomenon that requires diagnostic recognition from malignant masses, such as rhabdomyosarcoma. • Hemangiomas of the submandibular gland may be managed like other hemangiomas. • Propranolol at a concentration of 1–2 mg/kg/day may help resolve this benign mass quickly.

Purpose: The pandemic related to the novel coronavirus (COVID-19) has led to a decrease in communicable diseases due to social distancing and mask-wearing. How have the prevalence of otitis media (OM) and its associated procedures changed during the pandemic?Study design: Retrospective Cohort Study.Methods: This is a retrospective cohort study using the Pediatric Health Information System (R) (PHIS) database, which consists of 48 children's hospitals. Regions were defined according to PHIS rules. We compared proportion of OM to total diagnoses codes, and collected mastoiditis, and MT placements from all encounters through January 1, 2019-June 31, 2021. Results: In April 2020, there was a decrease in mean proportion of OM cases per 100 hospital visits (7 v. 2, p < 0.0001) and this was sustained through 2020 and until June 2021 (6-7 v. 2-4, p < 0.05; p < 0.05). Compared to 2020, the months of April and June 2021 showed an increase in mean proportion of OM cases (6-7 v. 3-4, p < 0.05) while May did not. This relative increase in OM cases through April-June were primarily driven by the South, the Midwest, and the Northeast in April and the South and the Midwest in June. MT procedures followed similar trends. In 2020, there was no difference in mastoiditis as a proportion of OM cases compared to 2019 however there was a statistically higher rate of mastoiditis in 2020 compared to 2021.Conclusions: The COVID-19 pandemic led to declines in OM and MT case volumes that have started to increase. A geographic relationship may exist, and this connection could be influenced by mask mandates and social distancing.

Session Description: The COVID-19/SARS-CoV2 pandemic has highlighted concerns regarding disease transmission to both surgeons and assisting staff during procedures that generate droplets and aerosols. Aerosol and droplet formation is known to occur during otologic and lateral skull base surgery, particularly when powered instrumentation is used. This expert panel will review both the basic science and clinical studies regarding risk identification. Recommendations regarding minimization of these risks will be thoroughly discussed in both scientific and practical terms that can be utilized by practicing otolaryngologists in real-life scenarios. In addition, the panel will address controversies regarding these risks and mitigation schemes and address real-life situations using case-based examples relevant to both the general otolaryngologist and neurotologic specialist. The discussion will focus not only on mitigation of spread of SARS-CoV2 virus but also on other currently identified pathogens of the middle ear and mastoid and future threats. This panel will address emerging pathogens that have not yet become threats in the United States and Western Europe but have affected otolaryngologists in other areas of the world. It will also provide guidance for hypothetical novel future threats that have not yet presented in clinical practice. This presentation is highly relevant to practicing otolaryngologists, including general otolaryngologists, pediatric otolaryngologists, and neurotologists and will provide the attendee with a thorough update clinical practice patterns, potential spread of contagion, and strategies of spread mitigation. Outcome Objectives: (1) Examine the basic and clinical science of pathogens of the middle ear, mastoid, and cerebrospinal fluid and the patterns of spread of these pathogens during otologic and lateral skull base procedures. (2) Understand and implement strategies to mitigate spread of currently known pathogens in otologic and lateral skull base procedures, including limitation of the spread of SARS/CoV2. (3) Understand a framework of strategies and best practices for mitigation of spread of emerging pathogens and future pathogens.

Pierre-Robin sequence (PRS) patients frequently exhibit symptoms of airway obstruction due to multiple etiologies, predominantly from glossoptosis and tongue base obstruction. Rarely, these patients can have palatal mass and even rarer is one of neural origin. To date, there are few reports of heterotopic neural tissue causing airway obstruction in literature, and there are only two reports related to PRS. The objective of this report is to detail a PRS patient with obstructive airway symptoms that resolved after removal of a right-sided soft palatal mass containing heterotopic neural tissue. A 5-month-old boy with a past medical history of cleft palate, PRS status-post-mandibular distraction osteogenesis was hospitalized after continuing respiratory distress. Imaging showed a cystic submucosal mass that arose from the right soft palate. Trans-palatal and trans-oral approaches were applied for the removal. The patient tolerated the procedure well and his obstructive events have resolved at follow-up.