OBJECTIVE:To assess and summarize the outcomes of major pharmacologic, device-based, and surgical interventions reported in systematic reviews and meta-analyses for the treatment of Meniere's disease. DATA SOURCES:CINAHL, Cochrane, PubMed, Scopus. REVIEW METHODS:Twenty-two systematic reviews with meta-analyses of randomized and nonrandomized studies were identified, assessing interventions including gentamicin, corticosteroids, betahistine, positive pressure therapy, adjunctive acupuncture, endolymphatic sac decompression, and cochlear implantation. The review was reported in accordance with PRISMA 2020 and PRISMA-S, and methods followed Cochrane Handbook guidance. Four investigators extracted data. When possible, data were pooled using a random-effects model. Outcomes included vertigo control, tinnitus improvement, and adverse events. RESULTS:Intratympanic gentamicin showed the highest vertigo control rate (89%) but carried a mild hearing loss risk and a 23% subjective hearing reduction rate. Intratympanic steroids offered modest benefit with fewer auditory risks. Positive pressure therapy showed mixed results, while acupuncture demonstrated symptomatic benefit when combined with other therapies. Endolymphatic sac decompression achieved 75%-82% control of vertigo initially but declined over time. Cochlear implants improved speech perception and tinnitus in profound hearing loss. No eligible meta-analyses evaluated antivirals, ventilation tubes, vestibular nerve section, or labyrinthectomy. CONCLUSION:Intratympanic gentamicin provides the strongest vertigo control but is backed by low-quality evidence and risks hearing loss. Conservative treatments like intratympanic steroids and betahistine show modest benefit with mixed evidence. Adjunctive options like acupuncture require cautious interpretation due to low-quality evidence. Surgical and device-based options demonstrate variable effectiveness, highlighting the need for individualized, symptom-driven care and further high-quality trials.

OBJECTIVE:To evaluate current understanding of external auditory canal cholesteatoma (EACC), its symptomatic burden, clinical features, diagnostic approach, and management strategies to reduce delays in diagnosis. DATA SOURCES:PubMed, CINAHL, COCHRANE Library, and SCOPUS. REVIEW METHODS:A comprehensive literature search was completed in March 2025. The search identified 2117 English-language articles, of which 30 studies reported patients diagnosed with EACC. Meta-analyses of mean difference (Δ), proportions (%), and continuous measures with 95% confidence intervals (CI) were performed using random and fixed effects models. RESULTS:A total of 1007 patients were included with a mean age of 43.9 years (range 6-89). Most were diagnosed with Stage III EACC (60.7%, CI 43.5-76.7). Nicotine use (33.1%, CI 15.2-54.1) and cotton swab abuse (24.3%, CI 16.7-33.7) were common risk factors. Patients most often presented with otalgia (39.9%, CI 30.5-49.7) or otorrhea (50.3%, CI 37.8-62.7), though 15.7% (CI 4.5-31.6) were asymptomatic. Conservative treatment with serial debridement was used in most patients (69.6%, CI 44.5-89.7). Canalplasty (68.6%, CI 48.3-85.7), tympanoplasty (24.7%, CI 3.7-56.1), and mastoidectomy (33.7%, CI 17.4-52.3) were the most common surgical approaches. Recurrence was low (4.5%; 95% CI 2.3-8.0). CONCLUSION:Patients with EACC are frequently diagnosed at advanced stages. Recognizing risk factors and symptoms can expedite detection and guide management. This review highlights how tailored interventions achieve low recurrence rates and reduce morbidity linked to delayed diagnosis.

OBJECTIVE:To evaluate the prevalence of suicidality, including suicidal ideation and attempts, in individuals with any type of hearing loss compared to individuals without hearing loss, and to assess risk factors for suicidality in this population. DATA SOURCES:CINAHL, Cochrane Review, PubMed, Scopus, and PsycINFO through March 25, 2025. REVIEW METHODS:Two investigators independently performed the search, screened abstracts, and selected publications for data extraction. Studies that assessed hearing loss and at least one suicidality measure in individuals aged 16 years or older were included for fixed and random-effects meta-analyses (proportions, continuous measures, relative risks [RR]). Depression and social isolation were also assessed. RESULTS:Of 5,015 abstracts identified, 14 studies (N = 221,681) were included. Individuals with hearing loss had higher prevalences of suicidal ideation (13.2% vs 9.3%) and suicide attempts (4.9% vs 2.4%) compared to controls (P < .0001). Hearing loss was associated with significantly increased risks of suicidal ideation (RR = 1.47, 95% CI [1.37-1.57]) and suicide attempts (RR = 1.83, 95% CI [1.31-2.55]). Subgroup analyses revealed that risk of depression was elevated only in individuals with subjective hearing loss, while risk of suicidal ideation was increased in individuals with either subjective or audiometrically measured hearing loss. CONCLUSION:This meta-analysis demonstrates a clear association between hearing loss and suicidality, although the strength of this relationship varies depending on how hearing loss is measured. Clinicians should consider both audiometric data and patient-reported concerns when assessing psychiatric risk. These findings support early screening and timely interventions to mitigate mental health consequences.

Sensorineural hearing loss results from an absence or loss of function of the inner ear and its connections with the remainder of the auditory system. Some patients present with both conductive and sensorineural hearing losses. Additionally, some patients present with central or functional hearing losses.

OBJECTIVES:Tinnitus is a highly prevalent and challenging neurotologic condition affecting over 740 million individuals worldwide. Despite the growing number of studies, treatment approaches remain fragmented and inconsistent. This umbrella review aims to aggregate results from systematic review to comprehensively synthesize the available evidence. METHODS:Following PRISMA guidelines, we systematically searched CINAHL, COCHRANE Library, PubMed, and Scopus through April 2025. Systematic reviews with meta-analyses of primary tinnitus interventions were included. Outcomes focused on validated measures of tinnitus severity, distress, loudness, and quality of life. Study quality was assessed using AMSTAR-2. RESULTS:A total of 44 systematic reviews were included, covering 7 intervention domains. Cognitive behavioral therapy (CBT), hearing aids, tinnitus retraining therapy (TRT), and sound/music therapy consistently improved tinnitus-related outcomes (eg, THI reductions up to -14.50, P < .001). Cochlear implantation yielded the largest effects (eg, THI -29.97) but is reserved for patients with moderate-to-profound sensorineural hearing loss who are not adequately helped by hearing aids. Neuromodulation and acupuncture showed modest or inconsistent benefits with high heterogeneity. CONCLUSIONS:This umbrella review provides the current and comprehensive analysis of tinnitus treatments. CBT, hearing aids, TRT, and sound/music therapy show consistent benefit. Cochlear implantation offers the greatest effect in patients with moderate-to-profound hearing loss unresponsive to hearing aids. Other therapies show mixed evidence. These findings offer a much-needed evidence framework to guide treatment decisions and future research.

ObjectiveCochlear implant (CI) devices are fitted with two external processor styles-a behind-the-ear (BTE) or an off-the-ear (OTE) option. Although previous research has predominantly focused on speech recognition abilities between processor styles, the current study aims to examine the potential real-world functional differences between processor types.Study DesignRetrospective case-control, matched at a 1:2 ratio.SettingTertiary Otolaryngology Referral Center.PatientsPatients with bilateral sensorineural hearing lossInterventionCochlear implantationMain Outcome MeasuresCochlear Implant Quality of Life 35 Profile (CIQOL-35 Profile), and CNC word (CNCw) and AzBio sentence (quiet) recognition.ResultsA total of 36 patients were included (n = 12 OTE and n = 24 BTE users). The overall study population demonstrated improvements in CNCw (d = 1.9 [1.3, 2.4]), AzBio sentences in quiet (d = 2.1 [1.5, 2.6]), and medium-to-large effect sizes for domains of the CIQOL-35 (d range: 0.5-0.9) after cochlear implantation. Between-group analysis demonstrated that BTE users performed better in CNCw (d = 0.4 [-0.3, 1.1]) and AzBio quiet (d = 0.5 [-0.2, 1.2]) than their OTE counterparts. However, there were minimal differences identified between processor types based on CIQOL domain and global scores (d range: 0.04-0.2).ConclusionBTE users may have a better speech recognition ability than their OTE counterparts. However, CIQOL domain and global scores are comparable between the two processor types. A prospective, randomized controlled trial will be needed to address the limitations of a retrospective analysis.

OBJECTIVE:Cisplatin-induced hearing loss leads to significant neurologic, social, and behavioral impairment in children. The goal of this study is to characterize options available to prevent cisplatin-induced hearing loss and to identify gaps in the literature. DATA SOURCES:CINAHL, Cochrane Library, PubMed, Scopus. REVIEW METHODS:Literature was searched between 1990 and 2024. Studies evaluating interventions to prevent hearing loss in children receiving cisplatin were included. Audiometric data including pure tone threshold, pure tone average, and incidence of hearing loss were extracted from included studies. RESULTS:Six studies (N = 760) pertaining to cisplatin-induced hearing loss in children were included. This includes four randomized control trials (N = 652), one nonrandomized control trial (N = 97) and one prospective cohort study (N = 11). The studies examined sodium thiosulfate or amifostine, both given intravenously. The relative risk of hearing loss between intervention and control groups was 0.78 (95% CI 0.71-0.85). The proportion of patients in the treatment group categorized as grade zero on the Brock ototoxicity grading scale was significantly higher (p < 0.0001) than in the control group (36.3% vs. 15.5%). The change in pure tone average after chemotherapy was significantly higher in the control group compared to the intervention group (5.2 vs. -1.2 dB, 95% CI 5.53-7.25). CONCLUSIONS:These results show mild success in reducing the incidence of hearing loss in children undergoing chemotherapy with cisplatin. However, the literature is limited, and further investigation is warranted.

METHODS:A systematic review of CINAHL, Cochrane Library, PubMed, and SCOPUS databases was conducted according to PRISMA guidelines to identify studies evaluating T2DM and hearing loss. Primary outcome measures included continuous measures (mean), proportions (%), proportional difference (∆), and relative risks (RR) with 95% confidence intervals (CI). RESULTS:A total of 39 studies with 88,395 patients with T2DM and 20,337 controls were included. The mean ages of the T2DM and control groups were 50.3 (range: 19-96) and 46.7 (range: 19-76), respectively, with females comprising 63.8% and 64.3% of the groups. The mean duration of diabetes in the T2DM group was 9.1 years (95% CI: 8.1-10.1), and mean HbA1c of 8.4% (95% CI: 8.1-8.6), while the control group had 4.8% (95% CI: 3.9-5.7). Patients with T2DM had significantly higher prevalence and relative risk of clinically significant hearing loss compared to controls (53.0% vs 25.2%; ∆ = 27.7%, p < .0001; RR = 2.3, 95% CI: 1.1-4.8). In T2DM, 5.0% had conductive, 46.2% sensorineural, and 10.4% mixed hearing loss. According to WHO criteria, the T2DM group exhibited 22.1% mild (26-40 dB), 25.5% moderate (41-60 dB), 8.5% severe (61-80 dB), and 1.7% profound (>80 dB) hearing loss all with statistically significant differences compared controls (p ≤ .0001). In the T2DM group, data on laterality showed 15.0% unilateral and 29.6% bilateral hearing loss, both significantly higher than the controls (p = .008, p < .0001). CONCLUSION:This meta-analysis provides most updated estimates of the prevalence and relative risk of hearing loss in patients with T2DM, including details on the classification, laterality, and degrees. The significantly increased risk highlights the importance of incorporating hearing assessments and management into routine care for patients with T2DM.

OBJECTIVE:To assess the prevalence of auditory symptoms among recreational and professional musicians. DATA SOURCES:CINAHL, Cochrane Library, PubMed, and SCOPUS were searched for English-language studies published from inception through November 19, 2024. REVIEW METHODS:We included cohort and cross-sectional studies reporting auditory symptom prevalence among recreational or professional musicians at least 18 years old. Studies involving children or noise exposure data only were excluded. Data were extracted independently by two authors, with disagreements resolved by discussion. Risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies - of Exposure for prospective cohort studies, the Joanna Briggs Institute (JBI) checklist for retrospective cohort and cross-sectional studies, and the Risk of Bias 2 tool for randomized controlled trials. Primary outcome measures included continuous measures (mean) and proportions (%) with 95% confidence intervals. RESULTS:Sixty-seven studies (n = 28,311) on auditory symptoms among musicians were included. The mean age was 34.7 years for the musicians and 30.2 years for the control group. Musicians experienced a significantly higher prevalence of tinnitus (42.6% vs 13.2%), hearing loss (25.7% vs 11.6%), and hyperacusis (37.3% vs 15.3%) compared to the control population. However, there was no significant difference in the prevalence of hearing loss, hyperacusis, and tinnitus between classical and pop/rock musicians. CONCLUSION:At least one in three musicians reports tinnitus or hyperacusis, while approximately one in four has hearing loss. This evidence suggests otolaryngologists treating musicians should consider routine auditory assessments and preventive counseling.

OBJECTIVE:Explore the impact of the COVID-19 pandemic on pediatric acute mastoiditis (AM). DATA SOURCES:CINAHL, Cochrane Library, PubMed, Scopus. METHODS:Literature was searched from 2014 to 2025 for articles reporting AM in children. Specific outcomes included clinical presentation, bacterial epidemiology, complications, and management. Primary outcome measures included continuous measures (mean), proportions (%), mean difference (Δ), and relative risk (RR) with 95 % confidence intervals (CI). RESULTS:There were seven included studies (N = 1001 children) with 632 patients in the pre-COVID cohort and 369 in the COVID-era cohort. There was a significant difference in the proportion of intracranial complications with a 20 % greater risk of having an intracranial complication after the COVID pandemic than before (RR: 1.2 [95 % CI: 0.6-2.3], p = 0.0097). There was also a significant decrease in the proportion of cases treated conservatively with antibiotics after the pandemic (mean difference 10.8 % [95 % CI: 2.9 %-18.0 %], p < 0.01). Bacterial epidemiology also experienced a significant shift in composition following the pandemic. CONCLUSION:The COVID-19 pandemic has led to a rise in intracranial complications in pediatric AM, with fewer cases being treated solely with antibiotics. Additionally, the pandemic has altered the bacterial epidemiological patterns of AM, highlighting opportunities for further investigation into the characteristics of AM during and after this period to inform and improve future management strategies.

OBJECTIVE:To assess the prevalence of panic disorder (PD) among patients with vestibular dysfunction. DATABASES REVIEWED:CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS. METHODS:Databases were searched from inception through August 2024. Observational studies on PD in adults with vestibular dysfunction were included. Studies of patients without a vestibular disorder diagnosis or vertigo arising from trauma or tumors were excluded. Primary outcome measures included continuous measures (mean), proportions (%), and relative risk (RR) with 95% confidence intervals (CI). Two authors extracted data and discrepancies were resolved with a third party. Level of evidence was evaluated using Oxford Centre for Evidence-Based Medicine criteria. Risk of bias was assessed with Risk Of Bias In Non-randomized Studies-of Exposure for cohort studies and Joanna Briggs Institute criteria for case-control and cross-sectional studies. RESULTS:Ten studies (n = 874) on PD and vestibular disorders were included. The mean age was 49.7 years for the vestibular group and 46.0 years for the control group. Although there were no significant differences in the prevalence of anxiety and depression, there was a significantly higher prevalence of PD (7.4% vs. 2.5%) in patients with vestibular dysfunction than the control population ( p = 0.02). However, the risk of developing PD among patients with vestibular disorders was not significantly higher (RR = 1.9, 95% CI: 0.4-8.1) than the controls. CONCLUSION:The prevalence of PD in patients with vestibular dysfunction is nearly three times higher than in people without vestibular dysfunction. This evidence suggests otolaryngologists treating this condition should consider screening for PD.

To assess relations between obstructive sleep apnea (OSA) and suicidality, measured by suicidal ideation, suicide attempts, and death by suicide. CINAHL, Cochrane Library, PubMed, PsycINFO and SCOPUS were searched from inception through June 24, 2024. Observational studies related to suicidality in adult OSA patients were included. Case reports and studies on central sleep apnea were excluded. Data were extracted and reviewed by two authors, with disagreements resolved by a third. Risk of bias was assessed with the Risk Of Bias In Non-randomized Studies - of Exposure for cohort studies and the Joanna Briggs Institute checklist for case-control and cross-sectional studies. Random effects meta-analyses (single means, proportions, and relative risks (RR)) were performed. Fifteen studies (n = 1,438,523) were included: eight assessed suicidal ideation, two assessed suicide attempts, and six assessed death by suicide. The OSA group experienced a higher prevalence of suicidal ideation (12.4

OBJECTIVE:To assess relations between tinnitus and suicidality, measured by suicidal ideation and suicide attempts. DATA SOURCES:CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS databases were searched from inception through June 14, 2024. REVIEW METHODS:Observational studies related to suicidality in tinnitus patients at least 18 years old were included. Case reports and studies on objective or pulsatile tinnitus were excluded. Two authors extracted data, and disagreements were resolved with a third party if needed. The risk of bias was assessed according to the Risk Of Bias In Non-randomized Studies of Exposure for cohort studies and the Joanna Briggs Institute critical appraisal checklist for cross-sectional studies. Random effects meta-analyses (single means, proportions, and relative risks (RR)) were used for primary analysis. RESULTS:Nine studies (n = 912,013) pertaining to suicidality and tinnitus in an adult population were included. The tinnitus group experienced a significantly higher prevalence of suicidal ideation (19.5% [95% CI: 12.9%-27.1%] versus 9.9% [95% CI: 7.1%-13.2%]) and suicide attempts (1.9% [95% CI: 0.1%-5.7%] versus 0.9% [95% CI: 0.0%-3.9%]) than the control population (p < 0.0001). The tinnitus group had a significantly (p < 0.001) higher risk of suicidal ideation (RR = 2.1, 95% CI: 1.6-2.8) and suicide attempts (RR = 1.8, 95% CI: 1.3-2.4) than the control group. CONCLUSION:Nearly one in five people with tinnitus will experience suicidal ideation, and nearly 2% will attempt suicide. Thus, otolaryngologists should be mindful of the increased risk of suicidality in patients with tinnitus.

ObjectiveTo develop a convolutional neural network-based computer vision model to recognize and track 2 mastoidectomy surgical instruments-the drill and the suction-irrigator-from intraoperative video recordings of mastoidectomies.Study DesignTechnological development and model validation.SettingAcademic center.MethodsTen 1-minute videos of mastoidectomies done for cochlear implantation by varying levels of resident surgeons were collected. For each video, containing 900 frames, an open-access computer vision annotation tool was used to annotate the drill and suction-irrigator class images with bounding boxes. A mastoidectomy instrument tracking module, which extracts the center coordinates of bounding boxes, was developed using a feature pyramid network and layered with DETECTRON, an open-access faster-region-based convolutional neural network. Eight videos were used to train the model, and 2 videos were used for testing. Outcome measures included Intersection over Union (IoU) ratio, accuracy, and average precision.ResultsFor an IoU of 0.5, the mean average precision for the drill was 99% and 86% for the suction-irrigator. The model proved capable of generating maps of drill and suction-irrigator stroke direction and distance for the entirety of each video.ConclusionsThis computer vision model can identify and track the drill and suction-irrigator from videos of intraoperative mastoidectomies performed by residents with excellent precision. It can now be employed to retrospectively study objective mastoidectomy measures of expert and resident surgeons, such as drill and suction-irrigator stroke concentration, economy of motion, speed, and coordination, setting the stage for characterization of objective expectations for safe and efficient mastoidectomies.

Objective To compare quality of life (QOL) outcomes of percutaneous and transcutaneous bone conduction devices (pBCD and tBCD, respectively). Databases Reviewed Pubmed, Scopus, CINAHL. Methods A systematic review was performed searching for English language articles from inception to March 15, 2023. Studies reporting QOL outcomes measured using a validated tool following implantation of either pBCDs or tBCDs were considered for inclusion. QOL outcomes included scores for Glasgow Benefit Inventory, Glasgow Children's Benefit Inventory, Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial, and Qualities of Hearing Scale. A meta-analysis of continuous measures was performed. Results A total of 52 articles with 1,469 patients were included. Six hundred eighty-nine patients were implanted with pBCDs, and the remaining 780 were implanted with tBCDs. Average Glasgow Benefit Inventory scores for the tBCD group (33.0, 95% confidence interval [22.7–43.3]) were significantly higher than the pBCD group (30.9 [25.2–36.6]) (Δ2.1 [1.4–2.8], p < 0.0001). Mean Glasgow Children's Benefit Inventory scores (Δ3.9 [2.0–5.8], p = 0.0001) and mean gain in Abbreviated Profile of Hearing Aid Benefit scores (Δ5.6 [4.8–6.4], p < 0.0001) were significantly higher among patients implanted with tBCDs than those implanted with pBCDs. Patients implanted with tBCDs also had significantly higher gains on the Speech (Δ1.1 [0.9–1.3], p < 0.0001), Spatial (Δ0.8 [0.7–0.9], p < 0.0001), and Qualities of Hearing (Δ1.2 [1.1–1.3], p < 0.0001) portions of the Speech, Spatial, and Qualities of Hearing Scale than those implanted with pBCDs. Conclusions Patients implanted with transcutaneous devices had better QOL outcomes than those implanted with percutaneous devices.

ObjectiveThis review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature. Data Sources. Studies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023. Review Methods. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta-analysis of proportions and continuous measures was conducted. Results. Of the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1-88.3) and dyspnea with exertion (83.8%, 64.8-96.3). The most suspected etiology was exercise-induced (86.0%, 69.4-95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0-99.1). Nonsurgical options were attempted in 87.0% (54.0-99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0-91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0-74.6). Conclusion. Adult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.

OBJECTIVE:To characterize the short-term outcomes of patients undergoing surgical repair of lateral skull base cerebrospinal fluid (CSF) leaks followed by a shortened length of stay (LOS) protocol. STUDY DESIGN:Retrospective study. SETTING:Tertiary medical center. METHODS:A total of 156 adult patients from July 2016 to December 2022 who underwent repair of CSF leaks via transmastoid (TM), middle cranial fossa (MCF), or combined (TM/MCF) approaches were included. Data collected included: LOS, presentation to the emergency department (ED), need for readmission, major neurologic complications (stroke, seizure, and meningitis), and CSF leak recurrence. RESULTS:Approximately half of patients underwent a TM repair (49.4%), whereas the other half underwent either an MCF (3.8%) or combined TM/MCF repair (46.8%). No peri-/postoperative lumbar drains were used and only 2 (1.3%) patients were admitted to the intensive care unit after surgery. Mean LOS for the cohort was 1.1 ± 0.7 days and was longer for surgeries involving MCF (1.3 ± 0.6) compared to TM (0.8 ± 0.7). Ninety-two percent of TM cases were discharged within 24 hours (32% on the same day) while for cases involving an MCF approach, 72.2% of patients were discharged within 24 hours. Of the patients in the study, 6 (3.8%) presented to an ED for minor complications and no patient required readmission. Revision surgery was required for 3 (1.9%) patients for recurrent CSF leak. CONCLUSION:Our findings suggest that short LOS after surgical repair of lateral skull base defects in the treatment of CSF leak is safe and effective.

Objective: This review sought to answer the following research question: What are the characteristics of pediatric necrotizing otitis externa (NOE)? Moreover, we wanted to highlight the clinical importance of the current limitations in the literature. Methods: A scoping review was performed to determine what is known about NOE in the pediatric population. Four databases (COCHRANE Library, CINAHL, PubMed, and Scopus) were queried for articles published in English between 1976 to 2022. Variables extracted included comorbidities, demographics, outcomes, and treatment. Results: A total of 20 studies (N = 439) reported sufficient measures to be included in the review. Patients with NOE had a mean age of 10.0 years (range 2 months to 14 years) with a male-to-female gender ratio of 1.1:1. Mean length of hospital stay was 2.9 days (95%CI: 2.7-3.0). Demographics included 45.4% Caucasian, 6.0% African American, and 2.7% Asian/Pacific Islander. Less than 5% of patients had diabetes, while other reported comorbidities included neutropenia (n = 6), anemia (n = 5), dehydration/malnutrition (n = 4), Stevens Johnson Syndrome (n = 2), some form of immunosuppression/organ transplantation (n = 2), thrombocytopenia (n = 2), and leukopenia (n = 2). There have been no reported deaths from NOE in children. Conclusions: In the adult population NOE most commonly affects patients with diabetes, but our review reveals that diabetes does not appear to play as big a role in children. The disease seems to commonly affect patients with immunosuppression or severe health conditions. Complications such as cranial nerve palsies appear to be more common in the pediatric population. Specifically, the role of biopsy and culture in the treatment of pediatric NOE is stressed as they are important in treatment decisions.