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Objective: Lack of ergonomic practices in the operating room results in significant musculoskeletal strain. This study obtains a current assessment of self-reported musculoskeletal strain associated with endoscopic endonasal and open skull base surgery as reported by members of the North American Skull Base Society (NASBS).

Study design: Online Survey.

Setting: Online.

Methods: A survey assessing current symptoms in endoscopic skull base surgery was distributed to members of the NASBS.

Results: Sixty-six responses were completed and analyzed. 95% of respondents indicated they had musculoskeletal strain at the neck and C-spine. There was no significant difference in average operating time per week and musculoskeletal strain. Prolonged standing during endoscopic cases increased neck/C-spine musculoskeletal strain (OR: 3.96; CI: 1.26, 14.2; P = .024). Dominant hand, operating with 1 versus multiple gloves, switching holding the endoscope with other physicians, foot pedal position, monitor, position, and manipulation of endoscopic instruments did not impact musculoskeletal strain (P > .05). Endoscopic endonasal skull base surgeons (EESBs) that operate on the same side of the table had significantly less L-spine pain than EESBs that operate on the opposite side of the table (OR: 0.25; CI: 0.07, 0.82; P = .026).

Conclusion: The results found that most respondents experience musculoskeletal strain and that factors including surgeon positioning and prolonged standing increase pain. Altering strategies in the operating room, including surgeon and instrument positioning, may help to decrease ergonomic strain amongst skull base surgeons.

Objective: Cervical lymphadenopathy is a common presentation in Otolaryngology-Head and Neck Surgery, often requiring biopsy to exclude malignancy. Fine-needle aspiration (FNA) is the standard initial diagnostic tool; however, evidence from other anatomical sites suggests that core needle biopsy (CNB) may offer superior diagnostic performance. This systematic review aims to compare the diagnostic accuracy and safety of FNA versus CNB for adult cervical lymphadenopathy.

Data sources: PubMed, Embase, and Cochrane databases were systematically searched for studies published between 1995 and 2025 evaluating FNA versus CNB for adult cervical lymphadenopathy. Studies lacking extractable cervical lymphadenopathy data were excluded.

Review methods: Two investigators independently screened studies and extracted data on study characteristics and diagnostic performance. A meta-analysis was performed in Stata using a random-effects model, and a quality assessment was conducted using the QUADAS-2 criteria.

Results: Of 2523 abstracts identified, 6 studies met inclusion criteria, with 5 providing adequate data for meta-analysis (total n = 649 patients, 331 FNA, 318 CNB). Pooled sensitivity and specificity were higher for CNB (0.94 and 0.98, respectively) compared to FNA (0.72 and 0.96; P < .001). CNB was 1.32 times more sensitive than FNA in detecting malignancy (P < .001). Both techniques had low complication rates. Study heterogeneity was low to moderate, and risk of bias was similarly moderate.

Conclusion: CNB demonstrates significantly greater diagnostic accuracy than FNA in detecting malignant cervical lymphadenopathy without increased complication risk. While further studies are warranted, these findings support greater consideration of CNB as a first-line diagnostic test to minimize inconclusive results and diagnostic delays.

Objective: To assess the pattern of oxymetazoline and xylometazoline (OXM) use in patients with deviated nasal septum (DNS).

Study design: A retrospective Computer-Assisted Telephone Interviewing survey.

Setting: Patients who underwent septoplasty in University Clinical Hospital in Opole, Poland.

Methods: A retrospective Computer-Assisted Telephone Interviewing (CATI) survey was conducted among patients who underwent septoplasty between 2018 and 2024. The questionnaire included inquiries about the frequency of OXM use, awareness of the consequences of long-term OXM application, and alternative treatment options, all prior to septoplasty.

Results: The study was conducted on 159 of 305 (52.1%) patients identified in the hospital database. Approximately one-third of respondents (55 of 159, 34.6%) denied using OXM, about one-third had used OXM for no more than 7 days (52 of 159, 32.7%), and the remaining one-third (52 of 159, 32.7%) admitted to OXM overuse. Lack of awareness of the consequences of chronic OXM use was associated with a 6.5-fold increased risk of addiction (OR = 6.5, 95% CI: 1.2-33.6, P = .02). Furthermore, 16 of 52 (30.8%) respondents were unaware of intranasal steroid therapy in the preoperative period.

Conclusions: DNS may increase the risk of OXM dependence; however, further controlled studies are needed. Increasing awareness about the risks of OXM overuse substantially reduces this risk.

The comparative ease of cannulating Stensen's duct is contrasted by the acknowledged difficulty in cannulating Wharton's duct. Although access to Wharton's duct can be facilitated with a floor-of-mouth incision, it is desirable to avoid this open approach. We present a technique emphasizing the use of a tapered 4-0 Prolene suture to cannulate Wharton's duct. This guide directs placement of a 26-gauge angiocatheter through a modified Seldinger technique. The suture guide is then removed to permit infusion of saline with expansion of the duct to allow for passage of a 0.38-mm guidewire and progressive dilation with a 24- and 22-gauge angiocatheter over the larger guidewire. This technique was successful in all 4 patients who had difficult access to Wharton's duct. One of these patients also underwent successful cannulation of Bartholin's duct. This novel technique for cannulation of Wharton's duct offers an alternative approach for patients with challenging anatomy.

Objective: Obstructive sleep apnea (OSA) is a prevalent pediatric disorder that, if untreated, can result in substantial developmental and health consequences. Tongue reduction procedures, such as midline posterior glossectomy (MPG), are increasingly used to address tongue base obstruction. This systematic review evaluates the effectiveness and safety of tongue reduction procedures for pediatric OSA.

Data sources: Embase, PubMed, and Web of Science databases were queried for studies from inception to September 20, 2023.

Review methods: Studies reporting on outcomes of pediatric patients (≤21 years) undergoing tongue reduction surgery for OSA were included.

Results: From 477 abstracts, 9 studies met the inclusion criteria, representing 146 pediatric patients. Surgical techniques included MPG, transoral robotic-assisted tongue base resection, and keyhole partial glossectomy. Primary outcomes assessed were apnea-hypopnea index (AHI), minimum oxygen saturation, and adverse events. All studies reported a reduction in AHI and increased minimum oxygen saturation following tongue reduction despite the method. Adverse events appear to be rare but included postoperative bleeding, need for reintubation, and wound dehiscence.

Conclusion: Tongue reduction procedures appear to be safe and effective for managing pediatric OSA, improving key clinical outcomes. However, long-term results, comparative studies of surgical techniques, and refined patient selection criteria are needed. Future research should also identify risk factors for persistent OSA following tongue base reduction. These findings suggest that tongue reduction is a valuable addition to the treatment arsenal for pediatric OSA.

Objectives: Silent sinus syndrome (SSS) arises from negative pressure in the maxillary sinus through occlusion of the ethmoidal infundibulum. Convexity of the surrounding bone towards the lumen and a hypoglobus can occur. It may endanger surrounding structures during endoscopic sinus surgery. This research identifies and quantifies radiological changes in inferoposterior anatomical structures associated with SSS.

Study design: Retrospective case series study.

Setting: Computed tomography and magnetic resonance imaging scans of 23 patients with SSS who were treated at the University Hospital of Zurich between 2013 and 2023 were evaluated.

Methods: The volume of the maxillary sinus, the orbital floor and sinus rear wall convexity, the height of the tuber maxillae, and the pterygopalatine fossa dimension were measured. The affected side was quantitatively compared with the healthy side.

Results: The extension of the pterygopalatine fossa and the height of the tuber maxillae were significantly larger on the affected side (mean difference = 2.354 mm, 4.99 mm; P < .01 for both). A stronger indentation of the back wall (mean difference = 3.763 mm; P < .01) and the orbital floor (mean difference = 2.268 mm; P < .01) was measured in SSS. In addition, the syndrome reduces the volume of the affected maxillary sinus (mean difference = 8.885 mL; P < .01).

Conclusion: SSS causes a marked enlargement of the neighbouring inferoposterior anatomical spaces. Shrinking of the sinus' volume could explain this effect. These findings have direct clinical implications, as the surgeon might inadvertently enter these structures more easily in SSS.

Objective: To identify clinical and surgical risk factors for miniplate removal after oromandibular reconstruction with fibula free flap (FFF) and evaluate the timing of this complication.

Study design: This was a retrospective cohort study.

Setting: This study was conducted at Kaohsiung Veterans General Hospital, a tertiary care center, from January 2015 to December 2023. Patients undergoing oromandibular reconstruction with FFF were categorized by miniplate removal status.

Methods: The incidence of miniplate removal and postoperative complications were analyzed. Multivariate logistic regression identified independent risk factors, and Kaplan-Meier analysis assessed the time to miniplate removal.

Results: Out of 184 patients, 30 (16.3%) experienced miniplate issue required removal. This group showed significantly higher complication rates, including abscess/fistula (53.3% vs 5.8%), osteomyelitis (43.3% vs 0.6%), and osteoradionecrosis (23.3% vs 2.6%) (P < .001 for all). Preoperative or postoperative radiotherapy (OR, 9.27; P = .046) and number of osteotomies (OR, 3.77; P = .038) were identified as independent risk factors. Kaplan-Meier analysis indicated a trend of higher miniplate removal rates in the radiotherapy group (P = .055), with the highest risk within the first 30 months.

Conclusion: Radiotherapy and an increased number of osteotomies are independent risk factors for miniplate removal after FFF reconstruction. The risk is particularly high in irradiated patients within the first 30 months post-surgery, emphasizing the need for tailored surgical planning and close monitoring.

Objective: Chatbots powered by large language models (LLMs) have recently emerged as prominent sources of information. However, their ability to propagate misinformation as well as information, particularly in specialized fields like audiology and otolaryngology, remains underexplored. This study aimed to evaluate the accuracy of 6 popular chatbots-ChatGPT, Gemini, Claude, DeepSeek, Grok, and Mistral-in response to questions framed around a range of unproven methods in audiological and otolaryngological care.

Study design: Cross-sectional study.

Setting: A set of 50 questions was developed based on common conversations between patients and clinicians. We then posed these questions to the chatbots.

Methods: We tested each chatbot 10 times to account for variable responses, producing a total of 3000 responses. The responses were compared with correct answers based on the general opinion of 11 professionals. The consistency of the responses was evaluated by Cohen's Kappa.

Results: Most chatbot responses to the majority of questions were deemed accurate. Grok consistently performed best, where its answers aligned perfectly with the opinions of the experts. Deepseek exhibited the lowest accuracy, scoring 95.8%. Mistral exhibited the lowest consistency, scoring 0.96.

Conclusions: Although all the chatbots generally avoided endorsing unproven methods, some responses deviated from the expert consensus and could therefore be said to contribute to the spread of misinformation. The best performer among the group was Grok, which provided consistently accurate responses, showing it has the potential for clinical and educational use within audiology and otolaryngology.

Objective: This study aimed to evaluate the feasibility and efficacy of a virtual reality (VR) platform for understanding head and neck anatomy in medical education.

Study design: Prospective trial using a pretest/posttest design to assess understanding of head and neck anatomy.

Setting: Single academic institution.

Methods: 21 medical students performed a standardized, guided VR experience. Students had completed formal education in cadaveric anatomy and reported varying levels of VR and video game exposure. Baseline knowledge was assessed with a multiple-choice quiz (MCQ) (T1). Students then engaged in an educational experience using the Meta Quest platform, followed by a post-VR MCQ (T2). Outcomes included performance metrics, self-reported confidence, user satisfaction, and potential influence of prior technologic exposure on these outcomes.

Results: Post-VR, the average MCQ score increased from 4.33 ± 1.53 (T1) to 6.67 ± 1.52 (T2) (P < .001). This improvement was consistent across all technological backgrounds, with no significant influence of prior VR (P = .18) or gaming (P = .14) on performance. Subjects found the VR intervention effective for understanding head and neck anatomy, with 90.48% reporting increased confidence in their knowledge. Students rated the VR educational experience highly for control, sensory immersion, and realism, with minimal distraction or frustration.

Conclusions: Anatomic VR experiences are a valuable adjunct in medical education, enhancing student confidence and understanding of complex head and neck anatomy, independent of technological background.