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Objective: To assess if patients with enlarged vestibular aqueduct (EVA) experience symptoms characteristic of other third mobile window disorders such as superior semicircular canal dehiscence syndrome (SCDS).

Study design: Cross-sectional study.

Setting: Tertiary care center.

Methods: Adult and pediatric patients with EVA were screened. Patients with additional middle or inner ear pathology were excluded. The included patients and parents of pediatric patients were asked to complete a survey regarding symptoms, including autophony, hyperacusis, and sound- and pressure induced dizziness.

Results: Of the 121 patients who met inclusion criteria, 36 patients and parents completed the questionnaire (15 children and 21 adults). Adult EVA patients appeared to suffer from similar rates of hyperacusis (67%), autophony (52%), pressure induced dizziness (38%), ear fullness (62%), and spontaneous dizziness or vertigo (67%) compared to reported rates among SCDS patients. Children with EVA also appeared to have similar rates of hyperacusis (67%), ear fullness (47%), and spontaneous dizziness or vertigo (40%), while pressure induced dizziness (13%) and autophony (20%) seem less common in children and sound induced dizziness appears less common in both children and adults (13% and 14% respectively).

Conclusion: This is the first study investigating the prevalence of typical third-window symptoms in patients with EVA. We found an overlap in the prevalence of several specific and nonspecific third window symptoms for patients with EVA and SCDS.

Objective: Evaluate the feasibility of the midface degloving approach (MDA) in total maxillectomy without orbital exenteration (TMWOE) and reconstruction for sino-nasal neoplasms.

Study design: Retrospective case series.

Setting: Tertiary referral center.

Methods: This single-center series included 9 consecutive sino-nasal neoplasm patients who had TMWOE using MDA, free tissue reconstruction, and orbital floor implants (April 2018-Dec 2022) assessing tumor characteristics, margins, and complications.

Results: There were 3 female and 6 male patients with a median age of 61 years. The median follow-up was 462 days. There were 7 malignant and 2 benign tumors. The median tumor size was 4.6 cm. There were 7 clear margins and 2 positive margins. Most patients underwent some combination of preoperative and or postoperative therapies. After resection, a variety of free tissue reconstruction was performed. Overall, there were no complications clearly attributable to the midface degloving approach. Flap debulking was required in one patient but no long-term complications were encountered.

Conclusion: Midface degloving offers an alternative to the Weber-Ferguson for TMWOE and avoids facial incision while providing adequate exposure to the orbital rim. Patient selection is critical, as tumors extending laterally into the zygomatic arch and infratemporal fossa may not be accessible.

Objective: To investigate machine learning-based regression models to predict the postoperative apnea-hypopnea index (AHI) for evaluating the outcome of velopharyngeal surgery in adult obstructive sleep apnea (OSA) subjects.

Study design: A single-center, retrospective, cohort study.

Setting: Sleep medical center.

Methods: All subjects with OSA who underwent velopharyngeal surgery followed for 3 to 6 months were enrolled in this study. Demographic, polysomnographic, and anatomical variables were analyzed. Compared with traditional stepwise linear regression (LR) algorithm, machine learning algorithms including artificial neural network (ANN), support vector regression, K-nearest neighbor, random forest, and extreme gradient boosting were utilized to establish the regression model. Surgical success was defined as a ≥50% reduction in AHI to a final AHI of <20 events/h.

Results: A total of 152 OSA adult patients (median [interquartile range] age = 40 [35, 48] years, male/female = 136/16) were included in this study. The ANN model achieved the highest performance with a coefficient of determination (R ²) of 0.23 ± 0.05, a root mean square error of AHI of 10.71 ± 1.01 events/h, an accuracy for outcomes classification of 81.3% ± 1.2% and an area under the receiver operating characteristic of 74.6% ± 1.9%, whereas for LR model, they were 0.094 ± 0.06, 11.61 ± 0.76 events/h, 71.7% ± 1.5% and 68.8% ± 2.9%, respectively.

Conclusion: The machine learning-based model exhibited excellent performance for predicting postoperative AHI, which is helpful in guiding patient selections and improving surgery outcomes.

Simulators allow junior otolaryngology residents to practice the delicate procedure of pressure equalization tube (PET) insertion. However, most simulators lack the ability to mimic the differing anatomic complexities between patients, such as variable external auditory canal (EAC) size. We developed a novel low-cost, medium-fidelity 3-dimensional-printed PET simulator with different EAC sizes to better reflect procedure complexity. Additionally, a variety of materials were tested to mimic the elastic modulus of the tympanic membrane, with "Press'n Seal" cling film being chosen for its cost-effectiveness and tactile similarity. Ten otolaryngologists performed PET insertion on both EAC sizes followed by a survey to assess face and content validity. Results indicated both high face and content validity, with most participants agreeing the simulator provided a realistic experience and would be useful for training. While our study has a small sample size, our PET simulator adds a unique and valuable addition to PET training.

Objective: Identification of patients with head-and-neck malignancies who are especially vulnerable to malnutrition is critical for optimizing outcomes. The objectives are; to correlate Bioelectrical-impendence-analysis (BIA) parameters with Subjective-Global-Assessment (SGA) scores, and determine the association of BIA parameters with common perioperative complications in patients undergoing head-and-neck surgery.

Study design: Patients underwent formal SGA scoring and BIA preoperatively in a multidisciplinary allied health clinic.

Settings: This is a cohort study of 61 patients with head-and-neck malignancies who were admitted for elective surgery from 2018 to 2019 in a tertiary hospital in Singapore.

Methods: BIA was performed using the Bodystat Quadscan 4000. Kruskal-Wallis rank sum tests and were performed for associations between SGA and BIA parameters. Wilcoxon rank sum tests and multivariable logistic regression models (Firth's bias reduction method) were performed to evaluate associations between BIA parameters and perioperative complications. Receiver-operating-characteristic (ROC) curves were plotted for determination of optimal cut-off values of phase angle and Wellness marker in detecting malnutrition and perioperative pneumonia using Youden's-Index (YI).

Results: 45 males and 16 females with median age of 62 were included in the study. Significant differences were observed in Wellness Marker (P = .006) and phase angle (P = .008) among patients in the 3 SGA categories. The Wellness Marker (P = .02) was associated with perioperative pneumonia in the univariate analysis. No significant differences were observed for other perioperative complications studied.

Conclusion: BIA shows promise as a preoperative tool, in conjunction with SGA, to detect malnutrition in patients undergoing surgery for head-and-neck malignancies and highlight patients at risk of developing perioperative pneumonia.

The use of bone cement in ossicular chain reconstruction (OCR) represents an area of recent interest. This multi-institutional retrospective study assesses the efficacy of glass ionomer cement (GIC) in OCR following the explantation of a fully implantable active middle ear implant. A postoperative 4-frequency mean air-bone gap (ABG) was obtained for 15 subjects by averaging 0.5, 1, 2, and 4 kHz frequencies. For Group A (short-term, N = 15), at a mean of 4.5 months postoperatively, 9 (60%) achieved an ABG between 0 and 10 dB, 5 (33%) were 11 to 20 dB, and 1 (7%) was 21 to 30 dB. For Group B (long-term, N = 5), at a mean of 50 months postoperatively, 4 (80%) were 0 to 10 dB and 1 (20%) was 11 to 20 dB. These results suggest that GIC represents an effective means of ABG closure after device explantation.

Children post-tracheoesophageal fistula (TEF) repair may present with chronic respiratory and gastrointestinal symptoms that can affect quality of life.

Objective: To identify factors associated with positive findings on triple endoscopy following neonatal TEF repair.

Study design: Case series with retrospective review of patients.

Setting: Tertiary care center aerodigestive program.

Methods: Children with neonatally repaired congenital TEF who had a triple endoscopy between 2011 and 2022 were reviewed. The presence of chronic cough, recurrent pulmonary infections, lipid-laden macrophages (LLM), and airway and esophageal anomalies were among the variables analyzed. Chi-square and Kruskal-Wallis univariate analysis was performed.

Results: The mean age was 4.28 ± 4.65 years old, and the most common type of TEF repaired was type C (78%). Within our cohort, 87% of patients had GERD, 60% of patients had prior esophageal dilations, and 84% of patients had tracheomalacia. Thirty-one (46.3%) patients had laryngeal cleft, of which 77.4% had a history of prior esophageal dilations (P = .01). Twenty-one (33.9%) patients had tracheal diverticulum on bronchoscopy, which was associated with chronic cough, stridor, and coughing with feeds. Patients with positive LLM on BAL were associated with presentation of chronic cough and stridor (P = .03). Recurrent TEF was associated with chronic cough. Subglottic stenosis was associated with a history of prolonged intubation (P < .05).

Conclusion: Chronic cough was frequently reported and associated with tracheal diverticulum, recurrent TEF, and positive LLM findings on triple endoscopy in patients after congenital TEF repair. Patients presenting with chronic cough and stridor following congenital TEF repair may benefit from a multidisciplinary evaluation.

Objective: This study aims to compare the effectiveness of 2 artificial saliva substitutes (Biotène vs HydraSmile) in the symptomatic management of radiation-induced xerostomia.

Study design: Randomized double-blind cross-over study.

Setting: Single tertiary care academic institution.

Methods: Included adult patients $\ge$ 6 months postradiotherapy (50-70 gy) for squamous cell carcinoma of the oral cavity, oropharynx, or larynx. The primary endpoint was change in overall subjective xerostomia score from baseline, through use of HydraSmile versus Biotène. Scores were derived from a 100-point visual analog scale, with higher scores indicating better symptomatic control. Analysis of covariance model was used to regress the difference in after-treatment measurement between HydraSmile and Biotène, with respect to baseline differences.

Results: A total of 91 participants were included (mean age 63.0 years [SD 9.7]; 85.7% male; 97.8% White). Change in overall xerostomia score with respect to baseline was not significantly different between HydraSmile and Biotène (mean difference 1.24, 95% confidence interval [CI] -2.35 to 4.81). Compared to water alone, both HydraSmile (mean difference 7.45, 95% CI 3.61-11.29) and Biotène (mean difference 7.24, 95% CI 3.06-11.43) significantly improved overall xerostomia score. Forty (44%) patients reported a preference for Biotène, 46 (50.5%) preferred HydraSmile, and 5 (5.5%) had no preference. Patients who preferred Biotène did not significantly benefit from HydraSmile, whereas those who preferred HydraSmile did not significantly benefit from Biotène.

Conclusion: Biotène and HydraSmile significantly improved oral dryness among patients with radiation-induced xerostomia. While neither product demonstrated treatment superiority, individual product preference was predictive of greatest treatment benefit.

Objectives: Auditory brainstem response (ABR) is the gold standard to assess hearing loss in pediatric patients. Multiple widely accepted ABR protocols with varying parameters are accepted, difference in standards may lead to misdiagnosis or delay in diagnosis and treatment. This study investigates the quality of ABR testing in pediatric patients in addition to changes in diagnoses and management.

Study design: Retrospective chart review.

Setting: University Hospital, Rutgers New Jersey Medical School.

Methods: Retrospective chart review was conducted for all pediatric patients from 2012 to 2019 who had undergone prior outside ABR testing before presenting to our institution for hearing loss evaluation. The ABR tests were analyzed for completeness following the American Academy of Audiology (AAA), American Speech Language Hearing Association (ASHA), and The Joint Committee on Infant Hearing (JCIH) guidelines. Descriptive statistics on changes in patient diagnoses and interventions after repeat ABR were performed.

Results: 80 patients met inclusion criteria. The most common reasons for an incomplete ABR were inadequate components of testing including tone burst bone conduction (85.0%), polarity (82.5%), and tone burst air conduction (48.7%). 77 of the patients who presented required a repeat ABR. 37 repeated ABRs resulted in a change of diagnosis, the most common being from unspecified hearing loss to sensorineural hearing loss (10%). 23 cases had a change in ultimate management.

Conclusion: Incomplete ABR testing may result in misdiagnosis, delay in diagnosis and treatment. Identifying common reasons for incomplete ABR testing may aid Otolaryngologists develop a screening workflow to recognize patients requiring repeat testing.

Level of evidence: 4.

Objective: This study aimed to evaluate the intraoperative use of a drain line for smoke suction during robotic thyroidectomy using a gas insufflation one-step single-port transaxillary (GOSTA) approach and its impact on surgical outcomes.

Study design: Retrospective cohort study.

Setting: University tertiary care facility.

Methods: A comprehensive retrospective analysis was conducted in patients divided into 2 groups: the Drain group, where a drain line was directly inserted into the surgical space during surgery (n = 53), and the Control group (n = 83). The 2 groups were compared in terms of perioperative surgical outcomes, including operative time, number of endoscope cleaning, and the number of patients with endoscopes that did not require cleaning.

Results: The operative time was significantly shorter in the Drain group than in the Control group (P = .003). The number of endoscope cleaning procedures was considerably lower in the Drain group (P < .001), indicating a decreased need for endoscope cleaning during surgery. Moreover, a higher number of patients with endoscopes that did not require cleaning were observed in the Drain group (P = .001), suggesting a potential benefit in maintaining endoscope clarity.

Conclusion: These results suggest that using smoke suction with a drain line directly inserted into the surgical space in robotic thyroidectomy using the GOSTA approach may offer advantages such as reduced operative time and improved endoscope clarity.