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Objective: The objective of this study was to determine the rate at which veterans with head and neck squamous cell carcinoma (HNSCC) received care adhering to National Comprehensive Care Network (NCCN) guidelines for postoperative radiation and to identify factors associated with non-adherence. The guidelines recommend initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery.

Study design: This was a retrospective cohort analysis of a pre-existing database.

Setting: This study, performed at the DC Veterans Affairs Medical Center, identified patients with HNSCC who underwent surgery with curative intent followed by adjuvant radiation ± chemotherapy between 1991 and 2021.

Methods: Variables assessed included patient demographics, cancer stage and site, treatment type, dates of treatment initiation and completion, and adherence to the NCCN guidelines for PORT initiation. Fisher exact test was used to identify factors associated with delays >6 weeks.

Results: Among the 132 veterans identified, 72 (54.5%) underwent surgery followed by adjuvant PORT. Only 18 veterans (25%) started radiation within 6 weeks of surgery. Patients who underwent a neck dissection at the time of the index surgery (P = .028), dental extraction (P = .032), or gastrostomy tube placement (P = .041) were more likely to experience delays.

Conclusion: Only 25% of veterans initiated PORT within 6 weeks. Identifying causes of delays provides an important step in addressing discrepancies between guideline-directed care and actual care delivered. Development of efficient care pathways to increase guideline-congruent initiation of PORT should be considered.

While outpatient otolaryngology procedures have been increasingly performed at ambulatory surgery centers (ASCs), the cost differences compared to hospital outpatient departments (HOPDs) remain unclear. Utilizing newly available data collected from Turquoise Health's Rate Sense as required under the Transparency in Coverage rule, we assess, in this cross-sectional analysis, the differences in negotiated facility fees between ASCs and HOPDs for 20 common otolaryngologic procedures. Analyzing data from 4613 ASCs and 2382 hospitals, we found significantly higher facility fees at HOPDs, with a median relative price difference of +146% (P < .0001). This may be explained by greater infrastructure costs and market power differences between facilities. Our findings suggest that further shifting outpatient otolaryngology procedures toward ASCs could yield substantial cost reductions across health care systems. Additional research is needed to ensure safe and cost-effective patient selection for ASCs.

Objective: Individuals with primary ciliary dyskinesia (PCD) frequently report olfactory dysfunction, yet this deficit is poorly documented. The purpose of this study was to characterize the presence and degree of olfactory dysfunction in PCD compared to controls and determine whether certain PCD genes are associated with worse olfaction.

Study design: A prospective cohort study.

Setting: Tertiary referral center.

Methods: We administered the University of Pennsylvania Smell Identification Test (UPSIT) to individuals with PCD. Participants were divided into 3 age groups (15-29 years, 30-44 years, and 45+ years) and compared to age- and sex-matched normal controls (n = 2170).

Results: Twenty-nine individuals with PCD (8 males and 21 females) met the criteria (median age: 38 years; interquartile range: 22-47). Only 27.6% of patients with PCD had UPSIT scores within the normosmia range. The UPSIT median scores of each PCD age group were significantly lower than the median scores of the controls (P < .0001 for each age group). UPSIT scores generally worsened with age: mean 33 (mild hyposmia) for 15 to 29 years, 26.8 (moderate hyposmia) for 30 to 44 years, and 20.9 (severe hyposmia) for 45+ years. The most common genes coded were absent inner dynein arm/microtubule disorientation (IDA/MTD) defect (11/24, 45.8%), followed by absent outer dynein arm defect (8/24, 33.3%). The CCDC39 gene (IDA/MTD) was associated with worse olfactory dysfunction.

Conclusion: Individuals with PCD have a substantially higher prevalence and degree of olfactory dysfunction compared to age-matched controls. Our study is the first to report greater olfactory dysfunction with age in PCD patients, highlighting an important area for research.

Objective: This study aims to characterize concurrent nasal symptoms in a cohort of patients with non-rhinogenic headache (NRH) presenting to an otolaryngology clinic.

Study design: A prospective cohort.

Setting: Single tertiary care institution.

Methods: Adults with NRH were recruited over a 2-year period (February 2021 to February 2023). Patients were eligible if they endorsed midfacial pain or pressure for at least 10 days a month over the previous 3 months and had no evidence of rhinosinusitis on both nasal endoscopy and computed tomography imaging. Study participants used a mobile application to keep a daily log of their facial pain/pressure, nasal congestion, and nasal mucus/discharge. Symptom severity was scored on a scale from 1 (none) to 10 (worst) for 30 consecutive days. Repeated measures correlation coefficients were calculated to evaluate overall or common intra-individual association for each symptom.

Results: Twenty-eight patients were enrolled, and they completed the 30-day symptom log. Median (range) scores were 5 (1-10), 4 (1-10), and 2 (1-10) for facial pain/pressure, congestion, and mucus, respectively. Patients had significant day-to-day fluctuations in scores for all 3 symptoms, with a significant positive correlation between symptoms: congestion/mucus (r = 0.74181, P < .0001), congestion/facial pain (r = 0.5873, P = .001), and mucus/facial pain (r = 0.49384, P = .0076).

Conclusion: Patients with NRH often have concurrent nasal symptoms. Moreover, nasal congestion, mucus, and facial pain/pressure had significant correlations in day-to-day fluctuations in severity. Our findings suggest the possibility that all three symptoms share a common pathophysiology.

Objective: This study aims to evaluate the clinical efficacy of electro-pneumatic intracorporeal lithotripsy for the treatment of salivary gland stones.

Study design: A prospective cohort study of patients diagnosed with obstructive salivary gland syndrome, where basket-assisted sialendoscopy alone failed to remove the calculi.

Setting: This study was conducted at the "Queen Maria" Military Hospital in Brașov, Romania, and a private practice, between February 2023 and May 2024.

Methods: A total of 29 patients with salivary calculi were treated using the SialoLither device (Hidromed), which operates on the electro-pneumatic principle. The number of sessions required for complete stone removal, the duration of each session, and the number of ballistic impulses applied were recorded. Statistical analyses, including the Mann-Whitney U test and multiple linear regression, were conducted to assess the relationship between stone size, location, and treatment outcomes.

Results: Complete removal was achieved in 72.4% of patients after a single session, with 100% success after 3 sessions. The average number of impulses was 13.9 (±4.25), with no significant difference in outcomes between the parotid and submandibular glands (P > .05). The total duration varied, with a mean time of 89.97 (±54.89) minutes. Complications were minimal, with only 2 cases of minor epithelial damage.

Conclusion: Electro-pneumatic intracorporeal lithotripsy is a highly effective, minimally invasive technique for managing salivary calculi, offering a safe and efficient alternative to traditional surgical methods.

Objective: The objective of this study is to determine the effectiveness and safety profile of coblation tongue base reduction (CBTR) compared to radiofrequency base of tongue (RFBOT) reduction on sleep-related outcomes in patients with obstructive sleep apnea (OSA).

Data sources: PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews databases.

Review methods: Literature search by 2 independent authors was conducted using the abovementioned databases. Studies on CBTR and RFBOT as part of OSA treatment in adult patients with pre- and postoperative apnea-hypopnea index (AHI) were included. Direct meta-analysis and single-arm meta-analysis were conducted to compare sleep-related outcomes (AHI, apnea index [AI], surgical success rates, Epworth sleepiness score [ESS], SpO₂, body mass index [BMI], and visual analog scale [VAS]) between both groups.

Results: A total of 40 studies with a total of 1940 patients were included, of which 1440 individuals who underwent tongue base reduction interventions (RF = 306, RF + UPPP = 656, and coblation + UPPP = 482) met inclusion criteria. Pooled analysis showed significant improvements in AHI (CBTR = -22.84, RFBOT = -11.14), AI (CBTR = 15.64, RFBOT = -5.26), ESS (CBTR = -7.59, RFBOT = -7.18), mean oxygen saturation (CBTR = 7.43, RFBOT = 4.25), mean BMI (CBTR = -0.69, RFBOT = -4.09), and snoring visual analog scale (CBTR = -16.20, RFBOT = -18.21). Surgical success rate (postoperative AHI < 20 and drop >50% from baselines) was 70% for CBTR and 43% for RFBOT.

Conclusion: Both interventions decreased sleep-related outcomes in adult patients with OSA. Coblation appears to exhibit superiority over radiofrequency with a similar safety profile. However, further studies with direct comparisons between both interventions must be performed.

Objective: Stress hormone levels such as cortisol and epinephrine increase with general anesthesia (GA) and surgery. Parathyroid hormone (PTH) has been shown to increase with GA in those undergoing parathyroidectomy (PT) with abnormal parathyroid function, but there are conflicting reports of it in those with normal parathyroid function. In this study, we aim to determine the effects of anesthetic and surgical stress on those with abnormal parathyroid function undergoing PTs as well as those with normal parathyroid function undergoing unilateral/total thyroidectomies (UTs/TTs).

Study design: Prospective study.

Setting: Single tertiary academic center.

Methods: Patients undergoing TT, UT, and PT were studied. PTH was measured consecutively during the preoperative, postanesthetic induction before incision, intraoperative, and postoperative periods.

Results: One hundred sixty patients were included, with 77 and 31 undergoing TT and UT, respectively, and 52 undergoing PT. Mean PTH levels were significantly higher following induction and intubation across all groups (TT: 139.2 vs 65.1 pg/mL, 113.8% increase; UT: 130.4 vs 57.1 pg/mL, 128.4% increase; PT: 219.6 vs 163.7 pg/mL, 34.1% increase) and remained elevated until excision (TT: 131.8 pg/mL; UT: 124.9 pg/mL; PT: 228.7 pg/mL). Following UT, mean PTH declined to preoperative levels by 1 hour postexcision. Compared to thyroidectomy groups, PTH in the PT group showed more variable responses to anesthesia induction.

Conclusion: PTH consistently increases in response to anesthetic and surgical stress in adults undergoing UT and TT with normal preoperative parathyroid function. In contrast, those with hyperparathyroidism demonstrated variable changes.

Objective: This study aims to evaluate the impact of prompt construction on the quality of artificial intelligence (AI) chatbot responses in the context of head and neck surgery.

Study design: Observational and evaluative study.

Setting: An international collaboration involving 16 researchers from 11 European centers specializing in head and neck surgery.

Methods: A total of 24 questions, divided into clinical scenarios, theoretical questions, and patient inquiries, were developed. These questions were entered into ChatGPT-4o both with and without the use of a structured prompt format, known as SMART (Seeker, Mission, AI Role, Register, Targeted Question). The AI-generated responses were evaluated by experienced head and neck surgeons using the Quality Analysis of Medical Artificial Intelligence instrument (QAMAI), which assesses accuracy, clarity, relevance, completeness, source quality, and usefulness.

Results: The responses generated using the SMART prompt scored significantly higher across all QAMAI dimensions compared to those without contextualized prompts. Median QAMAI scores for SMART prompts were 27.5 (interquartile range [IQR] 25-29) versus 24 (IQR 21.8-25) for unstructured prompts (P < .001). Clinical scenarios and patient inquiries showed the most significant improvements, while theoretical questions also benefited, but to a lesser extent. The AI's source quality improved notably with the SMART prompt, particularly in theoretical questions.

Conclusion: This study suggests that the structured SMART prompt format significantly enhances the quality of AI chatbot responses in head and neck surgery. This approach improves the accuracy, relevance, and completeness of AI-generated information, underscoring the importance of well-constructed prompts in clinical applications. Further research is warranted to explore the applicability of SMART prompts across different medical specialties and AI platforms.

Objective: This study aims to compare research productivity and barriers to research between high-income countries (HICs) and low- and middle-income countries (LMICs) otolaryngologists.

Study design: Cross-sectional survey.

Setting: International survey.

Methods: A survey developed by members of the Lebanese Otolaryngology Research and Awareness Group was disseminated globally to otolaryngologists and otolaryngology residents. The survey assessed research efficiency, funding, and perceived barriers. Data were analyzed using t tests and χ ² tests.

Results: A total of 82 responses from 21 countries were recorded, with 33 from HICs (40.2%) and 49 from LMICs (59.8%). LMIC respondents reported significantly less research funding (84.4% vs 60.6%, P = .013) and fewer publications (24.4% vs 3.1%, P = .001) compared to HIC respondents. LMICs faced unique individual barriers like elderly care responsibilities (17.8% vs 0%, P = .035). Organizational challenges in LMICs included limited access to information sources (35.7% vs 15.6%, P = .017) and financial resources (85.7% vs 40.6%, P < .001). Institutional challenges such as lack of funding (83.3% vs 34.4%, P < .001) and protected research time (71.4% vs 56.3%, P = .047) were more prominent in LMICs. Governmental barriers were also greater in LMICs, including demotivating government policies (59.0% vs 9.4%, P < .001). Additionally, covering article processing charges was a significant challenge for 76.2% of LMIC respondents compared to 31.3% in HICs (P = .001).

Conclusion: Otolaryngologists in LMICs encounter substantial barriers to research productivity compared to those in HICs, primarily due to funding gaps, lack of institutional support, and unfavorable governmental policies. Addressing these disparities is essential for fostering equitable global research contributions.

Barbed reposition pharyngoplasty (BRP) is a new technique to manage velo-pharyngeal obstruction and collapse in OSA patients. Tonsillectomy is a preliminary step of BRP surgery. Dissection of the PPM with monopolar or hot instruments is an essential step of the BRP technique. Tonsillectomy and muscle manipulation should be managed with careful attention due to the risk of muscle fibers rupture and surgical failure. We describe the coblator assisted BRP. The aim of this paper is to report the use and advantages of coblator technology in tonsillectomy and the velo-pharyngeal dissection before the PPM relocation with barbed sutures. In this operative technique study 100 OSA patients underwent Co-barbed technique. The CO-BRP technique has been considered fast, safe and minimally invasive with a low postoperative pain (mean value 3.63 ± 0.7). Postoperatively, a significant decrease in mean AHI from 35.63 ± 10.57 to 17.06 ± 5.92 (P < .005) emerged.