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Objective: To determine whether exposure to monopolar electrosurgery during subsequent surgeries following Bonebridge implantation has negative impact on the implant.

Study design: Retrospective study.

Setting: Tertiary medical center.

Methods: Fifty-six patients who received Bonebridge implantation between December 2014 and June 2024 were reviewed. Twelve patients with exposure to monopolar electrosurgery during subsequent operation were included. Bonebridge-aided sound field thresholds, as well as subjective outcomes based on patient experience were analyzed to determine if there are any adverse effects on the implant after monopolar electrosurgery exposure.

Results: The mean age at receiving Bonebridge implantation and subsequent operation were 15.1 ± 6.8 (range, 7.7-29.9) years and 16.5 ± 6.5 (range, 10.2-30.1) years, respectively. Each of the included patients experienced one episode of monopolar electrosurgery exposure after Bonebridge implantation. All monopolar electrosurgery exposures were in the head-and-neck region, but none of them involved the ipsilateral temporoparietal area. The mean pre-monopolar electrosurgery and post-monopolar electrosurgery Bonebridge aided sound field thresholds pure tone average were 31.8 ± 3.3 decibel hearing level and 29.5 ± 3.9 decibel hearing level, respectively (Wilcoxon signed-rank test, P = .203). No adverse events associated with implant malfunction occurred after monopolar electrosurgery exposure.

Conclusion: No adverse events or hearing impairment were observed in this series of Bonebridge-implanted patients who underwent operations involving monopolar electrosurgery. Notably, the exposures were of relatively brief duration and limited to areas outside the ipsilateral temporoparietal region. Further multicenter, prospective studies with larger cohorts and comprehensive adverse event analysis are warranted to better corroborate these findings.

Objective: To evaluate the validity of the Oura Ring (OR; Oura Health Ltd.) in measuring sleep parameters compared to medical-grade sleep studies including polysomnography (PSG) or actigraphy (ACT).

Data sources: PubMed, Scopus, and CINAHL.

Review methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Studies were included if they evaluated sleep parameters measured simultaneously by the OR and PSG or ACT. Outcomes assessed included Total Sleep Time (TST), Sleep Efficiency (SE), Wake After Sleep Onset (WASO), Sleep Onset Latency (SOL), Light Sleep Time (LST), Deep Sleep Time (DST), and Rapid Eye Movement (REM) sleep time. Mean differences with 95% confidence intervals were calculated using a random-effects model. A P < .05 was considered statistically significant.

Results: Out of 2104 articles, 6 studies (n = 388) were included. There were no statistically significant differences between the OR and PSG/ACT for TST (MD: -2.97 min; 95% confidence interval [CI]: -10.27 to 4.33), SE (MD: -1.32%; 95% CI: -2.76 to 0.12), WASO (MD: 1.64 min; 95% CI: -12.57 to 15.86), SOL (MD: 0.48 min; 95% CI: -2.93 to 3.89), LST (MD: -4.27 min; 95% CI: -24.68 to 16.13), DST (MD: 1.39 min; 95% CI: -10.45 to 13.23), and REM sleep time (MD: -3.89 min; 95% CI: -17.23 to 9.46).

Conclusion: The OR demonstrates comparable accuracy to PSG and ACT for commonly measured sleep parameters, supporting its utility as a self-monitoring tool. This could prompt earlier clinical evaluation in symptomatic individuals or support remote monitoring of sleep.

Objective: To perform a systematic review of the effect of preoperative teaching methods on outcomes for adult patients undergoing major head and neck surgery.

Data sources: OVID Medline, CINAHL, Cochrane, Pubmed, and Embase databases were queried.

Review methods: A comprehensive literature search was conducted in January 2024 using Medline (Ovid), Embase (Ovid), CINAHL Complete (EBSCOhost), and Cochrane Central Register of Controlled Trials (CENTRAL). Following PRISMA methodology, primary literature published between January 2000 and January 2024 was queried. The search focused on studies examining preoperative patient education for major head and neck cancer surgeries. The Methodological Index for Non-Randomized Studies (MINORS) criteria were employed to assess the risk of bias in the included studies.

Results: Our initial search strategy yielded 1140 titles with 54 meeting criteria for full-text review. Four publications were included in the final study, all of which were published within the last 8 years. Thematic analysis revealed that most teaching interventions included multidisciplinary sessions or days, educational material, and support to caregivers. The most common finding from teaching interventions was decreased hospital length of stay, while some authors also found decreased readmission rates and fewer post operative complications in intervention cohorts.

Conclusion: Preoperative education utilizing multidisciplinary teams has demonstrated an improvement in length of stay and in some cases, fewer complications and readmissions in adult patients following major head and neck surgery. More robust research is needed to draw further conclusions on impact to patient outcomes and cost.

Introduction: Fenestration of the lateral semicircular canal has been proposed to improve intracochlear gene therapy delivery, but the relationship between the membranous and bony labyrinths at the canal apex has not been systematically defined.

Methods: We examined 62 human temporal bones, including 31 unaffected specimens and 31 with chronic otitis media, using histologic review to assess the membranous-to-bony relationship at the apex.

Results: In all specimens, the membranous labyrinth directly contacted the outer circumferential bony wall.

Conclusion: This consistent finding, independent of disease state, indicates that fenestration at the lateral canal apex carries a high risk of membranous injury. Potential consequences include hearing loss, vestibular dysfunction, and reduced therapeutic effect. Inadvertent entry into the endolymphatic compartment might not adequately support perilymphatic flow and compromise therapeutic delivery. Because fenestration of the outer circumference of the lateral semicircular canal is histologically unfavorable, histologic assessment of proposed fenestration sites is necessary.

Objective: An increasing number of patients are electing to undergo balloon sinuplasty for treatment of chronic rhinosinusitis due to its minimally invasive nature. This study aimed to evaluate the readability and understandability of online patient education materials (PEMs) related to balloon sinuplasty.

Study design: Cross sectional.

Setting: Digital environment.

Methods: A Google search was performed using 6 different search terms related to balloon sinuplasty. Websites related to PEMs for balloon sinuplasty were included. Four different measures of readability were utilized to assess the readability of each website: Flesch-Kincaid Grade Level (FKGL), Flesch-Kincaid Reading Ease (FKRE), Gunning-Fog Index, and Simple Measure of Gobbledygook Index. Understandability was determined using the Patient Education Materials Assessment Tool (PEMAT).

Results: Fifty-three online PEMs related to balloon sinuplasty were included. The average FKGL was 9.07 ± 2.1, which is higher than the recommended grade reading levels. The average FKRE was 45.11 ± 9.3, indicating they were difficult for the general public to read. The mean PEMAT was 49.7 ± 16.3%, which is lower than the accepted standard of 80%, which indicates materials are not readily understandable. Most PEMs were obtained from private medical clinics (79.2%, N = 42).

Conclusion: Online PEMs related to balloon sinuplasty are written above the recommended 6th grade reading level. Poor readability was seen across all readability measures and all material categories. Patients and clinicians alike should be aware of the shortcomings of online materials and consider the effects on patient understanding and decision making.

Objective: Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a method of apneic oxygenation gaining popularity in upper aerodigestive surgery. Retrograde cricopharyngeus muscle dysfunction (RCPD) is characterized by the inability to belch, managed by intraoperative injection of botulinum toxin to the cricopharyngeus muscle (CPBI), often performed under general anesthesia with endotracheal intubation. We sought to assess the safety and efficacy of THRIVE when performing CPBI for RCPD.

Study design: We conducted a retrospective review of adult RCPD patients undergoing CPBI under general anesthesia with THRIVE.

Setting: The study was conducted at both the University of Texas Health Science Centers in Houston and San Antonio over a 5-month period from June 2023 to November 2023.

Methods: Patients were placed under general anesthesia using THRIVE. CPBI was performed. Demographic, clinical, and anesthesiologic data were collected and analyzed.

Results: In total, 32/39 (82%) were able to maintain oxygenation throughout the procedure. Mean (standard deviation) time from induction to paralytic reversal was 7.8 (3.3) minutes. Time from induction to return of spontaneous breathing was 9.9 (3.2) minutes. Excluding seven patients who required "rescue" bag-mask ventilation due to failure to maintain oxygenation, the median oxygen saturation nadir was 97.7% (range 92%-100%). The average increase in end-tidal CO₂ level (EtCO₂) was 1.14 mm Hg/min. Body mass index (BMI) significantly predicted failure to maintain oxygenation on binary logistic regression (coefficient 0.239, P = .010).

Conclusion: THRIVE is a feasible means of apneic oxygenation when performing operative CPBI for patients with RCPD, although the need for "rescue" ventilation may occur at a higher rate in comparison to existing literature for laryngotracheal surgery.

Level of evidence: IV.

Objective: Otolaryngology (OTO) remains one of the most competitive surgical specialties, with limited residency positions. In 2021, a 25-program preference signaling system was introduced to enhance communication between applicants and programs. This study evaluates how signaling affects application metrics.

Study design: Retrospective database study.

Setting: Texas Seeking Transparency in Application to Residency (STAR) program, 2021 to 2024.

Methods: Statistical analysis in R (v4.3.3) included descriptive statistics, ANOVA for comparing continuous variables across match years, and T-tests to assess differences between matched and unmatched groups.

Results: From 2021 to 2024, there were 393 respondents, representing 26.77% of all OTO positions. Preference signaling use among matched applicants rose from under 25% in 2021 to 95.7% in 2024. Nonsignaling applicants had more publications (6.31 ± 3.74 vs 5.30 ± 3.78, P < .01) and volunteer experiences (7.82 ± 3.15 vs 6.00 ± 3.42, P < .001) than signaling applicants. Step 2 scores were similar between groups. Applications per applicant declined from 75.93 ± 31.79 in 2021 to 48.16 ± 23.55 in 2024.

Conclusion: Applicants with fewer traditional strengths, such as research and volunteering, were more likely to match using preference signaling. Strategic signaling may improve chances of matching into OTO. The decline in application numbers suggests growing trust in the signaling process from both applicants and programs.

Objective: To understand the content of patient calls after functional rhinoplasty and to evaluate artificial intelligence chatbots' ability to provide accurate, intelligible, and safe responses.

Study design: Retrospective review.

Setting: Tertiary-care institution.

Methods: A single-institution, retrospective review was conducted for patients who underwent functional rhinoplasty between 2017 to 2023. Postoperative calls and messages prior to first follow-up were analyzed, and 48 representative prompts were generated, including 6 "Red Flag Questions" indicating potential complications. Prompts were input into 4 chatbots (ChatGPT, Claude, Perplexity, and Gemini). Two independent, blinded experts graded responses using a Likert-style Global Quality Scale (GQS) and a binary Expert Opinion Question (EOQ; "Would you feel comfortable if your patient received this response rather than speaking with your staff?"). Flesch-Kincaid (FK) Grade Levels measured readability. Chi-square and Mann-Whitney U tests compared chatbot performance.

Results: Of 378 patients, 137 (36%) initiated contact, with 181 total calls. Common concerns included pain (19%) and medication questions (14%). Seventy-three percent (n = 132) received routine counseling, with no complications at first follow-up. ChatGPT produced "Good" or "Excellent" responses 98% of the time, significantly outperforming the next-best chatbot (Perplexity, 79%; P = .0039). Experts unanimously approved ChatGPT responses (mean EOQ = 1) 96% of the time, and 100% for Red Flag Questions. Perplexity was the most readable (median FK 13.2), and ChatGPT the least (16.8; P < .0001).

Conclusion: Patient calls are common after functional rhinoplasty. Most can be managed with reassurance. Chatbots, especially ChatGPT, provide reliable responses, which may improve satisfaction and reduce workload without compromising safety. Future development should focus on readability.

Objective: While one-fifth of eligible candidates use hearing aids (HAs), a smaller proportion of eligible candidates receive a cochlear implant (CI), partly due to cost and knowledge gaps. This study aims to quantify internet relative search volumes (RSVs) as a general awareness proxy for HAs and CIs around relevant events.

Study design: Retrospective infodemiologic study.

Setting: Google searches from 2004 to 2024.

Methods: Using Google Trends, we performed Welch's t-tests to compare average HA and CI RSVs (search volume relative to comparator search volume from 0%-100%) during event and non-event periods.

Results: From 2004 to 2024, HA RSV increased from 37% to 100% while CI RSV remained below 13%. Some federal announcements such as hybrid CI approval (Mar 2014; P < .045) and a new over-the-counter HA category (Oct 2021; P < .001) coincided with significantly increased CI and HA RSVs, respectively, while others like the Nov 2024 federal announcement stating when all cell phones must have wireless connectivity with HA (P = .099) and CI (P = .777) did not. Similarly, some public awareness campaigns like "Hearing 20/20" (P < .001 for HA and CI) and Feb 2024 International CI Day (P < .001) coincided with significantly increased RSVs, while others like the Feb 2009 (P = .093) and Feb 2023 International CI Days (P = .327) did not.

Conclusion: This study highlights that, unlike increasing search activity around HAs, CIs have not exhibited the same substantial changes in search volume, aside from brief spikes around certain campaigns. These findings underscore the need for more effective and sustained public outreach strategies to improve hearing device awareness.