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Objective: While the etiology of Meniere's disease (MD) is likely multifactorial, genetics are thought to play a role. Several previous studies have yielded inconclusive results, potentially due to phenotypic uncertainty and variable diagnostic criteria. To explore potential genetic bases in a more rigorous context, we assessed the clinical predictors and diagnostic yield of current hearing loss panels in a highly curated cohort of patients with bilateral and/or early-onset MD.

Study design: Retrospective cohort study.

Setting: Multidisciplinary tertiary care hearing loss genetics clinic.

Methods: Data from clinical notes, audiograms, and genetic reports of adult patients diagnosed with bilateral and/or early-onset (<40 years) MD from October 2019 to June 2025 were analyzed with logistic regression and summary statistics to determine predictive factors and diagnostic yields of existing genetic panels.

Results: Of the 37 patients analyzed (mean age 47.7 + 14.5 years, 54% male), 24 (64.8%) had early-onset MD, 22 (59.5%) had bilateral MD, and 9 (24.3%) had both. Moderately severe to profound hearing loss prior to 65 was significantly associated with pathogenic or likely pathogenic variants (PLPV) (OR 8.98 [1.17, 101]; P = .046). No significant predictors were found for definitive diagnosis, plausible diagnosis, or negative panels. Eight (22%) patients had a PLPV detected on their hearing loss panel, with 0 definitive diagnoses, 3 (8.1%) plausible diagnoses (MYO15A, SLC17A8, P2RX2), and 6 (16%) completely negative panels.

Conclusions: Current hearing loss panels show limited diagnostic utility for MD. Future research should prioritize whole genome sequencing to identify novel MD-associated loci and provide guidance to patients.

Objective: When medical management fails to solve skin flap complications following cochlear implantation (CI), same-sided reimplantation may be attempted using revision flaps that provide viable, vascularized tissue. This systematic review assesses long-term outcomes and complications of the most prevalent skin flaps in revision CI.

Data sources: PubMed, Web of Science, and Embase.

Review methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, each database was queried from inception to December 15, 2024 for articles describing revision CI after skin flap failure. A qualitative synthesis of postoperative complications and long-term outcomes was employed for selected studies.

Results: Of an initial 1878 abstracts screened, 12 studies met the inclusion criteria, amounting to 69 flap revisions following CI. Thirty-four revisions were performed after wound breakdown or skin necrosis at the implant site. Among the 7 studies that reported initial incision shape for their cohort, 5 used C-shaped, 1 used inverted U, and 1 used lazy S. Of the 11 articles that described their revision flap technique, 8 used a rotational flap. Three of these studies also used temporoparietal fascia flaps (TPFF). There were 9 revision flap failures (13.4%). Successful techniques included the rotational flap with either TPFF or free flap supplementation when required for coverage.

Conclusion: The current data shows that skin flap revision for CI reimplantation is a feasible option following original flap failure; however, surgeons should take care to plan appropriately for each patient's unique anatomy and available viable tissue.

Objective: Early and integrated palliative care (PC) interventions are recommended for advanced-stage cancers. The rate with which patients with stage IV oral cavity squamous cell carcinoma (OCSCC) receive PC as part of their oncologic care is unknown. We sought to understand the utilization of PC for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states.

Study design: Retrospective cohort.

Setting: National Cancer Database was queried for patients with stage IV OCSCC from 2004 to 2017.

Methods: Patients in Medicaid expanded (EXP) states were categorized as pre-expansion (pre-EXP) or post-expansion (post-EXP). Patients in nonexpanded states (NEXP) were categorized as diagnosed before 2014 (pre-NEXP) or during/after 2014 (post-NEXP). Multivariable logistic regressions were used to compare receipt of PC among pre-EXP and post-EXP patients, and separately among post-EXP and post-NEXP cases.

Results: Among 15,356 patients who met inclusion criteria, 629 (4.10%) received PC. There was a trend towards increased receipt of PC in post-EXP compared to pre-EXP cases, but this did not reach statistical significance. Among pre-EXP and post-EXP cases, patients were more likely to receive PC with the lowest income quartile, tongue cancer as the oral cavity subsite, and no insurance.

Conclusion: There was no significant difference of PC receipt for patients with stage IV OCSCC in Medicaid expanded versus non-expanded states. Results among patients in pre-EXP and post-EXP states suggest increased PC use among more disadvantaged patient groups. Further analysis on receipt of PC in vulnerable patient populations with advanced-stage cancer is warranted.

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.