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Objective: Complex ablative maxillary and mandibular defects often require osseous free flap reconstruction. Workhorse options include the fibula, scapula, and osteocutaneous radial forearm flap (OCRFF). The choice of donor site for harvest should be driven not only by reconstructive goals but also by donor site morbidity. The goal of this study is to evaluate the long-term postoperative musculoskeletal morbidity at the donor site after osseous free flap harvest.

Study design: Cohort study and cross-sectional analysis.

Methods: A retrospective review of patients who underwent free flap harvest at 1 of the 3 donor sites from 2015 through 2021 was performed. An additional cross-sectional analysis at ≥1 year postoperatively was performed from 2021 to 2022 using validated patient-reported orthopedic surveys: Disabilities of the Arm, Shoulder, and Hand for scapula or OCRFF harvest, and Foot and Ankle Ability Measure for fibula harvest.

Setting: Single, high-volume tertiary care institution.

Results: Among 731 eligible patients, 162 (22.1%) answered the telephone surveys and were included. Functional differences between operated and nonoperated sides were 18.5% (scapula, n = 33), 13.5% (OCRFF, n = 29), and 10% (fibula, n = 98). Postoperative physical therapy (for all donor sites), ipsilateral neck dissection (for scapula and OCRFF), and extent of bony resection (for OCRFF) were not factors associated with long-term morbidity. Acute donor site complications were most common in fibula patients and were associated with worse long-term functional outcomes (7.5% difference; 95% confidence interval, -14.0 to -1; P = .03).

Conclusion: There is acceptable long-term musculoskeletal morbidity at the donor site after osseous free flap harvest, and patients should be counseled appropriately.

Objective: We investigated use of hearing care among US veterans and explore motivations, barriers, and adherence to hearing healthcare.

Study design: Cross-sectional online survey.

Setting: US Veterans.

Methods: This cross-sectional, online survey-based study included 287 respondents who identified themselves as veterans on ResearchMatch (NIH-sponsored national registry of research volunteers). Questions regarding hearing loss, tinnitus, use of hearing care, and facilitators/barriers to hearing care were asked. Descriptive statistics were utilized for data analysis.

Results: In this cohort, the rate of self-reported hearing loss and tinnitus were 61.0% and 74.2%, respectively. Among these, 66.9% of those with hearing loss and 36.2% of those with tinnitus reported seeking hearing care. Most important motivators of seeking hearing care (average on 1-5 Likert scale) included personal importance of hearing (4.0; SD = 1.1), difficulty hearing others (3.6; SD = 1.1), and degree of hearing loss (3.3; SD = 1.1). Most common barriers included uncertainty regarding who to reach out to for hearing care (42.9%), inability to get time off work (34.3%), and nervousness about seeing a provider (28.6%). Common reasons to decline hearing aids reporting that hearing was not bad enough for hearing aids (72.2%) and included inability to afford hearing aid (55.6%).

Conclusion: In this cohort, many US veterans sought care for hearing loss, though barriers still exist, including uncertainty regarding how to access appropriate care, being too far from a provider, and challenges with cost. Future studies should investigate methods to alleviate these internal and external barriers to hearing care and emphasize the importance of motivators for seeking care.

Objective: To analyze the accuracy of ChatGPT-generated responses to common rhinologic patient questions.

Methods: Ten common questions from rhinology patients were compiled by a panel of 4 rhinology fellowship-trained surgeons based on clinical patient experience. This panel (Panel 1) developed consensus "expert" responses to each question. Questions were individually posed to ChatGPT (version 3.5) and its responses recorded. ChatGPT-generated responses were individually graded by Panel 1 on a scale of 0 (incorrect) to 3 (correct and exceeding the quality of expert responses). A 2nd panel was given the consensus and ChatGPT responses to each question and asked to guess which response corresponded to which source. They then graded ChatGPT responses using the same criteria as Panel 1. Question-specific and overall mean grades for ChatGPT responses, as well as interclass correlation coefficient (ICC) as a measure of interrater reliability, were calculated.

Results: The overall mean grade for ChatGPT responses was 1.65/3. For 2 out of 10 questions, ChatGPT responses were equal to or better than expert responses. However, for 8 out of 10 questions, ChatGPT provided responses that were incorrect, false, or incomplete based on mean rater grades. Overall ICC was 0.526, indicating moderate reliability among raters of ChatGPT responses. Reviewers were able to discern ChatGPT from human responses with 97.5% accuracy.

Conclusion: This preliminary study demonstrates overall near-complete and variably accurate responses provided by ChatGPT to common rhinologic questions, demonstrating important limitations in nuanced subspecialty fields.

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.