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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.

Objective: Mohs micrographic surgery (MMS) and subsequent reconstructive procedures for the treatment of facial nonmelanoma skin cancers (NMSCs) significantly impact quality of life (QoL). A validated patient-reported outcome measure (PROM) for patients who undergo Mohs reconstruction is not yet established. This study aims to systematically assess the quality of existing PROMs to determine their effectiveness in capturing the challenges faced after Mohs reconstruction for facial NMSC.

Data sources: A systematic review following established Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. Medline, PubMed, Scopus, and Cochrane databases were searched using keywords relevant to MMS, NMSC, facial reconstruction, QoL, and PROMs.

Review methods: Inclusion and exclusion criteria were used to compile eligible PROMs. Methodological quality and psychometric properties of PROMs were evaluated using COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.

Results: Of 2997 articles, 78 met the inclusion criteria. Of these, 45 studies utilized a PROM as an outcome measure, and 33 reported PROM development or validation. COSMIN assessment demonstrated that the FACE-Q Skin Cancer Module and Facial Skin Cancer Index have the strongest validation. The Mohs Reconstruction Questionnaire-12 (MRQ-12) was the only PROM specific to this population of interest; however, it has not undergone psychometric property assessment.

Conclusion: Various PROMs have been utilized to assess QoL for patients undergoing facial reconstructive surgery after MMS. A clinically validated PROM specific to this patient population is required to gain deeper insight into these emotional impacts. Further validation and psychometric testing of the MRQ-12 may be beneficial.

Objective: Nasal surgery can improve patient-reported obstructive sleep apnea (OSA) outcomes as well as adherence with medical device treatments. The aim of this study was to examine whether previous nasal surgery was associated with hypoglossal nerve stimulation (HNS) therapy outcomes.

Study design: Retrospective observational cohort study was performed utilizing the multicenter international HNS registry (ADHERE).

Methods: Propensity score matching generated a cohort of HNS patients with prior nasal surgery (NS) and a comparable cohort without prior nasal surgery (WNS). Data included demographics and therapy outcome measures including apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), therapy use, and responder rate. Student's t-test was used to compare normally-distributed numeric data, Fisher's exact test to compare categorical data, and 1-sided t-tests to determine noninferiority.

Results: From the ADHERE dataset, 169 HNS patients were identified and matched from each cohort. AHI reduction was 21.01 ± 17.94 in the WNS cohort and 18.39 ± 16.4 in the NS cohort (P = .162). ESS reduction in the WNS cohort was 4.85 ± 4.98 and 4.48 ± 5.83 in the NS cohort (P = .528). Therapy use was similar, 5.67 ± 1.95 in WNS and 5.97 ± 2.06 in NS (P = .181). Responder rate was also similar in WNS (64.5%) and NS (62.1%) groups (P = .735).

Conclusion: Prior nasal surgery was not a predictor of HNS therapy response or adherence. Future prospective studies of HNS candidates with nasal airway obstruction may better determine the role of adjunctive nasal surgery in this population.

Objective: To characterize neighborhood-level area deprivation's association with oropharyngeal carcinoma clinicodemographics, tumor staging, recurrence, and overall survival.

Study design: Retrospective study.

Setting: Single institution academic medical center.

Methods: Patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) between 2007 and 2022 at our institution were included in this study. The Area Deprivation Index (ADI) was used to quantify neighborhood-level disadvantage based on patients' primary residence at the time of their diagnosis. Continuous variables were compared between groups using the Wilcoxon rank sum test. For categorical variables, proportions were compared using Fisher's exact test. Overall survival (OS) and recurrence-free survival (RFS) distributions were estimated using the Kaplan-Meier method and log-rank test. OS and RFS were further assessed by univariable and multivariable analyses performed using the Cox proportional hazards model.

Results: The higher ADI (more disadvantaged) group consisted of a significantly greater proportion of Black race (P < .001), 10+ pack-year smoking history (P = .003), and Medicare patients (P = .018). On logistic regression analysis, neither ADI nor other social factors were significantly associated with increased likelihood of advanced clinical staging in the p16 positive OPSCC population. Furthermore, while ADI did not correspond with significant differences in survival, multivariate cox regression model demonstrated that "Other" insurance type (Medicaid and uninsured) (hazard ratio [HR] = 10.1, P = .008), age at diagnosis (1.10, P < .001), and advanced clinical staging (HR = 3.25, P = .004) were all significantly associated with increased HR of death.

Conclusion: While ADI may not be significantly associated with outcomes in HPV-related OPSCC patients, this study revealed significant sociodemographic and risk factor differences across ADIs, as well as individual factors influencing prognosis. These findings emphasize the need for a comprehensive approach to understanding factors influencing HPV-related OPSCC incidence and prognosis.

Objective: Assessing the quality of human papillomavirus (HPV) vaccination-related content on TikTok is crucial due to its popularity among adolescents. We assessed these videos while comparing the content and quality of videos with and without physician involvement.

Study design: Cross-sectional cohort analysis.

Setting: HPV vaccination-related TikTok videos.

Methods: The TikTok library was queried using the search terms #HPVvaccine, #HPVvaccination, #Gardasil, #Gardasilvaccine, and #Gardasilvaccination. Video quality was evaluated using the DISCERN scale, assessing treatment-related information quality. Descriptive statistics were used to characterize our cohort. t Test and Fischer's exact test were used to assess for differences in video content and quality based on physician involvement. Significance was set at P < .05.

Results: Our search yielded 131 videos, averaging 68,503.12 views, 2314.27 likes, and 89.28 comments per video. Videos frequently involved physicians (48.09%), focused on education (54.96%) or advocacy (22.90%), and were US-made (68.90%). Otolaryngologists were rarely featured (3.17%). While most videos mentioned the HPV vaccine protected against cancer generally (86.26%), and cervical cancer specifically (67.94%), few discussed its protective effect against head and neck cancer (26.72%). Videos infrequently discussed updated eligibility among all adults ≤45 years of age (26.72%) or that men can also receive the vaccine (28.24%). Physician-involved videos were more focused on education (P < .001) and focused less on patient experiences (P < .001) and advocacy (P = .036). Overall DISCERN scores were low among physician (mean = 2.46, SD = 1.13) and nonphysician (mean = 2.09, SD = 1.02) content.

Conclusion: TikTok HPV vaccination content is poor in quality, even with physician involvement. Enhancing content quality and increasing otolaryngologist participation can boost HPV awareness and vaccination rates.

We present O-T advancement reconstruction (OTAR) in lateral tongue defects, describing technique, indications, outcomes, and limitations. 11 patients with lateral tongue defects who underwent OTAR after earlystage cancer removal. Demographics, staging, functional oral intake scale (FOIS), dysphagia outcome severity scale (DOSS), defect size, and complications were included. Functional outcomes assessed through telephone encounters. Preoperative FOIS and DOSS were 6.9 and 6.8, postoperatively were 4.8 and 5. Mean defect of 4.7 cm × 3.4 cm. Nine patients required nasogastric tubes postoperatively. Site complications included 2 minor dehiscence. By telephone, tongue-biting was reported in 3, mild dysarthria in 3, and food impaction in 2. FOIS and DOSS were 6.7 and 6.5. Reconstruction of tongue defects may be achieved with OTAR as a reliable alternative to primary closure or even more complex microvascular techniques. Utilization may preserve functional swallowing and speech outcomes, most probably due to lateral sulcus sparing features.

Objective: This study investigates ChatGPT's accuracy, readability, understandability, and actionability in responding to patient queries on sudden sensorineural hearing loss (SSNHL) in English and Spanish, when compared to Google responses. The objective is to address concerns regarding its proficiency in addressing medical inquiries when presented in a language divergent from its primary programming.

Study design: Observational.

Setting: Virtual environment.

Methods: Using ChatGPT 3.5 and Google, questions from the AAO-HNSF guidelines were presented in English and Spanish. Responses were graded by 2 otolaryngologists proficient in both languages using a 4-point Likert scale and the PEMAT-P tool. To ensure uniform application of the Likert scale, a third independent evaluator reviewed the consistency in grading. Readability was evaluated using 3 different tools specific to each language. IBM SPSS Version 29 was used for statistical analysis using one-way analysis of variance.

Results: Across both languages, the responses displayed a native-level language proficiency. Accuracy was comparable between sources and languages. Google's Spanish responses had better readability (effect size 0.35, P < .001), while Google's English responses were more understandable (effect size 0.67, P = .018). ChatGPT's English responses demonstrated the highest level of actionability (60%), though not significantly different when compared to other sources (effect size 0.47, P = .14).

Conclusion: ChatGPT offers patients comprehensive and guideline-conforming answers to SSNHL patient medical queries in the 2 most spoken languages in the United States. However, improvements in its readability and understandability are warranted for more accessible patient education.