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Objective: Analyze the relationship between surgical and non-surgical interventions for otitic barotrauma (OB), and identify underlying medical diagnosis, recurrence rates, and treatment outcomes.

Study design: Retrospective cohort analysis.

Setting: TriNetX US collaborative network.

Methods: The network was queried for patients diagnosed with OB within the past 20 years and a surgical intervention within 1 month. Patients receiving surgical intervention were assigned to the surgical cohort while those that did not receive operative care were assigned to the non-surgical cohort. Cohorts were 1:1 propensity score matched for age and gender.

Results: Patients that undergo operative treatment have significantly increased association with previous diagnoses of middle ear pathology, as well as most forms of sinonasal disease (P < .05). Surgical treatment was significantly associated with recurrence of OB, tympanic membrane (TM) perforation, otitis media, as well as mixed hearing loss (P < .05).

Conclusion: Our study indicates an association between previous sinonasal and otologic pathology and higher likelihood of undergoing operative treatment for OB. Our findings also indicate that operative treatment is significantly associated with recurrence of the condition. Increasing air travel and participation in recreational activities tied to OB underscore the need to better understand treatment options.

Objective: Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) offers a scarless alternative to conventional thyroidectomy. Most studies incorporate intraoperative neuromonitoring (IONM), which may be unavailable in resource-limited settings. We evaluated the learning curve, feasibility, and safety of TOETVA without IONM.

Study design: Retrospective.

Setting: A retrospective analysis of 103 patients undergoing hemithyroidectomy by TOETVA between February 2020 and January 2025 was conducted at a tertiary care center in central India.

Method: Learning curve assessment was performed using Cumulative Sum (CUSUM) analysis, and outcomes were compared between phase 1 (cases 1-50) and phase 2 (Cases 51-103). Statistical analyses included independent t tests for continuous variables and chi-square tests for categorical variables (P < .05).

Results: Mean operative time significantly decreased from 185 ± 24 minutes in phase 1 to 105 ± 12.95 minutes in phase 2 (P < .001), with proficiency achieved after 50 cases. Nodule size was larger in phase 2 (4.5 ± 2.3 cm vs 3.0 ± 1.0 cm, P = .003). The conversion rate was 4.9%, with no permanent recurrent laryngeal nerve palsy. Hoarseness of voice and seroma rates remained unchanged (P = 1.00), whereas hospital stay significantly decreased (P < .001).

Conclusion: TOETVA without IONM is feasible and safe, demonstrating a well-defined learning curve with low complication rates. These findings support its adoption in low-resource settings.

Objective: Carcinoma ex pleomorphic adenoma (CXPA) is a rare malignancy and survival rates vary throughout literature. The primary objectives are to study overall survival (OS), disease-specific survival (DSS), locoregional recurrence-free survival (LRFS), and secondarily margin status.

Study design: Multi-institutional retrospective cohort study.

Setting: Queen Elizabeth II Health Sciences Center (QEII HSC) from 2006 to 2023 and the University of Michigan (UM) from 2017 to 2023.

Methods: An institutional pathology database (QEII HSC) and parotidectomy database (UM) were used to identify 37 patients with CXPA who underwent surgical resection.

Results: Most cases were locoregionally advanced with 51% being ≥T3 and 32% being cervical node positive. All cases were treated with surgery, 78% received adjuvant radiation. Overall, 2-year survival was 82% and 5-year survival was 61.7%. In univariate analysis, tumor size >4 cm, pathologic nodal stage ≥1, pathologic overall stage 4 disease, lymphovascular invasion, extranodal extension, and positive margins were associated with increased risk of death. In adjusted multivariable analysis, only pathologic nodal stage ≥1 (hazard ratio [HR] 9.474, confidence interval [CI] 1.19-75.41, P = .034) remained statistically significant. The 2-year LRFS was 80% and the 5-year LRFS was 75%. Of the 7 patients with locoregional recurrence, 6 had prior adjuvant radiation, and 4 recurred locally. Multivariable cox models for LRFS were not significant.

Conclusion: Patients with CXPA that metastasize to the neck have a worse prognosis. LRFS after surgery is 75% with high rates of adjuvant radiation. Further research on prognostic factors of LRFS and adjuvant radiation outcomes is required.

N,N-Diethyl-meta-toluamide (DEET) and permethrin are pesticides commonly used in combination due to their synergistic insecticidal and repellent properties. This study investigates whether simultaneous exposure to these compounds elicits synergistic cytotoxicity in sinonasal epithelial cells (SNECs). Ethmoid sinus mucosal specimens were procured from eight patients during endoscopic sinus surgery. SNECs were expanded on culture plates and exposed to various concentrations of DEET and permethrin (0-5 mM), individually and concurrently, for up to 156 hours. Experiments were replicated in triplets, and cell viability was recorded every 2 hours using Incucyte real-time cell imaging system. Synergy score was calculated on the basis of the Loewe additivity synergy model. DEET and permethrin exhibited synergistic cytotoxicity across all eight tissues, albeit with variations in onset and magnitude. In conclusion, the concurrent exposure of DEET and permethrin can lead to synergistic cytotoxicity in sinonasal epithelia.

Objective: The effectiveness of various palatopharyngeal surgeries is currently poorly understood. This study compares various palatopharyngeal surgery techniques without tonsillectomy for reducing the apnea-hypopnea index (AHI).

Data sources: Embase, MEDLINE, Web of Science, ClinicalTrials, CINAHL, the Cochrane Library, and International Clinical Trials Registry Platform.

Review methods: We included studies of palatopharyngeal surgery in adults reporting AHI outcomes, excluding those with tonsillectomy or combined surgeries. A random-effects model was used to pool effect sizes. Surgical techniques were categorized into cold steel, muscle relocation, suture, radiofrequency, laser, powered instruments, and implants. The primary outcome was the reduction in AHI. Secondary outcomes were the AHI responder rate, AHI reduction over the follow-up duration, and the outcomes by publication year.

Results: From 3793 screened records, 45 studies with 1501 patients were included. Overall, palatopharyngeal surgery reduced AHI by 5.2/h (95% CI, 2.7-7.7; P < .0001). Powered instruments showed the greatest AHI reduction (26.3/h; 95% CI, 18.9-33.7), followed by muscle relocation (20.2/h; 95% CI, 3.7-36.7) and suture techniques (15.3/h; 95% CI, 9.6-21.0). Palatal implants (2.6/h; 95% CI, 0.4-4.7) and laser techniques (4.5/h; 95% CI, 1.3-7.8) showed modest effects, whereas radiofrequency (0.4/h; 95% CI, -2.0 to 2.8) and cold steel (6.6/h; 95% CI, -0.2 to 13.5) had no significant impact. The overall responder rate was 51% (95% CI, 41-60), with powered instruments, relocation, and suture techniques demonstrating the highest rates.

Conclusion: Palatopharyngeal surgery techniques significantly differ in reducing AHI. Powered instruments, muscle relocation, and suture techniques are most effective.

Trial registration: PROSPERO identifier: CRD42024559063.

This report introduces an endoscopic knot-tying technique for a wide range of procedures, such as nasal mucosa suturing and dura mater reconstruction, without the need for specialized instruments. The technique utilizes basic tools like a needle holder, sutures, and bayonet-shaped nasal forceps. The surgeon ties a surgeon's knot, guided by an endoscope, and pulls the suture with forceps to ensure proper tension. The method is effective in various surgeries, from septoplasty to skull base procedures, and has shown no adverse events in 137 patients. Its advantages include simplicity, no need for specialized tools, and ease of use in different facilities. The technique has the potential to advance endoscopic surgery, providing an efficient solution for diverse surgical applications.

Objective: Stearoyl-coenzyme A desaturase 1 (SCD1) is a key enzyme in fatty acid metabolism and has been implicated in cancer progression, including head and neck squamous cell carcinoma (HNSCC). The phosphoinositide 3-kinase (PI3K)-AKT-mammalian target of rapamycin (mTOR) signaling pathway is a critical regulator of cellular metabolism and survival in cancer. This study investigates the crosstalk between SCD1 inhibition and the PI3K-AKT-mTOR pathway, highlighting the therapeutic potential of targeting SCD1 in HNSCC.

Study design: Basic science.

Setting: Laboratory.

Methods: Four HNSCC cell lines were utilized to evaluate the relationship between SCD1 and the mTOR signaling pathway. Cell viability was assessed following treatment with various mTOR inhibitors. The effect of AKT-mTOR signaling on SCD1 expression was examined through pharmacological inhibition and gene silencing approaches. Additionally, the impact of SCD1 knockdown on cell proliferation and survival was analyzed.

Results: mTOR inhibitors significantly reduced HNSCC cell viability and downregulated SCD1 expression in a dose-dependent manner. Inhibition of AKT, a key upstream effector of mTOR, also suppressed SCD1 expression, suggesting that SCD1 is regulated through the PI3K-AKT-mTOR axis. Silencing SCD1 independently impaired cancer cell growth and enhanced the cytotoxic effects of mTOR inhibitors, indicating a synergistic anticancer effect.

Conclusion: SCD1 is a downstream target of the PI3K-AKT-mTOR pathway and contributes to HNSCC cell survival. Dual targeting of SCD1 and the mTOR signaling pathway represents a promising therapeutic strategy for HNSCC treatment. Further investigation is warranted to explore the clinical potential of SCD1 inhibitors in combination with mTOR-targeted therapies.

Objective: Stated preference research methods, including discrete choice experiments (DCEs), conjoint analysis (CA), best-worst scaling (BWS), and willingness-to-pay/contingent valuation (WTP/CV) studies, are excellent tools for understanding patient preferences in healthcare. Their application in otolaryngology has yet to be described. This work encompasses a scoping review assessing the field of stated preference research in otolaryngology, to identify gaps in the current literature and identify areas of future applications of such methodologies.

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

Review methods: A search of three databases for all relevant publications through 2023 was performed using relevant search terms. Eligibility criteria for included studies included the use of one of four methodologies (DCE, CA, BWS, and WTA/CV). After screening and full-text review by two authors, data were extracted, including relevant methodologic parameters including type of study, survey development characteristics, sample size, and outcome. Data were analyzed using descriptive statistics.

Results: Of 3064 search results, 57 were included for full data extraction from inception to 2023, across 14 countries, with an increasing number of studies in recent years. WTP/CV was the most common method (58%), followed by DCE (30%), CA (23%), and BWS studies (5%). Otology was the most frequently studied subspeciality (36.8%). Treatment options were more commonly studied than diagnostics or health state preferences. Many studies did not specify survey development methods (38.6%).

Conclusion: Stated preference research in otolaryngology is relatively sparse, and there is significant methodological inconsistency in the development and implementation of these methods. This review provides research priorities for stated preference research in otolaryngology in an era of patient-centered care.

Level of evidence: Level 4.