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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.

Objective: Unilateral hypoglossal nerve stimulation (HGNS) to treat obstructive sleep apnea involves implantation of a pulse generator, a respiratory sensing lead, and a stimulation lead. Complications may arise related to all components. Previous studies have presented the overall incidence of reported adverse events. The objective of this study was to provide an updated report of complications from the Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database, with a focus on the respiratory sensing lead, and propose a care algorithm with two cases of sensing lead migration.

Study design: Retrospective cross-sectional study, case report.

Setting: Tertiary care center.

Methods: The MAUDE database was queried for events related to the HGNS respiratory sensing lead from January 1, 2000, to December 1, 2022. Primary outcomes were respiratory lead migration resulting in pneumothorax or need for revision surgery/explantation.

Results: In total, 151 out of 765 HGNS adverse events were related to the respiratory sensing lead, and of those, 75 were related to lead migration. There were seven events related to migration of the sensing lead into the pleural space, of which six cases underwent revision surgery (<1% of adverse events reported related to HGNS). Two cases noted pneumothorax due to sensing lead migration. We report two cases of sensing lead migration at our institution. Migration was demonstrated with serial imaging. These cases highlight the potential need for preoperative or intraoperative chest tube placement, based on the extent of migration, complications, and complexity.

Conclusion: Migration of the respiratory sensing lead is a rare event with multidisciplinary surgical planning considerations.

Objective: To investigate the prevalence of depression and anxiety in patients with vestibular disorders using a large patient database.

Study design: Retrospective cohort.

Setting: The TriNetX database.

Methods: TriNetX, a deidentified database, was retrospectively queried to identify adults with vestibular disorders. The rates of anxiety and depression in patients with vestibular disorders were compared to patients without vestibular disorders within 5 years of the index event, which was set at the time of diagnosis of vestibular dysfunction.

Results: On analysis of patients with and without vestibular disorders, after propensity score matching for demographics and common comorbidities, 64,153 patients were identified in each cohort. Patients with vestibular disorders were more likely to have depression (relative risk [RR] 1.37 [95% CI 1.35-1.40]) and anxiety (RR 1.51 [95% CI 1.45-1.57]) compared to the general population. Similarly, a higher rate of antidepressant use was seen in patients with vestibular disorders (RR 1.41 [95% CI 1.39-1.43]).

Conclusion: Patients with vestibular disorders have higher rates of depression and anxiety compared to the general population.

Objective: This study investigates the roles of allergy, serum IgE, serum eosinophils, and tissue eosinophils in chronic rhinosinusitis (CRS) patients undergoing functional endoscopic sinus surgery (FESS). The study aims to evaluate these biomarkers in predicting disease severity and postoperative outcomes.

Study design: A retrospective cohort study.

Setting: A single academic institution.

Methods: This retrospective study enrolled patients from 2017 to 2023. Preoperative evaluations included blood tests, sinus computed tomography, nasal endoscopy, questionnaires, olfactory tests, acoustic rhinometry, saccharine transit test, and nasal bacterial culture. The number of eosinophils was counted in the surgical specimens. Postoperative evaluations were performed 3 months after surgery. The severity and outcomes of CRS were compared between allergy-positive and -negative groups, IgE-positive and -negative groups, serum eosinophil-positive and -negative groups, and eosinophilic and noneosinophilic CRS groups.

Results: Ninety-six CRS patients who underwent bilateral primary FESS were enrolled. Allergy and serum IgE showed limited predictive value for CRS outcomes. In contrast, serum eosinophils and tissue eosinophils were significantly associated with worse preoperative CRS severity, especially in olfactory dysfunction. Both biomarkers demonstrated greater postoperative improvements, with serum eosinophils showing predictive potential for ECRS (sensitivity 73.5%, specificity 78.7%).

Conclusion: Our results show that allergy testing and serum IgE levels were not reliable tools for CRS severity or outcomes, while elevated serum and tissue eosinophils were associated with worse preoperative CRS severity, particularly in olfactory dysfunction. FESS provided effective improvements in olfactory outcomes in eosinophilic CRS patients. Serum eosinophils could serve as a reliable noninvasive biomarker for predicting disease severity and surgical outcomes in ECRS patients.

Level of evidence: 3.

Objective: To describe and assess the usefulness of delayed postcontrast three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences on 3-Tesla (3 T) magnetic resonance imaging (MRI) in patients presenting with acute inner ear complications after stapes surgery.

Study design: Case series.

Setting: French tertiary referral center.

Methods: The clinical records and imaging of patients who underwent delayed postcontrast 3D-FLAIR MRI sequences for labyrinthine complications after stapes surgery, performed between January 2019 and April 2023, were retrospectively reviewed.

Results: A total of 712 patients underwent stapes surgery between January 2019 and December 2023. Eight patients (1.12%) were included in the study, with a median age of 52 years (interquartile range 40-54). After the surgery, seven patients presented with vertigo and sensorineural hearing loss (SNHL), and one patient presented with only vertigo with complete areflexia on caloric testing. Computed tomography (CT) of the temporal bone showed a slightly excessive penetration of the prosthesis (>1 mm) into the vestibule in one patient and a periprosthetic granuloma in another patient. CT was normal for six patients. Delayed postcontrast 3D-FLAIR MRI sequences showed blood-labyrinth barrier (BLB) impairment in the cochlea, the vestibule, and the semicircular canals in seven patients. No endolymphatic hydrops were found, but one patient presented with utricular collapse, and the saccule was not visible in three other patients.

Conclusion: Delayed postcontrast MRI sequences may reveal BLB impairment and help analyzing the endolymphatic compartment in cases of SNHL or vestibular disorders after stapes surgery. Those sequences could help uncovering the causes of such events.