ImportancePerioperative efficiency is an increasingly important consideration in head and neck surgery, yet comparative evaluations of surgical techniques for benign parotid tumors remain limited.ObjectiveTo evaluate the perioperative efficiency of extracapsular dissection (ECD) compared to superficial parotidectomy (SP) for benign parotid tumors.DesignSystematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingStudies retrieved from PubMed, Embase, and the Cochrane Library.ParticipantsPatients with benign parotid tumors who underwent either ECD or SP. Fifteen studies encompassing 2399 patients were included.InterventionsECD and SP as primary surgical techniques for the removal of benign parotid tumors.Main Outcome MeasuresParameters related to perioperative efficiency were defined in this study as operative time, anesthesia time, duration of drain placement, length of hospital stay (LOS), and medical costs. Tumor size was also included as a comparative parameter.ResultsECD was associated with significantly shorter operative time [mean difference (MD), -48.95 minutes; 95% confidence interval (CI), -66.40 to -31.50], anesthesia time (MD, -73.17 minutes; 95% CI, -81.61 to -64.73), drain placement duration (MD, -2.10 days; 95% CI, -3.82 to -0.38), and LOS (MD, -0.91 days; 95% CI, -1.34 to -0.48) compared to SP. Tumor size did not significantly differ between groups (MD, -0.14 cm; 95% CI, -0.33 to 0.05).ConclusionsECD demonstrates superior perioperative efficiency compared to SP.RelevanceThese findings support the use of ECD as a more efficient surgical option for benign parotid tumors in appropriately selected patients.

ImportanceSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious virus that has been reported to be transmitted via aerosolization and other aerosol-generating activities. However, viral plumes from CO lasers have yet to be investigated.ObjectiveEvaluate the viability of SARS-CoV-2 in the CO laser plume in a porcine model for laryngeal surgery.DesignExperimental studies.SettingLaboratory.ParticipantsWild-type SARS-CoV-2 (), Omicron SARS-CoV-2 (Omicron), and fluorescent SARS-CoV-2 (GFP).InterventionThree viral strains on porcine larynx exposed to CO laser setting-1.5, 7, and 15 W.Main Outcome MeasuresThe laser plume was collected during ablation. Dilutant of the plume was then applied to Vero E6 cells for culture; quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) (in duplicate) and fluoroscopy were used to establish the presence of viable virus.Results, Omicron, and GFP strains were found to be present on the larynx before and after the application of the laser by qPCR copies (cp) per microliter (µl). After ablation with 1.5, 7.0, and 15 W with , the plume samples were shown to be 0, 0, and <10 cp/µl, respectively. For GFP, at all intensity levels, the copies were less than 10 cp/µl. Omicron did not show any copies at any of the power levels. Cultures did not show the presence of viable , Omicron, and GFP strains in any of the collected laser plumes.ConclusionThe CO laser plume of SARS-CoV-2 aerosolized minimal viral particles. None of the tested experimental conditions demonstrated a viable virus after laryngeal ablation with the CO laser.RelevanceCO laser use in the context of virus SARS-CoV-2 suggests minimal transmission risks associated with CO laser procedures when appropriate safety protocols are followed.

ImportanceEffective anesthesia with minimal side effects is essential for pediatric patients undergoing adenoidectomy.MethodsA single-center, prospective, randomized controlled trial was conducted at Gaoming District People's Hospital (China, January 2022-October 2023). Two-hundred fifty-six children (ASA I-II, age 3-12 years) scheduled for elective plasma radiofrequency adenoidectomy were randomized to 4 groups (n = 64 each). Group A received 0.9% normal saline; groups B, C, and D received continuous infusions of benzenesulfonate remimazolam at 0.4, 0.6, and 0.8 mg/kg/h, respectively, combined with 6% sevoflurane for induction and 2% to 3% for maintenance. Primary outcomes were emergence time and postanesthesia care unit (PACU) stay. Secondary outcomes included incidence of adverse events, peak Pediatric Anesthesia Emergence Delirium (PAED) scores, and parental satisfaction.ResultsMedian awakening time was longer in groups B, C, and D than in group A ( < .001). PACU stay was shorter in groups C and D versus group A ( < .05). Postoperative pain scores (Face, Legs, Activity, Cry, and Consolability) were lower in groups C and D than in groups A and B ( < .05). Peak PAED scores were lower in groups B, C, and D than in group A ( < .05); negative behavioral changes on postoperative day 3 were also reduced ( < .05). Parental satisfaction was higher in groups B, C, and D than in group A ( < .001). No serious adverse events occurred.Conclusion and RelevanceBenzenesulfonate remimazolam (0.6 mg/kg/h) combined with sevoflurane provides effective, safe anesthesia for pediatric plasma radiofrequency adenoidectomy, balancing induction efficacy, sedation depth, and safety. This regimen reduces emergence delirium, postoperative pain, and negative behavioral changes while enhancing parental satisfaction, supporting its use in pediatric adenoidectomy and warranting further investigation in other pediatric procedures.

ImportanceThere are many methods for pediatric voice assessment, but each has its own limitations. Currently, there are few studies that have compared the outcomes of subjective and objective evaluation methods in children with voice disorders.ObjectiveTo apply and compare the pediatric Voice Handicap Index (pVHI) with acoustic analysis in pediatric benign voice disorders.DesignCase-control study.SettingThis study was conducted at a single institution.ParticipantsPediatric participants with and without benign voice disorders were included from August 2021 to April 2023.Intervention or ExposuresThe questionnaire results for the pVHI were obtained, and acoustic analysis was conducted.Main Outcome MeasuresThe main outcomes included the pVHI scores, acoustic parameters, and the Pearson Correlation Coefficient.ResultsOut of the 338 participants, 160 children were diagnosed with voice disorders, whereas 178 did not exhibit such conditions. The total scores and those of each subscale were significantly higher in the patient group than in the control group ( < .05). Significant differences were also observed in the fundamental frequency (228.13 ± 66.78 vs 253.65 ± 47.21), jitter (2.08 ± 2.59 vs 2.42 ± 1.75), shimmer (8.52 ± 5.78 vs 9.44 ± 3.69), harmonic to noise ratio (HNR) (0.50 ± 0.68 vs 0.65 ± 0.19), s/z ratio (1.46 ± 1.89 vs 0.99 ± 0.44), and maximum phonation time (6.08 ± 3.38 vs 7.82 ± 2.50) ( < .05). When comparing the types of diseases, the physical dimension of the pVHI (17.43 ± 7.02 vs 15.29 ± 6.92 vs 13.32±7.71) and the HNR (0.39 ± 0.16 vs 0.41 ± 0.21 vs 0.75 ± 1.24) were most negatively affected in the vocal fold polyps group. Moderate to strong correlations were shown among the pVHI total and each subscale scores ( < .05), while the highest r score was shown between the physical and the total scores of the pVHI (r = 0.882).Conclusions and RelevancePediatric patients with voice disorders exhibit more severe voice handicaps in both pVHI scores and acoustic parameters. The total score of the pVHI is moderately to strongly correlated with each subscale, whereas no strong correlation was presented between different acoustic parameters or between acoustic parameters and pVHI scores. This indicates that the two evaluation methods are not interchangeable; thus, a comprehensive evaluation is essential in clinical practice to prevent bias.

ObjectiveThere is a lack of consensus regarding postoperative care for pediatric patients with obstructive sleep apnea (OSA) following adenotonsillectomy. At our institution, all patients with severe OSA are routinely admitted to the pediatric intensive care unit (PICU), raising concerns about the optimal use of health care resources. The objective of this study was to identify the risk factors necessitating PICU admission for pediatric patients who underwent adenotonsillectomy for OSA.MethodsAn 8 year retrospective cohort study was conducted at a tertiary care pediatric hospital among consecutive patients with confirmed OSA undergoing adenotonsillectomy. All patients for whom a preoperative PICU request was made were included. A patient requiring PICU-level care was defined as needing respiratory support, such as intubation, positive pressure ventilation, or high-flow nasal cannula.ResultsA total of 112 medical charts were included in the analysis. Only 13 patients (11.6%) had respiratory complications requiring PICU-level care. No preoperative or intraoperative variables were predictive of need for PICU. Early-postoperative need for supplemental oxygenation ( = .002, OR = 6.7) and respiratory retraction ( < .000, OR = 27.4) were significant predictors of PICU-level airway escalation. Nearly all patients (11/13) requiring escalated airway measures were identified in the first 4 hours postoperatively.ConclusionA small subset of subjects with OSA required PICU-level care after adenotonsillectomy. Our data suggest that pediatric patients with OSA undergoing adenotonsillectomy may be safely monitored outside of an ICU setting for an extended period before determining eventual care setting.

ImportanceChatGPT has emerged as a medical resource through advanced language processing. Patients with thyroid nodules classified under The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) may use it to complement discussions with physicians.ObjectiveWe aimed to determine whether ChatGPT's recommendations on managing thyroid nodules classified by TBSRTC align with those of experienced thyroid specialists.Setting/ParticipantsA multidisciplinary panel of 5 thyroid cancer specialists, including otolaryngologists and endocrinologists, from 3 university-affiliated teaching hospitals in Montreal, Canada, evaluated the responses.Intervention/ExposureChatGPT-3.5 was prompted with 4 questions for each of the 6 Bethesda categories regarding the meaning and management of thyroid nodules, generating 24 responses for evaluation.Main Outcome/MeasuresWe assessed ChatGPT's accuracy against the latest American Thyroid Association (ATA) guidelines using a 4-point Likert scale (<50%, 50-74%, 75-89%, >90%). Additionally, specialists rated their comfort or reluctance in recommending ChatGPT as a complementary tool for patient discussions.ResultsOf the 24 ChatGPT-generated responses, 19 (79.2%) demonstrated moderate to good consistency with the ATA guidelines. The mean consistency score was 3.38/4 and median was 3.5. Consensus (IQR ≤ 1) was achieved in 23 out of 24 responses (95.8%), reflecting strong inter-rater reliability. Consistency scores were highest in Bethesda I-III and declined progressively in higher-risk categories, with the lowest mean score observed in Bethesda VI. Similarly, an upward trend in clinician reluctance was observed from Bethesda I through VI, indicating greater caution in recommending ChatGPT responses for patients suspicious for or diagnosed with malignancy (Bethesda V-VI).Conclusion and RelevanceWhile ChatGPT's responses generally align with specialist recommendations, they are not fully reliable. ChatGPT lacks the ability to serve as an independent or accurate source of medical advice for thyroid nodule management. It remains a useful complement for patient discussions, especially in low-risk scenarios, but further improvements are necessary to make it a safe, reliable component of patient care in complex cases.

ImportanceOnabotulinumtoxin A (BTX) is the first-line treatment for laryngeal dystonia (LD). The US FDA designated BTX as a pregnancy category C drug because there are no well-controlled studies in pregnant women.ObjectivesTo describe pregnancy and neonatal outcomes in pregnant LD patients treated with BTX injections and to assess the current practice and comfort level of Canadian laryngologists in treating these patients.DesignCase Series and Survey.SettingAcademic, tertiary care, laryngology center.ParticipantsPregnant women who received BTX for LD from 2010 to 2020.InterventionA retrospective chart review was conducted for eligible patients. An anonymous, online, cross-sectional survey was distributed to Canadian laryngologists, according to Dillman's Total Design method.Main outcome measuresPregnancy and neonatal outcomes.ResultsFour adductor LD patients received BTX during each of their 2 pregnancies; 8 pregnancies were examined. Patients received a median of 4.5 treatments (IQR 3) with a median cumulative dose of 5.12 U (IQR 2.93 U) over the whole pregnancy. One pregnancy was pre-term and the median APGAR score was 9 (IQR 0.5). All mothers breastfed their infants. There were no adverse events (AE) and all children were healthy, with a median age of 7 (IQR 2). Twenty-three Canadian laryngologists responded to the survey, for an 85.2% response rate. Three laryngologists (13.0%) have previously injected BTX in a total of 5 pregnant women. All 5 pregnancies went to term with no AE. The majority (68.4%) of respondents indicated that they would offer BTX injections to pregnant LD patients after obtaining informed consent.ConclusionThis case series was the largest in the literature of pregnant LD patients undergoing BTX treatment. The majority of Canadian laryngologists would offer the procedure to pregnant women with informed consent.RelevanceThis study added to the growing literature on the safety of BTX injections in LD patients during pregnancy.

ImportanceIntraoperative narrow-band imaging (NBI) has been used to improve superficial (mucosal) resection margin clearance in oral squamous cell carcinoma (OSCC). However, no study has been conducted in a randomized controlled trial comparing OSCC resection using NBI and standard white light (WL).ObjectiveTo compare the rate of pathological margin clearance between NBI-guided and WL-guided resection in OSCC patients.DesignParallel-design, single-center, randomized controlled trial.SettingTertiary care center, Department of Otolaryngology.ParticipantsOne hundred and four OSCC patients undergoing surgical resection were included in the study.InterventionPatients were randomly assigned to have either NBI-guided (n = 52) or WL-guided (n = 52) resection.Main Outcome MeasuresFinal pathological margin status and clinical outcomes, including type of defect reconstruction and functional outcomes (persisting tracheostomy and tube feeding), were compared between the 2 groups.ResultsA significantly higher rate of clear superficial margin was achieved in patients in the NBI group than in the WL group (96.2% and 80.8%, respectively,  = .014). The locoregional or free flap reconstruction rates between the 2 groups were indistinguishable. Oral tongue and floor of the mouth primaries were detected more frequently in the NBI group, which may affect the postoperative deglutition function, leading to insignificantly higher rates of persistent tracheostomy and feeding tube (11.5% vs 5.8%,  = .488, and 19.2% vs 13.5%,  = .597, respectively).Conclusions and RelevanceThe study demonstrated that intraoperative NBI-guided resection in OSCC resulted in a more precise definition of superficial tumor margin than the standard WL-guided resection. In addition, the reconstruction method and functional outcomes were comparable between the 2 groups.

ImportanceChildhood recurrent anterior epistaxis (RAE) commonly coexists with allergic rhinitis (AR), causing significant symptoms and distress to patients; however, treatment remains controversial.ObjectiveTo compare the clinical outcomes of pediatric patients with RAE and AR treated intraoperatively with silver nitrate cauterization (SNC) or radiofrequency coagulation (RFC).Study DesignProspective, randomized controlled study.SettingTertiary referral center.ParticipantsPediatric patients presenting with RAE and AR.Exposure or InterventionPatients received SNC or RFC in a double-blind, prospective cohort study.Main Outcome MeasuresThe Epistaxis Severity Score (ESS) and Visual Analog Scale (VAS) scores for AR-related symptoms were recorded at baseline, 4thweek, 3rd month, and 12th month.ResultsThe rebleeding rate in the SNC group was 18.0% at the 4th week, 46.0% at the 3rdmonth, and 58.0% at the 12th month, whereas the RFC group demonstrated rates of 2.0%, 0%, and 0%, respectively ( < .05). At each follow-up time point, the mean ESS was significantly lower in the RFC group than in the SNC group. In addition, mean VAS scores for nasal crusting and impact on daily life (IDL) were significantly lower in the RFC group at all postoperative time points. Moreover, the RFC group exhibited significantly-lower mean VAS scores for runny nose and itchy nose at the 3rd and 12th month postoperatively. Similarly, the mean VAS score for nasal obstruction was significantly lower in the RFC group at the 12th month postoperatively. No cases of septal necrosis or perforation were observed in the SNC group. However, septal perforation occurred in 1 patient among the 4 who underwent RFC using the ablation mode.Conclusion/RelevanceThe thermocoagulation mode of RFC is a safe and effective treatment modality for bilateral RAE in pediatric patients. It significantly improves epistaxis and alleviates associated nasal symptoms. Furthermore, compared with patients treated with SNC, those receiving RFC exhibited a significantly-prolonged nosebleed-free period and a reduced likelihood of recurrent epistaxis within 1 year of treatment.

ImportanceInterest in equity, diversity, and inclusion (EDI) in medicine is growing, with women now making up 54% of Canadian physicians under the age of 40. Despite this, women in surgery remain underrepresented, facing challenges such as professional isolation. In response, a Women in Surgery in (WISE) Ear Nose and Throat (ENT) group was created to foster EDI. This is the first journal club of its kind described in the literature.ObjectiveOur objective was to describe the creation and program evaluation of a WISE group.Design(1) Setting and Intervention: A quarterly journal club meeting was created in a hybrid format to discuss peer-reviewed articles on EDI. Grant funding was obtained from a physician association's wellness budget. (2) Participants: Responses were from members of a Canadian University's otolaryngology mailing list attending these sessions. There were multiple responses from some of the same individuals across the 7 meetings. (3) Outcome Measures: An anonymous web-based survey with Likert-style questions was administered to participants 1 week after each session. General self-efficacy scale (GSES) was also administered. Moore's pyramid of effectiveness in continuing medical education was used as a framework for program evaluation.ResultsEighty-two responses to the survey were collected over 7 meetings. Among the 75 who responded to the gender identification question, 57 (76%) identified as women and 18 (24%) identified as men. Responses included 38 (46%) attendings, 8 (10%) fellows, 29 (35%) residents, and 7 (9%) medical students. Ninety percent of the responses "agreed" or "strongly agreed" that the group promoted collegiality, 82% of the responses "agreed" or "strongly agreed" that the group supported the participants' well-being, and 89% of the responses "agreed" or "strongly agreed" that the group provided a safe environment for discussion. The responses showed that the initiative was rated as outstanding by 48% and above average by 46%. From the responses, the GSES was high at 31.0 ± 4.3.ConclusionsA WISE group has been created and highly rated. This initiative represents one step of the university's ENT division's commitment to EDI.

ImportanceNasal septal deviation (NSD) and rhinosinusitis (RS) are common conditions with overlapping symptoms, yet they require distinct treatment approaches. Clarifying their relationship is essential to guide preventative management strategies.ObjectiveTo examine the association between NSD and RS.DesignSystematic review following the PRISMA guidelines. Embase, MEDLINE, and Web of Science were searched from inception to January 2025.ParticipantsStudies were included if participants were adults (≥18 years); studies conducted exclusively in pediatric populations were excluded.Main Outcome MeasuresAssociation between NSD and RS based on prevalence, NSD severity, and mean nasal septal angle (NSA), as well as overall study quality and risk of bias.ResultsA total of 34 studies were included, of which 26 reported NSD and 8 reported RS as their primary outcome. Among the studies reporting on NSD, 17 assessed prevalence, of which 7 (41.2%) demonstrated an association with RS; 5 assessed severity, of which 2 (40.0%) demonstrated an association between moderate/severe NSD and RS; and 10 assessed mean NSA, of which 3 (30.0%) demonstrated an association with RS. All studies reporting on RS assessed prevalence, of which 4 (50.0%) demonstrated an association with NSD. Overall, 16/40 (40.0%) individual outcome measures indicated an association between NSD and RS. A risk of bias analysis identified 12/34 (35.3%) studies as low risk. Of these, 5/17 (29.4%) individual outcomes measures demonstrated an association between NSD and RS.ConclusionThe current body of evidence reveals an inconclusive relationship between NSD and RS. Variability in definitions, diagnostic criteria, and outcome measures, combined with insufficient control for bias, limit the ability to draw definitive conclusions.Relevance:We propose standardized reporting guidelines to ensure consistency across studies and enable more meaningful comparisons. Implementing this framework may ultimately support the development of preventative strategies to optimize patient outcomes.PROSPERO registration numberCRD42024514049.

ImportanceMost French Olfactory Questionnaires are time consuming, which may affect the patient participation.ObjectiveTo validate a short French version of the Olfactory Disorders Questionnaire (Fr-ODQ).DesignProspective controlled study.SettingMulticenter study.ParticipantsPatients with long-lasting olfactory dysfunction (OD) treated with platelet-rich plasma into the olfactory clefts and asymptomatic subjects.InterventionDevelopment and validation of a short ODQ.Main OutcomesIndividuals completed the full Fr-ODQ. The Threshold, Discrimination, and Identification (TDI) test was performed in OD patients. A combined statistical analysis was performed to determine the most informative items of the Fr-ODQ to develop a shorter version. The internal consistency was determined with Cronbach's alpha. The reliability and external validity were evaluated through a test-retest approach and by correlating with the Fr-ODQ. Both the minimal clinically important difference (MCID) and the threshold of the short ODQ version were determined.ResultsA total of 263 patients (173 [65.8%] females) and 129 controls (92 [71.3%] females) completed the evaluations. The mean age of patients was 51.2 ± 15.3 years. The mean duration of OD was 42.4 ± 54.3 months. The biostatistical models selected 10 essential items composing the Fr-ODQ-10. The baseline Fr-ODQ-10 was significantly correlated with the TDI ( = 0.228;  = .001) and the Fr-ODQ ( = 0.875;  = .001), demonstrating high external validity. Fr-ODQ-10 was significantly lower in controls compared to OD patients ( = .001), highlighting high internal validity. The internal consistency was good (α = .796). The external consistency was adequate, with significant correlations between the test-retest Fr-ODQ-10. The Fr-ODQ-10 significantly decreased from baseline to 4 months post-treatment. A Fr-ODQ-10 score >7.5 was considered abnormal (sensitivity: 84.8%, specificity: 84.2%). The MCID of Fr-ODQ-10 was established at >3.Conclusion and RelevanceThe Fr-ODQ-10 is a valid and reliable clinical instrument, demonstrating correlation with the psychophysical olfactory assessment.

ImportanceTrimming perforation margins (TFMs) is a classic procedure of myringoplasty.ObjectiveThe objective of this study was to evaluate the long-term graft outcomes and iatrogenic cholesteatoma of endoscopic cartilage myringoplasty with preserving perforation margins (PFMs) for repairing small- to medium-size perforation.Study designProspective semi-randomly control study.SettingTertiary university hospital.ParticipantsPatients with chronic small- to medium-size perforations.InterventionTFM group or the PFM group.Main outcome measuresComprehensive evaluations included graft success rate, hearing improvement, and imaging examinations at 3, 6, and 36 months after surgery and complications.ResultsAt postoperative 3 months, the graft success rate was 91.84% in the TFM group and 96.30% in the PFM group ( = .59). At postoperative 6 months, graft separation resulted in re-perforation in 3.70% patients in the PFM group, and the graft success rate was 91.84% in the TFM group and 92.59% in the PFM group ( = .82). At postoperative 3 years, the graft success rate was 93.88% in the TFM group and 94.44% in the PFM group ( = .77). Although postoperative air bone gaps (ABGs) were not significantly different between 2 groups, the PFM group had better hearing restoration compared with the TFM group in postoperative 3 months or 3 years. Additionally, although no significant differences were found in the ABGs between postoperative 3 months and postoperative 3 years in any group, postoperative 3 years showed better hearing restoration compared with postoperative 3 months. In addition, endoscopic morphology showed the graft stratification in .00% in the TFM group and 11.11% in the PFM group ( = .05). Postoperative high-resolution computed tomography (HRCT) revealed a few soft tissue shadow in 8.16% patients in the TFM group and in 5.56% patients in the PFM group ( = .89); middle ear cholesteatoma was excluded by magnetic resonance imaging. However, HRCT revealed that the middle ear and mastoid were well pneumatized in the remaining patients.Conclusions and relevanceThe long-term graft success rate and hearing improvement of cartilage underlay myringoplasty with PFMs are reliable for repairing small- to medium-size perforations; 3 years imaging examinations did not reveal iatrogenic cholesteatoma. However, it may cause graft stratification and graft separation.

ImportanceDuring the COVID-19 [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] pandemic, reports emerged of croup secondary to SARS-CoV-2 in the pediatric population. Children with croup and concurrent SARS-CoV-2 infection seemed to require a greater number of doses of dexamethasone and nebulized epinephrine and were more likely to need hospitalization and intensive care unit (ICU) admission compared to pre-SARS-CoV-2 croup.ObjectiveThis study aimed to compare the outcomes of children presenting with SARS-CoV-2-associated croup and those with conventional croup.DesignObservational, retrospective review.SettingTertiary care pediatric hospital.ParticipantsChildren (age <18 years) presenting with croup between January 2019 and February 2022.ExposureSARS-CoV-2Main outcome measureNumber of doses of dexamethasone and nebulized epinephrine, need for hospital admission, ICU admission, assisted ventilation, and length of stay.ResultsTwo thousand and three hundred ninety-eight children [68.2% male, median (interquartile range) age 25 months (15-42 months)] were included. Twenty-seven patients (1.1%) tested positive for SARS-CoV-2, 467 (19.5%) tested negative for SARS-CoV-2, and 1904 (79.4%) were not tested for SARS-CoV-2. Dexamethasone was given to 27 (100%) SARS-CoV-2-positive and 457 (98%) SARS-CoV-2-negative patients at an average of 1.4 (±1.2) and 1.1 (±1.0) doses, respectively. SARS-CoV-2-positive patients were more likely to require nebulized epinephrine (41%) compared to SARS-CoV-2-negative (12%, OR: 4.2; 95% CI 1.8-9.6,  < .001) patients, and were more often admitted (30%) to hospital than SARS-CoV-2-negative (3.4%) patients (OR: 12; 95% CI 4.4-37.7,  < .001). ICU admission was required for 3 SARS-CoV-2-negative patients, but none of the SARS-CoV-2-positive patients. Length of stay was similar across groups.ConclusionPatients with croup and SARS-CoV-2 infection were found to have an increased need for nebulized epinephrine and an increased frequency of admission to the hospital. However, there was no increased need for ICU admission or longer length of stay in the hospital.Level of EvidenceIII.

ImportanceChronic rhinitis (CR) affects quality of life and often coexists with obstructive sleep apnea (OSA), a comorbidity that may increase surgical risks. Understanding OSA's impact on outcomes of minimally invasive nasal surgery is clinically relevant.ObjectiveTo evaluate the efficacy and safety of minimally invasive nasal surgery for CR and assess the influence of OSA on postoperative complications and symptom relief.DesignRetrospective cohort study.SettingSingle tertiary medical center in Taiwan.ParticipantsA total of 325 CR patients underwent nasal surgery between March 2023 and June 2024. Based on sleep study results, patients were stratified into OSA (n = 48) and non-OSA (n = 277) groups.Exposure or InterventionMinimally invasive nasal surgery, including radiofrequency inferior turbinate reduction and/or posterior nasal nerve neurolysis. Patients receiving adjunctive procedures (eg, septoplasty, uvulopalatopharyngoplasty, and tonsillectomy) were excluded.Main Outcome MeasuresPostoperative complications (eg, epistaxis) within 1 month and symptom relief based on reflective total nasal symptom score and nasal obstruction symptom evaluation.ResultsOSA [odds ratio (OR), 5.105; 95% confidence interval (CI), 1.222-21.328;  = .025] and hypertension (OR, 5.809; 95% CI, 1.134-29.744;  = .035) were independent risk factors for major epistaxis. OSA patients had higher overall complication rates (22.9% vs 4.3%,  = .005), epistaxis (18.8% vs 3.6%,  = .012), and major epistaxis (14.6% vs 1.8%,  = .018). Both groups showed significant symptom improvement postoperatively ( < .001).ConclusionMinimally invasive nasal surgery improves CR symptoms regardless of OSA. However, OSA and hypertension are linked to increased complication risk and require careful perioperative management.RelevanceThese findings support tailored preoperative assessment and multidisciplinary care to optimize safety and outcomes in CR patients with OSA.

ImportanceThis systematic review determines that the patients with obstructive sleep apnea (OSA) can undergo upper airway surgery in ambulatory surgical centers (ASCs) safely and determines which patients with OSA are appropriate for this environment.ObjectiveThe systematic review aimed to determine the safety of conducting upper airway surgeries on patients with OSA in ASCs.DesignThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform a systematic review on ambulatory upper airway surgery studies. A comprehensive search was conducted from MEDLINE, Embase, CENTRAL, and Scopus from inception through February 2024. A descriptive analysis was conducted. Risk of bias was assessed using the Murad Tool and the Newcastle-Ottawa Scale.SettingHospital outpatient department or ambulatory surgical center.ParticipantsAdult patients with OSA.InterventionUpper airway surgery.Main Outcome MeasuresUnplanned admission rates and 24 hour complications.ResultsFrom 9313 studies, 11 upper airway surgery studies with 5714 participants were identified. Studies observed a 5.4% admission rate for medical reasons, predominantly stemming from avoidable admissions for desaturations. There was a 9.2% 24 hour complication rate. By initiating an oxygen discontinuation trial, OSA patients with controlled comorbidities can confidently proceed with OSA surgery at ASCs feasibly and safely. Patient selection is paramount in the ASC environment, with a focus on age, body mass index, apnea-hypopnea index, and controlled comorbidities.Conclusions and RelevanceOSA patients with mild or controlled comorbidities can safely undergo ambulatory OSA surgery in ASCs without sacrificing the cost-effectiveness of the ASC model. Future studies should use larger populations and prospective study designs.OtherThe protocol for this review was registered with the PROSPERO database (registration number: CRD42023415162).

ImportanceA predictive formula for pediatric nasopharyngeal depth (ND) could tailor nasopharyngeal swabbing technique to individual anatomy and reduce the incidence of false negatives.ObjectiveTo provide a formula predicting ND based on surface anatomy measurements in children.Study DesignProspective pilot study.SettingBritish Columbia Children's Hospital Pediatric Otolaryngology Clinic (Canada) between June 2022 to May 2024.ParticipantsChildren receiving flexible nasal endoscopy at a tertiary otolaryngology clinic.Intervention and Main Outcome MeasuresPredictor variables collected were sex, age, height, weight, curved nasal ala-tragus distance, finger lengths, and history of adenoidectomy. The outcome variable of ND was measured from the nasal nares to the posterior nasopharyngeal wall during routine nasal endoscopy. Relationships between predictor and outcome variables were analyzed. A predictive formula for ND was generated using stepwise linear regression, formula simplification, and model validation.ResultsSixty-three pediatric patients were included (67% male, average age 6.4 years, range 3 weeks-18 years). ND differed by age: average ND for age <2 was 5.4 ± 0.8 cm, ages 2 to 10 was 7.4 ± 1.1 cm, and ages >10 was 9 ± 1.1 cm. Stepwise linear regression resulted in the formula: ND (cm) = ⅔ (pinky length) + ⅓ (ala-tragus distance) + 1 (if history of adenoidectomy) + 1. was .78 with an average error of estimation ±0.81 cm.ConclusionPediatric ND varies with age and surface anatomy dimensions. ND can be predicted in children using simple bedside measurements of pinky length, curved ala-tragus distance, and history of adenoidectomy using the equation ND (cm) = ⅔ (pinky length) + ⅓ (ala-tragus distance) + 1 (if history of adenoidectomy) + 1.RelevanceFuture studies are required to further validate the proposed predictive formula to ultimately improve accuracy in procedures involving blind instrumentation of the nasal cavity, such as nasopharyngeal swabs and posterior nasal packing.

ImportanceFew centers globally use transoral laser microsurgery (TLM) for primary treatment of T3 glottic squamous cell carcinoma (SCC); consequently, data on its use in this setting are sparse.ObjectiveThe aim of this study was to evaluate the oncologic and functional outcomes in T3 glottic SCC following TLM, including the impact of anterior commissure (AC) involvement.DesignRetrospective chart review.SettingSingle Canadian tertiary care hospital in Halifax, Nova Scotia, from January 2006 to December 2021.ParticipantsAdult (>18 years old) patients with T3 glottic SCC treated with TLM. Patients were excluded if they were previously treated for laryngeal cancer.Intervention or ExposuresThis study used prospectively collected data for patients treated with TLM for T3 glottic SCC.Main Outcome MeasuresOncologic outcomes were assessed using disease-specific survival (DSS), local control (LC), and laryngectomy-free survival (LFS). Functional outcomes were measured using the Voice Handicap Index-10 (VHI-10).ResultsIn total, 28 patients (mean age = 68.4 years) underwent curative TLM for T3 glottic SCC. Sixteen of the cases involved the AC and 22 had paraglottic space involvement. Two and 5-year DSS were 79.2% (CI = 62.3%-100%). Two and 5-year LC were 80.2% (CI = 65.9%-97.4%) and 52.6% (CI = 27.4%-100%), respectively, and 2- and 5-year LFS rates were 86.1% (CI = 72.6%-100%) and 64.6% (CI = 35.8%-100%). AC involvement had no significant impact on DSS, LC, or LFS. There was no significant difference in preoperative and 3-month VHI-10 scores ( = .6632); however, there was significant improvement noted at the 6 ( = .042) and 12-month ( = .037) periods.ConclusionsTLM is a viable surgical option for appropriately selected patients with T3 glottic SCC, with or without AC involvement, achieving favorable oncologic and functional outcomes.RelevanceThese findings further contribute to the limited evidence supporting the use of TLM in the management of advanced-stage glottic cancer.

ImportanceSudden sensorineural hearing loss (SSNHL) is associated with metabolic syndrome, central obesity, and albumin level. Malnutrition may adversely affect recovery in older patients with SSNHL, yet its clinical relevance remains underexplored.ObjectiveThis study investigated the associations of the geriatric nutritional risk index (GNRI) with clinical outcomes in older patients (age >65 years) with SSNHL.DesignObservational retrospective study.SettingTertiary academic medical center.ParticipantsA total of 328 patients aged over 65 years who were diagnosed with SSNHL were retrospectively enrolled. Patients were included if they had complete clinical, audiometric, and laboratory data, including serum albumin levels and anthropometrics for GNRI calculation.Intervention/ExposuresThe primary exposure was the GNRI, calculated using body weight, height, and serum albumin. All patients received steroid treatment for SSNHL.Main Outcome MeasuresThe primary outcome was hearing recovery, categorized as favorable or unfavorable based on clinical audiometric improvement.ResultsAmong older patients with SSNHL, 107 (32.62%) and 221 (67.38%) had favorable and unfavorable outcomes, respectively. Vertigo, worse initial level of hearing loss, and low GNRI were mainly associated with unfavorable hearing outcomes in older patients with SSNHL. Furthermore, low GNRI (<99) was linked to unfavorable clinical outcomes (odds ratio [OR] = 1.91,  = .0151). Multivariate logistic regression revealed that vertigo (aOR = 3.45,  = .0002), worse initial level of hearing loss (per 1 unit increase in hearing loss elevates the risk of poor hearing recovery by 2%,  = .0015), and low GNRI (aOR = 1.79,  = .0435) were associated with unfavorable clinical outcomes.ConclusionIn summary, evaluation of nutritional status plays a crucial role in improving clinical outcomes in SSNHL. Moreover, GNRI can predict clinical outcomes in older patients with SSNHL treated with steroids. Older patients with SSNHL who have vertigo, a worse initial level of hearing loss, and low GNRI exhibit unfavorable outcomes.RelevanceGNRI is a simple, accessible marker that can help identify older SSNHL patients at higher risk of poor recovery. Future prospective studies should validate its use as a prognostic tool and explore whether nutritional interventions can improve hearing outcomes.

ImportanceClinicians face great challenges in diagnosing dizziness/vertigo disease due to its subjectivity. Currently, there is an absence of machine learning model that could make full use of the information gained from both medical history and physical signs.ObjectiveTo develop and validate a machine learning model based on medical history and physical signs for dizziness/vertigo disease diagnosis, relieving the burden of diagnosis for clinicians.DesignA retrospective cohort study.SettingTertiary referral center.ParticipantsThis study included 1003 patients conformed to the inclusion criteria at the neuro-otologists' clinics.ExposuresThirty-one medical history items, and 9 bedside examination signs recorded by routinely performing a detailed ocular motor examination using video goggles.Main Outcome MeasuresThe accuracy, precision, recall, F1 scores, and Matthews' correlation coefficient of disease diagnosis.ResultsOn the collected dataset of 16 categories of dizziness/vertigo diseases, the proposed model achieved an accuracy of 98.11% and an F1 score of 95.43%. The model demonstrated its optimal robustness when tested with datasets containing added noise. Additionally, an analysis of the correlation between medical history and signs was conducted, along with several case studies.ConclusionsA machine learning-based model was proposed for the diagnosis of dizziness/vertigo, which effectively combined patients' medical history and signs. In terms of diagnostic accuracy, it outperforms models that rely solely on either medical history or signs for diagnosis.RelevanceThe proposed method can effectively combine the patient's medical history and physical sign information to make the diagnosis of dizziness/vertigo disease, which has the potential to relieve the burden of diagnosis for clinicians to a certain extent.

ImportanceExpanding the appropriate use of ambulatory surgical care may improve operating room (OR) efficiency.ObjectiveTo demonstrate that pediatric adenoidectomy with laryngeal mask airway (LMA) for select patients in the minor procedure room (MPR) is comparable in safety but more efficient than OR adenoidectomy in a pilot study of 20 patients from July to November 2023.DesignThe Institute for Healthcare Improvement Model for Improvement guided this quality improvement project. Safety and efficiency outcomes were prospectively collected for adenoidectomies with LMA in the MPR and compared with retrospective data from similar OR cases with LMA or endotracheal intubation (ETT).SettingA single tertiary referral center.ParticipantsPediatric patients who underwent adenoidectomy from July to November 2023.InterventionsThe intervention involved adenoidectomy in the MPR with LMA, as opposed to traditional OR settings.Main Outcome MeasuresThe main outcome measures included safety (perioperative respiratory adverse events, conversion from LMA to ETT), efficiency (length of hospital stay, wait time for surgery), and patient/provider satisfaction.ResultsFinal analysis included 55 patients [20 (36%) MPR, 35 (64%) OR]. In the OR, 16 (46%) patients used LMA, the rest used ETT. The median [interquartile range (IQR)] age was 5.5 (3.7-7.3) years, and 22 (41%) patients were female. No major respiratory adverse events occurred in the MPR compared to 1 (3%) event in the OR. One (5%) MPR patient required conversion from LMA to ETT due to limited surgical access. Time-based measures were superior in the MPR, with median hospital stay 91 minutes shorter (158.0; IQR: 143.0-204.0 vs 249.0; IQR: 210.0-278.0). Patient and provider satisfaction were highly rated in the MPR.ConclusionsPediatric adenoidectomy for select patients in the MPR is a safe and time-efficient alternative to the OR.RelevanceFurther exploration of suitable procedures for the MPR may enhance OR resource allocation.Level of Evidence. 3.