Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820932869. doi: 10.1177/0194599820932869. Online ahead of print.
Glycoprotein Nonmetastatic Melanoma Protein B as Potential Imaging Marker in Posttherapeutic Metastatic Head and Neck Cancer
Jeroen E van Schaik 1, Saskia H Hanemaaijer 1, György B Halmos 1, Max J H Witjes 2, Bernard F A M van der Laan 1, Bert van der Vegt 3, Boudewijn E C Plaat 1
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PMID: 32600105 DOI: 10.1177/0194599820932869
Abstract
Objective: To evaluate expression of potential molecular imaging targets epidermal growth factor receptor (EGFR), glycoprotein nonmetastatic melanoma protein B (GPNMB), and vascular endothelial growth factor (VEGF) in lymph nodes (LNs) with or without head and neck squamous cell carcinoma (HNSCC) metastases after (chemo)radiation.

Study design: Retrospective study comparing receptor expression in paired lymph nodes after initial treatment.

Setting: A tertiary referral hospital.

Subjects and methods: Salvage neck dissection specimens of 40 patients treated with (chemo)radiation were selected. LNs that contained viable tumor, reactive changes after initial treatment, and normal LNs were analyzed using immunohistochemically determined H-scores and by calculating sensitivity and specificity rates and positive/negative predictive values (PPVs/NPVs).

Results: EGFR expression was found in 86% and GPNMB expression in 100% of the LNs with viable tumor. VEGF expression was present in all lymph node types. For EGFR, the sensitivity rate was 86%, and specificity rate was 81%. For GPNMB, these were 100% and 75%, respectively. PPV of EGFR was 61.8% and NPV was 98.2%. These were 56.4% and 100% for GPNMB, respectively.

Conclusion: In residual or recurrent HNSCC lymph node metastases, both EGFR and GPNMB show tumor-specific expression in immunohistochemistry, which may prove useful in future molecular imaging in salvage neck dissections. Immunohistochemically detected VEGF expression indicates that this target is not feasible for imaging purposes in salvage surgery. Therefore, GPNMB could be a new potential imaging target showing comparable results to EGFR in immunohistochemistry.

Keywords: head and neck squamous cell carcinoma; lymph nodes; molecular markers; neck dissection; salvage therapy.

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Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820936249. doi: 10.1177/0194599820936249. Online ahead of print.
Comparison of Endoscopic and Ultrasonographic Measurements of the Subglottic Airway in Children
Elton M Lambert 1, Huy D Tran 2, Julina Ongkasuwan 1
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PMID: 32600181 DOI: 10.1177/0194599820936249
Abstract
Objective: To compare measurements of the pediatric subglottis obtained by surgeon-performed ultrasound and endoscopy.

Study design: Prospective observational comparison-of-methods study.

Setting: Tertiary care pediatric hospital.

Subjects and methods: Thirty-one patients who underwent direct laryngoscopy from May 2017 to July 2018 were recruited. Transcervical ultrasound was used to visualize the vocal folds, subglottis, and cervical trachea. The anterior-posterior (AP) and transverse (TV) diameter of the subglottic space were measured endoscopically and via ultrasound by 2 independent evaluators. Measurements were compared for correlation, bias, and agreement. A clinically acceptable bias for subglottic diameter was assumed to be 0.5 mm or less.

Results: The median age of enrolled patients was 2.6 years (range, 4 months-13.3 years). Endoscopic subglottic AP and TV measurements ranged from 3.33 mm to 14.81 mm and from 4.44 mm to 11.65 mm, respectively, while ultrasonographic AP and TV measurements ranged from 4.57 mm to 9.85 mm and from 3.77 mm to 8.96 mm. Pearson coefficient showed strong a correlation for both endoscopic and ultrasound AP (R = 0.8081, P < .0001) and TV (R = 0.8796, P < .001) measurements of the subglottis. Bland-Altman plots revealed a bias (average discrepancy) for AP measurements of 0.22 mm and 0.11 mm for TV measurements.

Conclusion: Endoscopic and ultrasonography measurements of the pediatric subglottic airway were strongly correlated. The discrepancy between AP and TV measurements was less than 0.5 mm. Ultrasound of the subglottis may be an alternative to endoscopic assessment of the airway for measurement of the subglottic airway in children in select cases.

Keywords: airway; subglottis; ultrasound.

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3
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820932851. doi: 10.1177/0194599820932851. Online ahead of print.
Quantitative Assessment of Surgical Ergonomics in Otolaryngology
Cole Rodman 1, Natalie Kelly 2, Weston Niermeyer 1 2, Laura Banks 2, Amanda Onwuka 3, Eric Mason 4, Tendy Chiang 1 2 4
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PMID: 32600215 DOI: 10.1177/0194599820932851
Abstract
Objectives: Objective evaluation of the ergonomic risk of common otolaryngology procedures and assessment of work-related musculoskeletal pain and injury.

Study design: Cross-sectional intraoperative assessment and survey.

Setting: Department of Otolaryngology at a tertiary children's hospital.

Subjects and methods: Sixteen otolaryngology attendings, fellows, and residents participated in a blinded study. Intraoperative ergonomics was assessed for tonsillectomies, adenoidectomies, and tympanostomy tube insertions using the Rapid Upper Limb Assessment (RULA). Follow-up surveys were sent to all participating surgeons to determine the prevalence of musculoskeletal pain and formal ergonomic training.

Results: Zero percent (N = 0/275) of intraoperative observations were found to have a negligible level of ergonomic risk, with 47% low risk, 37% high risk, and 16% very high risk. Tympanostomy tube insertions conferred less risk than tonsillectomy and adenoidectomy, while the use of headlamp or loupes conferred increased risk. Eighty percent of respondents reported having musculoskeletal pain and 40% reported experiencing pain while operating within the past year. The most common area of pain was the cervical spine. No surgeons reported formal ergonomic training.

Conclusions: Our study demonstrates an unacceptable level of ergonomic risk for common procedures in otolaryngology. Furthermore, most participants reported experiencing musculoskeletal pain despite the duration of examined procedures being relatively short. The high prevalence of work-related musculoskeletal pain and the lack of ergonomic training in our cohort highlight the need for increased awareness of ergonomics as well as the development of formal ergonomic curricula.

Keywords: Rapid Upper Limb Assessment; ergonomics; occupational hazard; otolaryngology.

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Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935402. doi: 10.1177/0194599820935402. Online ahead of print.
Familial Aggregation in Idiopathic Subglottic Stenosis
Virginia E Drake 1, Alexander Gelbard 2, Nara Sobriera 3, Elizabeth Wohler 3, Lynne L Berry 4, Lena L Hussain 4, Alexander Hillel 1
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PMID: 32600122 DOI: 10.1177/0194599820935402
Abstract
Objective: To evaluate inheritance patterns and define the familial clustering rate of idiopathic subglottic stenosis (iSGS).

Study design: Retrospective observational study.

Setting: International multicenter collaborative of >30 tertiary care centers.

Methods: Patients with a clinically confirmed iSGS diagnosis within the North American Airway Collaborative's iSGS1000 cohort consented between 2014 and 2018 were eligible for enrollment. Patient demographics and disease severity were abstracted from the collaborative's iSGS longitudinal registry. Pedigrees of affected families were created.

Results: A total of 810 patients with iSGS were identified. Positive family history for iSGS was reported in 44 patients in 20 families. The rate of familial clustering in iSGS is 2.5%. Mean age of disease onset is 42.6 years. Of the 44 patients with familial aggregation of iSGS, 42 were female and 2 were male; 13 were mother-daughter pairs and 2 were father-daughter pairs. There were 3 sister-sister pairs. There was 1 niece-aunt pair and 2 groups of 3 family members. One pedigree demonstrated 2 affected mother-daughter pairs, with the mothers being first-degree paternal cousins. Inheritance is non-Mendelian, and anticipation is present in 11 of 13 (84%) parent-offspring pairs. The mean age of onset between parents (48.4 years) and offspring (36.1 years) was significantly different (P = .016).

Conclusion: This study quantifies the rate of familial clustering of iSGS at 2.5%. Inheritance is non-Mendelian, and disease demonstrates anticipation. These data suggest that there may be a genetic contribution in iSGS.

Keywords: idiopathic subglottic stenosis; laryngotracheal stenosis.

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5
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935042. doi: 10.1177/0194599820935042. Online ahead of print.
A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience
Asitha D L Jayawardena 1, Zelda J Ghersin 2, Marcos Mirambeaux 3, Jose A Bonilla 4, Ernesto Quiñones 5, Evelyn Zablah 1, Kevin Callans 1 6, Marina Hartnick 1, Nita Sahani 7, Makara Cayer 7, Cheryl Hersh 8, Thomas Q Gallagher 9, Phoebe H Yager 2, Christopher J Hartnick 1
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PMID: 32600113 DOI: 10.1177/0194599820935042
Abstract
Objective: To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy.

Study design: Consecutive case series with chart review.

Setting: This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic.

Methods: Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes.

Results: A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded.

Conclusion: This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.

Keywords: global health; low and middle income country; pediatric airway; surgical mission; surgical teaching.

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6
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820933206. doi: 10.1177/0194599820933206. Online ahead of print.
Computer-Assisted Quantitative Analysis of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea/Hypopnea Syndrome
Chi-Chih Lai 1, Pei-Wen Lin 2 3, Hsin-Ching Lin 1 3 4, Michael Friedman 5 6, Anna M Salapatas 6, Ju-Pin Chen 7, Hsueh-Wen Chang 8, Sin-Ei Juang 9, Shao-Chun Wu 9, Meng-Chih Lin 3 10
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PMID: 32600112 DOI: 10.1177/0194599820933206
Abstract
Objectives: To use computer-assisted quantitative measurements of upper airway changes during drug-induced sleep endoscopy (DISE) and to correlate these parameters with disease severities and physiologic changes in patients with obstructive sleep apnea/hypopnea syndrome (OSA).

Design: A retrospective study.

Setting: Tertiary academic medical center.

Patients and methods: A total of 170 patients who failed continuous positive airway pressure therapy and then underwent upper airway surgery were enrolled. All patients received polysomnography and DISE preoperatively. We used ImageJ 1.48v to obtain maximal and minimal measurements, including cross-sectional areas and anterior-posterior and lateral diameters at 4 anatomic levels (retropalatal, oropharyngeal, retroglossal, and retroepiglottic) under DISE, and then computed the percentage changes. We analyzed the clinical values of DISE changes by computer-assisted analysis in patients with OSA and any correlations between these changes and polysomnography parameters.

Results: The percentage changes of upper airway showed significant collapses at all 4 anatomic levels (all P < .0001). We also found that the changes at retropalatal levels were significantly greater and that retroglossal levels were significantly smaller, while the changes of anterior-posterior diameters at retroglossal levels showed a significant positive association with apnea-hypopnea index and desaturation index. However, there were no statistically significant correlations between upper airway changes and obesity.

Conclusion: Computer-assisted quantitative analysis could evaluate upper airway changes of OSA in an objective way and may help identify the sites of obstruction during DISE more accurately. Upper airway showed multilevel collapse with independent significant changes in patients with OSA, with the retropalatal and retroglossal levels playing important roles in particular.

Keywords: drug-induced sleep endoscopy; obstructive sleep apnea/hypopnea syndrome; snoring.

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7
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820937670. doi: 10.1177/0194599820937670. Online ahead of print.
Effect of Bumetanide on Facial Nerve Regeneration in Rat Model
Ecem Sevim Longur 1, Özgür Yiğit 2, Çiğdem Kalaycık Ertugay 2, Ela Araz Server 2, Turgut Adatepe 3, Dilek Akakın 4, Oya Orun 5, Ayça Karagöz Köroğlu 4
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PMID: 32600218 DOI: 10.1177/0194599820937670
Abstract
Objective: We investigated the effects of bumetanide alone and in combination with dexamethasone on facial nerve regeneration in rats with facial paralysis.

Study design: A prospective controlled animal study.

Setting: An animal laboratory.

Subjects and methods: Facial paralysis was induced in 32 Wistar rats that we then divided into 4 groups: group 1, control; group 2, bumetanide; group 3, dexamethasone; group 4, bumetanide and dexamethasone. Electroneurography was performed 1, 2, and 4 weeks later, and nerve regeneration was evaluated by electron and light microscopy and Western blotting in week 4.

Results: Regarding the comparison between preoperative values and week 4, the latency difference in group 1 (1.25 milliseconds) was significantly higher than those of groups 2 to 4 (0.56, 0.34, and 0.10 milliseconds, respectively; P = .001). The latency increment in groups 2 and 3 was higher than that of group 4 (P = .002 and P = .046) in week 4, whereas groups 2 and 3 did not differ significantly (P = .291). Amplitude difference was not statistically significant from week 4 among all groups (all P > .05). The number of myelinated axons was significantly higher in all treatment groups than in the control group (P = .001). Axon number and intensity were significantly higher in group 4 as compared with groups 2 and 3 (P = .009, P = .005).

Conclusion: After primary neurorrhaphy, dexamethasone and bumetanide alone promoted nerve recovery based on electrophysiologic and histologic measures. Combination therapy was, however, superior.

Keywords: aquaporin; bumetanide; facial paralysis; regeneration.

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8
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820939538. doi: 10.1177/0194599820939538. Online ahead of print.
Olfactory and Gustatory Outcomes in COVID-19: A Prospective Evaluation in Nonhospitalized Subjects
Alberto Paderno 1, Davide Mattavelli 1, Vittorio Rampinelli 1, Alberto Grammatica 1, Elena Raffetti 2, Michele Tomasoni 1, Tommaso Gualtieri 1, Stefano Taboni 1, Silvia Zorzi 1, Francesca Del Bon 1, Davide Lombardi 1, Alberto Deganello 1, Luca Oscar Redaelli De Zinis 1, Alberto Schreiber 1
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PMID: 32600175 DOI: 10.1177/0194599820939538
Abstract
Objective: To prospectively assess the rate and timing of recovery of olfactory (OD) and gustatory (GD) dysfunction in patients affected by COVID-19.

Study design: Cohort study.

Setting: Population-based evaluation in a COVID-19 high-prevalence region.

Subjects and methods: We analyzed the clinical course of OD and GD in a cohort of home-quarantined SARS-CoV-2-positive patients from Northern Italy. Physicians administered a survey-based questionnaire at recruitment (T0). During follow-up, patients responded to online dedicated surveys modulated according to symptoms at T0.

Results: A total of 151 patients completed the follow-up survey. OD and/or GD were observed in 83% and 89% of subjects, respectively. Resolution rates of OD and GD at 30 days from onset were 87% and 82%, respectively. Risk factors for late resolution were grade of dysfunction at onset (total vs partial), gender, and presence of nasal congestion. Three (2%) patients previously reporting complete resolution of symptoms complained of subsequent recurrence of OD and/or GD after a mean of 19 days from resolution of the previous episode.

Conclusion: COVID-19-related OD and GD had high rate of resolution in the first month from onset of symptoms. However, in 10% to 15% of patients, these symptoms showed only partial improvement after this period.

Keywords: COVID-19; SARS-CoV-2; gustatory dysfunction; olfactory dysfunction; recovery; smell; taste.

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9
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820937676. doi: 10.1177/0194599820937676. Online ahead of print.
In Vivo Accuracy of Ultrasound for Sizing Salivary Ductal Calculi
Christopher D Badger 1, Sahil Patel 1, Nahir J Romero 1, Andrew Fuson 1, Arjun S Joshi 1
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PMID: 32600219 DOI: 10.1177/0194599820937676
Abstract
Objectives: The present study was developed to evaluate the accuracy of in vivo ultrasound sizing for parotid and submandibular salivary gland calculi, as compared with ex vivo pathology sizing with a standard plastic ruler after extraction.

Study design: Retrospective chart review.

Setting: Ultrasound is frequently used to size salivary calculi and make treatment decisions, but the accuracy of measurements from this modality has not been validated.

Subjects and methods: We evaluated and reviewed the charts and ultrasound examinations of 167 patients who underwent procedures for the treatment of sialolithiasis involving the parotid and submandibular glands. US examinations were performed between 2009 and 2016 in a tertiary-level hospital setting by the senior author. Measurements were collected from ultrasound evaluation before sialolithotomy, and pathology measurements were taken after removal. Ultrasound measurements in millimeters were compared with the measurements collected with a ruler. The differences were calculated and compared.

Results: A total of 167 calculi measurements were compared. Good concurrent validity between pathology and ultrasound measurements was suggested by a Pearson correlation of 0.92 (95% CI, 0.887-0.937). On Bland-Altman plot, correlation of the difference between US and pathology measurements showed a mean difference of 0.095 mm (95% CI, -0.19 to 0.38 mm) with a limit of agreement ranging from -3.59 mm (95% CI, -3.84 to -3.34 mm) to +3.78 mm (95% CI, +3.53 to +4.03 mm).

Conclusions: Ultrasound is an accurate, relatively precise, and minimally invasive imaging tool for salivary gland sialolithiasis. Preoperative size of calculi can be used to guide management and clinical decision making.

Level of evidence: 2C.

Keywords: accuracy; salivary glands; sialolith; stones; ultrasound.

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10
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820938045. doi: 10.1177/0194599820938045. Online ahead of print.
Reverse-Surge Planning During the COVID-19 Pandemic: A Cautionary Ramp-up for the Otolaryngologist
Taha Z Shipchandler 1, B Ryan Nesemeier 1, Kaitlyn J Barnes 1, Leah R Kelly 1, Cecelia E Schmalbach 2, Jonathan Y Ting 1
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PMID: 32600099 DOI: 10.1177/0194599820938045
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This "reverse-surge" planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams.

Keywords: COVID-19; aerosol generating procedures; pandemic; personal protective equipment; reverse-surge; telehealth.

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11
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820932138. doi: 10.1177/0194599820932138. Online ahead of print.
Systematic Review of Outcomes After Cochlear Implantation in Children With X-Linked Deafness-2
Joshua D Smith 1, Nour El-Kashlan 2, Owen A F Darr 3, Marc C Thorne 1
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PMID: 32600118 DOI: 10.1177/0194599820932138
Abstract
Objective: Outcomes following cochlear implantation in children with X-linked deafness-2 are variable, resulting in challenges in appropriate preoperative counseling. To address this uncertainty, we performed a systematic review and synthesis of the literature on audiologic and speech outcomes after cochlear implantation in these patients to inform prognostic counseling.

Data sources: PubMed, Embase, and Cochrane Library were queried for articles published between January 2000 and July 2019.

Review methods: We performed a systematic review of all studies published between 2000 and 2019 that reported on (1) children with confirmed X-linked deafness-2 undergoing cochlear implantation and (2) formal assessment of hearing and/or speech capabilities postimplantation.

Results: Our initial database search yielded 313 articles. Fourteen articles met inclusion criteria. These studies reported on 61 children with X-linked deafness-2 who underwent implantation at a wide age range (1-29 years) for severe-profound sensorineural hearing loss of prelingual onset. The mean follow-up duration after implant activation was 32 months (range, 12-61). Outcome domains assessed at follow-up were heterogeneous, though each study employed at least 1 assessment of hearing (eg, pure tone audiometry), speech perception (eg, Early Speech Perception Test), or auditory perception (eg, Categories of Auditory Perception scores). In 10 of 14 studies, cochlear implantation afforded significant improvement in hearing and speech capabilities relative to preoperative performance or as compared with age-matched, normal-hearing controls.

Conclusion: The majority of studies demonstrate that cochlear implantation provides improvements in hearing and speech performance in patients with X-linked deafness-2. This information is valuable for decision making regarding cochlear implantation in these patients.

Keywords: DFNX2; X-linked deafness-2; cochlear implant; outcomes.

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12
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820933887. doi: 10.1177/0194599820933887. Online ahead of print.
Assessing the Educational Quality of Facebook Videos as an Informative Resource on Otitis Media
Chase I Kahn 1, Rita Wang 1, Kunal Shetty 1, Mikayla J Huestis 1, Michael B Cohen 2, Jessica R Levi 2
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PMID: 32600106 DOI: 10.1177/0194599820933887
Abstract
Objective: This study analyzes the quality and reliability of otitis media (OM) videos on Facebook and investigates whether the videos shared within the Facebook community are considered to be a valuable educational tool. The results of this study are important for providing clinicians with the necessary understanding about the video content that their patients may be exposed to.

Study design: Cross-sectional analysis of video content.

Setting: A new Facebook account was created to carry out a search for videos on OM.

Methods: Inclusion criteria were as follows: videos intended for educating patients or guardians on OM, videos in the English language, and videos with at least 1 share.

Results: A total of 364 videos were screened, and 62 fit our inclusion criteria for analysis. The majority (56%) of OM videos on Facebook focused on complementary and alternative medication without mentioning any current guidelines. A limited amount of videos (29%) made any mention to surgical treatment options for OM. There was a strong positive correlation (rho = 0.8419, P < .001) between a video's content and its reliability. There was no correlation seen between a video's content and its shares (rho = -0.142, P = .1359).

Conclusions: The majority of OM videos on Facebook are inadequate for educational value. Clinicians should know about the existence of videos on OM and the quality of information that parents are exposed to.

Keywords: acute otitis media; health services; otitis media/chronic otitis media/conductive hearing loss; pediatric otology; recurrent otitis media.

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13
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820934748. doi: 10.1177/0194599820934748. Online ahead of print.
Otopathologic Analysis of Patterns of Postmeningitis Labyrinthitis Ossificans
Danielle R Trakimas 1, Renata M Knoll 2, Melissa Castillo-Bustamante 2, Elliott D Kozin 2, Aaron K Remenschneider 2 3 4
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PMID: 32600100 DOI: 10.1177/0194599820934748
Abstract
Objective: Labyrinthitis ossificans (LO) may occur following meningitis and, in cases where cochlear implantation is indicated, complicate electrode insertion. LO is critical to identify for successful cochlear implantation, and histopathology is more sensitive than imaging for identification of LO. Herein we utilize otopathologic techniques to study the timing and location of intracochlear tissue formation following meningitic labyrinthitis (ML).

Study design: Retrospective review.

Setting: Academic institution.

Methods: Temporal bone specimens with a history of bacterial ML were histologically evaluated. The location and extent of intracochlear tissue formation within the scala tympani (ST) and scala vestibuli (SV) were graded, and spiral ganglion neurons were counted.

Results: Fifty-one temporal bones were identified: 32 with no intracochlear tissue formation, 9 with fibrosis alone, and 10 with LO. Fibrosis was identified as early as 1.5 weeks after ML, while ossification was found only in specimens that survived multiple years after ML. All LO cases showed ossification of the ST at the round window membrane (RWM) with continuous extension throughout the basal turn. Extent of SV ossification correlated with that in the ST but showed frequent isolated distal involvement of the cochlea. Spiral ganglion neuron counts were lower than those in age-matched controls.

Conclusion: In this human temporal bone study, we found that postmeningitic LO results in ossification at the RWM with continuous extension into the ST of the basal turn and variable involvement of the SV. Identification of a patent basal turn beyond RWM ossification of the ST should permit full electrode insertion.

Level of evidence: Retrospective review.

Keywords: labyrinthitis ossificans; meningitis; otopathology.

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14
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935395. doi: 10.1177/0194599820935395. Online ahead of print.
Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?
Jordan I Teitelbaum 1, Khalil Issa 1, Ian R Barak 2, Feras Y Ackall 1, Sin-Ho Jung 2, David W Jang 1, Ralph Abi Hachem 1
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PMID: 32600116 DOI: 10.1177/0194599820935395
Abstract
Objective: To determine whether treatment of sinonasal squamous cell carcinoma (SCC) at a high-volume facility affects survival.

Study design: Retrospective database analysis.

Setting: National Cancer Database (2004-2014).

Subjects and methods: The National Cancer Database was queried for sinonasal SCC from 2004 to 2014. Patient demographics, tumor characteristics and classification, resection margins, treatment regimen, and facility case-specific volume-averaged per year and grouped in tertiles as low (0%-33%), medium (34%-66%), and high (67%-100%)-were compared. Overall survival was compared with Cox proportional hazards regression analysis.

Results: A total of 3835 patients treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. Patients who underwent surgery with adjuvant RT had better overall survival (hazard ratio [HR], 0.74; P < .001; 95% CI, 0.63-0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. Univariate analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR, 0.77; P = .002). Multivariable Cox proportional hazards regression analysis, adjusting for age, sex, tumor classification, and treatment regimen, demonstrated that patients who underwent treatment at a high-volume facility (HR, 0.81; P < .001) had significantly improved survival.

Conclusion: This study shows a better overall survival for sinonasal SCC treated at high-volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.

Keywords: facility volume; oncologic outcome; sinonasal squamous cell carcinoma; sinonasal tumors; treatment center.

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15
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820933886. doi: 10.1177/0194599820933886. Online ahead of print.
Auditory Quality-of-Life Measures in Patients With Traumatic Brain Injury and Normal Pure Tone Audiometry
Renata M Knoll 1 2, Rory J Lubner 1 2, Jacob R Brodsky 2 3, Kevin Wong 4, David H Jung 1 2, Aaron K Remenschneider 1 2, Seth D Herman 5, Elliott D Kozin 1 2
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PMID: 32600124 DOI: 10.1177/0194599820933886
Abstract
Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range. Adult patients with normal auditory thresholds and a history of TBI were evaluated for subjective hearing loss, tinnitus, aural fullness, hyperacusis, and autophony. Hearing Handicap Inventory for Adults, Tinnitus Handicap Inventory, and Hyperacusis Questionnaire were administered. Thirty-one patients were prospectively recruited. Twenty-eight TBI participants (90%) reported ≥1 auditory symptoms at the time of survey intake. Mild to severe handicap in the Hearing Handicap Inventory for Adults and Tinnitus Handicap Inventory was reported in 71.4% and 40% of the participants with hearing loss and tinnitus, respectively. Hyperacusis handicap was considered significant in 41.1% of the participants who complained of hyperacusis and completed the survey. Despite normal hearing thresholds, individuals with TBI experience decrements in auditory quality-of-life metrics. Level of evidence: 3.

Keywords: auditory symptoms; head injury; traumatic brain injury.

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16
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820933882. doi: 10.1177/0194599820933882. Online ahead of print.
Subjective vs Computerized Assessment of Surgeon Skill Level During Mastoidectomy
Michaela F Close 1, Charmee H Mehta 1, Yuan Liu 1, Mitchell J Isaac 1, Mark S Costello 1, Kyle D Kulbarsh 1, Ted A Meyer 1
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PMID: 32600121 DOI: 10.1177/0194599820933882
Abstract
This pilot study examines the use of surgical instrument tracking and motion analysis in objectively measuring surgical performance. Accuracy of objective measures in distinguishing between surgeons of different levels was compared to that of subjective assessments. Twenty-four intraoperative video clips of mastoidectomies performed by junior residents (n = 12), senior residents (n = 8), and faculty (n = 4) were sent to otolaryngology programs via survey, yielding 708 subjective ratings of surgical experience level. Tracking software captured the total distance traveled by the drill, suction irrigator, and patient's head. Measurements were used to predict surgeon level of training, and accuracy was estimated via area under the curve (AUC) of receiver operating characteristic curves. Key objective metrics proved more accurate than subjective evaluations in determining both faculty vs resident level and senior vs junior resident level. The findings of this study suggest that objective analysis using computer software has the potential to improve the accuracy of surgical skill assessment.

Keywords: drill; mastoidectomy; resident education; skill assessment; surgical skill; video analysis.

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17
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820937675. doi: 10.1177/0194599820937675. Online ahead of print.
Thyroplasty Type III to Lower the Vocal Pitch in Trans Men
Charlotte Bultynck 1 2, Marjan Cosyns 3, Guy T'Sjoen 4 5, John Van Borsel 3, Katrien Bonte 2
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PMID: 32600117 DOI: 10.1177/0194599820937675
Abstract
About 20% of trans men do not achieve cisgender male frequencies (F0≤131 Hz) after gender-affirming hormone treatment (GAHT) with testosterone. The surgical procedure Isshiki thyroplasty type III (TPIII) is described to lower F0, but data on this technique in trans men are lacking. In this study, 8 trans men, unsatisfied with their voice after a minimum of 12 months of GAHT, underwent TPIII to lower F0 at the Department of Head and Neck Surgery at Ghent University Hospital. TPIII was performed by 1 surgeon using the same method each time. Pre- and postoperatively, an acoustic evaluation of the voice took place. The F0 dropped significantly from the preoperative mean of (154.60 ± 12.29) Hz to the postoperative mean of (105.37 ± 10.52) Hz (t = 9.821, P < .001). TPIII is an effective method for lowering the F0 in trans men who are not satisfied with their voice after long-term GAHT.

Keywords: fundamental frequency; thyroplasty; trans man; transgender; vocal surgery; voice.

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18
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935446. doi: 10.1177/0194599820935446. Online ahead of print.
Machine Learning Prediction of Extracapsular Extension in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma
Kyle M Hatten 1, Julian Amin 1, Amal Isaiah 1
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PMID: 32600154 DOI: 10.1177/0194599820935446
Abstract
Objective: To determine whether machine learning (ML) can predict the presence of extracapsular extension (ECE) prior to treatment, using common oncologic variables, in patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC).

Study design: Retrospective database review.

Setting: National Cancer Database study.

Methods: All patients with HPV-associated OPSCC treated surgically between January 1, 2010, and December 31, 2015, were selected from the National Cancer Database. Patients were excluded if surgical pathology reports did not include information regarding primary tumor stage, number of metastatic regional lymph nodes, size of largest metastatic regional lymph node, and tumor grade. The data were split into a random distribution of 80% for training and 20% for testing with ML methods.

Results: A total of 3753 adults with surgically treated HPV-associated OPSCC met criteria for inclusion in the study. Approximately 38% of these patients treated with surgical management demonstrated ECE. ML models demonstrated modest accuracy in predicting ECE, with the areas under the receiver operating characteristic curves ranging from 0.58 to 0.68. The conditional inference tree model (0.66) predicted the metastatic lymph node number to be the most important predictor of ECE.

Conclusion: Despite a large cohort and the use of ML algorithms, the power of clinical and oncologic variables to predict ECE in HPV-associated OPSCC remains limited.

Keywords: HPV-associated oropharyngeal squamous cell carcinoma; extracapsular extension; human papillomavirus; machine learning.

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19
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935859. doi: 10.1177/0194599820935859. Online ahead of print.
Telemedicine Algorithm for the Management of Dizzy Patients
Divya A Chari 1 2, Matthew J Wu 3, Matthew G Crowson 4, Elliott D Kozin 1 2, Steven D Rauch 1 2
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PMID: 32600170 DOI: 10.1177/0194599820935859
Abstract
As a result of the COVID-19 pandemic, telemedicine has been thrust to the forefront of health care. Despite its inherent limitations, telemedicine offers many advantages to both patient and physician as an alternative to in-person evaluation of select patients. In the near term, telemedicine allows nonpandemic care to proceed while observing appropriate public health concerns to minimize the spread of pandemic pathogens. Thus, it behooves practitioners to use telemedicine consultations for common otolaryngology complaints. Assessment of the dizzy patient is well-suited to an algorithmic approach that can be adapted to a telemedicine setting. As best practices for telemedicine have yet to be defined, we present herein a practical approach to the history and limited physical examination of the dizzy patient in the telemedicine setting for the general otolaryngologist. Indeed, once the acute crisis has abated, we suspect that this approach will continue to be an effective way to manage dizzy patients.

Keywords: dizziness; mobile health technology; telehealth; telemedicine; vertigo.

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20
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820935454. doi: 10.1177/0194599820935454. Online ahead of print.
Feasibility of In-office Fine-Needle Aspiration for Base of Tongue Tumors
Allison Reeder 1, Ricardo Aulet 2, Mirabelle Sajisevi 3, William Brundage 3
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PMID: 32600111 DOI: 10.1177/0194599820935454
Abstract
We aim to demonstrate the feasibility of in-office transcervical ultrasound (TCUS)-guided fine-needle aspiration (FNA) of base of tongue (BOT) tumors in a single-institution. Retrospective chart review was performed and 3 patients met criteria, with BOT tumors ≥3 cm . Two patients had no cervical adenopathy, while FNA of a cervical lymph node was inconclusive in patient 3. Two patients had multiple medical comorbidities rendering them high risk for general anesthesia, and 1 patient had a BOT tumor obscuring visualization of the glottis, which would have precluded intubation and potentially required tracheostomy to proceed. All patients underwent successful in-office TCUS-guided FNA, with results showing squamous cell carcinoma. There were no related complications. In-office TCUS-guided FNA can be used for diagnosis of BOT lesions that are evident on ultrasound. This is beneficial in cases where general anesthesia is considered high risk. Additionally, 1 patient safely continued anticoagulation, and another was able to avoid tracheostomy. This technique is cost-effective as it avoids the expenses associated with operative intervention.

Keywords: squamous cell carcinoma; tongue base cancer; ultrasound.

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21
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820938016. doi: 10.1177/0194599820938016. Online ahead of print.
Misconceptions About Negative Pressure Rooms and Their Impact Aboard USNS Comfort in New York City
Christopher J Hill 1, Gregory G Capra 1, Thomas P McDonald 1, Gabriel F Santiago 1, J Paul Radabaugh 1
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PMID: 32600101 DOI: 10.1177/0194599820938016
Abstract
The outbreak of novel coronavirus disease 2019 (COVID-19) has had a momentous impact on the field of otolaryngology due to the high number of aerosol-generating procedures involving the upper aerodigestive tract. These procedures bear significant risk to the provider and clinical environment due to the possibility of viral aerosolization. While significant attention has been appropriately paid to personal protective equipment during this pandemic, an understanding of industrial hygiene is also necessary for the safe delivery of health care to mitigate the risk of exposure to other patients and health care workers. We provide a review of air ventilation practices and their role in reducing pathogen spread. In addition, we share our experiences with effectively treating COVID-19-positive patients aboard the USNS Comfort through proper environment control measures.

Keywords: COVID-19; SARS CoV-2; aerosol-generating procedure; air changes per hour; air handling; environmental control; environmental safety; high-risk aerosol; industrial hygiene; negative pressure room; otolaryngology; respiratory protection.

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22
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820940654. doi: 10.1177/0194599820940654. Online ahead of print.
Reply to the Letter to the Editor, "Tracheostomy in the COVID-19 Era: The Apneic Approach"
Juan Riestra-Ayora, Joaquin Yanes-Diaz, Eduardo Martin-Sanz
PMID: 32600096 DOI: 10.1177/0194599820940654
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23
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820939072. doi: 10.1177/0194599820939072. Online ahead of print.
Should Gender-Affirming Surgery Be Prioritized During the COVID-19 Pandemic?
Anna J Flaherty 1, Arun Sharma 1, Dana L Crosby 1, Michael J Nuara 2
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PMID: 32600129 DOI: 10.1177/0194599820939072
Abstract
No abstract available
Keywords: COVID-19; SARS-CoV-2; coronavirus; ethics; facial feminization surgery; facial plastic and reconstructive surgery; gender-affirming care; intersectionality; otorhinolaryngology; transgender; transgender surgery.

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24
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820940652. doi: 10.1177/0194599820940652. Online ahead of print.
Tracheostomy in the COVID-19 Era: The Apneic Approach
Georgios Papathanakos, Ioannis Andrianopoulos, Xanthi Zikou, Athanasios Papathanasiou, Vasilios Koulouras
PMID: 32600179 DOI: 10.1177/0194599820940652
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25
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820940655. doi: 10.1177/0194599820940655. Online ahead of print.
Early Data From Case Series of Tracheostomy in Patients With SARS-CoV-2
Elizabeth Floyd 1, Scott S Harris 1, Jessica W Lim 2, David R Edelstein 2, Briana Filangeri 1, Margherita Bruni 1
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PMID: 32600107 DOI: 10.1177/0194599820940655
Abstract
Thirty-eight tracheostomies were performed on patients with respiratory failure secondary to SARS-CoV-2 infection over the month of April at North Shore University Hospital and Lenox Hill Hospital (members of Northwell Health System in Long Island and New York City). Follow-up by May 14 revealed that 21 (55.2%) had been weaned from ventilators and 7 (18.4%) underwent decannulation. Two patients (5.3%) expired in the weeks following tracheostomy. Between the 2 institutions, 10 attending surgeons performed all of the tracheostomies using appropriate personal protective equipment, and none demonstrated seroconversion within 1 to 2 weeks of this article.

Keywords: COVID-19; SARS-CoV-2; novel coronavirus; respiratory failure; tracheostomy.

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26
Otolaryngol Head Neck Surg
. 2020 Jun 30;194599820933866. doi: 10.1177/0194599820933866. Online ahead of print.
Labyrinthitis Ossificans and Cholesteatoma Associated With Gardner Syndrome: A Rare Case
James Sullivan 1, Luke W Edelmayer 2, Nazanin Dadfar 3, Mohammad Seyyedi 2
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PMID: 32600114 DOI: 10.1177/0194599820933866
Abstract
No abstract available
Keywords: Gardner syndrome; cholesteatoma; labyrinthitis ossificans; osteoma.

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