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Objectives: To determine the proportion of otolaryngologists with work‐related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD. Study Design: Systematic review and meta‐analysis. Methods: A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta‐analysis. Random effects meta‐analyses were used to estimate the proportion of otolaryngologists reporting WRMD. Results: The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%–84% of otolaryngologists underwent medical treatment for WRMD. 5%–23% took time off work and 1%–6% stopped operating completely as a result of WRMD. 23%–62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk. Conclusions: Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467–475, 2023 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: In otolaryngology, γ‐aminobutyric acid (GABA) analogues have been previously analyzed for their roles in neuropathic pain, chronic cough, tinnitus, and perioperative analgesia. The primary aim of this study is to comprehensively summarize and synthesize the existing evidence for lesser known uses of gabapentin and pregabalin in otolaryngology. Study Design: A scoping review conducted of the available English‐language literature was performed by two authors through April 1, 2021. Methods: The Preferred Reporting Items for Systematic Review and Meta‐Analysis criteria were followed, and a quality assessment of included studies was performed using the Methodological Index for Non‐Randomized Studies. Results: Ten studies met inclusion criteria. Three studies found that gabapentin may reduce gastrostomy tube usage and improve swallowing function in head and neck cancer patients undergoing radiation therapy (RT). Three studies suggested that gabapentin may help reduce opiate use when used as a primary analgesic in patients with radiation‐induced mucositis. One study demonstrated that pregabalin‐reduced trismus severity in patients with radiotherapy‐induced trismus. One study demonstrated gabapentin may be useful in patients with phonasthenia. Two studies demonstrated that GABA analogues may be a useful adjunct in patients with globus pharyngeus in the context of likely laryngeal sensory neuropathy. Conclusions: The most promising potential uses for GABA analogues identified in this review are for improving swallowing, trismus, and narcotic overuse after RT. The benefit of GABA analogues for improving nonorganic voice disorders is also promising while the benefit for globus pharyngeus when possibly related to laryngeal sensory neuropathy is inconclusive. Laryngoscope, 132:954–964, 2022 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: To assess for semantic differences regarding the definition of dizziness among otolaryngology patients, otolaryngologists, and non‐otolaryngologist providers. Study Design: Cross‐sectional survey. Methods: Between March and May 2020, a survey consisting of 20 common descriptors for dizziness within five domains (lightheadedness, motion sensitivity, imbalance, vision complaints, and pain) was completed by patients at two outpatient otolaryngology clinics. Surveys were subsequently obtained from otolaryngology and non‐otolaryngology providers attending a multidisciplinary dizziness lecture. The primary outcome measure was to assess for differences in definition of dizziness between patients and providers. Secondary outcome measures included assessing differences between otolaryngologists and non‐otolaryngologists. Results: About 221 patients and 100 providers participated. Patients selected a median of 7 terms compared to 8 for providers (P =.375), although providers had a larger overall distribution of number of terms selected (P =.038). Patients were more likely than providers to define dizziness according to the following domains: lightheadedness (difference 15.0%; 95% confidence interval [CI] 5.5%–25.3%), vision complaints (difference 21.6%, 95% CI 12.0%–29.6%), and pain (difference 11.5%, 95% CI 4.7%–17.1%). Providers were more likely to define dizziness according to the motion sensitivity domain (difference 13.8%, 95% CI 6.8%–19.6%). Otolaryngology and non‐otolaryngology providers defined dizziness similarly across symptom domains. Conclusion: Although patients and providers both view dizziness as imbalance, patients more commonly describe dizziness in the context of lightheadedness, vision complaints, and pain, whereas providers more frequently define dizziness according to motion sensitivity. These semantic differences create an additional barrier to effective patient‐provider communication. Level of Evidence: 4. Laryngoscope, 131:E1443–E1449, 2021 [ABSTRACT FROM AUTHOR]

Objective: Rigid endoscopes can improve visualization of the tympanic space compared to traditional microscopic techniques. This study investigates whether use of transcanal endoscopic ossiculoplasty influences audiologic outcomes compared to microscopic ossiculoplasty following chronic ear surgery in children. Study Design: Comparative cohort study at two tertiary care centers. Methods: Retrospective review of pediatric chronic ear cases where ossiculoplasty was performed from February 2009 to March 2018. Results: We identified 100 ears that underwent endoscopic ossiculoplasty and 100 ears that underwent microscopic ossiculoplasty. The mean age was 11 years (range, 4–18 years) with 63% males. There were no significant differences in these parameters between the two groups. Subjects underwent either primary ossiculoplasty or ossiculoplasty during second‐look procedures. There was no significant difference in air conduction pure tone average (PTA) after microscopic cases compared to endoscopic cases (−12.5 dB vs. −10.5 dB, P =.40). These results were independent of prosthesis type. Microscopic ossiculoplasty was significantly more likely to use a post‐auricular approach (P =.0001). There was no difference in complication rate between the two groups. The malleus was more likely to be absent or removed prior to endoscopic ossiculoplasty (P =.0004) with no significant difference in the change in PTA between groups. Conclusions: Transcanal endoscopic ossiculoplasty was found to have equivalent audiometric outcomes with significantly fewer post‐auricular approaches and no increase in complications compared to microscopic ossiculoplasty. While the malleus was more likely to be absent in endoscopic cases, this did not appear to influence the change in PTA. Level of Evidence: 4 Laryngoscope, 2020 [ABSTRACT FROM AUTHOR]

Patients who had a history of prior stapes surgery who underwent totally endoscopic revision stapes surgery were included in the study (three patients from each institution). One patient had a history of three prior stapes surgeries of the ipsilateral ear, whereas the remaining patients had a history of a single prior stapes surgery. Four (66.7%) patients underwent laser stapedotomy; one patient underwent laser stapedectomy; and one patient required an oval window drill-out due to extensive oval window involvement of otosclerosis. (C) Prosthesis displacement (removed) with prolapsed facial nerve (white arrow) and prominent bony overhang (black arrow), which was drilled to allow for prosthesis placement during revision surgery (patient 3). [Extracted from the article]

View Video S1Laryngoscope, 2020 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Malpractice claims pertaining to laryngology procedures are a potentially important source of information that could be used to minimize the risk of future litigation and improve patient care.Study Design: A retrospective review of two publicly available databases containing jury verdicts and settlements.Methods: The LexisNexis Jury Verdicts and Settlements and WestlawNext legal databases were reviewed for all lawsuits and out-of-court adjudications related to the practice of laryngology. Data including patient demographics, type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed.Results: Of 87 cases meeting inclusion criteria, 56 were decided by a jury and 31 were adjudicated out of court. Vocal cord surgery was the most commonly litigated surgery. The two most commonly cited legal allegations were physical injury and negligence. No statistical difference for legal outcome was found when death or vocal cord injuries occurred. Complications in procedures that utilized a laser predicted an unfavorable outcome (P = 0.013). A payout was made in over one-half of cases, but defendants were favored in over two-thirds of cases decided by a jury. The average indemnities were significant for both jury verdicts ($4.6 million) and out-of-court settlements ($0.9 million).Conclusion: An awareness of laryngology malpractice litigation has the potential to provide better patient care and help laryngologists avoid potential risks for litigation. The factors determining legal responsibility in laryngology cases underscore the importance of close communication with anesthesiologists and careful evaluation of hoarseness in all patients regardless of risk factors.Level Of Evidence: N/A. Laryngoscope, 126:2301-2304, 2016. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The primary objective was to determine if sleep study variables (e.g., apnea-hypopnea index [AHI] and lowest oxygen saturation) and quantitative sleepiness data improve following isolated hyoid surgery for obstructive sleep apnea (OSA).Study Design: Systematic review and meta-analysis.Methods: Nine databases, including PubMed, were searched through September 5, 2015.Results: Four hundred ninety-eight studies were screened, 64 were reviewed, and nine studies met inclusion criteria. A total of 101 patients were identified who underwent hyoid surgery alone for treatment of OSA. Subanalyses were performed for: 1) type of surgery, 2) primary versus secondary hyoid surgery, 3) positional versus nonpositional OSA, 4) age, and 5) body mass index. In patients undergoing isolated hyoid surgery, the AHI decreased from a mean ± standard deviation of 37.3 ± 21.1 (95% confidence interval [CI]: 33.1, 41.5) to 23.0 ± 18.6 (95% CI: 19.3, 26.7) events/hour, which correspond to a 38.3% reduction (P < .0001). AHI reduced by 38.3% for hyoid myotomy with suspension, by 50.7% for hyothyroidopexy, and by 7.1% for hyoid expansion. The Epworth Sleepiness Scale decreased by 3.2 points from 10.3 ± 4.9 (95% CI: 8.8, 11.8) to 7.1 ± 4.2 (95% CI: 5.8, 8.4; P = .0027).Conclusions: Isolated hyoid surgery has reduced OSA severity and improved sleepiness in adults. Hyothyroidopexy provided a 50.7% reduction in AHI, followed by hyoid myotomy with suspension (38.3% reduction in AHI) and hyoid expansion (7.1% reduction in AHI). The current literature lacks high-quality evidence with regard to hyoid surgery, and additional studies are needed to further elucidate the effect of hyoid surgery in OSA.Level Of Evidence: NA Laryngoscope, 126:1702-1708, 2016. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Malpractice claims pertaining to rhinological procedures are a potentially important source of information that could be used to minimize the risk of future litigation and improve patient care.Study Design: A retrospective review of a publicly available database containing jury verdicts and settlements.Methods: The LexisNexis Jury Verdicts and Settlements database was reviewed for all lawsuits and out-of-court adjudications related to the practice of rhinology. Data including patient demographics, type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed.Results: Of 85 cases meeting inclusion criteria, 42 were decided by a jury and 43 were adjudicated out of court. Endoscopic sinus surgery was the most commonly litigated surgery. The plaintiff was favored when the eye was injured (P = 0.0196), but the defendant was favored when neuropsychological injuries (P = 0.0137) or recurrent/worsened symptoms (P = 0.0050) were cited. No difference was found when death or skull base injuries occurred. When lack of informed consent was an allegation, the defendant was favored (P = 0.0001). A payout was made in two-thirds of cases overall, but the defendant was favored in two-thirds of cases decided by a jury. Payments were significant for both out-of-court settlements ($1.3 million) and jury verdicts ($2 million).Conclusions: Endoscopic sinus surgery remains the most commonly litigated rhinology procedure and has the potential to result in large payouts. Meticulous dissection, recognition of complications, and documentation of informed consent remain paramount for providing optimal patient care. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To describe and analyze the causes and outcomes of lawsuits pertaining to sleep surgery to mitigate future litigation and improve physician education. Study Design A retrospective review of a publicly available database containing jury verdicts and settlements. Methods The LexisNexis MEGA Jury Verdicts and Settlements database was reviewed for all lawsuits including settlements and trial verdicts related to sleep surgery. Data including type of surgery performed, plaintiff allegation, nature of injury, outcomes, and indemnities were collected and analyzed. Results Fifty-one cases met the inclusion criteria. Of these, 30 were decided by a jury, nine were settled out of court, and 10 were resolved by other means. Overall, 57% of known outcomes favored the defendant. The most common surgery performed was tonsillectomy (57%), followed by uvulopalatopharyngoplasty (45%), adenoidectomy (31%), and septoplasty (31%). No difference was found between outcomes when comparing the most common injuries cited, including wrongful death ( P = .572), airway compromise ( P = .376), and drug reaction ( P = .443). If failure to recognize a complication ( P = .034) or delay in diagnosis ( P = .026) was a component of the legal allegations, the outcome significantly favored the plaintiff. The median settlement ($545,000) and plaintiff award ($1.45 million) were not significantly different ( P = .13). Conclusions The majority of outcomes favored the defendant. Type of injury did not predict outcome. Failure to recognize complications and delay in diagnosis strongly predicted a verdict in favor of the plaintiff. Level of Evidence 2c Laryngoscope, 124:E250-E254, 2014 [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article related to hyoid surgery for obstructive sleep apnea.