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Background: There is increasing focus on the development of high‐quality simulation models for medical education. Cadaveric models, although considered more realistic, may be difficult to obtain and costly. The advent of three‐dimensional (3D) printing has offered a low‐cost, reliable, and reproducible alternative. This study sought to compare the utility of 3D‐printed to cadaveric models for training in transcutaneous injection laryngoplasty (TIL). Methods: A simulation course with a cross‐over design was employed. Video laryngoscopes were utilized for both the 3D and cadaveric models to assess the accuracy of injection into the vocal fold. Pre‐procedure and post‐procedure surveys were administered to evaluate understanding and comfort level on a Likert scale of 1–10. Each model was also rated on a 1–5 Likert scale for self‐efficacy, fidelity, and educational value. Results: Pre‐ and post‐survey data were completed by 15 otolaryngology residents and medical students. Mean pre‐seminar understanding and comfort level were 3.7 and 2.2, respectively, compared to 6.9 and 5.9 (p <.05) following use of the 3D model and 6.4 and 4.7 (p <.05) following use of the cadaver model. When comparing 3D and cadaveric models, no significant differences were observed regarding self‐efficacy, fidelity, and educational value. Conclusion: There was a similar mean increase in understanding and comfort following use of the 3D and cadaveric models. 3D‐printing can provide an excellent adjunct to, and eventually a potential replacement for hands‐on cadaveric training in medical education, particularly for TIL. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Objectives: Patients undergoing head and neck free flap reconstruction (HNFFR) may have significant change to their baseline functional status requiring inpatient rehabilitation (IPR) after discharge. We sought to identify patient/procedure characteristics predictive of discharge destination. Methods: Patients undergoing elective HNFFR between July 2017 and July 2022 were reviewed for discharge destination. Those discharged to IPR versus home were compared across patient/procedure characteristics and physical/occupational therapy metrics. Significance was assessed via bivariate and multivariable analyses. Results: Of the 531 patients, 102 (19.2%) required IPR postoperatively. Patients discharged to IPR versus home were significantly older (70.1 [11.6] vs. 64.1 [13.1] years; p < 0.001) and more likely to lack family assistance (26.5% vs. 8.6%; p < 0.001), require baseline assistance for activities of daily living (ADLs) (31.4% vs. 9.8%; p < 0.001), have baseline cognitive dysfunction (15.7% vs. 6.1%; p = 0.001), were more likely to have neoplasm as the surgical indication for HNFFR (89.2% vs. 80.0%; p = 0.033) and more likely to have a tracheostomy postop (62.7% vs. 51.7%), and had a significantly longer length of stay (11.2 [8.0] vs. 6.8 [8.3] days; p < 0.001). There was no significant difference in gender, donor site, use of tube feeds, and use of assistive devices between the two groups. Following logistic regression, the strongest predictors of discharge to IPR include lack of family assistance (OR = 3.8; p < 0.001) and baseline assistance for ADLs (OR = 4.0, p < 0.001). Conclusion: Certain patient factors predict the need for discharge to rehab after HNFFR. Perioperative identification of these factors may facilitate patient counseling and discharge planning with potential to reduce hospital length of stay and further optimize patient care. Level of Evidence: III Laryngoscope, 134:2721–2725, 2024 [ABSTRACT FROM AUTHOR]

Keywords: allergic rhinitis; chronic rhinosinusitis; computed tomography; imaging; rhinitis; sinus anatomy EN allergic rhinitis chronic rhinosinusitis computed tomography imaging rhinitis sinus anatomy 942 945 4 04/25/23 20230501 NES 230501 INTRODUCTION Chronic rhinitis affects up to 33 million adults in the United States.[1] One proposed explanation for rhinitis symptoms is nasal parasympathetic overactivity via the Vidian nerve, particularly in cases of vasomotor rhinitis (VMR). All rhinitis patients (vasomotor or mixed) over the age of 18 years who received in-office PNN ablation and had sinus computed tomography (CT) scans to rule out sinus disease in 2021 were included. CONCLUSION This study shows that the diameter of the Vidian canal at PPF entry may contribute to rhinitis pathogenesis and that CT imaging could potentially be helpful for diagnosis. [Extracted from the article]

Chronic rhinitis, cryotherapy, middle turbinate nonallergic rhinitis, radiofrequency therapy, vasomotor rhinitis Keywords: chronic rhinitis; cryotherapy; middle turbinate nonallergic rhinitis; radiofrequency therapy; vasomotor rhinitis EN chronic rhinitis cryotherapy middle turbinate nonallergic rhinitis radiofrequency therapy vasomotor rhinitis 88 91 4 01/06/23 20230101 NES 230101 INTRODUCTION Chronic rhinitis (CR) affects up to 30% of the US adult population.[1] Approximately 10%-20% of patients fail to respond to medical therapies and can benefit from alternative treatment options. Two fellowship-trained rhinologists randomly selected and performed all procedures; three to five treatments on each side with radiofrequency therapy and two treatments with cryotherapy. [Extracted from the article]

Background: The treatment of facial nerve synkinesis remains complex and variable. Objective: To compare oral, palpebral fissure, and brow symmetry among surgical and nonsurgical interventions in patients with facial synkinesis. Methods: Patients with facial nerve synkinesis at a single tertiary care center between 2008 and 2022 were analyzed before and after interventions using Emotrics software. Symmetry was compared among treatment combination groups (chemodenervation and rehabilitation [CR] vs. chemodenervation and surgery [CS] vs. chemodenervation, surgery, and rehabilitation [CSR]) and among surgical intervention groups (selective neurectomy [SN] vs. selective neurectomy with facelift [SnFa] vs. no surgery). Results: Of the 29 patients meeting inclusion criteria, 72.4% were female and the median age was 60.6 years (interquartile range 49.9-67.6). The median follow-up was 32.6 months; patients who received surgery had a greater follow-up time (57.4 months vs. 26.5 months, p  = 0.045). The use of a trimodal approach (CSR) was associated with improved symmetry versus CR for smile angle ( p  = 0.021). Among surgical interventions, the greatest improvement in palpebral fissure symmetry was in patients who received SN versus no surgery ( p  = 0.039); the greatest improvement in smile angle was in patients who received SnFa versus no surgery ( p  = 0.008). Conclusion: We recommend a comprehensive approach to the management of facial synkinesis consisting of chemodenervation, rehabilitation, and surgery tailored to each patient's needs.

Study Objectives: Upper airway stimulation (UAS) is a hybrid surgical-medical device used to treat moderate-to-severe obstructive sleep apnea (OSA). Comorbid insomnia and OSA (COMISA) is present in ∼50% of these patients. Our aim was to study UAS outcomes and adherence in patients with COMISA., Methods: A retrospective review of 379 patients with OSA who underwent UAS implantation at a single institution between 2014 and 2021. Demographics, OSA severity metrics, and insomnia data were collected. Patients were categorized into OSA alone (OSAa) or COMISA. Objective adherence data were collected from device downloads during follow-up. Data were analyzed with using R Studio (R Foundation for Statistical Computing, Vienna, Austria) and Prism (Boston, MA, USA)., Results: Of the 274 patients included, 148 had COMISA (54.0%) and 126 OSAa (46.0%). Average follow-up time was 2.5 years and OSAa had more males than COMISA ( P < .001). Patients with COMISA had higher insomnia severity index scores than OSAa preoperatively (16 vs 8.7; P = .003). All groups showed significant decreases in objective and self-reported OSA outcomes postoperatively, but there was no difference between COMISA and OSAa. Patient with COMISA had decreased device usage (4.9 vs 5.8 h/night; P = .015) and paused therapy more often than patients with OSAa (1.4 vs 0.4 pauses/night; P < .001). Multivariate linear regression, when controlling for sex as a covariate, showed insomnia to be an independent predictor of lower UAS hours/night and more pauses/night ( P < .01)., Conclusions: Patients with COMISA use UAS therapy for shorter durations and require more breaks from therapy when compared with those with OSAa. Future research is needed to explore the underlying mechanism and improve UAS treatment adherence in patients with COMISA., Citation: Kaffenberger TM, Chandna M, Kaki P, et al. Reduced usage of upper airway stimulation therapy in patients with comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med . 2023;19(12):1997-2004., (© 2023 American Academy of Sleep Medicine.)