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Objectives: With widespread vaccination against COVID‐19, concerns regarding side effects have been raised. We aim to assess the frequency of otolaryngologic adverse events (AEs) following COVID‐19 vaccination as compared with other vaccines in a national database. Study Design: Retrospective analysis of national registry. Methods: The Food and Drug Administration's Vaccine Adverse Event Reporting System (VAERS) database was queried from December 2020 to May 2021 for all COVID‐19 vaccination AEs. Complaints were categorized as otolaryngologic and sub stratified into different anatomic components. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were determined for AEs of clinical significance. Results: The total number of AEs reported from vaccination with the Moderna, Pfizer‐BioNTech, and Janssen vaccines equaled 1,280,950. Of these, 62,660 (4.9%) were otolaryngologic in nature, with 32.6% associated with the oropharynx/larynx, 18.3% with the nasal cavity/sinuses, 17.1% with the ears/vestibular system, 10.0% with the oral cavity, and 21.9% miscellaneous. Signal ratios reached significance levels for dysgeusia (n = 2124, PRR: 17.33, ROR: 16.36), ageusia (n = 1376, PRR: 2.81, ROR: 2.81), anosmia (n = 983, PRR: 4.01, ROR: 4.01), rhinorrhea (n = 2203, PRR: 2.99, ROR: 3.00), throat tightness (n = 3666, PRR: 4.99, ROR: 5.00), throat irritation (n = 3313, PRR: 4.51, ROR: 4.52), dysphagia (n = 2538, PRR: 2.07, ROR: 2.07), tinnitus (n = 4377, PRR: 3.97, ROR: 3.98), and vertigo (n = 2887, PRR: 3.93, ROR: 3.93). Signal ratios were not significant for facial paralysis, Bell's palsy, anaphylaxis, sinusitis, hearing disability, and ear pain. Conclusions: Although several otolaryngologic symptoms were reported, few were found to be clinically significant. Of note, facial paralysis, Bell's palsy, and anaphylaxis did not meet signal thresholds to be determined significant. Level of Evidence: 4 Laryngoscope, 134:1163–1168, 2024 [ABSTRACT FROM AUTHOR]

Objective The Model for End-stage Liver Disease-Sodium (MELD-Na) score was designed for prognosis of chronic liver disease and has been predictive of outcomes in a variety of procedures. Few studies have investigated its utility in otolaryngology. This study uses the MELD-Na score to investigate the association between liver health and ventral skull base surgical complications. Methods The National Surgical Quality Improvement Program database was used to identify patients who underwent ventral skull base procedures between 2005 and 2015. Univariate and multivariate analyses were performed to investigate the association between elevated MELD-Na score and postoperative complications. Results We identified 1,077 patients undergoing ventral skull base surgery with laboratory values required to calculate the MELD-Na score. The mean age was 54.2 years. The mean MELD-Na score was 7.70 (standard deviation = 2.04). Univariate analysis showed that elevated MELD-Na score was significantly associated with increased age (58.6 vs 53.8 years) and male gender (70.8 vs 46.1%). Elevated MELD-Na score was associated with increased rates of postoperative acute renal failure, transfusion, septic shock, surgical complications, and extended length of hospital stay. On multivariate analysis, associations between elevated MELD-Na and increased risk of perioperative transfusions (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.20–2.93; p = 0.007) and surgical complications (OR, 1.58; 95% CI, 1.25–2.35; p = 0.009) remained significant. Conclusions This analysis points to an association between liver health and postoperative complications in ventral skull base surgery. Future research investigating this association is warranted. [ABSTRACT FROM AUTHOR]

Background: Preoperative laboratory tests (PLTs) are often obtained prior to outpatient surgical procedures. The objective of this study is to examine the current practice of routine PLT in low-risk patients undergoing ambulatory endoscopic sinonasal surgery (ESS) and to assess whether such testing impacts surgical outcomes. Methods: Patients undergoing ambulatory ESS were identified from the 2011 to 2018 NSQIP database. Low-risk patients were defined as American Society of Anesthesiologist class 1 or 2. PLTs were grouped into hematologic, chemistry, coagulation, and liver function tests. Chi-square analyses and independent samples t -tests were conducted to compare categoric and continuous variables, respectively. Results: A total of 664 cases met the inclusion criteria, of which 419 (62.1%) underwent at least one PLT. Of these, the most frequent PLT obtained was a complete blood cell count (92.4%). Major complications occurred in 1.5% of patients. There were no statistically significant differences in overall postoperative complications between those with and without PLT (P =.264). Specifically, no significant difference was seen in the incidence of postoperative bleeding (P =.184), urinary tract infection (P =.444), pulmonary embolism (P =.444), or wound infection (P =.701). On multivariable analyses, PLT status was not significantly associated with any complication (P =.097) or unplanned readmission (P =.898). Conclusions: Our analysis did not reveal an association between the use of PLT and postoperative morbidity or unplanned readmission in low-risk patients undergoing outpatient ESS. [ABSTRACT FROM AUTHOR]

Objectives: Surgical repair of nasal septal perforations (NSPs) is technically challenging. Advantages associated with endoscopic NSP repair (ENSPR) include enhanced visualization and its minimally invasive nature. Purely endoscopic techniques have successful outcomes with low morbidity. This study provides a review of clinical features, surgical techniques, and outcomes in patients who underwent ENSPR. Methods: A systematic review was conducted using PubMed/MEDLINE, Cochrane library, and Embase databases. Manual bibliography search produced additional articles. Studies reporting purely endoscopic approaches for NSP repair were included. Patient demographics, NSP size, etiology, repair strategy, incidence of closure, and follow-up were analyzed. Results: A total of 329 cases from 20 studies were included. The mean age was 37.2 years (range, 12.3-51 years) and 55.0% were male. Common etiologies were iatrogenic (n = 180, 60.0%), trauma (n = 66, 22.0%), and idiopathic (n = 36, 12.0%). The mean NSP size was 17.1 mm (range, 4-23). Repair techniques included unilateral random pattern flaps (n = 205, 62.3%), interposition grafts (n = 137, 41.6%), and unilateral axial pedicled local flaps (n = 81, 24.6%). 222 patients (67.5%) underwent a 2-layered repair, while 70 (21.3%) and 37 (11.2%) patients underwent single and 3-layered repairs, respectively. Successful closure was achieved in 296 patients (90.0%). When stratified by layers of repair, 65 single-layered (92.9%), 196 2-layered (88.3%), and 34 3-layered repairs (91.9%) were successful at a mean follow-up of 16.3 months (range, 3-31 months). Conclusions: ENSPR generally achieves NSP closure with high rates of success among varying types of repairs. Further studies may determine how clinical factors and surgical methods impact the likelihood of obtaining successful closure. [ABSTRACT FROM AUTHOR]

Background: Our study investigates the prognostic significance of spindle cell histology on overall survival (OS) of conventional head and neck squamous cell carcinoma (HNSCC). Methods: The 2004 to 2017 National Cancer Database was queried for patients with head and neck spindle cell carcinoma (HNSpCC) (n = 1572) or HNSCC (n = 242 697) of the oral cavity, major salivary glands, sinonasal tract, oropharynx, hypopharynx, and larynx treated with curative intent. Results: Patients with HNSpCC presented more frequently with higher‐grade tumors and cN0 disease than those with HNSCC (p < 0.001). In the oral cavity, the HR for death for SpCC compared with SCC was 1.33 (p < 0.001). In the oropharynx, the HR for death for SpCC compared with SCC was 1.47 (p = 0.028). Conclusions: After adjusting for patient, tumor, and treatment characteristics, SpCC histology had an independent adverse prognostic effect on OS in the oral cavity and oropharynx. SpCC histology does not necessarily portend poorer survival in all HNSCC. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with hospital safety net burden and its impact on survival for patients with sinonasal squamous cell carcinoma (SNSCC). Study Design: Retrospective database study. Setting: National Cancer Database from 2004 to 2016. Methods: SNSCC cases were identified in the National Cancer Database. Hospital safety net burden was defined by percentage of uninsured/Medicaid patients treated, namely ≤25% for low‐burden hospitals, 26% to 75% for medium‐burden hospitals, and >75% for high‐burden hospitals (HBHs). Univariate and multivariate analyses were used to investigate patient demographics, clinical characteristics, and overall survival. Results: An overall 6556 SNSCC cases were identified, with 1807 (27.6%) patients treated at low‐burden hospitals, 3314 (50.5%) at medium‐burden hospitals, and 1435 (21.9%) at HBHs. On multivariate analysis, Black race (odds ratio [OR], 1.39; 95% CI, 1.028‐1.868), maxillary sinus primary site (OR, 1.31; 95% CI, 1.036‐1.643), treatment at an academic/research program (OR, 20.63; 95% CI, 8.868‐47.980), and treatment at a higher‐volume facility (P <.001) resulted in increased odds of being treated at HBHs. Patients with grade III/IV tumor (OR, 0.70; 95% CI, 0.513‐0.949), higher income (P <.05), or treatment modalities other than surgery alone (P <.05) had lower odds. Survival analysis showed that hospital safety net burden status was not significantly associated with overall survival (log‐rank P =.727). Conclusion: In patients with SNSCC, certain clinicopathologic factors, including Black race, lower income, treatment at an academic/research program, and treatment at facilities in the West region, were associated with treatment at HBHs. Hospital safety net burden status was not associated with differences in overall survival. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). Study Design: Retrospective database review. Setting: National Inpatient Sample database (2003‐2011). Methods: The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in‐hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. Results: An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5‐3.7]; P <.001) and mortality (OR, 30.1 [95% CI, 18.5‐48.8]; P <.001) with a PSI. The incidence rates of PSIs at low‐, intermediate‐, and high‐volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low‐volume facilities (OR, 3.3 [95% CI, 2.4‐4.4]; P <.001) vs intermediate (OR, 3.1 [95% CI, 2.1‐4.2]; P <.001) and high (OR, 2.5 [95% CI, 1.7‐3.8]; P <.001). Odds of mortality with PSIs were greater at high‐volume facilities (OR, 43.0 [95% CI, 14.3‐129.4]; P <.001) vs intermediate (OR, 40.0 [95% CI, 18.5‐86.4]; P <.001) and low (OR, 17.3 [95% CI, 8.0‐37.7]; P <.001). Conclusion: PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher‐volume facilities. [ABSTRACT FROM AUTHOR]

Background: Although recent studies have identified an association between race and adverse outcomes in head and neck surgeries, there are limited data examining the impact of racial disparities on adult inpatient outcomes following epistaxis management procedures. Objective: To analyze the association between race and adverse outcomes in hospitalized patients undergoing epistaxis treatment. Methods: This retrospective cohort analysis utilized the 2003 to 2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify cases with a primary diagnosis of epistaxis that underwent a procedure for epistaxis control. Cases with missing data were excluded. Higher total charges and prolonged length of stay (LOS) were indicated by values greater than the 75th percentile. Demographics, hospital characteristics, Elixhauser comorbidity score, and complications were compared among race cohorts using univariate chi-square analysis and one-way analysis of variance (ANOVA). The independent effect of race on adverse outcomes was analyzed using multivariate binary logistic regression while adjusting for the aforementioned variables. Results: Of the 83 356 cases of epistaxis included, 80.3% were White, 12.5% Black, and 7.2% Hispanic. Black patients had increased odds of urinary/renal complications (odds ratio [OR] 2.148, 95% confidence interval [CI] 1.797-2.569, P <.001) compared to White patients. Additionally, Black patients experienced higher odds of prolonged LOS (OR 1.227, 95% CI 1.101-1.367, P <.001) and higher total charges (OR 1.257, 95% CI 1.109-1.426, P <.001) compared to White patients. Similarly, Hispanic patients were more likely to experience urinary/renal complications (OR 1.605, 95% CI 1.244-2.071, P <.001), higher total charges (OR 1.519, 95% CI 1.302-1.772, P <.001), and prolonged LOS (OR 1.157, 95% CI 1.007-1.331, P =.040) compared to White patients. Conclusion: Race is an important factor associated with an increased incidence of complications in hospitalized patients treated for epistaxis. [ABSTRACT FROM AUTHOR]