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Background: The management of craniopharyngiomas is challenging due to their high rate of recurrence following resection. Excision of recurrent tumors poses further surgical challenges due to loss of arachnoidal planes and adherence to anatomical structures. The endoscopic endonasal approach (EEA) offers a favorable alternative to transcranial approaches for primary craniopharyngiomas. However, the safety and efficacy of EEA for recurrent tumors, specifically after a prior transcranial approach, needs further investigation. Methods: We performed a systematic review using PubMed to develop a database of cases of recurrent craniopharyngiomas previously treated with a transcranial approach. Results: Fifteen articles were included in this review with a total of 75 cases. There were 50 males and 25 females with a mean age of 38 years (range 2–80). One prior transcranial surgery was done in 80.0% of cases, while 8.0% had two and 12.0% had more than two prior surgeries. Radiotherapy after transcranial resection was given in 18 cases (24.0%). Following EEA, vision improved in 60.0% of cases, and vision worsened in 8.6% of the cases. Of cases, 64.4% had pre-existing anterior hypopituitarism, and 43.8% had diabetes insipidus prior to EEA. New anterior hypopituitarism and diabetes insipidus developed in 24.6% and 21.9% of cases, respectively following EEA. Gross total resection (GTR) was achieved in 64.0%, subtotal resection in 32.0%, and partial resection in 4.0% revision EEA cases. GTR rate was higher in cases with no prior radiotherapy compared to cases with prior radiotherapy (72.0% vs 39.0%, p = 0.0372). The recurrence rate was 17.5% overall but was significantly lower at 10.0% following GTR (p = 0.0019). The average follow-up length was 41.2 months (range, 1–182 months). Conclusion: The EEA can be utilized for resection of recurrent or residual craniopharyngiomas previously managed by a transcranial approach. [ABSTRACT FROM AUTHOR]

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]

Objectives: To explore the association between diabetes and outcomes in thyroidectomy patients. Methods: This retrospective cohort analysis used the 2015–2017 American College of Surgeons National Surgery Quality Improvement Program database. Current Procedural Terminology (CPT) codes were used to identify thyroidectomy cases (60210, 60212, 60220, 60225, 60240, 60252, 60254, 60260, 60270, and 60271). Demographics, comorbidities, and complication incidences were compared between diabetic and nondiabetic patients using Pearson's chi‐square test/Fisher's exact test as appropriate. The independent effect of diabetes on outcomes was analyzed using binary logistic regression. Results: A total of 47,776 (95.4%) nondiabetic and 2307 (4.6%) diabetic patients undergoing thyroidectomy were identified from 2015 to 2017. Chi‐square analysis demonstrated that diabetic patients had higher incidences of obesity (55.2% vs. 33.2%; p < 0.001), dyspnea (12.7% vs. 4.8%; p < 0.001), poor functional status (1.9% vs. 0.4%; p < 0.001), ventilator dependence (0.6% vs. 0.1%; p < 0.001), chronic obstructive pulmonary disease (COPD; 6.8% vs. 2.2%; p < 0.001), congestive heart failure (1.1% vs. 0.3%; p < 0.001), acute renal failure (0.3% vs. 0.0%; p < 0.001), hypertension (79.2% vs. 32.4%; p < 0.001), dialysis (2.0% vs. 0.4%; p < 0.001), open wound (1.1% vs. 0.1%; p < 0.001), steroid use (5.3% vs. 2.3%; p < 0.001), bleeding disorders (3.6% vs. 0.9%; p < 0.001), preoperative blood transfusions (0.2% vs. 0.0%; p = 0.001), and systemic sepsis (1.0% vs. 0.3%; p < 0.001). Demographic characteristics were significantly different between the cohorts including gender (p < 0.001), age (p < 0.001), race (p < 0.001), and Hispanic ethnicity (p = 0.033). After adjusting for these factors, logistic regression analyses showed that diabetes was associated with acute renal failure (OR: 5.836; 95% CI: 1.060–32.134; p = 0.043), wound disruption (OR: 6.194; 95% CI: 1.752–21.900; p = 0.005), prolonged length of stay (OR: 1.430; 95% CI: 1.261–1.622; p < 0.001), unplanned readmission (OR: 1.380; 95% CI: 1.096–1.737; p = 0.006), superficial incisional surgical site infections (OR: 0.240; 95% CI: 0.058–0.995; p = 0.049), urinary tract infection occurrences (OR: 2.173; 95% CI: 1.186–3.980; p = 0.012), organ space surgical site infection occurrences (OR: 3.322; 95% CI: 1.016–10.864; p = 0.047), pneumonia occurrences (OR: 2.091; 95% CI: 1.125–3.884; p = 0.020), any medical complication (OR: 1.697; 95% CI: 1.246–2.313; p = 0.001), and any complication (OR: 1.495; 95% CI: 1.136–1.968; p = 0.004). Conclusion: Diabetes mellitus is a significant factor associated with increased odds of complications following thyroidectomy. Level of Evidence: 3 Laryngoscope, 133:3628–3632, 2023 [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]

Objectives: Treatment for primary hyperparathyroidism is parathyroidectomy. This study identifies the association between hypoalbuminemia (HA) and outcomes in patients undergoing parathyroidectomy for primary hyperparathyroidism. Methods: This retrospective cohort analysis utilized the 2006–2015 National Surgical Quality Improvement Program database. Current Procedure Terminology codes were used to identify patients undergoing parathyroidectomy for primary hyperparathyroidism. Prolonged length of stay (LOS) was defined as a duration of 2 days or greater. Demographics and comorbidities were compared between HA (serum albumin <3.5 g/dL) and non‐HA cohorts using chi‐square analysis. The independent effect of HA on adverse outcomes was analyzed using binary logistic regression. Results: A total of 7183 cases with primary hyperparathyroidism were classified into HA (n = 381) and non‐HA (n = 6802) cohorts. HA patients had increased complications, including renal insufficiency (0.8% vs. 0.0%, p = 0.001), sepsis (1.0% vs. 0.1%, p = 0.003), pneumonia (0.8% vs. 0.1%, p = 0.018), acute renal failure (1.0% vs. 0.0%, p < 0.001), and unplanned intubation (1.3% vs. 0.2%, p = 0.004). HA patients had increased risk of death (1.6% vs. 0.1%, p < 0.001), prolonged LOS (40.9% vs. 6.3%, p < 0.001), and any complication (5.5% vs. 1.2%, p < 0.001). Adjusted binary logistic regression indicated HA patients experienced increased odds of progressive renal insufficiency (OR 18.396, 95% CI 1.844–183.571, p = 0.013), prolonged LOS (OR 4.892; 95% CI 3.571–6.703; p < 0.001), unplanned reoperation (OR 2.472; 95% CI 1.012–6.035; p = 0.047), and unplanned readmission (OR 3.541; 95% CI 1.858–6.748; p < 0.001). Conclusions: HA may be associated with adverse complications in patients undergoing parathyroidectomy for primary hyperparathyroidism. Level of Evidence: 3 Laryngoscope, 133:2035–2039, 2023 [ABSTRACT FROM AUTHOR]

Objectives: To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. Study Design: Retrospective database review. Setting: 2003 to 2014 National Inpatient Sample. Methods: Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. Results: A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p >.05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32‐1.51, p <.001) and prolonged length of stay (OR 1.11, 95% CI 1.05‐1.17, p <.001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09‐1.19, p <.001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80‐0.97, p =.013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65‐0.84, p <.001) were lower. There were no significant differences in in‐hospital mortality, patient discharge disposition, and total hospital charges (p >.05). Conclusion: Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objective: This study reviews the presentation, management, and outcomes of patients with rhinolithiasis. Data Sources: An electronic database search of PubMed, SCOPUS, CINAHL, and the Cochrane Library was performed in accordance with the PRISMA 2020 updated guidelines for reporting systematic reviews. Review Methods: Case reports and case series published from 2004 to 2020 were included. Data collected included patient demographics, clinical symptoms at presentation, diagnosis, treatment, complications, and follow‐up. Relevant descriptive statistics were computed using Microsoft Excel 2013 (Microsoft Corp). Results: Fifty‐five case reports and five case series were included (n = 122). The majority were female (60.7%). The mean age was 29.4 years (range, 4‐80 years). The most common symptoms were rhinorrhea (81.1%), nasal obstruction (79.5%), nasal malodor (38.5%), and headache (27.9%). Computed tomography imaging was obtained in 109 (91.5%) cases. Concurrent rhinosinusitis (35.2%) and deviated nasal septum (28.7%) were commonly identified. Rhinoliths were commonly found in the right nostril (52.5%) and in between the inferior turbinate and nasal septum (26.9%). All rhinoliths were fully excised using endoscopic sinonasal surgery, accompanied by a septoplasty (9.2%). The nidus was identified in 27 (22.2%) patients. There were no recurrences or complications over an average follow‐up of 8.5 months (range, 0.25‐36 months). Conclusion: Rhinolithiasis is an uncommon entity of the nasal cavity and should be suspected in patients with long‐standing unilateral nasal obstruction, rhinorrhea, and nasal malodor. Rigid nasal endoscopy and endoscopic sinonasal surgery are the most important methods for diagnosis and treatment, respectively. [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: Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes. Data Sources: PubMed, CINAHL, SCOPUS, and Cochrane Library. Review Methods: A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow‐up, and outcome were analyzed. Results: A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8‐81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS‐associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow‐up was 20.4 months (range, 0.75‐120). Most patients with AIDS‐associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow‐up (n = 13). Conclusion: This review contains the largest pool of laryngeal KS cases to date. Long‐term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis. [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]

Objective: To determine how prolonged operative time (POT) impacts 30‐day outcomes in patients undergoing endoscopic sinonasal surgery (ESNS). Study Design: Retrospective study. Methods: Data from patients who underwent ESNS (nonsinus, sinus, and extended sinus) between 2005 to 2018 were collected from the American College of Surgeons National Surgical Quality Improvement database. Univariate and multivariate analyses were performed to evaluate the effect of POT on postoperative outcomes. Results: Among 1,994 ESNS cases, 495 nonsinus procedures, 1,191 sinus procedures, and 308 extended sinus procedures were identified. Median OT was 90 minutes (interquartile range [IQR], 51–165 minutes) for nonsinus procedures, 113 minutes (IQR, 66–189 minutes) for sinus procedures, and 187 minutes (IQR, 137–251 minutes) for extended sinus procedures. Other than older age (P =.008), POT was not significantly associated with baseline demographics and comorbidities for patients undergoing non‐sinus procedures. Older age (P <.001), White and Black race (P <.001), ASA physical classifications III or IV (P <.001), and several preoperative comorbidities, including obesity (P =.045), and hypertension (P <.001) were associated with POT for sinus procedures. Older age (P =.030), male sex (P =.010), and lower body mass index (P =.004) were associated with POT for extended sinus procedures. After risk‐adjustment, POT was independently associated with prolonged hospital stay (LOS) for all procedure categories, and associated with overall surgical complications and postoperative bleeding for sinus and extended sinus procedures specifically. Conclusion: POT is independently associated with several adverse outcomes following ESNS, including prolonged LOS, overall surgical complications, and bleeding. Preoperative planning should include optimizing modifiable patient risk factors for POT and identifying surgeon‐specific factors to enhance surgical efficiency. Level of Evidence: 4 Laryngoscope, 133:51–58, 2023 [ABSTRACT FROM AUTHOR]

Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher's exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection (P =.012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications (P <.001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay (P <.001) and risk of overall complications (P =.032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection (P =.049), postoperative bleeding (P =.036), and failure to wean off ventilator (P =.027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification. [ABSTRACT FROM AUTHOR]

Objective: This study aims to provide an age-stratified analysis of associations with patient sex in pediatric inpatients with acute rhinosinusitis (ARS). Study Design: Retrospective cohort study. Setting: National administrative database. Methods: The 2016 Kids' Inpatient Database was queried for pediatric inpatients (<21 years old) with ARS (ICD-10 J01). Orbital and intracranial sequelae were selected via ICD-10 codes. Statistical associations by sex were determined via univariate and multivariable analyses. Weighted measures are reported to provide national estimates. Results: Of the 5882 patients identified with ARS, 2404 (40.9%) were female and 3478 (59.1%) were male. Male patients were younger than female patients (mean, 9.3 vs 9.9 years; P <.001). Multivariable analysis indicated that males and females had similar total charges ($71,094 vs $66,892, P =.464) and length of stay (5.8 vs 6.1 days, P =.263). However, male patients underwent more procedures (1.8 vs 1.5, P <.001). Mortality was similar between male and female patients (odds ratio [OR], 0.91; P =.664). Male patients also had increased odds for having orbital (OR, 1.58; P <.001) and intracranial (OR, 1.99; P <.001) complications. Differences in sex-dependent sequela risk were starkest in patients aged 14 to 20 years, with male patients being more likely to have orbital (OR, 2.91; P <.001) and intracranial (OR, 3.86; P <.001) complications. Conclusion: In a cohort of pediatric inpatients with ARS, males have increased odds for orbital and intracranial sequelae and undergo more procedures than females. However, males and females have similar charges and length of stay. Our study highlights age-stratified differences in ARS across patient sex. [ABSTRACT FROM AUTHOR]

Background: While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series. Objective: To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP. Methods: The National Cancer Database was queried for all patients with SN-EMP between 2004–2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival. Results: The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone. Conclusion: In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Preoperative anemia has been shown to be a predictor of complications in different surgeries. This has not been exclusively studied in skull base surgery. This study investigates the impact of preoperative hematocrit on complications following ventral skull base (VSB) surgery. Study Design: Retrospective database review. Methods: The National Surgical Quality Improvement Program was queried for all cases of VSB surgery from 2005 to 2015. Univariate and multivariate analyses were performed to investigate the impact of preoperative anemia on complications following VSB procedures. Results: 3,053 patients meeting inclusion criteria were identified. On univariate analysis, low hematocrit was found in 39.7% of patients and was associated with increased mean age (55.71 vs. 53.25 years), male gender (63.6% vs. 36.4%), and Black race (18.5% vs. 10.9%). Preoperative anemia was also associated with increased incidences of postoperative pneumonia, blood transfusions, sepsis, medical complications, surgical complications, extended length of hospital stay (LOS), and mortality. On multivariate analysis, associations between low preoperative hematocrit and perioperative transfusions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.88–3.50, P <.001), total surgical complications (OR 2.12, 95% CI 1.60–2.80, P <.001), and extended LOS (OR 1.29, 95% CI 1.05–1.57, P =.013) remained significant. Conclusions: Low preoperative hematocrit is associated with increased risk of postoperative complications and extended LOS in patients undergoing VSB surgery. This study highlights the importance of careful preoperative assessment and management of anemia in these patients. Level of Evidence: 3 Laryngoscope, 132:1707–1713, 2022 [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to analyze national trends in human papillomavirus (HPV) testing for patients diagnosed with sinonasal squamous cell carcinoma (SNSCC). Study Design: Retrospective database study. Setting: National Cancer Database (2010-2016). Methods: Cases from 2010 to 2016 with a primary SNSCC diagnosis and known HPV testing status were extracted from the National Cancer Database. Univariate and multivariate analyses were then performed to assess differences in socioeconomic, hospital, and tumor characteristics between tested and nontested patients. Results: A total of 2308 SNSCC cases were collected, with 1210 (52.4%) HPV tested and 1098 (47.6%) not tested. On univariate analyses, patient age, insurance, income quartile, population density, treatment facility location, and tumor grade were significantly associated with HPV testing status. After multivariate logistic regression modeling, living in a suburban area had lower odds of HPV testing as compared with living in urban areas (odds ratio, 0.74 [95% CI, 0.55-0.99]; P =.041), while tumor grade III/IV had higher odds than grade I (odds ratio, 1.73 [95% CI, 1.29-2.33]; P <.001). HPV-tested patients had a similar 5-year overall survival to nontested patients (48.3% vs 45.3%, log-rank P =.405). A sharp increase in HPV testing rates was observed after 2010 (P <.001). Conclusion: Among patients with SNSCC, those with high-grade tumors were more likely to be tested for HPV, while patients with a suburban area of residence were less likely. Additionally, there was no significant survival benefit to HPV testing, with tested and nontested groups having similar overall survival. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To investigate the morbidity and mortality of patients undergoing endoscopic sinus surgery (ESS) in the inpatient setting. Study Design: Retrospective database review. Methods: The Nationwide Inpatient Sample was queried for all ESS between 2008 and 2014. Using All Patients Refined Diagnosis Related Groups (APR‐DRG) codes, cases with APR‐DRG codes under Major Diagnostic Category 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat) were designated as patients with primary otolaryngology diagnoses undergoing ESS (ORL), and all other codes were designated as patients with non‐otolaryngology pathologies as their primary reason for admission but undergoing ESS (non‐ORL). A univariate analysis and a logistic regression were used to compare patient demographics, comorbidities, disease severity, and mortality. Results: There were 8,305 ORL patients and 6,342 non‐ORL patients. ORL patients were more likely to be elective admissions (61.3% vs. 48.5%, P <.001), have a deviated nasal septum (17.9% vs. 12.3%, P <.001), nasal polyps (15.8% vs. 5.0%, P <.001), obstructive sleep apnea (10.7% vs. 5.2%, P <.001), and pulmonary disease (15.9% vs. 10.5%, P <.001). Non‐ORL patients had a higher likelihood of in‐hospital mortality (odds ratio [OR] 6.22, 95% confidence interval [CI] 3.29–11.78, P <.001), length of stay in the highest quartile (OR 2.43, 95% CI 2.16–2.74, P <.001), and a higher proportion had APR‐DRG subclasses indicating extreme severity of illness (19.3% vs. 4.3%, P <.001) or extreme risk of mortality (12.5% vs. 2.0%, P <.001). Conclusion: Patients undergoing ESS in the inpatient setting have a higher than expected mortality rate which can be associated with a non‐otolaryngology pathology as the primary reason for their admission. Level of Evidence: 4 Laryngoscope, 132:1523–1529, 2022 [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to compare the number of citations received by open access articles versus subscription access articles in subscription journals in the Otolaryngology literature. Methods: Using the Dimensions research database, we examined articles indexed to PubMed with at least 5 citations published in 2018. Articles were included from Otolaryngology — Head and Neck Surgery, The Laryngoscope, JAMA Otolaryngology — Head and Neck Surgery, Annals of Otology, Rhinology, and Laryngology, and American Journal of Otolaryngology. Multivariate Poisson regression modeling was used to adjust for journal, article type, and topic. Practice guidelines, position statements, or retractions were excluded as potential outliers. Results: 137 open access articles and 337 subscription access articles meeting inclusion criteria were identified, with a median citation number of 8 (IQR 6-11). The most common article type was original investigation (82.5%), and the most common study topic was head and neck (28.9%). Open access articles had a higher median number of citations at 9 (IQR 6-13) when compared to subscription access articles at 7 (IQR 6-10) (P =.032). Open access status was significantly associated with a higher number of citations than subscription access articles when adjusting for journal, article type, and topic (β =.272, CI 0.194-0.500, P <.001). Conclusions: Although comprising a minority of articles examined in this study of subscription journals, open access articles were associated with a higher number of citations than subscription access articles. Open access publishing may facilitate the spread of novel findings in Otolaryngology. [ABSTRACT FROM AUTHOR]

Objective: To analyze population-level data for Burkitt's lymphoma of the head and neck. Study Design: Retrospective study of a national cancer database. Setting: Academic medical center. Methods: The SEER database (Surveillance, Epidemiology, and End Results) identified all patients with primary Burkitt's lymphoma of the head and neck from 1975 to 2015. Demographic, clinicopathologic, and treatment characteristics were analyzed. Multivariable Cox regressions analyzed factors associated with survival while controlling for baseline differences. Results: A total of 920 patients with a mean (SD) age of 37.6 years (25.0) were identified. A majority of patients were White (82.8%) and male (72.3%). The most primary common sites included the lymph nodes (61.3%), pharynx (17.7%), and nasal cavity/paranasal sinuses (5.2%). The majority of patients received chemotherapy (90.5%), while fewer underwent surgery (42.1%) or radiotherapy (12.8%). Choice of treatment differed significantly among patients of different ages, year of diagnosis, primary site, nodal status, and Ann Arbor stage. Overall 10-year survival was 67.8%. On multivariable Cox regression, patients with older age (hazard ratio [HR], 1.05 per year; P <.001) and higher stage at presentation had increased risk of mortality (P <.001). Furthermore, cases diagnosed between 2006 and 2015 (HR, 0.35; P <.001) and 1996 and 2005 (HR, 0.53; P =.001) had lower mortality when compared with those diagnosed between 1975 and 1995. Treatment including surgery and chemotherapy tended to have the best survival (P <.001). Conclusion: Burkitt's lymphoma of the head and neck diagnosed in more recent years has had improved survival. Factors significantly associated with survival include age, Ann Arbor stage, and treatment regimen. Treatment including surgery and chemotherapy was associated with the highest survival. [ABSTRACT FROM AUTHOR]

Objectives  Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. There is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS among the membership of the North American Skull Base Society (NASBS). Design  An online-based survey was designed and distributed to the membership of the NASBS. Data was analyzed using bivariate analysis and logistic regression modeling. Setting  Online-based questionnaire. Participants  NASBS membership. Main Outcome Measures  Use of intraoperative antibiotics and use of postoperative antibiotics. Results  The survey response rate was 26% (208 respondents). Of the 208 total respondents, 143 (69%) respondents performed LSBS. Most respondents are neurosurgeons (69%) with the remaining being otolaryngologists (31%). The majority of respondents (79%) are fellowship-trained in skull base surgery. Academic or government physicians make up 69% of respondents and 31% are in private practice with or without academic affiliations. Bivariate analysis showed that practice setting significantly influenced intraoperative antibiotic use (p  = 0.01). Geographic location significantly affected postoperative antibiotic use (p  = 0.01). Postoperative antibiotic duration was significantly affected by presence of chronic otitis media, cerebrospinal fluid leak, and surgeon training (p  = 0.02, p  = 0.01, and p  = 0.006, respectively). Logistic regression modeling showed that the motivation to reduce infection significantly impacted postoperative antibiotic use (p  = 0.03). Conclusion  This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS among the NASBS membership. Appropriate guidelines for optimal perioperative antibiotic use patterns should be determined with randomized studies in the future. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To identify factors that may increase the risk of unplanned admission following elective outpatient endoscopic sinonasal surgery (ESS). Study Design: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP). Methods: All cases of ESS were extracted from the 2010 to 2018 NSQIP database using Current Procedural Terminology codes. Only cases coded as outpatient, elective, and nonemergent procedures were included. Unplanned admissions were defined as cases with a total hospital stay of 1 day or more. Univariate and multivariate analyses were performed to identify variables that independently predicted unanticipated admission. Results: A total of 971 cases met inclusion criteria, of which 274 (28.2%) were unanticipated admissions. Patients in the unplanned admission group were more likely to be older (46.8 vs. 41.1 years, P <.001), male (57.7% vs. 48.4%, P =.009), obese (54.8% vs. 43.8%, P =.003), and have hypertension (35.0% vs. 25.0%, P =.002). Unplanned admitted patients were also more likely to be included under American Society of Anesthesiologists (ASA) classification III‐IV (43.1% vs. 27.2%, P <.001). There were no significant differences in race, smoking, diabetes, or chronic steroid use. Unplanned admitted patients had a higher rate of surgical complications (2.9% vs. 1.0%, P =.041). Upon multivariate analysis, independent preoperative risk factors for unplanned admission included age (OR: 1.018, P =.002), male gender (OR: 1.415, P =.025), obesity (OR: 1.527, P =.008), and ASA III‐IV (OR 1.501, P =.018). Conclusions: Factors independently associated with unplanned admission following outpatient ESS were older age, male gender, obesity, and higher ASA. Identification of patients at risk may reduce unanticipated hospital admission after ESS. Level of Evidence: 4 Laryngoscope, 132:518–522, 2022 [ABSTRACT FROM AUTHOR]

Objective: To investigate the demographics of CORE grant recipients (Centralized Otolaryngology Research Efforts) over the last decade and evaluate disparity among recipients as compared with otolaryngology overall. To assess whether procurement of a grant predicts pursuit of an academic career. Study Design: Analysis of grant recipients' bibliometrics. Setting: Academic medical center. Methods: The list of recipients of grants from 2010 to 2019 was obtained from the website of the American Academy of Otolaryngology–Head and Neck Surgery. Demographics of recipients were collected through an internet search, including gender, race, residency program, and h -index. Recipients from 2010 were searched to determine current academic faculty rank. Univariate and multivariate analyses were used to compare these factors with otolaryngology overall. Results: The distribution of gender among recipients over the last decade remained nearly constant, with no significant difference versus residents in otolaryngology (P >.05). However, there were significantly more female recipients when adjusted for gender differences in the field overall (P <.01). Asians were relatively overrepresented, while Black and Hispanic residents were underrepresented (P <.01). Many recipients (52.6%) trained at institutions recognized as the best training programs with reputations for quality research output. The h -index of recipients decreased over the last decade (P <.01). The h -index of duplicate winners was significantly higher than those of nonduplicate winners (P <.01). After adjusting for gender and rank, recipients were significantly more likely to hold academic positions (P <.01). Conclusion: CORE grants are favorably distributed as related to gender and racial disparities, and recipients frequently go on to achieve high levels of academic success. [ABSTRACT FROM AUTHOR]

Objectives: There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. Methods: A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. Results: Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P =.018). Conclusion: The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold. [ABSTRACT FROM AUTHOR]

Objectives: Sinonasal mucosal melanoma (SNMM) is an aggressive cancer usually managed with surgical resection. This study evaluates the impact of treatment modality and positive surgical margin (PSM) on survival following resection of SNMM. Study Design: Retrospective study of a national cancer registry. Methods: The National Cancer Database was queried for cases of SNMM from 2010 to 2015. Data regarding patient demographics, tumor staging, and treatment modality were obtained. Survival rates were compared by margin status: PSM, negative (NSM), and no operation (0SM) using Kaplan–Meier analysis and log rank test. Results: A total of 446 patients met inclusion criteria. Most cases were elderly (>66 years‐old) (67.3%), female (54.3%), and white (89.5%). Cases of SNMM most commonly involved the nasal cavity (81.6%), were Stage 3 (60.0%), and underwent surgical resection at an academic center (65.0%). NSM and PSM were present in 59.0% and 26.9% of cases, respectively, while 14.1% of cases did not undergo surgical resection (0SM). Factors predictive of PSM included resection at a community hospital (OR 2.47) and Stage 4 disease (OR 2.07). The 2‐year survival rates were 72.1% (95% CI 69.4–75.4%), 36.3% (95% CI 22.0–48.9), and 16.0% (95% CI 8.2–25.4%) for NSM, PSM and 0SM, respectively. Survival was statistically significant between NSM and PSM (Log rank <0.001) but not between 0SM and PSM (Log rank = 0.062). Conclusion: Our study emphasizes the need for NSM for SNMM as PSM did not demonstrate any significant improvement in survival when compared to 0SM. Our findings suggest that cases of SNMM are best managed at academic centers. Level of Evidence: 4 Laryngoscope, 131:2429–2435, 2021 [ABSTRACT FROM AUTHOR]

Objective: Although extranodal extension (ENE) is a known indicator of poor prognosis for head and neck malignancies, its value as an indicator for sinonasal squamous cell carcinoma (SCC) has not been well characterized. This study seeks to assess the usefulness of ENE as a prognostic marker for sinonasal SCC. Study Design: Retrospective database review. Setting: National Cancer Database from 2010 to 2015. Methods: The National Cancer Database was queried from 2010 to 2015 for all patients with sinonasal SCC with available ENE status (n = 355). These cases were divided into those with pathologically confirmed ENE (n = 146) and those without ENE (n = 209). Univariate and multivariate analyses were used to examine survival differences and predictors of ENE status. Results: Most patients with ENE were ≥60 years old (61.7%), male (61.6%), and white (83.6%). Patients aged 60 to 69 and 80+ years were more likely to have ENE than those under 60 years (P <.05). Patients with ENE had worse 1-year overall survival than those without ENE (58.2% vs 70.8%, log-rank P =.008). After multivariate regression, however, there was no survival difference detected between ENE-positive and ENE-negative cases (hazard ratio, 1.14 [0.775-1.672], P =.508). Conclusion: ENE status did not have a significant effect on survival in patients with sinonasal SCC. Thus, ENE alone may not necessarily be a helpful indicator for sinonasal SCC prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Esthesioneuroblastoma (ENB) is a rare sinonasal malignancy with little known regarding how regional and socioeconomic differences in the United States alter disease survival. The aim of this study is to explore the geographic difference in clinical features, socioeconomic factors, and survival outcomes of ENB patients.Methods: ENB cases were extracted from the Surveillance, Epidemiology, and End Results registry from 1975-2016. Patient data were stratified based on geographical location and comparative analyses of socioeconomic features, disease characteristics, and survival patterns were performed. Kaplan-Meier regression analyses were used to estimate disease-specific survival (DSS).Results: A total of 987 patients were identified: 56.4% West, 14.0% South, 12.7% Midwest, and 16.6% East. The West had the highest proportion of patients with Medicaid coverage (P < .001), stage A malignancy (P < .001), and treated with surgery and adjuvant radiotherapy (P < .001). The South had the highest proportion of patients who were Black (P < .001), uninsured (P < .001), and resided in rural areas (P < .001). Five-year DSS patterns were 81.0% (West), 79.8% (East), 67.4% (Midwest), and 72.7% (South) [P = .018]. Ten-year DSS outcomes were 74.0% (West), 73.7% (East), 60.9% (Midwest), and 63.6% (South) [P = .017].Conclusion: In ENB patients, survival disparity exists in the United States based on geographical region. Patients from the West and East exhibit higher survival than those from the South and Midwest.Level Of Evidence: 4 Laryngoscope, 131:E2162-E2168, 2021. [ABSTRACT FROM AUTHOR]

This article is a response to a letter submitted by Kleebayoon and Wiwanitkit regarding the authors' previous manuscript on otolaryngologic side effects after COVID-19 vaccination. The authors used the Vaccine Adverse Event Reporting System database to compare the prevalence of otolaryngologic adverse events following COVID-19 vaccination with other vaccines. They found a higher signal for various adverse events, such as dysgeusia, anosmia, and rhinorrhea, after administration of the three vaccines approved by the FDA. The authors acknowledge the limitations of their study but emphasize the importance of pharmacovigilance studies in providing real-world data. They suggest that these results can be used as a starting point for discussions between physicians and patients. [Extracted from the article]

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. Methods: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. Results: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤.02) and time to follow up appointment (P ≤.002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. Conclusion: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data evaluating antibiotic use in anterior skull‐base surgery (ASBS). The goal of this study was to determine antibiotic prescribing patterns and factors that influence antibiotic use in ASBS. Methods: An online‐based survey was distributed to the membership of the North American Skull Base Society in 2018. Outcomes included practitioner preference regarding intraoperative and postoperative antibiotic use, practice location and environment, surgeon experience, and patient factors influencing antibiotic use. Results: There were 208 respondents (25.6% response rate) of which 182 (87.5%) performed ASBS; 60.4% were in academic institutions. Respondents were neurosurgeons (59.3%) or otolaryngologists (40.7%), and 75.3% were fellowship‐trained in ASBS. Most surgeons (95.0%) gave intraoperative antibiotics. Academic surgeons were 4 times more likely to prescribe intraoperative antibiotics than private practitioners (odds ratio [OR] 3.98; 95% confidence interval [CI], 1.53 to 10.36; p = 0.005). Among surgeons who did not routinely prescribe intraoperative antibiotics, regression analysis indicated that the presence of actively infected sinuses, transplantation, diabetes, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), and pulmonary disease influenced decision‐making (p < 0.03). Postoperative antibiotics were prescribed by 73.6% of respondents. European surgeons were 3 times less likely to prescribe postoperative antibiotics (OR 0.34; 95% CI, 0.15 to 0.80; p = 0.01). Regression modeling indicated that HIV/AIDS, cystic fibrosis, diabetes, transplantation, and pulmonary disease, as well as the use of absorbable packing influenced the decision to use postoperative antibiotics (p < 0.003). Conclusion: This study demonstrates the significant variation in intra‐ and postoperative antibiotic use among surgeons performing ASBS. Prospective randomized studies are necessary to establish evidence‐based practice guidelines for perioperative antibiotic use in ASBS. [ABSTRACT FROM AUTHOR]

Objective: Cystic fibrosis (CF) patients commonly develop chronic rhinosinusitis (CRS). The impact of the most common cystic fibrosis transmembrane conductance regulator (CFTR) mutation, F508del, on the severity of sinonasal disease remains inconclusive. The objective of this study is to evaluate the impact of CFTR genotype functional classification on sinonasal disease severity in patients with CRS.Methods: Retrospective chart review of patients with CF who underwent endoscopic sinus surgery for chronic rhinosinusitis from 1998 to 2015. Patients were divided into high- or low-risk genotypes based on standardized CFTR gene functional classification. The primary outcome was the 22-item Sino-Nasal Outcome Test (SNOT-22) score. Secondary outcomes included endoscopic scores, extent of surgery performed, presence of polyposis, number of revision surgeries, and Lund-MacKay computed tomography scores.Results: Thirty-eight patients harbored a high-risk CFTR genotype, and 11 had a low-risk genotype. On bivariate analysis, there was no association between CFTR genotype risk stratification and measures of preoperative disease severity or postoperative outcomes. There were no associations between genotype risk stratification and outcome variables on multivariate linear regression, adjusted for age and gender. There were significant improvements in several SNOT-22 subdomains before and after endoscopic sinus surgery (P < 0.05), but the magnitude of improvement was not significantly different on the basis of CFTR genotype risk stratification.Conclusion: High-risk CFTR genotypes are not associated with worse sinonasal disease severity or postoperative symptom control than low-risk CFTR genotypes after adjusting for confounding factors.Level Of Evidence: Level 4. Laryngoscope, 1752-1758, 2018. [ABSTRACT FROM AUTHOR]