Accessing the Eustachian tube: Conventional nasal spray vs. exhalation delivery system and the impact of targeted endoscopic sinus surgery on topical distribution patterns.

BACKGROUND: Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS). METHODS: Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0- to 3-point scale, with ratings averaged for analysis. RESULTS: Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21-10.09; p = 0.021) and post-ESS (OR, 9.00; 95% CI, 1.95-41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44-104.85; p = 0.001). CONCLUSIONS: EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.

Delivering Therapy to the Olfactory Cleft: A Comparison of the Various Methods of Administering Topical Nasal Medications.

Background and objective Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the nasal mucosa, and it causes olfactory dysfunction (OD) in up to 78.2% of patients. Corticosteroids are the mainstay of treatment to shrink nasal polyposis, reduce inflammation, and improve olfactory function. While many delivery methods for topical nasal corticosteroids exist, there is scarce data on the efficacy of the various medication delivery methods to the olfactory cleft (OC). In light of this, this study aimed to compare the following delivery methods to the OC: conventional nasal spray (NS), nasal drops in the Kaiteki position (KP), and exhalation delivery system (EDS). Methods We evaluated 16 sinonasal cavities from eight cadaver specimens in this study. Each sinonasal cavity was administered fluorescein dye solution via NS, KP, and EDS. Following administration, nasal endoscopy was employed to capture staining patterns in the OC. OC staining was rated with scores ranging from 0 (no staining) to 3 (heavy staining) after each administration of dye solution. Mean OC staining ratings were calculated and compared using the Kruskal-Wallis rank sum test and the Wilcoxon signed-rank test. Results The mean OC staining score for the different delivery methods was as follows - NS: 1.095 ± 1.008, EDS: 0.670 ± 0.674, and KP: 2.038 ± 1.097. Nasal drops in the KP had a significantly higher staining score compared to NS (p=0.041) and EDS (p=0.003). However, there was no significant difference in staining scores between NS and EDS. Conclusions Nasal drops in the KP are more effective at reaching the OC than NS or EDS and should be considered as a first-line modality for administering topical medications when treating OD.

Impact of Medicaid Expansion on Rhinologic Cancer Presentation, Treatment, and Outcomes.

OBJECTIVE: The United States Patient Protection and Affordable Care Act allocated funds for states to expand Medicaid coverage. However, several states declined expansion. We aim to determine whether Medicaid expansion is associated with healthcare coverage, cancer stage at diagnosis, treatment, and survival among patients with rhinologic cancer. Rhinologic cancer was defined to include cancer of the nasal cavity, paranasal sinus, nasopharynx, or olfactory nerve. STUDY DESIGN: Cohort study. METHODS: Patients diagnosed with primary rhinologic malignancies between 2007 to 2016 were extracted from the National Cancer Institute Surveillance, Epidemiology, End Results (SEER) registry. Patients were grouped by diagnosis before and after 2014 (when Medicaid expansion became effective) and whether their state had expanded Medicaid. Multivariable logistic regression controlling for age, sex, race, ethnicity, and income/education was utilized to examine associations between Medicaid expansion/insurance status and stage at diagnosis, treatment, and survival. Overall and disease-specific survival were examined using Kaplan-Meier analysis. RESULTS: Analysis included 10,164 patients. The proportion of uninsured patients decreased after 2014 (2.4%) compared to before 2014 (4.8%, P < .001). After 2014, patients in nonexpanded states were more likely to be diagnosed with advanced stage disease compared to patients in expanded states (N = 2,364; OR = 1.27, 95% CI 1.01-1.60). Being uninsured in any state was associated with advanced stage disease at diagnosis (OR = 1.75, 95% CI 1.41-2.22) and increased risk of disease-specific death (HR = 1.54, 95% CI 1.32-1.82). Survival measures were not associated with diagnosis before versus after 2014 or Medicaid expansion. CONCLUSIONS: Patients lacking insurance or residing in nonexpanded states may be more likely to present with advanced stage rhinologic cancer. Longitudinal studies should validate these findings. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:43-50, 2023.

Prevalence of Subclinical Hearing Loss in the United States.

OBJECTIVE: Current definitions of hearing loss (HL) may be insufficiently strict, as subclinical hearing loss (SCHL; >0 and ≤25 dB hearing level) has been associated with deleterious age-related conditions. SCHL prevalence and mean age of HL onset in the United States has not been characterized. STUDY DESIGN: A cross-sectional epidemiologic prevalence study. SETTING: US Community. METHODS: We analyzed cross-sectional audiometric data in the US National Health and Nutrition Examination Survey (2005-2012, 2015-2018, n = 15,649). Results were scaled to the current population using weighting. RESULTS: 79.6% of participants (227.32 million Americans) had SCHL. The mean age of HL onset at thresholds of 25, 20, and 15 dB was 74, 66, and 55 years, respectively, for the 4-frequency pure-tone average, and 48, 44, and 35 years for the high-frequency pure-tone average. CONCLUSION: We present SCHL prevalence and define HL onset by various sensitive definitions. These results inform ongoing public health efforts to increase hearing aid utilization, particularly given the arrival of over-the-counter hearing aids.

Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training.

The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.

The Laterality of Age-Related Hearing Loss and Depression.

OBJECTIVE: There is a known association between hearing loss (HL) and depressive symptoms. The objective was to establish if there is a stronger association with the left or right ear. STUDY DESIGN: Cross-sectional analysis of an ongoing prospective epidemiologic cohort study. SETTING: Hispanic Community Health Study (US, multicentered). PATIENTS: Five thousand three hundred and twenty-eight adults 2:50 years old. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The main outcome was depressive symptoms, measured by the 10-Item Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and defined continuously and binarily. Subjects with CESD-10 2: 10 were categorized as having clinically significant depressive symptoms (CSDS). Linear and logistic regressions were performed to assess the association between depressive symptoms and hearing in each ear, controlling for hearing aid use, age, sex, educational level, study site, geographic background, cardiovascular disease, and antidepressant use. RESULTS: Mean age was 58.5 ± 6.3 years. Mean pure-tone average (PTA) was 20.3 ± 11.7 dB (range = 0 - 125) in the right ear and 20.3 ± 12.4 dB (range = -2.5 to 120) in the left. Multivariable regression adjusting for covariates demonstrated significant associations between depressive symptoms and HL in both the left and right ear. For every 20-dB worsening in right ear PTA, there was 0.89-point increase in CESD-10 (95% confidence interval = 0.59 - 1.2), and odds of CSDS increased 1.31 times (1.17 - 1.46). For every 20-dB worsening in left ear PTA, there was a 0.85-point increase in CESD-10 (0.55 - 1.14), and odds of CSDS increased 1.34 times (1.20 - 1.49). CONCLUSIONS: Worsening hearing in the right and left ears individually was associated with increased depressive symptoms and odds of CSDS. No ear laterality was demonstrated.

The Laterality of Age-related Hearing Loss and Cognition.

Objectives: To analyze the association between neurocognitive performance and age-related hearing loss in the right and left ear, individually. Design: Subjects included 5277 participants (≥50 years) from the general Hispanic population who underwent audiometric testing in a US multicentered epidemiologic study. Linear regression was performed to assess the cross-sectional association between cognitive performance (Digit Symbol Substitution Test [DSST], Word Frequency Test, Spanish-English Verbal Learning Test [SEVLT] 3 Trials, SEVLT Recall, and Six-Item Screener) and hearing in each ear (4-frequency pure-tone average), adjusting for age, sex, education, cardiovascular disease, and hearing aid use. Results: Mean age was 58.4 ± 6.2 years; 3254 (61.7%) were women. Mean pure-tone averages were 20.2 ± 11.7 dB (right ear) and 20.2 ± 12.3 dB (left ear). Multivariable regression demonstrated significant associations between all cognitive tests and hearing loss in both ears. Conclusions: Worsening hearing loss in the right and left ear was associated with decreased performance across all tests. No laterality in the association was demonstrated.

Simulation training in endoscopic skull base surgery: A scoping review.

Objective: Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement. Methods: In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated. Results: We identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three-dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality-based models, and five 5 articles described task trainers. Conclusions: There are a wide variety of simulation models for endoscopic skull base surgery, including high-fidelity cadaveric, virtual reality, and 3D-printed models. These models are an asset for trainee development and preoperative surgical preparation.

Carotid artery injury in endoscopic endonasal surgery: Risk factors, prevention, and management.

Objective: Endoscopic approaches for sinus and skull base surgery are increasing in popularity. The objective of this narrative review is to characterize risk factors for internal carotid artery injury in endoscopic endonasal surgery (EES), highlight preventative measures, and illustrate key management principles. Data Sources: Comprehensive literature review. Methods: Relevant literature was reviewed using PubMed/MEDLINE. Results: Carotid artery injury in EES is rare, with most studies reporting an incidence below 0.1%. Anatomic aberrancies, wide dissection margins, as well as specific provider and hospital factors, may increase the risk of injury. Multidisciplinary teams, comprehensive preoperative imaging, patient risk assessment, and formal training in vascular emergencies may reduce the risk. Management protocols should emphasize proper visualization of the injury site, fluid replacement, rapid packing, angiography, and endovascular techniques to achieve hemostasis. Conclusions: While EES is a relatively safe procedure, carotid artery injury is a devastating complication that warrants full consideration in surgical planning. Important preventative measures include identifying patients with notable risk factors and obtaining preoperative imaging. Multidisciplinary teams and management protocols are ultimately necessary to reduce morbidity and mortality.

The Laterality of Early Age-Related Hearing Loss and Brain ß-Amyloid.

OBJECTIVE: Worse hearing was linked to higher brain ß-amyloid, a pathologic hallmark of Alzheimer's disease, in a recent study. We analyze the associations between ß-amyloid and early age-related hearing loss in the right versus left ear to explore the laterality of this relationship. STUDY DESIGN: Cross-sectional analysis of a prospective cohort study. SETTING: Tertiary referral center. PARTICIPANTS: Ninety-eight late middle-age adults. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The primary outcome was whole brain and regional ß-amyloid standardized uptake value ratio (SUVR) on positron emission tomography. The exposure was hearing in the right and left ear, measured by pure tone average (PTA) and word recognition score (WRS). Linear regression analyzed the association between ß-amyloid and hearing in each ear, adjusting for potential confounders, including age, gender, education, cardiovascular disease, and hearing aid use. RESULTS: Mean age ±â€Šstandard deviation was 64.3 ±â€Š3.5 years. Mean PTA was 20.4 ±â€Š8.8 dB. Multivariable regression adjusting for covariates demonstrated that a 10 dB worsening in PTA in the left ear was associated with significantly higher ß-amyloid (SUVR) in the bilateral cingulate gyri (right coefficient: 0.029 [95% confidence interval: 0.003-0.054]; left: 0.029 [0.003-0.055]), bilateral frontal lobes (right: 0.024 [0.002-0.047]; left: 0.028 [0.006-0.049]), and the right temporal lobe (0.019 [0.002-0.037]). Consistent results were observed when WRS served as the exposure. No associations were observed between ß-amyloid and PTA or WRS in the right ear. CONCLUSIONS: Worse hearing in the left ear, but not the right ear, was associated with higher ß-amyloid. This might relate to asymmetric central auditory processing.

Prevalence of Single-Sided Deafness in the United States.

OBJECTIVES/HYPOTHESIS: The aim of this study was to obtain a reliable estimate of single-sided deafness (SSD) prevalence in the adult U.S. METHODS: A cross-sectional national epidemiologic study was performed. Participants were included from the National Health and Nutrition Examination Survey (NHANES). Each cohort includes a nationally representative sample of approximately 5,000 noninstitutionalized civilians. Subjects 20 years old and over with audiometric testing were included. SSD was defined as normal hearing (pure-tone average [PTA] of ≤25 dB) in one ear and severe or worse hearing (PTA > 70 dB) in the other, using both three- and four-frequency PTA definition. Prevalence was measured as a raw number (n) and percentage (%) of the sample. Weighted estimates of prevalence were calculated based on the 2019 U.S. population census. RESULTS: An estimated 345,064 Americans (estimated prevalence of 0.14%, 95% confidence interval = 0.08-0.24) had SSD. SSD was more prevalent in individuals 60 to 79 years of age (estimated 155,917 U.S. adults, prevalence of 0.25%). A higher prevalence of SSD was noted among women compared to men (215,430 U.S. adult women, prevalence of 0.17% vs. 131,726 U.S. adult men, prevalence of 0.11%). Using a three-frequency PTA definition resulted in an estimated prevalence of 0.11%. Finally, 27% of adults with SSD reported having "good" or "excellent" hearing despite their hearing loss. CONCLUSIONS: The prevalence of SSD in the United States is estimated at 0.11%-0.14% (271,122 to 345,064 adults), depending on PTA definition used. These individuals could potentially benefit from auditory rehabilitation, including cochlear implantation. LEVEL OF EVIDENCE: 2 Laryngoscope, 132:1652-1656, 2022.

Hearing Aid Usage and Reported Hearing Difficulty in Americans With Subclinical Hearing Loss.

OBJECTIVE: Subclinical hearing loss (SCHL) (previously defined by our group as a four-frequency pure tone average [PTA4] >0 to ≤25 dB) has recently been associated with depressive symptoms and cognitive decline. This suggests that the common 25 dB adult cutpoint in the United States for normal hearing may not be sensitive enough. We aim to characterize real-world hearing difficulties, as measured by hearing aid use and self-reported hearing difficulty, among individuals with SCHL. STUDY DESIGN: Analysis of biennial cross-sectional epidemiologic survey (National Health and Nutrition Examination Survey, 1999-2012, 2015-2016). SETTING: Community, multicentered, national. SUBJECTS: Noninstitutionalized US citizens ≥12 years old, n = 19,246. MEASURES: PTA4 (500, 1,000, 2,000, 4,000 Hz), high-frequency pure tone average (PTAhf) (6,000, 8,000 Hz), reported hearing aid use, subjective difficulty hearing. RESULTS: There were 806,705 Americans with SCHL who wore hearing aids (or 0.35% of the 227,324,096 Americans with SCHL; 95% confidence interval = 0.23%-0.54%). Among those with SCHL, 14.6% (33.1 million Americans) perceived a little trouble hearing and 2.29% (5.21 million Americans) perceived moderate/a lot of trouble hearing. When restricted to the borderline subcategory (>20 to ≤25 dB), 42.43% (6.64 million Americans) had at least a little trouble hearing. Among those with SCHL who wore hearing aids, 81% had a PTAhf >25 dB. CONCLUSION: Despite hearing loss traditionally being defined by PTA4 ≤ 25 dB in the United States, nearly 1 million adults and adolescents with SCHL wore hearing aids, and nearly half with borderline HL had subjective difficulty hearing. To better reflect real-world difficulties, stricter definitions of hearing loss should be explored, including a lower cutpoint for the PTA4 or by using the more sensitive PTAhf.

Association of Race, Ethnicity, and Socioeconomic Status With Esthesioneuroblastoma Presentation, Treatment, and Survival.

OBJECTIVE: Socioeconomic and other demographic factors are associated with outcomes in head and neck cancer. This study uses a national cancer database to explore how patient race, ethnicity, and socioeconomic status (SES) are associated with esthesioneuroblastoma outcomes, including 5-year disease-specific survival (DSS), conditional DSS, stage at diagnosis, and treatment. STUDY DESIGN: Retrospective cohort analysis. SETTING: Patients with esthesioneuroblastomas between 1973 and 2015 from the SEER registry (Surveillance, Epidemiology, and End Results). METHODS: The National Cancer Institute Yost Index, a census tract-level composite score composed of 7 parameters, was used to categorize the SES of patients. Kaplan-Meier analysis and Cox regression were conducted to assess DSS. Conditional DSS was calculated per estimates from simplified Cox models. Logistic regression was conducted to identify risk factors for advanced cancer stage at diagnosis and the likelihood of receiving multimodal therapy. RESULTS: Complete data were included for 561 patients. DSS was significantly associated with SES (log-rank, P < .01) but not race. According to Cox regression, DSS was worse for the lowest SES tertile vs the highest (hazard ratio, 1.70 [95% CI, 1.05-2.75]; P = .03). Patients of the lowest SES tertile exhibited an increased risk of advanced cancer stage at diagnosis as compared with the highest SES tertile (odds ratio, 1.84 [95% CI, 1.06-3.30]; P = .035). Black patients (odds ratio, 0.44 [95% CI, 0.24-0.84]; P = .011) were less likely than other patients to receive multimodal therapy. SES alone was not associated with receiving multimodal therapy. CONCLUSION: SES is significantly associated with DSS and conditional DSS for patients with esthesioneuroblastomas. Inequalities in access to care and treatment likely contribute to these disparities.

Conditional and Overall Disease-Specific Survival in Patients With Paranasal Sinus and Nasal Cavity Cancer: Improved Outcomes in the Endoscopic Era.

BACKGROUND: The management of paranasal sinus and nasal cavity malignancies has evolved significantly with the development of advanced endoscopic techniques and improvements in adjuvant therapy. We sought to characterize both disease-specific survival (DSS) and 5-year conditional disease-specific survival (CDSS, the change in life expectancy with increasing survivorship) for sinus malignancies diagnosed before and after the year 2000. METHODS: Patients diagnosed with sinus and nasal cavity cancer between 1973-2015 were extracted from the Surveillance, Epidemiology, End Results (SEER) registry. Kaplan-Meier analysis for DSS was stratified by year of diagnosis before and after 2000. Cox-proportional hazards models of DSS controlling for stage, age, and year of diagnosis were generated. CDSS was calculated using Cox-regression models stratified by stage. RESULTS: We analyzed 10,535 patients. Diagnosis after the year 2000 was independently associated with improved DSS (HR:0.81, 95% CI: 0.75-0.87, P < .001) after controlling for age and stage. After stratifying by stage, diagnosis after year 2000 was associated with improved DSS for localized (HR:0.71, 0.59-0.86, P < .001) malignancies, regional (HR: 0.86, 0.78-0.94, P = .001) and distant malignancies (HR 0.74, 0.63-0.87, P < .001). CDSS improved with increasing survivorship for all stages of sinus and nasal cavity cancer, and those diagnosed after 2000 had improved CDSS compared to those diagnosed before 2000. Descriptively, the association of year of diagnosis with CDSS diminished with increasing survivorship for localized cancers, but was consistent for other stages. CONCLUSION: For paranasal sinus and nasal cavity malignancies, year of diagnosis independently influences both DSS and CDSS. Improved survival is likely due to advances in both surgical and adjuvant treatments. To our knowledge, this study is the first to examine CDSS for these malignancies.

Longitudinal Associations of Subclinical Hearing Loss With Cognitive Decline.

BACKGROUND: Several studies have demonstrated that age-related hearing loss is associated with cognitive decline. We investigated whether subclinical hearing loss (SCHL) or imperfect hearing traditionally categorized as normal (pure-tone average ≤25 dB) may be similarly linked to cognitive decline and risk of incident mild cognitive impairment (MCI)/dementia. METHODS: Participants from the Baltimore Longitudinal Study of Aging were cognitively normal adults at least 50 years old with cognitive assessments from 1991 to 2019 and pure-tone average ≤25 dB measured between 1991 and 1994 (n = 263). The exposure was hearing based on the better ear pure-tone average. Outcomes were test scores in various cognitive domains. Multivariable linear-mixed effects models were developed to analyze the association between hearing and change in cognition over time, adjusting for age, sex, education, vascular burden, and race. Kaplan-Meier survival curves and Cox proportional hazards models portrayed associations between hearing and incident MCI/dementia diagnosis based on predefined criteria. RESULTS: Of 263 participants, 145 (55.1%) were female; mean age was 68.3 years (SD = 8.9). Follow-up ranged up to 27.7 years (mean = 11.7 years). Adjusting for multiple comparisons, a 10-dB increase in hearing loss was associated with an annual decline of -0.02 SD (95% confidence interval: -0.03, -0.01) in Letter Fluency. No significant relationships were observed between hearing and incident MCI/dementia. CONCLUSIONS: A relationship between SCHL and cognitive decline was observed for the Letter Fluency test. Further studies are necessary to determine where in the spectrum of hearing loss there begins to be an observable relationship between hearing and cognitive decline.

Chemosensory deficits are best predictor of serologic response among individuals infected with SARS-CoV-2.

OBJECTIVE: Smell and taste alteration are closely linked to infection with SARS-CoV-2 and may be associated with a more indolent disease course. Serologic response rates among individuals with mild disease remains limited. We sought to identify whether chemosensory changes associated with COVID-19 were predictive of a serologic response. STUDY DESIGN: Cross-sectional study. METHODS: The sample consisted of 306 adults (≥18 years old) volunteering for convalescent plasma donation following perceived COVID-19 illness from April-June 2020. Documentation of COVID-19 PCR status, clinical symptoms at time of illness, and treatment course occurred at the time of serologic analysis, where we assessed chemosensory function using patient-perceived deficits. We implemented previously validated ELISA screening to determine serologic status regarding anti-Spike immunoglobulins. Statistical analysis using stepwise logistic models were employed to identify predictive factors of serologic response. RESULTS: Of 306 patients undergoing serologic and chemosensory evaluation, 196 (64.1%) and 195 (63.7%) reported subjective olfactory and taste dysfunction, respectively, during the first two weeks of COVID-19 infection. In unadjusted models, the odds of developing suprathreshold IgG antibody titers were 1.98 times higher among those who reported altered smell (95% CI 1.14-3.42, p = 0.014) and 2.02 times higher among those with altered taste (95% CI 1.17-3.48, p = 0.011) compared to those with normal smell and taste. Multivariable logistic models adjusting for sex, age, race/ethnicity, symptom duration, smoking status and comorbidities index demonstrated that altered smell and taste remained significant predictors of positive anti-spike IgG response (smell OR = 1.90, 95% CI 1.05-3.44, p = 0.033; taste OR = 2.01, 95% CI = 1.12-3.61, p = 0.019). CONCLUSION: Subjective chemosensory dysfunction, as self-reported smell or taste deficiency, is highly predictive of serologic response following SARS-CoV-2 infection. This information may be useful for patient counseling. Additional longitudinal research should be performed to better understand the onset and duration of the serologic response in these patients.

Smartphone-Based Applications to Detect Hearing Loss: A Review of Current Technology.

BACKGROUND/OBJECTIVES: Age-related hearing loss (ARHL) is a widely prevalent yet manageable condition that has been linked to neurocognitive and psychiatric comorbidities. Multiple barriers hinder older individuals from being diagnosed with ARHL through pure-tone audiometry. This is especially true during the COVID-19 pandemic, which has resulted in the closure of many outpatient audiology and otolaryngology offices. Smartphone-based hearing assessment apps may overcome these challenges by enabling patients to remotely self-administer their own hearing examination. The objective of this review is to provide an up-to-date overview of current mobile health applications (apps) that claim to assess hearing. DESIGN: Narrative review. MEASUREMENTS: The Apple App Store and Google Play Store were queried for apps that claim to assess hearing. Relevant apps were downloaded and used to conduct a mock hearing assessment. Names of included apps were searched on four literature databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and CINAHL) to determine which apps had been validated against gold standard methods. RESULTS: App store searches identified 44 unique apps. Apps differed with respect to the type of test offered (e.g., hearing threshold test), cost, strategies to reduce ambient noise, test output (quantitative vs qualitative results), and options to export results. Validation studies were identified for seven apps. CONCLUSION: Given their low cost and relative accessibility, smartphone-based hearing apps may facilitate screening for ARHL, particularly in the setting of limitations on in-person medical care due to COVID-19. However, app features vary widely, few apps have been validated, and user-centered designs for older adults are largely lacking. Further research and validation efforts are necessary to determine whether smartphone-based hearing assessments are a feasible and accurate screening tool for ARHL. Key Points Age-related hearing loss is a prevalent yet undertreated condition among older adults. Why Does this Paper Matter? Smartphone-based hearing test apps may facilitate remote screening for hearing loss, but limitations surrounding app validation, usability, equipment calibration, and data security should be addressed.

The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study.

Objectives: To examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance. Design: Longitudinal analyses were conducted among 2,110 subjects who underwent audiometric testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only. Results: Among 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3-16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST [0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026-0.082] and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026-0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013-0.228), but not CLOX1 or 3MS. Conclusion: Among those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.

Additive Manufacturing of Resected Oral and Oropharyngeal Tissue: A Pilot Study.

Better visualization of tumor structure and orientation are needed in the postoperative setting. We aimed to assess the feasibility of a system in which oral and oropharyngeal tumors are resected, photographed, 3D modeled, and printed using additive manufacturing techniques. Three patients diagnosed with oral/oropharyngeal cancer were included. All patients underwent preoperative magnetic resonance imaging followed by resection. In the operating room (OR), the resected tissue block was photographed using a smartphone. Digital photos were imported into Agisoft Photoscan to produce a digital 3D model of the resected tissue. Physical models were then printed using binder jetting techniques. The aforementioned process was applied in pilot cases including carcinomas of the tongue and larynx. The number of photographs taken for each case ranged from 63 to 195. The printing time for the physical models ranged from 2 to 9 h, costs ranging from 25 to 141 EUR (28 to 161 USD). Digital photography may be used to additively manufacture models of resected oral/oropharyngeal tumors in an easy, accessible and efficient fashion. The model may be used in interdisciplinary discussion regarding postoperative care to improve understanding and collaboration, but further investigation in prospective studies is required.

Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy?

OBJECTIVE: To evaluate risk factors for pediatric posttonsillectomy hemorrhage (PTH) and the need for transfusion using a national database. STUDY DESIGN: Retrospective cohort study. SETTING: The study was conducted using the Pediatric Health Information System (PHIS) database. METHODS: Children ≤18 years who underwent tonsillectomy with or without adenoidectomy (T±A) between 2004 and 2015 were included. We evaluated the risk of PTH requiring cauterization according to patient demographics, comorbidities, indication for surgery, medications, year of surgery, and geographic region. RESULTS: Of the 551,137 PHIS patients who underwent T±A, 8735 patients (1.58%) experienced a PTH. The risk of PTH increased from 1.33% (95% confidence interval [CI]: 1.15%, 1.53%) in 2010 to 1.91% (95% CI: 1.64%, 2.24%) in 2015 (P < .001). Older age (≥12 vs <5 years old: adjusted odds ratio [aOR] 3.17; 95% CI: 2.86, 3.52), male sex (aOR 1.11; 95% CI: 1.05, 1.17), medical comorbidities (aOR 1.18; 95% CI: 1.08, 1.29), recurrent tonsillitis (aOR 1.15; 95% CI: 1.07, 1.24), and intensive care unit admission (aOR 1.74; 95% CI: 1.55, 1.95) were significantly associated with an increased risk of PTH. Use of ibuprofen (aOR 1.36; 95% CI: 1.22, 1.52), ketorolac (aOR 1.39; 95% CI: 1.14, 1.69), anticonvulsant (aOR 1.23; 95% CI: 1.03, 1.76), and antidepressants (aOR 1.35; 95% CI: 1.03, 1.76) were also associated with an increased risk of PTH. The need for blood transfusion was 2.1% (181/8735). CONCLUSION: The incidence of PTH increased significantly between 2011 and 2015, and ibuprofen appears to be one contributing factor. Given the benefits of ibuprofen, it is unclear whether this increased risk warrants a change in practice.