How Does Lacking a Home Program Impact Otolaryngology Applicants?

OBJECTIVES: To compare otolaryngology interview and match outcomes between applicants with and without home residency programs. METHODS: Otolaryngology applicants from US allopathic medical schools during the 2019-2023 cycles who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey were identified. Students were stratified based upon whether their medical school had an affiliated otolaryngology residency program. The primary outcomes were number of interviews and match rate. Wilcoxon-rank sum and χ2 testing was used to assess associations between home program status and interview and match outcomes. RESULTS: Of the 633 fourth-year medical students applying to otolaryngology during the 2019-2023 application cycles, 89 had no home program (NHP) and 544 had a home program (HP). Applicants with NHP completed significantly more away rotations than applicants with a HP (2.2 vs. 1.5; p < 0.01). There was no difference in mean number of applications submitted between applicants with NHP and applicants with a HP. However, applicants with a HP received a significantly greater number of interviews (14.7 vs. 11.8; p < 0.01), attended more interviews (12.4 vs. 11.3; p = 0.02), attended a lower percentage of their offered interviews (84.4% vs. 95.8%), and had a higher match rate (81.8% vs. 70.8%; p = 0.02) than applicants with NHP. Applicants with NHP interviewed at (1.9 vs. 1.3; p < 0.01) and matched at (33.7% vs. 23.9%; p = 0.048) significantly more away rotation institutions than applicants with a HP. CONCLUSION: Applicants with NHP received fewer interviews and had lower match rates. Away rotations may be especially important for applicants with NHP. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Regulatory T cells play a crucial role in maintaining sperm tolerance and male fertility.

Regulatory T cells (Tregs) modulate tissue homeostatic processes and immune responses. Understanding tissue-Treg biology will contribute to developing precision-targeting treatment strategies. Here, we show that Tregs maintain the tolerogenic state of the testis and epididymis, where sperm are produced and mature. We found that Treg depletion induces severe autoimmune orchitis and epididymitis, manifested by an exacerbated immune cell infiltration [CD4 T cells, monocytes, and mononuclear phagocytes (MPs)] and the development of antisperm antibodies (ASA). In Treg-depleted mice, MPs increased projections toward the epididymal lumen as well as invading the lumen. ASA-bound sperm enhance sperm agglutination and might facilitate sperm phagocytosis. Tolerance breakdown impaired epididymal epithelial function and altered extracellular vesicle cargo, both of which play crucial roles in the acquisition of sperm fertilizing ability and subsequent embryo development. The affected mice had reduced sperm number and motility and severe fertility defects. Deciphering these immunoregulatory mechanisms may help to design new strategies to treat male infertility, as well as to identify potential targets for immunocontraception.

Retrospective assessment of the impact of an education specialist on the care of children with hearing loss.

OBJECTIVE: To assess the impact of an education specialist in a multidisciplinary pediatric hearing loss clinic. STUDY DESIGN: Retrospective review and cross-sectional survey. SETTING: Single tertiary care center. METHODS: Consultations held between an education specialist and families of pediatric deaf or hard of hearing (DHH) children within a two-year period were reviewed. Reasons for referral and services provided to each patient and family who subsequently worked with the educational specialist were assessed. Parents of patients who had previously worked with the education specialist were invited to complete a survey evaluating their experience. RESULTS: 102 patients were referred to the educational specialist in a two-year period. Most common reasons for referral included need for special education plans to accommodate their hearing deficit (32) or family request to support for revisions to such plans (37). 14 patient families completed our survey. 76.9 % of respondents confirmed that the education specialist recommended resources they had not been introduced to before. Given a scale of 1 ("completely dissatisfied") and 10 being "completely satisfied," the average rating of the 14 respondents was 9.0. CONCLUSION: The role of an education specialist in a pediatric hearing loss clinic is to optimize patient and family access to resources that could benefit their DHH child's academic development over time. Future studies should prospectively investigate the impact of education specialist services on the educational progress of DHH patients compared to outcomes without these supports.

Otolaryngology-Head and Neck Surgery Boot Camp in Preclinical Undergraduate Medical Education: A Pilot Study.

Objectives: There are limited opportunities in the medical school curriculum to learn about the field of Otolaryngology-Head and Neck Surgery (ORL) and to acquire relevant clinical skills, especially during preclinical years. The purpose of this pilot study was to investigate the impact of implementing an ORL boot camp in preclinical undergraduate medical education to help first- and second-year medical students learn about common ORL problems and become more comfortable performing basic ORL clinical skills so that they are better prepared to provide care for patients during clerkships and beyond. Methods: First- and second-year medical students were recruited to a single 3-hour boot camp session consisting of didactics/demonstrations and clinical experiences. The boot camp provided an introduction into the field of ORL, description of common ORL pathologies, associated management and procedures, and demonstrations of basic ORL procedures typically performed in clinic. Under supervision, subjects practiced complete head and neck physical examinations (H&NPE) on their peers including otoscopy, tuning fork tests, examination with a nasal speculum, and oral, basic cranial nerve, and neck examination. Pre- and post-tests assessing subjective (0-5 point Likert scale) and objective (content exam) measures of ORL knowledge, comfort level performing ORL skills, and interest in ORL were used to evaluate the intervention. Results: A total of 17 students participated in the boot camp as part of an extracurricular session. Seventeen students completed pre-tests and 16 completed post-tests. Ratings of self-reported knowledge of ORL (2.06 vs 3.00; P = .019) and comfort level in performing H&NPE (1.76 vs 3.44; P < .001) increased significantly after the boot camp. Mean performance on an ORL content exam also increased significantly from 42.17% to 71.35% (P < .001). Conclusions: An ORL boot camp may be an effective method of teaching for preclinical medical students. Further studies with a larger cohort are warranted.

Impact of COVID-19 on diagnosis and management of newborn hearing loss.

INTRODUCTION: The COVID-19 pandemic has caused unexpected disruptions in patient care, including adherence to the Early Hearing Detection and Intervention (EHDI) 1-3-6 guidelines. These guidelines mandate newborn hearing screening (NHS) by 1 month of age, diagnosis of hearing loss (HL) by 3 months, and referral to Early Intervention by 6 months. The objective of this study was to investigate the impact of COVID-19 on EHDI benchmarks in a major US city to help clinicians address current needs and prepare for future disruptive events. METHODS: Retrospective review was performed for all patients who did not pass NHS at two tertiary care centers between March 2018 and March 2022. Patients were divided into three cohorts based on the periods of time before, during, and after the COVID-19 Massachusetts State of Emergency (SOE). Demographics, medical history, NHS results, Auditory Brainstem Response results, and hearing aid (HA) intervention data were collected. Two-sampled independent t-tests and analysis of variance were used to compute rate and time outcomes. RESULTS: 30,773 newborns underwent NHS and 678 failed NHS. There was no difference in 1-month benchmark NHS rates, increased 3-month benchmark HL diagnosis rate post-SOE COVID (91.7%; p = 0.002), and increased 6-month benchmark HA intervention rate post-SOE COVID compared to pre-COVID (88.9% vs. 44.4%; p = 0.027). Mean time to NHS was lower during SOE COVID compared to pre-COVID (1.9 days vs. 2.0 days; p = 0.038) and mean time to HL diagnosis was higher during SOE COVID (47.5 days; p < 0.001). Lost to follow-up (LTF) rate at HL diagnosis decreased post-SOE (4.8%; p = 0.008). CONCLUSION: No differences in EHDI 1-3-6 benchmark rates between pre-COVID and SOE COVID patients were observed. However, increased 3-month benchmark HL diagnosis and 6-month benchmark HA intervention rates and a decreased LTF rate at 3-month benchmark HL diagnosis were observed post-SOE COVID.

Functionally Clustered mRNAs Are Distinctly Enriched at Cortical Astroglial Processes and Are Preferentially Affected by FMRP Deficiency.

Mature protoplasmic astroglia in the mammalian CNS uniquely possess a large number of fine processes that have been considered primary sites to mediate astroglia to neuron synaptic signaling. However, localized mechanisms for regulating interactions between astroglial processes and synapses, especially for regulating the expression of functional surface proteins at these fine processes, are largely unknown. Previously, we showed that the loss of the RNA binding protein FMRP in astroglia disrupts astroglial mGluR5 signaling and reduces expression of the major astroglial glutamate transporter GLT1 and glutamate uptake in the cortex of Fmr1 conditional deletion mice. In the current study, by examining ribosome localization using electron microscopy and identifying mRNAs enriched at cortical astroglial processes using synaptoneurosome/translating ribosome affinity purification and RNA-Seq in WT and FMRP-deficient male mice, our results reveal interesting localization-dependent functional clusters of mRNAs at astroglial processes. We further showed that the lack of FMRP preferentially alters the subcellular localization and expression of process-localized mRNAs. Together, we defined the role of FMRP in altering mRNA localization and expression at astroglial processes at the postnatal development (P30-P40) and provided new candidate mRNAs that are potentially regulated by FMRP in cortical astroglia.SIGNIFICANCE STATEMENT Localized mechanisms for regulating interactions between astroglial processes and synapses, especially for regulating the expression of functional surface proteins at these fine processes, are largely unknown. Previously, we showed that the loss of the RNA binding protein FMRP in astroglia disrupts expression of several astroglial surface proteins, such as mGluR5 and major astroglial glutamate transporter GLT1 in the cortex of FMRP-deficient mice. Our current study examined ribosome localization using electron microscopy and identified mRNAs enriched at cortical astroglial processes in WT and FMRP-deficient mice. These results reveal interesting localization-dependent functional clusters of mRNAs at astroglial processes and demonstrate that the lack of FMRP preferentially alters the subcellular localization and expression of process-localized mRNAs.

Cocaine Self-administration and Extinction Inversely Alter Neuron to Glia Exosomal Dynamics in the Nucleus Accumbens.

Alteration of glutamatergic synaptic plasticity in the Nucleus Accumbens (NAc) has been implicated in cocaine-seeking behaviors. Astroglial mechanisms for maintaining extracellular glutamate homeostasis through cysteine/glutamate exchanger (xCT) and glutamate transporter GLT1 are dysregulated following cocaine exposure and contribute to altered glutamatergic synaptic plasticity. However, how these astroglial proteins become dysregulated in cocaine addiction remains unknown. We recently showed that neuron to astroglial exosome signaling is essential to maintain GLT1 protein expression by transferring neuronal miR-124-3p into astrocytes to suppress GLT1-inhibiting microRNAs (miRs) in astrocytes. In the current study, by selectively labeling neuronal exosomes using CD63-GFPf/+ exosome reporter mice, we examined how the self-administration and extinction stages of the mouse cocaine self-administration model alter neuronal exosome signaling to astrocytes and microglia in the NAc. We found that cocaine (but not food) self-administration strongly reduces the internalization of neuronal exosomes, particularly in astrocytes in the NAc (but not in motor cortex), which can be effectively reversed by extinction training. In parallel, cocaine self-administration alone specifically and differentially affects activation of glial cells by decreasing GFAP expression in astrocytes but increasing Iba1 expression in microglia. However, extinction training fully reverses the increased Iba1 expression in microglia but only partially reverses the reduction of GFAP in astrocytes. Taken together, our study reveals altered in vivo dynamics of NAc neuronal exosomes in the cocaine addiction model, providing new insights about how altered neuron to glial exosome signaling may contribute to astroglial dysfunction in cocaine addiction.