A comparison of endoscopic endonasal versus open approaches for skull base chordoma: a comprehensive National Cancer Database analysis.

OBJECTIVE: The authors of this study aimed to investigate independent prognostic factors of survival with a particular focus on comparing the safety and efficacy of endoscopic endonasal versus open approaches in the surgical management of skull base chordoma. METHODS: A retrospective National Cancer Database review of skull base chordoma patients was performed to capture resection cases from 2010 to 2020, evaluating overall survival (OS), early postoperative mortality, readmission rates, and hospital length of stay (LOS) between surgical approaches and the independent prognostication of death utilizing Cox multivariate regression analysis. RESULTS: Among the 736 patients included in the cohort, 456 patients (62.0%) and 280 patients (38.0%) underwent endoscopic endonasal and open resection, respectively. These values represent a rate of change over the study period of +4.1 versus -0.14 cases per year, respectively. Gross-total resection was achieved in 32.5% of cases. A positive margin status was found in 51.8% of cases. There was no association between extent of resection and surgical approach (p = 0.257). There was no difference in OS (p = 0.562), 30- and 90-day mortality (p = 0.209 and 0.126, respectively), and 30-day readmission (p = 0.438) between the two surgical groups. The mean LOS was reduced by 2.1 days in the endoscopic cohort (p = 0.013) compared with the open approach cohort. Finally, multivariate analysis revealed a tumor size ≥ 4 cm (HR 4.03, p = 0.005) and public insurance (HR 2.76, p = 0.004) as negative predictors of survival and treatment at an academic center (HR 0.36, p = 0.043) as a positive prognosticator of survival. CONCLUSIONS: The endoscopic endonasal approach has been increasingly utilized over time and touts noninferiority with respect to safety and efficacy with a marked improvement in LOS, which carries substantial implications for both healthcare costs and enhanced patient recovery. Future prospective studies are necessary to further delineate trends and surgical outcomes for skull base chordoma.

Role of social determinants of health on quality of life in pediatric chronic rhinosinusitis.

KEY POINTS: Social determinants of health link to worse quality of life in pediatric chronic rhinosinusitis. The area deprivation index (ADI) may serve to predict health disparities in these patients.

Utilization of Face-to-Face Vestibular Support Groups: A Comparison to Online Group Participation.

OBJECTIVE: This study compared the utilization and outcomes of face-to-face (F2F) vestibular support groups and online support communities (OSC) for individuals with vestibular disorders. METHODS: We distributed a 31-question anonymous electronic survey through the Vestibular Disorders Association (VeDA) to F2F participants, categorizing user involvement in F2F, OSCs, or both and assessed impact on medical decision-making, psychosocial benefits, and goals achieved. RESULTS: The F2F cohort consisted of 97 individuals comprising primarily of non-Hispanic White women (mean age = 57 years, SD ± 14 years) with diagnoses including persistent postural-perceptual dizziness (19%), Meniere's disease (15%), and vestibular neuritis (13%). Most participants were diagnosed by an otolaryngologist (65%) and attended F2F meetings monthly or less frequently (78%). The OSC group comprised of 551 individuals, primarily of non-Hispanic White women, but was younger in age (mean age = 50 years, SD ± 13 years). OSC participants notably engaged more, with 36% participating on a daily basis and 32% multiple times a week. F2F participants were older (mean age 57 years vs 50 years, P < .001) and more commonly referred by medical professionals (22% F2F vs 6% OSC, P < .001). Both groups had similar achieved goals, including hearing from others with the same diagnosis (84% vs 89%, P > .05) and similar impact on medical decision-making (75% vs 78%, P > .05). More F2F participants reported increased development of coping skills (79% F2F vs 69% OSC, P = .037). OSC participants typically found the group via an online search (75%), compared to 51% for F2F. OSC participants had higher daily engagement (36%) compared to F2F (1%). CONCLUSION: F2F users are older and more commonly referred by medical professionals. Despite less frequent engagement, F2F participants reported similar influences on achieved goals, medical decision-making, and impact on psychosocial benefits. These findings highlight the importance of both F2F and OSC support groups for individuals with vestibular disorders.

Awareness Among Transgender and Nonbinary Adults of the Otolaryngologist's Role in Providing Gender-Affirming Care Services.

OBJECTIVE: To assess transgender and nonbinary adults' awareness of Otolaryngologists' (ENT) and speech-language pathologists' (SLP) ability to perform various face, neck, and voice procedures for gender-affirming purposes. STUDY DESIGN: Cross-sectional survey. SETTING: Online, from February to May 2022. METHODS: We developed a list of nonsurgical and surgical gender-affirming face, neck, and voice procedures. We asked transgender and nonbinary (TNB) adults which procedures from this list they knew could be performed by specially-trained ENTs or SLPs for gender-affirmation and which listed procedures they knew existed as gender-affirming treatment before the survey. We assessed awareness of ENTs' and SLPs' ability for each procedure across gender identity using Fisher exact tests. We examined if demographic or socioeconomic factors were associated with the total number of gender-affirming procedures participants knew ENTs or SLPs could perform using univariable linear regression. RESULTS: TNB adults (N = 234) generally knew these procedures existed as gender-affirming treatment (64%-93%). However, TNB adults were largely unaware these gender-affirming procedures could be performed by specially-trained ENTs or SLPs (53% or less), especially procedures unrelated to the voice, neck, and nose (26% or less). Knowledge of ENTs' and SLPs' ability was similar across gender identity for most procedures. Total number of procedures known that ENTs or SLPs could perform did not differ by demographic/socioeconomic factors (p > .05). CONCLUSION: These findings suggest transgender and nonbinary individuals may not know to seek Otolaryngologists or SLP when desiring gender-affirming face, neck, or voice care. Increased efforts are needed to promote awareness of Otolaryngology's role in providing gender-affirming care.

Needs Assessment of Gender-Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria.

OBJECTIVE: To assess the needs of transgender and nonbinary (TNB) adults for gender-affirming face, neck, and voice procedures. STUDY DESIGN: Cross-sectional survey. SETTING: Online, February to May 2022. METHODS: Primary outcomes included utilization of otolaryngologists and speech-language pathologists; gender dysphoria felt from the face, neck, and voice self-reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender-affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site-specific dysphoria and the desire for relevant procedures. RESULTS: TNB participants (N = 234) infrequently sought gender-affirming care with speech-language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82). CONCLUSION: Gender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender-affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender-affirming face, neck, and voice care.

Creation of an Open Bedside Tracheostomy Program at a Community Hospital With a Single Surgeon.

Objective: To assess the adverse event rate and operating cost of open bedside tracheostomy (OBT) at a community hospital. To present a model for creating an OBT program at a community hospital with a single surgeon. Study Design: Retrospective case series pilot study. Setting: Academic-affiliated community hospital. Methods: Retrospective chart review of surgical OBT and operating room tracheostomy (ORT) at a community hospital from 2016 to 2021. Primary outcomes included operation duration; perioperative, postoperative, and long-term complications; and crude time-based estimation of operating cost to the hospital using annual operating cost. Clinical outcomes of OBT were assessed with ORT as a comparison using t tests and Fisher's exact tests. Results: Fifty-five OBT and 14 ORT were identified. Intensive care unit (ICU) staff training in preparing for and assisting with OBT was successfully implemented by an Otolaryngologist and ICU nursing management. Operation duration was 20.3 minutes for OBT and 25.2 minutes for ORT (p = .14). Two percent, 18%, and 10% of OBT had perioperative, postoperative, and long-term complications, respectively; this was comparable to rates for ORT (p = .10). The hospital saved a crude estimate of $1902 in operating costs per tracheostomy when performed in the ICU. Conclusion: An OBT protocol can be successfully implemented at a single-surgeon community hospital. We present a model for creating an OBT program at a community hospital with limited staff and resources.

Morphometric Analysis and Observer Perceptions Following Transvestibular Chondrolaryngoplasty.

OBJECTIVES: To assess novel morphometric measurement strategies and observer perception ratings as potential metrics for evaluating gender-affirming transvestibular chondrolaryngoplasty in reducing contour protrusion of the neck. METHODS: High-resolution preoperative and 3-month postoperative photographs of a pilot series of 10 patients (n = 10) who underwent endoscopic transvestibular chondrolaryngoplasty were collected. Morphometric measurements of "light reflex" and lateral view thyroid protrusion angles of the neck contours were analyzed. Pre- and postoperative photographs were presented in random order in a survey to 17 untrained judges and rated on perceived masculinity/femininity and thyroid notch protrusion on a 7-point scale. A pre- to postoperative change in morphometric angles and subjective ratings was assessed using paired t-tests and Wilcoxon signed-rank tests. RESULTS: Mean light reflex angles were reduced after surgery from 78.6° to 40.5° in the anterior neutral view (P = .0003), from 45.2° to 24.4° in the anterior extended view (P = .003), and from 7.03° to 4.32° in the lateral view (P = .006). Median survey ratings of neck photographs were improved after surgery, from 4 to 3 in gender perception toward more feminine perception (P < .0001) and from 4 to 2 in thyroid protrusion toward less protrusive perception (P < .0001). CONCLUSIONS: Morphometric analysis in anterior and lateral views as well as subjective gender perception and contour protrusion measures following feminization chondrolaryngoplasty by endoscopic transvestibular scarless approach demonstrate encouraging possibilities as outcome evaluation measures for chondrolaryngoplasty.

Cochlear implantation in Waardenburg syndrome: Systematic review and meta-analysis.

OBJECTIVE: Waardenburg syndrome (WS) is a genetic condition associated with moderate to profound sensorineural hearing loss. The aim of this review is to characterize cochlear implant (CI) outcomes in patients with a confirmed clinical diagnosis of WS. DATA SOURCES: MEDLINE, Ovid EMBASE, and Cochrane Library. REVIEW METHODS: All reports describing defined sets of patients with WS who underwent CI and subsequent evaluation of clinical outcomes were included. To harmonize outcome data between studies that used different measures, a binary variable Favored CI was developed to capture success of procedures (1 = favored, 0 = unfavored) based on original authors' description, commentary, discussion, and conclusions. Expert reviewers independently reviewed and selected articles, extracted data and scored Favored CI values. Synthetic and analytic meta-analyses were implemented using standard analytic techniques. RESULTS: Twenty articles meeting inclusion criteria provided data on 192 WS patients and 210 CIs. The mean age at CI was 3.8 years (95% confidence interval [95%CI]; 3.1-4.5 years), and the mean duration of follow up was 5.2 years (95% CI; 3.4-7.0 years). Surgical complications were rare (11/210 implants, 5.2%) where gusher was the most common complication. CIs yielded favorable hearing outcomes in 90% (95% CI; 84-94%) of cases, and appear successful for those with temporal bone anomalies (p = 0.04). CONCLUSIONS: Quantitative synthesis of the study data demonstrates that in the majority of patients with WS, CI yield favorable hearing outcomes and low rates of surgical complications. CI has shown to provide clinical benefits in patients with WS.

Legislation has Changed But Issues Remain: Provider Perceptions of Caring for People Who Use Cannabis During Pregnancy in Safety Net Health Settings, a Qualitative Pilot Study.

Objective: To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings. Methods: Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported via survey to being a maternal health provider (e.g., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009). Results: We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating. Conclusions: Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.

Cricothyroid Muscle Botulinum Toxin Chemodenervation to Treat Recalcitrant High-Pitched Functional Dysphonia in an Adult Male.

INTRODUCTION: Functional dysphonia occurs in the absence of structural or neurologic laryngeal abnormalities with various manifestations including aphonia and inappropriate vocal pitch. Voice therapy is the first-line treatment, and literature on treatment options for functional dysphonia unresponsive to voice therapy is limited. METHODS: Retrospective medical records review and report of a case. RESULTS: We report a unique case of an adult male with recalcitrant high-pitched functional dysphonia of adult-onset that was successfully treated with a single cricothyroid muscle botulinum toxin (Botox) chemodenervation injection. CONCLUSION: Cricothyroid muscle botulinum toxin chemodenervation can be an effective treatment for recalcitrant functional dysphonia.