Management of Cochlear Implant Electrode Arrays Misplaced in the Internal Auditory Canal: A Systematic Review.

OBJECTIVE: Misplacement of electrode arrays in the internal auditory canal (IAC) presents a unique clinical challenge. Speech recognition is limited for cochlear implant (CI) users with misplaced arrays, and there are risks with revision surgery including facial and/or cochlear nerve injury. DATABASES REVIEWED: PubMed, Embase, and Scopus. METHODS: A literature search was performed from inception to September 2023. The search terms were designed to capture articles on misplaced arrays and the management options. Articles written in English that described cases of array misplacement into the IAC for children and adults were included. The level of evidence was assessed using Oxford Center for Evidence Based Medicine guidelines. Descriptive statistical analyses were performed. RESULTS: Twenty-eight cases of arrays misplaced in the IAC were identified. Thirteen (46%) were patients with incomplete partition type 3 (IP3), and 7 (25%) were patients with common cavity (CC) malformations. Most misplaced arrays were identified postoperatively (19 cases; 68%). Of these cases, 11 (58%) were managed with array removal. No facial nerve injuries were reported with revision surgery. Eight cases (42%) were left in place. Several underwent mapping procedures in an attempt improve the sound quality with the CI. CONCLUSION: Electrode array misplacement in the IAC is a rare complication that reportedly occurs predominately in cases with IP3 and CC malformations. Removal of misplaced arrays from the IAC reportedly has not been associated with facial nerve injuries. Cases identified with IAC misplacement postoperatively can potentially be managed with modified mapping techniques before proceeding with revision surgery.

A Reproducible Peritonsillar Abscess Incision and Drainage Model for Junior Trainees.

OBJECTIVES: To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees' confidence. METHODS: The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin's palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants' confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included. RESULTS: Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores (P < .001). CONCLUSIONS: Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.

A Systematic Review of Peritonsillar Abscess Simulators: Enhancing Training and Identifying the Need for Standardization.

OBJECTIVES: To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation. DATA SOURCES: PubMed, Scopus, Web of Science, Ovid, and Cochrane. REVIEW METHODS: A search of the abovementioned databases was performed in August 2022 using the terms "peritonsillar abscess/quinsy," "incision/drainage/aspiration," and "simulation." No time restrictions were applied. We included studies that clearly described how their PTA models were built and underwent validation from experts and/or evaluation from trainees. Articles describing a model only without any evaluation and reports in languages other than English were excluded. RESULTS: Our search initially yielded 80 articles after duplicate removal, 10 of which met our criteria and were included. Two studies trained participants on both needle aspiration and incision and drainage (I&D), four studies on I&D only, and four on needle aspiration only. 87.5% to 100% of junior residents reported minimal exposure to PTA prior to simulation. Five studies provided some form of validation to their models. The value of the simulators to train participants on skills received better appreciation than their anatomical fidelity. The perceived confidence level of trainees in managing PTA, which was assessed in 7 studies, substantially improved after training. CONCLUSION: PTA simulation improves the confidence of trainees to perform PTA drainage. There is, however, a lack of standardization and evidence regarding transfer validity among PTA simulators. The development of a standardized PTA simulator could allow for more widespread use and increase resident comfort with this procedure in a pre-clinical setting. LEVEL OF EVIDENCE: NA Laryngoscope, 2023.

Public perception of common cancer misconceptions: A nationwide cross-sectional survey and analysis of over 3500 participants in Saudi Arabia.

Purpose/Background: Patients and healthcare providers use online health information and social media (SM) platforms to seek medical information. As the incidence of cancer rises, the popularity of SM platforms has yielded widespread dissemination of incorrect or misleading information about it. In this study, we aimed to assess public knowledge about incorrect cancer information and how they perceive such information in Saudi Arabia. Methods: A nationwide survey was distributed in Saudi Arabia. The survey included questions on demographics, SM platform usage, and common misleading and incorrect cancer information. Results: The sample (N = 3509, mean age 28.7 years) consisted of 70% females and 92.6% Saudi nationals. Most participants had no chronic illness. One-third were college graduates and less than one-quarter were unemployed. Conclusions: Differences in level of knowledge about cancer emerged in association with different demographic factors. Public trust in health information on SM also led to being misinformed about cancer, independent from educational level and other factors. Efforts should be made to rapidly correct this misinformation.

Functional Brain Regions Linked to Tinnitus Pathology and Compensation During Task Performance: A Systematic Review.

OBJECTIVE: To systematically search the literature and organize relevant advancements in the connection between tinnitus and the activity of different functional brain regions using functional magnetic resonance imaging (fMRI). DATA SOURCES: MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Web of Science, ProQuest Dissertations & Theses Global, Cochrane Database of Systematic Reviews, and PROSPERO from inception to April 2022. REVIEW METHODS: Studies with adult human subjects who suffer from tinnitus and underwent fMRI to relate specific regions of interest to tinnitus pathology or compensation were included. In addition, fMRI had to be performed with a paradigm of stimuli that would stimulate auditory brain activity. Exclusion criteria included non-English studies, animal studies, and studies that utilized a resting state magnetic resonance imaging or other imaging modalities. RESULTS: The auditory cortex may work to dampen the effects of central gain. Results from different studies show variable changes in the Heschl's gyrus (HG), with some showing increased activity and others showing inhibition and volume loss. After controlling for hyperacusis and other confounders, tinnitus does not seem to influence the inferior colliculus (IC) activation. However, there is decreased connectivity between the auditory cortex and IC. The cochlear nucleus (CN) generally shows increased activation in tinnitus patients. fMRI evidence indicates significant inhibition of thalamic gating. Activating the thalamus may be of important therapeutic potential. CONCLUSION: Patients with tinnitus have significantly altered neuronal firing patterns, especially within the auditory network, when compared to individuals without tinnitus. Tinnitus and hyperacusis commonly coexist, making differentiation of the effects of these 2 phenomena frequently difficult.

Intraparotid Recurrence of Papillary Thyroid Carcinoma After Thyroidectomy Coincident With Declining Thyroglobulin Levels: A Case Report and Review of the Literature.

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Intraparotid recurrence of PTC is, however, rare. Most parotid malignancies are either primary or metastatic from cancer outside the head and neck. We report a case of a 71-year-old man who had undergone lobectomy and completion thyroidectomy for PTC and presented to our clinic with an insidious intraparotid recurrence, for which he underwent a superficial parotidectomy and radioactive iodine therapy. We also present a review of the literature on similar cases. Intraparotid metastasis of PTC should be considered in the differential diagnosis of a parotid mass.

Effectiveness and safety of immediate application of negative pressure wound therapy in head and neck free flap reconstruction: a systematic review.

To our knowledge this is the first systematic review of the immediate application of negative pressure wound therapy (NPWT) to the head and neck in free flap reconstruction. We conducted a systematic search of the PubMed and Cochrane databases in October 2021 using the MeSH terms 'negative pressure wound therapy', 'free flaps', 'microsurgery', and 'vacuum-assisted closure'. Included studies evaluated the use of immediate NPWT in head and neck free flap reconstruction. Outcomes, indications, monitoring, and reported complications were retrieved. Of the 908 articles searched, nine published between 2000 and 2021 were included: four retrospective studies and five case series. NPWT was applied to 56 free flaps, and 54 had successful outcomes. The most common reported indication for flap reconstruction was malignancy. NPWT has the potential to be a valuable tool for complicated wounds, and further studies are needed to quantify functional and aesthetic outcomes.

Usher syndrome IIIA: a review of the disorder and preclinical research advances in therapeutic approaches.

Usher syndrome (USH) is an autosomal recessive disorder characterized by sensorineural hearing loss, progressive pigmentary retinopathy, and vestibular dysfunction. The degree and onset of hearing loss vary among subtypes I, II, and III, while blindness often occurs in the second to fourth decades of life. Usher type III (USH3), characterized by postlingual progressive sensorineural hearing loss, varying levels of vestibular dysfunction, and varying degrees of visual impairment, typically manifests in the first to second decades of life. While USH3 is rare, it is highly prevalent in certain populations. RP61, USH3, and USH3A symbolize the same disorder, with the latter symbol used more frequently in recent literature. This review focuses on the clinical features, epidemiology, molecular genetics, treatment, and research advances for sensory deficits in USH3A.

Complications of Body Contouring Surgery in Postbariatric Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Obesity is a major global health problem. With an increasing number of bariatric surgeries, the need for body-contouring procedures has grown. These procedures are associated with multiple complications because of various patient characteristics and risk factors. OBJECTIVES: In this study, we performed a systematic literature review of all the complications of postbariatric body contouring surgeries, as well as a meta-analysis to estimate the effects of body mass index (BMI) and the weight of the tissue resected during body contouring on the development of complications. METHODS: We conducted a literature search of the PubMed and Cochrane databases in September 2020, using the MeSH terms plastic surgery, weight loss, and complications. Studies were included if they involved more than 35 postbariatric patients and reported postoperative complication rates and types. RESULTS: In total, 561 articles were initially identified, and 25 studies were included after the final review. The overall weighted rate of postbariatric body contouring surgical complications in all studies was 31.5%. The most frequent complication from all regions of body contouring was seroma (weighted rate 12.7-13.9%). Regarding risk factors, analysis indicated that a BMI < 30 kg/m2 and low mean weight of resected tissue were associated with fewer complications. CONCLUSION: Body contouring procedures are relatively safe. Although complications after contouring are common, most either resolve spontaneously or require minimal intervention. In body contouring after bariatric surgery, there is a 37% increased risk of developing complications if the BMI is ≥ 30 kg/[Formula: see text] before body contouring. A higher weight of resected tissue appears to be linked to a greater risk of complications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prevalence of complementary and alternative medicine use in brain tumor patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

OBJECTIVES: To determine the prevalence and types of complementary and alternative medicine (CAM) being utilized and the possible factors that prompted the use of CAM in patients with brain tumors. Methods: The study conducted was a questionnaire-based, cross-sectional study of patients diagnosed with brain tumors at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia from January 2011 to May 2018. Patients with primary and secondary brain tumors, were included. Our questionnaire was conducted via phone interviews after obtaining patient consent.  Results: A total of 72 patients were included. The mean age of the participants was 45.89 (±16.52) years. We found that education level significantly affected the use of CAM. Fewer users of CAM held bachelor's degree and patients with lower degrees used CAM more frequently (p=0.027). The most frequent types of CAM were Zamzam (holy water) and Ruqya (Quran reading). Family members were the most frequent source of information about the use of CAM (81.6%).  Conclusion: Education level has a significant effect on CAM use. Gender plays a role in the type of CAM used. Future research should focus on the adverse effects of some CAM therapies, how effective CAM therapies are, and the effect CAM may play in delaying patients from seeking medical advice.

Psychological, sociodemographic, and clinicopathological predictors of breast cancer patients' decision to undergo breast reconstruction after mastectomy.

OBJECTIVES: To examine the influence of socioeconomic factors, anxiety, depression, and personality traits on the decision to undergo breast reconstruction (BR) post mastectomy. METHODS: In this cross-sectional study, adult female breast cancer (BC) patients who had undergone a mastectomy between January 2017 and 2019 were interviewed using a 46-item questionnaire at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The questionnaire was divided into 5 sections: demographic data, personality traits, the Narcissism Index (NI), and the Hospital Anxiety and Depression Scale (HADS). Results: The sample (N=196; mean age: 48.44 [± 9.87] years, opted for BR: 60.2%, with chronic diseases: 36.7%, Saudi nationals: 43.9%) obtained means of 4.17 (± 2.81) on NI score, 7.72 (± 4.88) on anxiety score, and 5.78 (± 4.65) on depression score. Group differences in age, depression, lymph node involvement, and 2 personality traits emerged. CONCLUSION: Age and depression significantly influenced the decision to undergo BR. Women who had opted for BR tended to be younger, be less depressed, and be characterized by lesser nodal involvement. Personality traits also influenced the decision to undergo BR. Diagnosing and treating depressed patients is an important component. A patient's age should not deter physicians from counselling them about BR.

SOX2 Is a Potential Novel Marker of Undifferentiated Thyroid Carcinomas.

Background Thyroid cancer is a very common endocrine malignancy. Cancer stem cells are attributable to initiation, progression, and treatment failure in thyroid carcinoma. In the current study, immunostaining of SRY-box 2 (SOX2) in thyroid carcinoma is investigated. Material and methods Tissue microarrays were generated from 219 thyroid carcinomas distributed as follows: papillary thyroid carcinoma (175), follicular thyroid carcinoma (11), medullary thyroid carcinoma (11), Hurthle cell carcinoma (three), poorly differentiated thyroid carcinoma (PTDC; nine), and anaplastic thyroid carcinoma (ATC; 10). Immunohistochemistry for SOX2 was done and examined for nuclear staining. The results were analysed.  Results SOX2 immunostaining was positive in one PDTC (out of nine; 11.1%) and in three ATC (out of 10; 30%). The rest of the thyroid cancers showed no immunostaining for SOX2. Conclusion The study represents for the first time SOX2 immunostaining on a large number of thyroid carcinomas. We discovered that SOX2 immunostaining is found in PDTC and ATC while SOX2 immunostaining is lacking in other thyroid cancer. SOX2 may be a marker of loss of differentiation in thyroid carcinoma. In vitro as well as in vivo molecular studies are required to explore the possible role of SOX2 in thyroid carcinoma.