The Impact of Sleep Deprivation on Video Head Impulse Test Results.

OBJECTIVE: To investigate the association between sleep deprivation and vestibular dysfunction by Video Head Impulse Test (vHIT). METHODS: This prospective clinical trial explores the impact of acute sleep deprivation on the vestibular-ocular reflex (VOR) in medical residents. The study involved healthy physicians from diverse medical disciplines. Participants underwent vHIT assessments before and after a 26-h shift. The examinations focused solely on the right lateral semicircular canal. Participants further completed a demographics and fatigue questionnaire, including the Fatigue Severity Scale (FSS) questionnaire and a Visual Analog Fatigue Score (VAFS). RESULTS: The study involved 30 medical residents. Participants experienced a statistically significant decrease in VOR gain in the right horizontal semicircular canal during a 26-h shift (p < 0.01). While the FSS and VAFS questionnaires showed no significant difference before and after the shift, the analysis of ∆VOR gain indicated a statistically significant increase associated with decreased sleep time during the shift (p = 0.018, 95% Confidence Interval [0.08, 0.68]). The most substantial increase in ∆VOR occurred between 22-26 h of sleep deprivation. No significant differences were observed in ∆VOR between genders, ages, disciplines, department shifts versus emergency room shifts, or years of residency. CONCLUSION: vHIT can be used as an objective, reliable screening tool for severe sleep deprivation among physicians. The decrease in the VOR gain may indicate that vestibular function is influenced by sleep deprivation. The clinical significance of these findings is still questioned, more studies may help to assess this effect. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Predictors of Delays in the Management of Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: To study predictors of delayed presentation, diagnosis, and treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN: Retrospective medical chart review and patient telephone survey. SETTING: Tertiary medical center. SUBJECTS AND METHODS: All patients who initially presented or referred with unilateral ISSNHL between 2016 and 2020 were included. Associations between epidemiological, demographic, and socioeconomic profiles and delays in presentation, diagnosis and treatment were studied. RESULTS: A total of 518 patients were suitable for study inclusion. The total delay in the emergency department (ED) setup was a median (interquartile range, IQR) of 1 (0-1) day, 7 (6-12) days in a community otolaryngologist setup, and 15 (8-25) days in a general practitioner setup. Patients who presented to the ED first also had fewer diagnostic and treatment delays. Those who presented to a community otolaryngologist first had significantly longer presentation delay (5 [4-8] days p < 0.001) and significantly longer treatment delays (1 [1-3] days p < 0.001). Patients who presented to a general practitioner first had significantly longer presentation delays compared with ED presentation, and the longest diagnostic and treatment delays (3 [2-5], 8 [4-12] days, and 4 [2-7] days, p = < 0.01, p = <0.01, and p < 0.001, respectively). There was no association between socioeconomic status or demography and presentation, diagnostic, or treatment delays. CONCLUSION: Total delay in ISSNHL management is affected by the venue of the first medical encounter. General practitioners' level of awareness of the need for empiric steroidal treatment of ISSNHL without delay should be raised. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Idiopathic sudden sensorineural hearing loss after COVID-19 vaccination: a systematic review and meta-analysis.

OBJECTIVE: To provide pooled analyses on the association between COVID-19 vaccine and the incidence of idiopathic sudden sensorineural hearing loss (ISSNHL). DATA SOURCES: "Medline" via "PubMed", "EMBASE", and "Google scholar". REVIEW METHODS: Data sources were inspected from January 2020 to January 2024 using search terms relevant to vaccines for COVID-19. Included were papers with reported numbers of vaccinated populations and incidence if ISSNHL in those populations. Quality assessment was performed with the Newcastle-Ottawa Quality Assessment Scale Criteria. RESULTS: Three publications encompassing more than 191.8 million patients and at least 283 million vaccine doses were included in the quantitative data synthesis. The pooled reported incidence (95%confidence interval) of ISSNHL among COVID-19 vaccine recipients was 1.2588 per 100,000 (0.1385-3.4836). This incidence is significantly lower than the incidence of 5-27 and 60 per 100,000/year reported in the United States and in the European Union, respectively (P < 0.0001). CONCLUSION: There is no evidence to indicate that the COVID-19 vaccine is associated with the incidence of ISSNHL.

Recovery rate after acute acoustic trauma: a case series and meta-analysis.

OBJECTIVE: Steroids given systemically, locally, or both are the mainstay of treatment for acute acoustic trauma (AAT). The overall recovery rate (full, partial, and none) is undetermined. STUDY DESIGN: Original case series and systematic literature review. SETTING: Case series of a tertiary referral center and a systematic literature review. METHODS: Cases of AAT between 2012 and 2022 were retrospectively analyzed for demographics, acoustic trauma characteristics, treatment modality and delay and prognosis. This case series was added to the series identified by a systematic literature review. This review included "Medline" via "PubMed", "EMBASE", and "Google scholar". All series were pooled for meta-analysis defining prognosis following steroidal treatment for AAT patients. RESULTS: The pooled analyses included 662 ears, out of which 250 underwent complete recovery of hearing (overall proportion = 0.2809, 95%confidence interval [CI] = 0.1611-0.4178). Any recovery was recorded for 477 ears (overall proportion = 0.7185, 95% CI = 0.5671-0.8493) and no recovery was documented for 185 ears (overall proportion = 0.2815, 95% CI = 0.1507-0.4329). CONCLUSION: The rate of overall recovery for AAT is around 70%, and around 30% for full recovery when steroids are initiated within the first 2 weeks following the insult.

An algorithm for the surgical approach to spontaneous temporal bone CSF leak.

OBJECTIVE: To suggest a comprehensive algorithm for the surgical approach for correcting of sources of temporal bone CSF leaks. METHODS: A case series for patients operated in a single academic tertiary referral center between 2011 and 4.2022. Included in the study were 46 patients, 5 of whom had a bilateral problem, resulting in 51 pathologic temporal bones. The presentation was an active CSF leak (38 patients) or bacterial otogenic meningitis (8 patients). Follow up ranged from 8 months to 5 years. RESULTS: Of the 42 ears operated via the default middle fossa approach, 37 were successful (88 %) in controlling CSF leak. None had intracranial complications or sensorineural hearing loss. Location, number and size of the defects, hearing status, associated superior semicircular canal dehiscence, additional intra-temporal or intra-cranial pathologies may indicate a transmastoid approach. Of the six ears that had a canal wall up mastoidectomy as a primary procedure, one required revision due to ongoing CSF leak. Five revision cases and three primary cases were effectively sealed with a subtotal petrosectomy and obliteration. One was lost to follow-up. Hearing was reconstructed with bone-anchored hearing implants in 6 out of these 8 ears. CONCLUSIONS: The middle fossa approach could be used as a default approach for sealing TD. There are a number of indications for transmastoid approaches in both primary and revision cases. Obliteration of the ear was used in all revision cases. The suggested algorithm can help in planning surgery for temporal bone CSF leaks or a history of otogenic meningitis.

The Role of Temporal Bone Pneumatization on Fracture Line and Involved Cranial Structures.

OBJECTIVE: Temporal bone pneumatization (TBP) is speculated to serve as a shock absorber in temporal bone fractures (TBF), directing the fracture line away from vital structures. This study correlates TBP extent with TBF patterns and preservations of vital TB structures. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral medical center. METHODS: All TBF patients referred to a single tertiary center 2017 to 2023 were evaluated. A pneumatization index score for each of their TBs was derived by counting automated-voxel density in a 0 to 100 scale. Results were correlated to the TBF type and the violated structure(s). The ossification index was compared to previously detailed qualitative classification systems of TBP. RESULTS: One hundred and forty-five patients were enrolled (mean age 43 ± 17 years). Kinematics were motor vehicle accidents (46%), scooter (15%), bicycle (14%), falls (13%), and assaults (8%). The mastoid ossification index we used showed a strong correlation to all qualitative classification systems (sigmoid = 0.829; labyrinthine = 0.849; carotis = 0.863, infralabyrinthine = 0.869, all P < .001). The pneumatization index strongly correlated with capsule-violating TBFs, with a mean of 44 ± 23 for otic capsule-sparing TBF and 61 ± 20 for otic capsule-violating (OCV) TBF (P < .001). The facial nerve was violated in 30 patients. Facial canal (FC) involvement was not correlated to the ossification index: it was 49 ± 23 for FC-sparing and 44 ± 23 for FC-violating (P = .620). CONCLUSION: TBP serves as a protective mechanism against OCV TBF. The more pneumatized the TB, the less likely the otic capsule will be violated in the event of a TBF with the exception of the carotid and FCs. TBP index is in strong agreement with qualitative TBP classification systems.

Success and safety of endoscopic versus microscopic resection of temporal bone paraganglioma: a meta-analysis.

PURPOSE: Temporal bone paraganglioma (TBP) are the most common tumors of the middle ear. They pose a challenge in otologic surgery due to their extensive vascularity and intricate location within the middle ear. This meta-analysis aimed to compare the safety and efficacy of two surgical approaches, microscopic middle ear surgery (MMES) and endoscopic middle ear surgery (EMES), in the resection of TBP. METHODS: Eligible studies published after 1988 were identified through systematic searches of "PubMed", "Scopus" and "Google Scholar". Retrospective studies and randomized/non-randomized control trials reporting on surgical approaches for TBP with a minimum of five adult patients were included. RESULTS: A total of 595 records were initially identified. After removing 229 duplicates, 349 articles were excluded based upon article subject, title and abstract. Following the review of full texts, 13 articles were assessed for eligibility. The pooled analysis included a total of 529 ears, with a complication rate of 7.8% for EMES and 14.2% for MMES. Subgroup differences indicated no significant variation between the two methods (p = 0.2945). CONCLUSION: Both EMES and MMES demonstrated favorable surgical outcomes with low complication rates for TBP resection. These findings suggest that EMES is a safe and effective method for TBP resection and one that is comparable to MMES. Since the risk of bleeding is significant in these tumors, a third-hand technique, endoscopic bipolar cautery or laser-assisted hemostasis should be considered. Conversion to MMES is another option when visibility is critically affected by bleeding.

Sound Exposure Promotes Intratympanic Drug Delivery to the Inner Ear.

OBJECTIVE: To investigate the impact of sound exposure, with the resultant windows vibration on perilymphatic concentrations following intratympanic (IT) dexamethasone and gentamicin in an animal model. STUDY DESIGN: Animal model blinded study. SETTING: Animal facility of a tertiary medical center. METHODS: Bilateral IT dexamethasone or gentamicin was applied to 15 tested rats. Following injections, each rat was exposed for 3 minutes to free field 30 dB sound pressure level (SPL), 512 vHz noise, with 1 external auditory canal plugged (contralateral control). Following noise exposure, perilymph was obtained from both ears. Drug concentrations were measured using ultrahigh-performance liquid chromatography-mass spectrometer. RESULTS: For dexamethasone, the average (±SD) perilymphatic steroidal concentration was 0.417 µg/mL (±0.549) in the control ears versus 0.487 µg/mL (±0.636) in the sound-exposed ears (P = .008). The average (±SD) gentamicin perilymphatic concentration was 8.628 µg/mL (±2.549) in the sound-exposed ears, compared to 4.930 µg/mL (±0.668) in the contralateral control (nonsound exposed) ears. Sound exposure promoted steroidal and gentamicin diffusion to the inner ear by an averaged (±SD) factor of 1.431 and 1.730 (±0.291 and 0.339), respectively. CONCLUSION: Low-intensity noise (30 dB SPL) was found to enhance dexamethasone phosphate and gentamicin diffusion to the inner ear (by an averaged factor of ∼1.4 and 1.7, respectively) in a murine model.

Validated mobile applications in otolaryngology head and neck surgery for patient and physicians: A systematic literature review.

IMPORTANCE: Mobile apps in the field of ORL-HNS, are widely used by patients and physicians, but neither necessarily developed in collaboration with healthcare professionals nor subjected to regulations by the United States Food and Drug Administration guidelines, with a resultant potential of risk for its users. OBJECTIVE: To provide the ORL-HNS physician with an updated list of scientific peer review literature- validated mobile apps for safe use for both the clinician and the patients, for screening, diagnosis, therapy and follow up for various ORL-HNS pathologies. EVIDENCE REVIEW: A comprehensive systematic review of the scientific literature was conducted in "PubMed," "EMBASE," and "Web of Science" without limitation of publication date up to January 1st, 2023. The included papers validated mobile apps in the ORL-HNS discipline. Each study was evaluated using the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) tool. FINDINGS: From the thousands of unregulated ORL-HNS mobile apps available for download and use in the various app stores, only 17 apps were validated for safe use by the clinician and/or patient. Their information is listed. CONCLUSIONS AND RELEVANCE: The limited number of validated mobile apps highlights the importance to use validated apps in clinical practice, to improve evidence-based medicine and patient safety. Physician are encouraged to use and recommend their patients to use validated mobile apps only, like any other tool in clinical practice in the evidence-based era.

Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review.

Objective: To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons. Methods: Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD). Balloon dilation Eustachian tuboplasty was performed under local anesthesia in a tertiary referral center, using the EVB. Systematic literature review was used for comparison, using Medline via "PubMed", "Embase", and "Web of Science". Results: Eight OETD candidates (12 ears) were enrolled; 5 males and 3 females. Average age was 48 (range -23 to 63) years. The most common presenting symptom was aural fullness (9/12), followed by ear pressure (7/12), hearing loss (5/12) and tinnitus (4/12). Otoscopically, tympanic membrane retraction was evident in 10/12 ears, the majority of which was class II-Sade classification. Pre-operative tympanogram was type B and C in 7 and 5 ears, respectively. All BDETs were performed without complications. Post-operative tympanometry was A in 8/12 ears. Post-operatively, Eustachian Tube Dysfunction Questionnaire-7 results reduced to within normal limits (average score ≤3) in 11/12 ears (p = 0.0014). The systematic literature review included 6 papers (193 patients, 262 ETs) with comparable results, most also with little adverse effects. Conclusion: BDET using an EVB is a safe and effective option for OETD. It is well tolerated under local anesthesia in properly selected individuals. The reduced procedural cost may be an important factor in certain healthcare jurisdictions.

Fast-Tracking of Publication Times of Otolaryngology Papers During the COVID-19 Pandemic.

Introduction The outbreak of COVID-19 has produced an unprecedented number of trials and articles. Objective To study the impact of the COVID-19 pandemic on otolaryngology-head and neck surgery (ORL-HNS) journal processing times. Methods Original papers search of published in selected ORL-HNS journals in terms of times from submission-to-acceptance (S-A), acceptance-to-first online publication (A-P), and submission-to-online publication (S-P). Papers were divided into those published in the pre-COVID-19 era and those during the COVID-19 era. The latter were further divided into unrelated to COVID-19 and related to COVID-19. Results A total of 487 articles from 5 selected ORL-HNS journals were included, of which 236 (48.5%) were published during the pre-COVID-19 era and 251 (51.5%) were published during the COVID-19 era. Among them, 180 (37%) papers were not related to COVID-19, and 71 (14.5%) were related to COVID-19. The S-A duration of COVID-19-related articles was significantly shorter compared with that of papers submitted in the pre-COVID-19 era and to papers submitted in the COVID-19 era but unrelated to COVID-19 (median 6 to 34 days compared to 65 to 125 and 46 to 127, respectively) in all 5 journals. The most prominent reductions in S-A and S-P times were documented in the laryngology and otology/neurotology disciplines, respectively. Conclusions Processing times of the included papers were significantly shorter in most of the selected ORL-HNS journals during the COVID-19 era compared with the pre-COVID-19 era. COVID-19-related papers were processed more rapidly than non-COVID-19-related papers. These findings testify to the possibility of markedly expediting S-P times and hopefully set a precedent for postpandemic publishing schedules. Level Of Evidence: 5.

Questioning the value of stalk drilling after external auditory canal osteoma excision: case series, literature review, and meta-analysis.

OBJECTIVES: To question the value of drilling the site of the stalk ("insertion site" or "stalk" drilling) of a pedunculated external auditory canal osteoma (EACO) in reducing recurrence. DATA SOURCES: A retrospective medical chart review of all patients treated for EACO in one tertiary medical center, a systematic literature review using Medline via "PubMed", "Embase", and "Google scholar" search, and a meta-analysis of the proportion for recurrence of EACO with and without drilling. RESULTS: The local cohort included 19 patients and the EACO origin was the anterior EAC wall in 42% and the superior EAC wall in 26%. The most common presenting symptoms were aural fullness and impacted cerumen (53% each), followed by conductive hearing loss (42%). All patients underwent post-excision canaloplasty, and one sustained EACO recurrence. Six studies suitable for analysis were identified (63 EACOs). Hearing loss, aural fullness, otalgia, and cerumen impaction were the most common clinical presentations. The most common EACO insertion site was the anterior EAC wall (37.5%), followed by the superior EAC and posterior walls (25% each). The inferior EAC wall was least affected (12.5%). There was no significant difference in recurrence between EACOs whose stalk insertions were drilled (proportion 0.09, 95% confidence interval [CI] 0.01-0.22) to the ones whose insertion was not drilled (proportion 0.05, 95% CI 0.00-0.17). The overall recurrence proportion was 0.07 (95% confidence interval 0.02-0.15). CONCLUSION: EACO insertion site drilling does not reduce recurrence and should be avoided in the absence of a definite pedicle projecting to the EAC lumen.

Fast-Tracking of Publication Times of Otolaryngology Papers During the COVID-19 Pandemic

Abstract Introduction The outbreak of COVID-19 has produced an unprecedented number of trials and articles. Objective To study the impact of the COVID-19 pandemic on otolaryngology-head and neck surgery (ORL-HNS) journal processing times. Methods Original papers search of published in selected ORL-HNS journals in terms of times from submission-to-acceptance (S-A), acceptance-to-first online publication (A-P), and submission-to-online publication (S-P). Papers were divided into those published in the pre-COVID-19 era and those during the COVID-19 era. The latter were further divided into unrelated to COVID-19 and related to COVID-19. Results A total of 487 articles from 5 selected ORL-HNS journals were included, of which 236 (48.5%) were published during the pre-COVID-19 era and 251 (51.5%) were publishedduring theCOVID-19era.Amongthem, 180 (37%) papers werenot related to COVID-19, and 71 (14.5%) were related to COVID-19. The S-A duration of COVID-19-related articles was significantly shorter compared with that of papers submitted in the pre-COVID-19 era and to papers submitted in the COVID-19 era but unrelated to COVID-19 (median 6 to 34 days compared to 65 to 125 and 46 to 127, respectively) in all 5 journals. The most prominent reductions in S-A and S-P times were documented in the laryngology and otology/neurotology disciplines, respectively. Conclusions Processing times of the included papers were significantly shorter in most of the selected ORL-HNS journals during the COVID-19 era compared with the pre-COVID-19 era. COVID-19-related papers were processed more rapidly than non-COVID-19-related papers. These findings testify to the possibility of markedly expediting S-P times and hopefully set a precedent for postpandemic publishing schedules. Level Of Evidence: 5

Fluctuating hearing loss secondary to spontaneous intracranial hypotension: A case report and review of the literature.

OBJECTIVE: Fluctuating sensorineural hearing loss (SNHL) has multiple etiologies, most commonly Ménière's disease (MD), recurrent sudden SNHL, and autoimmune inner ear disorders. Fluctuating SNHL has rarely been described as a symptom of spontaneous intracranial hypotension (SIH). PATIENT: A 39-year-old previously healthy female presented with "Ménière's like" symptoms responsive to steroid treatment, which worsened during the day and improved in the supine position. Conservative treatment for MD consisting of low salt and caffeine diet and betahistine medication yielded no improvement. Secondary revision of brain imaging scans showed signs indicative of SIH, and a spinal cerebrospinal fluid leak was ultimately found and treated by a novel technique of transvenous fistula embolization by means of Onyx® glue, leading to gradual clinical improvement and near-complete resolution of symptoms. CONCLUSION: SIH should be considered as part of the differential diagnosis of fluctuating SNHL. Clinical and radiological features should be known and sought. We suspect that early diagnosis and treatment can lead to cure and prevent permanent auditory damage.

Meta-Analysis of Acceptance and Commitment Therapy for Tinnitus.

Acceptance and commitment therapy (ACT) was found to be effective with a diverse range of clinical conditions. The aim of this study is to evaluate the efficacy of ACT-based treatment for individuals with tinnitus. Meta-analysis of the scientific literature of Medline via PubMed, EMBASE, Web of Science and Google Scholar. The meta-analysis included 3 studies. The pooled mean difference in the Tinnitus Handicap Inventory (THI) score was 17.67 points lower [95% CI (- 23.50) to (- 11.84)] for the intervention arm compared to the non-treated control arm. The significant clinical reduction in the THI score indicates that ACT is an effective treatment for tinnitus. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03878-z.

The Significance of Bell's Palsy That Presents as Monocranial Versus Polycranial Neuropathy: A Case Series and Systematic Literature Review.

PURPOSE: To investigate the effect of Bell's palsy (BP) presenting as polycranial neuropathy (PCN) compared with BP caused by isolated facial nerve (CNVII). METHODS: We carried out a retrospective cohort study of the medical records of all consecutive patients who were diagnosed with BP at a single tertiary referral center between 2010 and 2017. Included were patients 18 years or older who were clinically diagnosed with BP and completed 7 days of systemic steroidal treatment and at least 6 months of follow-up. The patients were divided into two groups according to whether the BP derived from a monocranial neuropathy or a PCN. Demographics and BP severity and outcome were compared between these groups. A systematic literature review using Medline via "PubMed," "Embase," and "Web of Science" was conducted. RESULTS: In total, 321 patients with BP were enrolled. The median (interquartile range) age at presentation was 44 (33-60) years. Sex distribution showed male predominance of 57.6% (n = 185) versus 42.4% (n = 136), and 21.2% (n = 68) had PCN. The most concomitantly affected cranial nerve (CN) was the trigeminal (CNV; n = 32, 47%), followed by the glossopharyngeal nerve (CNIX; n = 14, 21%) and the audiovestibular nerve (CNVIII; n = 10, 15%). Age, House-Brackmann score on presentation, and diabetes mellitus (DM) were independent predictors for PCN etiology ( p = 0.001, p = 0.034, and p < 0.001, respectively). Each increase in 1 year of age was associated with additional odds ratio (95% confidence interval) of 0.97 (0.95-0.99) for PCN. The odds ratio (95% confidence interval) associated with DM was 8.19 (4.02-16.70). Our systematic literature review identified 1,440 patients with the PCN type of BP. The most commonly affected CN was the trigeminus (25-48%), followed by the glossopharyngeal and audiovestibular nerves (2-19% and 0-43%, respectively). CONCLUSION: The severity of facial weakness on initial presentation among PCN patients was significantly higher compared with the monocranial neuropathy-type BP patients. The authors believe that the significant association and prevalence rate ratio between DM and PCN warrant that a patient presenting with PCN undergo screening for DM.

Google Scholar as a Sole Literature Source for Meta-analyses in Otolaryngology Head and Neck Surgery.

The strength of meta-analyses lies in the synthesis of data from multiple studies. Current guidelines require a thorough systematic search to maximize results, which usually includes searching multiple academic search systems (ASS). Google Scholar (GS) is considered a promising tool for searching the scientific literature. We aimed to determine whether GS is a valid and sufficient solitary data source for meta-analyses in the field of otolaryngology. Selected ENT-HNS journal was searched for meta-analyses published between 2010 and 2021 that adhered to the systematic reviews and meta-analyses guidelines and precisely followed the search algorithm. The latter was reproduced with GS, and the position of each enrolled study in each meta-analysis was determined. Ten meta-analyses were enrolled, the total number of search results ranged from 57 to 17,949. The number of GS search results was significantly greater than those of other ASS combinations (range 1,360-25,400, P = .006). The number of included papers for each meta-analysis ranged from 5 to 26. The position of all enrolled papers throughout GS searching was in the first 200 GS results in four of 10 meta-analyses. The reference lists of all included papers in the first 200 GS results identified 106 papers out of 108 (98%), while searching until the 500th GS output results identified 107 papers out of 108 papers (99%). GS can serve as a solitary ASS for systematic literature reviews and meta-analyses in the field of otolaryngology. Searching the first 500 or 200 results and including reference lists yields 99% and 98% coverage, respectively.

Is Sudden Sensorineural Hearing Loss an Otologic Emergency? Evidence-Based Cutoff for Optimal Treatment Initiation for Sudden Unilateral Sensorineural Hearing Loss: A Case Series and Meta-Analyses.

OBJECTIVES: To study the need for defining unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) as an otologic emergency and establish an evidence-based cutoff for treatment initiation for optimal outcome. METHODS: A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" and original case series comparing the outcome of steroidal treatment for ISSNHL as a function of delays of patient presentation, of diagnosis, and of treatment initiation. Total delay was defined as days from ISSNHL onset to first steroidal dose and divided into up to 3 days, up to 7 days, up to 14 days, and >14 days. RESULTS: The literature search identified 1,469 ears and our original case series contributed 154 ears suitable for study inclusion, resulting in 1,623 ears for statistical analysis. An odds ratio (OR) of 0.42 (95% confidence interval [CI], 0.25-0.71) was calculated for recovery if treatment had been initiated within the third day since the sudden occurrence of a unilateral hearing loss compared with treatment initiation on or after the fourth day (I 2 = 40.1%). The calculated OR for recovery was 0.35 (95% CI, 0.26-0.47) when treatment was initiated during the first 7 days after the sudden hearing loss onset compared with a delay of 8 days or more (I 2 = 52.1%). The OR was 0.31 (95% CI, 0.21-0.46) when treatment was initiated during the first 14 days after the event compared with a longer delay (I 2 = 0.0%). CONCLUSION: Unilateral ISSNHL should be considered a medical emergency. Initiating treatment before 3 days have elapsed since the event portends the best outcome. LEVEL OF EVIDENCE: Level I.

Preoperative Anxiety Levels and Postoperative Middle Ear Surgery Pain Levels.

OBJECTIVE: This study aimed to characterize self-reported postoperative pain after tympanoplasty and tympanomastoidectomy and correlate pain severity with the patient's preoperative anxiety state. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral medical center. PATIENTS: Adult patients undergoing any middle ear surgery between July 2018 and July 2019. MAIN OUTCOME MEASURES: Patient responses to an otology questionnaire (OQ) for scoring pain intensity on a visual analog scale preoperatively and on postoperative days (PODs) 1-4, 21, and 63. The responses were correlated with anxiety state (assessed by State-Trait Personality Inventory [STPI] scores) and clinical and operative data, including surgical technique-related details. RESULTS: Sixty patients were enrolled (mean age ± standard deviation, 40 ± 19.7 yr, 26 men). Their median preoperative (baseline) visual analog scale pain score was 6 on POD1, 5 on POD3, and 1 at 3 and 7 weeks. Their median preoperative OQ score was 32 of 70 (45.7%), 37 of 70 (52.8%) on POD1, 33 of 70 (47.1%) on POD3, 6 of 70 (8.5%) at 3 weeks, and 6 of 70 at 7 weeks. Their overall mean preoperative anxiety level (STPI score) was 2.63 ± 1.50. STPI scores were significantly higher among patients who reported OQ scores equal to or higher than the median during PODs 1 to 4 in comparison to patients who reported OQ scores lower than the median. The α Cronbach correlation between anxiety and postoperative pain scores on POD1 was 0.97. CONCLUSION: Preoperative anxiety levels are closely associated with postoperative pain levels after any middle ear surgery. Measures to control preoperative anxiety are warranted to alleviate postoperative pain.

Bell's palsy and pregnancy: Incidence, comorbidities and complications. A meta-analysis and systematic review of the literature.

OBJECTIVES: Data on the association between Bell's palsy (BP) and pregnancy is scarce and there is an ongoing debate regarding the association of BP and pregnancy. MAIN OUTCOME MEASURES: We aimed to investigate the prevalence of BP among pregnant patients and determine the frequency of pregnant women in BP cohorts and vice versa, assess which term of the pregnancy and peripartum bears a higher risk for BP occurrence, and determine the prevalence of maternal comorbidities associated with BP during pregnancy. DESIGN: Meta analysis. SETTINGS: Screening standard articles and extracting data from Ovid MEDLINE (1960-2021), Embase (1960-2021), and Web of Science (1960-2021). All study types were included except for case reports. MEASURES: Data were pooled by means of both fixed and random-effects models. RESULTS: The search strategy identified 147 records. Twenty-five of the studies that met our inclusion criteria described 809 pregnant patients with BP in a total of 11,813 BP patients and they were included in the meta-analysis. The incidence of BP among the pregnant patients was 0.05%; The incidence of pregnant patients among all BP patients was 6.62%. Most of the BP occurrences were during the third trimester (68.82%). The pooled incidence of gestational diabetes mellitus; hypertension; pre-eclampsia/eclampsia and fetal complications among the pregnant patients with BP was 6.3%, 13.97%, 9.54%, and 6.74%, respectively. CONCLUSIONS: This meta-analysis revealed a low incidence of BP during pregnancy. A Higher proportion occurred during the third trimester. The association of BP and pregnancy warrants further exploration.