Endoscopic repair of cribriform plate cerebrospinal fluid leaks: An easy and reproducible technique sparing the middle turbinate.

OBJECTIVE: The purpose of this study was to evaluate the outcomes of patients with cribriform cerebrospinal fluid leaks undergoing endoscopic repair with an easy and reproducible middle turbinate-sparing technique. MATERIAL AND METHODS: Date was obtained by retrospective chart review and includes a description of the technique with technical pearls and contraindications to the approach. RESULTS: We report 17 patients who underwent repair of cribriform cerebrospinal fluid leaks with a middle turbinate-sparing technique with 100% success rate at a mean follow up of 38 months. One patient complained of hyposmia. There were no other complications. CONCLUSIONS: The endoscopic middle turbinate-sparing approach to repair cribriform cerebrospinal fluid leaks using a free mucosal graft is easy, effective, and reproducible.

Body Mass Index and Olfactory Fossa Depth in Patients with and without Spontaneous Cerebrospinal Fluid Leaks.

BACKGROUND/AIMS: Spontaneous cerebrospinal fluid (SCSF) leaks are associated with a high body mass index (BMI) and an expanded skull base. The purpose of this study is to determine if a correlation exists between BMI and olfactory fossa depth (OFD) in patients with SCSF leaks and those without. METHODS: This is a cross-sectional study evaluating the correlation between OFD and BMI in patients with and without SCSF leaks. OFD was measured on computed tomography obtained in temporal proximity to the BMI. RESULTS: Patients with SCSF leaks had a deeper mean OFD than controls (6.39 vs. 5.46 mm, p = 0.013) and a larger BMI (38.2 vs. 30.5, p = 0.0003). Pearson correlation was positive between BMI and OFD in women from the control group (R = 0.319, n = 93, p = 0.002 on the left; R = 0.313, n = 93, p = 0.002 on the right) but insignificant in men. CONCLUSIONS: The olfactory fossa is deeper and the BMI higher in patients with SCSF leaks than in those without. Differences were statistically significant. Higher BMI may predict deeper olfactory fossa in women but not in men. These findings suggest expansion of weak points in the skull base as precursors to the development of SCSF leaks in response to elevated CSF pressures, particularly in women.

Current otolaryngologic applications of the novel self-assembling RADA-16 peptide matrix.

A novel bioresorbable agent on the market is PuraGel® (3-D Matrix, Tokyo, Japan), a RADA-16 product that acts as a synthetic hemostatic and space-filling gel that promotes wound healing and prevents adhesion formation. Given the reported benefits of accelerated wound healing and scar tissue prevention, there are multiple otolaryngologic applications where RADA-16 might improve outcomes. Our study highlights current utilization and associated post-operative complications with this product.

Nasopharyngeal Angiofibroma in an Adult Male: A Case Report and Review of the Literature.

A 32-year-old male presented with recurrent bilateral epistaxis and nasal obstruction, leading to a rare diagnosis of nasopharyngeal angiofibroma. Although primarily observed in adolescents, this case underscores its presence in older populations. The patient underwent a successful endoscopic resection, contributing to the scant documented instances of such cases in adult U.S. males.

Role of the otolaryngologist in nasopharyngeal swab training: A case report and review of the literature.

Nasopharyngeal swabs are commonly done in the medical field for a multitude of reasons, and they recently have been an essential component of widespread testing to control the spread of COVID-19. Although rare, improper technique when performing nasopharyngeal swabs has the potential to lead to injury or misleading test results. We present a case of uncontrolled epistaxis requiring hospitalization following a routine nasopharyngeal swab in a healthy patient. Both the complexity and variability of the anatomy of the nasopharynx can contribute to poor swabbing technique. Otolaryngologists should be encouraged to educate and support other healthcare workers to improve the yield and reduce the risk of harm due to nasopharyngeal swabs. Increased comfort levels with performing nasopharyngeal swabs will also improve the sensitivity of screening tests for common respiratory viruses such as influenza, Epstein-Barr virus (EBV), or bacteria such as Staphylococcus aureus.

Effect of Powered Air-Purifying Respirators on Speech Recognition Among Health Care Workers.

Powered air-purifying respirators (PAPRs) are used as personalized protective equipment for health care personnel. PAPRs offer health care workers added protection when dealing with patients who have high-risk infectious disease such as COVID-19. Unfortunately, PAPRs can produce notable levels of background noise. We hypothesize that PAPR use may be associated with increased hearing thresholds and impaired word discrimination and may ultimately have a negative impact on effective communication. Herein, we (1) determined sound levels generated by PAPRs and (2) measured hearing thresholds and word discrimination with and without operational PAPRs. All participants had normal hearing. When the PAPR was operational, mean ± SD thresholds increased from 4.5 ± 3.6 to 38.6 ± 5.6 dB HL (P < .001). Word discrimination dropped from 100% in all participants in quiet to a mean 48% ± 14% with operational PAPR (P < .001). Thus, we find that use of PAPR hoods results in hearing impairment comparable to moderate to severe hearing loss, and we suspect that users will experience communication difficulties as a result.Level of Evidence. Prospective study.

Denervation of the Eustachian Tube and Hearing Loss Following Trigeminal Schwannoma Resection.

Objectives To discuss eustachian tube dysfunction (ETD) as a cause of hearing loss and to discuss its pathogenesis following resection of trigeminal schwannomas. Methods Presented herein are two cases of trigeminal schwannoma that were resected surgically with sacrifice of the motor branch of the trigeminal nerve. Neither of the cases had evidence of extracranial extension nor preoperative ETD. Both patients developed ETD and have been followed without evidence of schwannoma recurrence. Conclusions Trigeminal schwannomas are rare tumors that typically require surgical resection. Hearing loss is a potential postsurgical deficit and warrants evaluation by an otolaryngologist with consideration given to a preoperative audiogram. ETD as a result of trigeminal motor branch sacrifice should be included in the differential diagnosis of postoperative hearing loss in this patient subset as it may be reversed with placement of a tympanostomy tube.