Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study.

OBJECTIVE: To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy. METHODS: All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia. RESULTS: A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist. CONCLUSIONS: Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.

Vitamin D deficiency and its relationship to cancer stage in patients who underwent thyroidectomy for papillary thyroid carcinoma.

PURPOSE: As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates. MATERIALS AND METHODS: The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors. RESULTS: Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p < 0.001). CONCLUSIONS: The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.

Ear Molding in Children-Timing, Technique, and Follow-up: A Systematic Review.

Background: Nonsurgical management of congenital ear anomalies using molding devices shows efficacy but lacks standardization of treatment protocols and outcome measures. Learning Objective: To compare ear molding techniques and identify factors related to treatment outcomes. Design Type: Systematic review of the literature (1990-2021). Methods: Studies reporting molding for congenital ear anomalies were assessed. PRISMA guidelines were used. Data extracted included: age at treatment initiation, treatment duration, correction rates, and complications. Data analysis included descriptive statistics and outcomes were compared using the Student t-test. Results: In total, 37 studies with 3,341 patients (mean patients per study, 95; range, 5-488) were included. Infants in whom treatment was initiated at 4.8 weeks (median, 3.7; range, 0.9-8.8 weeks) were treated for 5.1 weeks (median 4.7, range 2.6-7.6 weeks) with 11.0 months follow-up (median 11.4, range 1.4-21.0 months). Individualized devices (physician-customized) were used more (62.2% of studies) than commercial devices. No difference in correction (p = 0.44) or complication rates (p = 0.19) was identified between devices. Totally, 70.3% of studies reported complications and 40.5% of studies included long-term follow-up data. Conclusions: The available evidence supports initiating ear molding in the first weeks of life to be most effective, yet outcome data should be standardized in future studies to improve evidence quality.

Reversible Bevacizumab Induced Vocal Fold Necrosis.

BACKGROUND: As the use of anti-angiogenic treatments is gaining scope in the treatment of various malignancies, there are increasing reports of laryngeal side effects. We report two cases of laryngeal necrosis and dysphonia. METHODS: Two patients with gynecological malignancies presented with severe dysphonia 11-24 months after initiation of bevacizumab therapy. Videostroboscopic examination of the larynx revealed bilateral ulcerations and eschar of the superior surface with absent mucosal waves. RESULTS: Patients were treated with discontinuation of the bevacizumab, vocal rest, and proton pump inhibitors. Both had improvement in voice and resolution of the eschar and ulceration. Shallow sulci and mild breathiness persisted in one patient. CONCLUSION: With increasing use of potent systemic anti-angiogenic compounds, clinicians should be vigilant of this important complication of therapy. Time to onset of symptoms and reversibility of symptoms vary by patient and require further study. There may be long-term voice sequelae.

TikTok Tonsils.

There has been a subjective increase in the number of patients presenting for tonsil stones to our pediatric otolaryngology clinic. This may be related to frequent viewing of videos on the social media application, TikTok, pertaining to tonsil stones.

Factors Associated With Distribution of Female Otolaryngology Residents in United States.

OBJECTIVE: The gender balance within medicine, and specifically within otolaryngology, is equalizing. It is important to determine the factors that impact the distribution of female residents among otolaryngology programs in the United States to better understand factors that may affect these changing trends. STUDY DESIGN: Retrospective Study. METHODS: Cross-sectional analysis was performed using data from 2018 of otolaryngology residents at 90 programs across the United States. Each program's website was searched for a current resident roster. Data of geography, number of female faculty, number of female physicians in leadership positions, program setting, and program size were obtained. Statistical comparison of these factors with number of female residents was performed with P < .05 as significant. RESULTS: There was a significant association between programs having a higher-than-average female faculty representation and a greater representation of female residents (P < .001). Larger residency programs were more likely to have greater female representation (P = .010). There was a slight predominance of both female residents and female faculty at urban programs (odds ratio [OR] = 1.27, P = .04; OR = 1.28, P = .03). Geographic location, presence of a female chairperson, and presence of a female residency program director were not associated with higher female-to-male resident ratio. CONCLUSION: Availability of female role models in faculty, along with program setting and size, may be more likely to promote greater female representation. Focusing on gender equality in the workplace can help promote diversity in the workforce and improve patient outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E367-E372, 2021.

Peripheral Blood Lymphocytes and Platelets Are Prognostic in Surgical pT1 Non-Small Cell Lung Cancer.

BACKGROUND: There is a paucity of prognostic factors for patients with stage I non-small cell lung cancer (NSCLC) undergoing operations. We investigated the prognostic role of preoperative complete blood count values in patients with stage I NSCLC patients undergoing operations. METHODS: A retrospective medical record review was performed of patients who underwent operations for stage I NSCLC between 2000 and 2015. Patients who died within 30 days of the operations were excluded. The primary end point was recurrence. Preoperative complete blood count values were analyzed, and a median value was used as the cutoff. Statistical analysis used χ2 and t tests along with univariate and multivariate analyses by Cox regression modeling. RESULTS: The study included 103 patients. A high lymphocyte count was significantly associated with recurrence (5-year recurrence-free survival [RFS] of 69.8% for high vs 95.7% for low, P = .003), as well as high platelet (5-year RFS of 72.0% for high vs 91.8% for low, P = .02). Independent prognostic factors on multivariate analysis were high lymphocyte (hazard ratio [HR], 7.27; P = .005) and platelet counts (HR, 7.49; P = .003) as well as tumor (HR, 5.40; P = .008) and treatment characteristics (HR, 4.59; P = .01). Among patients with pT1 lesions, high lymphocyte (HR, 8.41; P = .03) and high platelet counts (HR, 19.78; P = .004) remained independent prognostic factors. Neither NLR nor PLR were significantly associated with recurrence. CONCLUSIONS: In patients with pathologic stage I NSCLC undergoing surgical resection, the preoperative blood count from peripheral blood may provide prognostic value. Of significance, in patients with pT1 N0 NSCLC, high lymphocyte count and high platelet count were associated with higher recurrence.

Are validated patient-reported outcomes used on children in pediatric otolaryngology? A systematic review.

OBJECTIVES: Review the pediatric otolaryngology literature to 1) identify studies in which children completed patient-reported outcome (PRO) measures and 2) appraise the psychometric quality and validity of these PROs as they apply to pediatrics. METHODS: In October 2016, a systematic review was performed by two reviewers on PubMed/MEDLINE and EMBASE for all otolaryngology-related studies that utilized PROs in children. Inclusion criteria included articles that required children (age<18) to complete PROs. Exclusion criteria included validation studies, reviews, and abstracts. Interreviewer agreement was determined using Cohen's kappa. Quality and rigor of validation testing for included PROs was determined using the COnsensus-based Standards for selection of health status Measurement Instruments. RESULTS: Interrater agreement was very good (κ = 0.91; 95% CI, 0.85-0.98). Out of 316 articles retrieved, 11 met inclusion criteria. Eight PROs were identified. Six PROs were tested for validity and three of these PROs were tested for validity specifically within children. The most frequently utilized PRO was the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire. Two studies (18.2%) utilized PROs within the scope of their validation. Seven studies (63.6%) used PROs outside the scope of their validation. Two studies (18.2%) used non-validated PROs. CONCLUSIONS: Patient-reported outcomes have become an integral part of research and quality improvement. There is a relative paucity of PROs directed towards children in pediatric otolaryngology and some studies utilized PROs that were not validated or not validated for use in this age group. Future efforts to design and validate more instruments may be warranted.