Correlation between MRI (DWI and DCE) and cellularity of parotid gland pleomorphic adenomas.

PURPOSE: Parotid pleomorphic adenomas present a risk of recurrence, higher when the tumour is a hypocellular subtype. The aim of the study was to determine whether it is possible to characterize this histological subtype with diffusion and perfusion sequences of the preoperative MRI. METHODS: This retrospective study included 97 patients operated between 2010 and 2020. Histologic slides review was performed to classify tumours into three histologic subtypes: hypocellular, classical and hypercellular. Univariate and multivariate analyses studied the correlation between histology and diffusion and perfusion MRI parameters obtained with OleaSphere® software. RESULTS: The hypocellular subtype had higher apparent diffusion coefficient values than the other two subtypes: 2.13 ± 0.23, 1.83 ± 0.42, and 1.61 ± 0.4 × 10-3 mm2/s for hypocellular, classical and hypercellular subtype respectively (p < 0.0001). Multivariate analysis showed that an ADCmean > 1.88 × 10-3 mm2/s was suggestive of a hypocellular pleomorphic adenoma in 79% of the cases, with a specificity and PPV of 94 and 96% (p < 0.001), respectively. CONCLUSION: The histological subtype of a pleomorphic adenoma can be predicted preoperatively with ADC values. A prospective and multicentric study on a larger cohort is needed to confirm our results.

Parotid cancer: analysis of preoperative parameters for adaptation of the therapeutic strategy.

PURPOSE: To establish typical clinical and radiological profiles of primary low-grade parotid cancers in order to tailor therapeutic strategy. MATERIALS AND METHODS: Retrospective study of 57 patients operated on for primary parotid cancer between 2010 and 2021, with review of preoperative MRI and histopathology according to a standardized scoring grid. OBJECTIVE: To study prognostic factors and determine the preoperative clinical and radiological profile of low-grade cancers. RESULTS: Good prognostic factors for specific survival were: staging ≤ cT3 (p = 0.014), absence of adenopathy on cN0 MRI (p < 0.001), superficial lobe location (p = 0.033), pN0 (p < 0.001), absence of capsular rupture (p = 0.004), as well as the absence of peri-tumoral nodules (p = 0.033), intra-parotid adenopathies (p < 0.001), vascular emboli (p < 0.001), peri-neural sheathing (p = 0.016), nuclear atypia (p = 0.031), and necrosis (p = 0.002). It was not possible to define a reliable clinical and radiological profile for low-grade cancers (sensitivity 38%, specificity 79%). CONCLUSION: Our study demonstrated multiple factors of good prognosis, but it was not possible to define a clinical and radiological profile of patients likely to benefit from more limited surgery, nor to diagnose, a priori, low-grade cancers.

Effectiveness and rapidity on olfatory fuction recovery in CRS patients treated with Dupilumab: a real life prospective controlled study.

BACKGROUND: Recovery of olfactory function plays a prominent role in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). While rates and timing of such recovery vary, monoclonal antibodies might yield better results which we aimed at evaluating with this study. METHODOLOGY: A prospective controlled study was conducted at our tertiary otolaryngological center from April 1, 2021, to October 1, 2022, in CRSwNP patients. We included an active group (n = 60 patients) performing dupilumab treatment and a control group (n = 60 patients) treated with intranasal and oral corticosteroids. Primary endpoints were changes in smell visual analogical scale (VAS) and SS-I (Sniffin' Sticks-identification) scores, and olfactory recovery rate. The secondary efficacy endpoints were nasal obstruction, rhinorrhea, headache, SNOT-22, and nasal congestion score (NCS). RESULTS: At 6 months, the active group demonstrated better outcomes than control in SS-I scores (10.23 ± 4.21 vs.3.68 ± 3.08; p < 0.001). No significant differences were found in blood eosinophil count, SNOT-22, and NPS (p > 0.05 for all). Olfactory function in the treatment arm improved in 86.66% (52/60 cases), with normal scores in 48.33% (29/60), while the control group reported a lower recovery rate (3/60; 5%), with no normal olfaction cases. Log-rank comparison for Kaplan-Meier functions was statistically significant (p < 0.001), but no differences were found in subanalysis in the active group based on blood eosinophil count at baseline, SNOT-22, and NPS scores. CONCLUSIONS: Patients who receive dupilumab treatment may experience a faster recovery of olfactory function compared to those receiving corticosteroid therapy. This result would be maintained regardless of the severity of type 2 CRSwNP inflammation, the volume of the polyps, or the patient's subjective symptomatology.

Is generative pre-trained transformer artificial intelligence (Chat-GPT) a reliable tool for guidelines synthesis? A preliminary evaluation for biologic CRSwNP therapy.

INTRODUCTION: Biologic therapies for Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) have emerged as an auspicious treatment alternative. However, the ideal patient population, dosage, and treatment duration are yet to be well-defined. Moreover, biologic therapy has disadvantages, such as high costs and limited access. The proposal of a novel Artificial Intelligence (AI) algorithm offers an intriguing solution for optimizing decision-making protocols. METHODS: The AI algorithm was initially programmed to conduct a systematic literature review searching for the current primary guidelines on biologics' clinical efficacy and safety in treating CRSwNP. The review included a total of 12 studies: 6 systematic reviews, 4 expert consensus guidelines, and 2 surveys. Simultaneously, two independent human researchers conducted a literature search to compare the results. Subsequently, the AI was tasked to critically analyze the identified papers, highlighting strengths and weaknesses, thereby creating a decision-making algorithm and pyramid flow chart. RESULTS: The studies evaluated various biologics, including monoclonal antibodies targeting Interleukin-5 (IL-5), IL-4, IL-13, and Immunoglobulin E (IgE), assessing their effectiveness in different patient populations, such as those with comorbid asthma or refractory CRSwNP. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha subunit, demonstrated significant improvement in nasal symptoms and quality of life in patients with CRSwNP in several randomized controlled trials and systematic reviews. Similarly, mepolizumab and reslizumab, which target IL-5, have also shown efficacy in reducing nasal polyp burden and improving symptoms in patients with CRSwNP, particularly those with comorbid asthma. However, additional studies are required to confirm the long-term efficacy and safety of these biologics in treating CRSwNP. CONCLUSIONS: Biologic therapies have surfaced as a promising treatment option for patients with severe or refractory CRSwNP; however, the optimal patient population, dosage, and treatment duration are yet to be defined. The application of AI in decision-making protocols and the creation of therapeutic algorithms for biologic drug selection, could offer fascinating future prospects in the management of CRSwNP.

Reply to: "Invited Discussion on: Video Assisted Septo-Rhinoplasty, the Future of Endonasal Rhinoplasty-a Technical Note".

We respond to Gryskiewic and Alameddine's commentary on our recent study regarding endoscopic use in rhinoplasty. Highlighting the context-dependent nature of technique superiority, we discuss the alternative approach of Video Assisted Rhinoseptoplasty (VARS) in mitigating visible scarring concerns. Additionally, we emphasize the benefits of comparing closed procedures with and without endoscopic assistance, underscoring the advantages of optical utilization. Our perspective on nasal tip surgery advocates for enlarged marginal incisions to facilitate direct visual control, complementing our approach. Addressing concerns on the learning curve, we share insights from our training experience, stressing the feasibility of achieving proficiency with practice. Lastly, we acknowledge the need for surgical flexibility, particularly in cases of cartilaginous weakness, where alternative strategies like spreader grafts may be considered. Our response contributes to advancing rhinoplasty techniques, promoting context-driven approaches and adaptability for optimized outcomes.Level of Evidence V 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 .

Advancing the Era of Liquid Rhinoplasty: A Methodological Approach to Injection Protocols.

BACKGROUND: Liquid rhinoplasty, a non-surgical procedure using hyaluronic acid (HA) to reshape and refine the nose, has gained in popularity as an alternative to traditional surgical rhinoplasty although its results are not definitive. However, the lack of standardized injection protocols has raised concerns about treatment consistency and patient safety. OBJECTIVES: In this article, the authors propose a systematic protocol for the most common indications of liquid rhinoplasty. METHODS: By adopting a standardized methodology, healthcare professionals can enhance patient safety, improve treatment consistency, and optimize patient satisfaction. RESULTS: The protocol includes standardized injection sites categorized as dorsal, paramedian, tip and endonasal injections. Specific injection areas are recommended for different nasal shapes such as droopy noses, dorsal humps, nasal saddle deformity, inverted V deformity, tip shape abnormalities, twisted noses, revision cases with dorsal irregularities, and internal nasal valve dysfunction. While variations in filler dosages may be necessary based on individual patient needs, a conservative approach is recommended to maintain natural-looking results and reduce the risk of complications. CONCLUSIONS: The increase in non-surgical techniques for nasal refinement offers patients more options, and systematized injection protocols based on different nasal types provide a structured framework for liquid rhinoplasty. LEVEL OF EVIDENCE IV: 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 .

Prospective Evaluation of Aesthetic and Functional Outcomes following Video-Assisted Rhino-Septoplasty.

BACKGROUND: Conservative techniques have been developed in the field of rhinoplasty, focusing on limited tissue resection while emphasizing the reshaping of nasal structural elements. OBJECTIVES: We aimed to prospectively evaluate aesthetic and functional outcomes following Video-Assisted Rhino-Septoplasty (VARS) using validated tools. METHODS: Patients' self-reported outcomes were assessed before and 6 months after surgery. Aesthetic evaluations used FACE-Q Rhinoplasty modules (FQRM) Satisfaction with Nose and Nostrils. Functional evaluations were performed with NOSE scores. T-tests were used to determine the significance of the change in scores before and after surgery. p value < 0.05 was considered statistically significant. RESULTS: Fifty patients were included (sex ratio = 0.16, mean age = 30 y.o., 78% primary cases). All patients had associated septoplasties, and 32 had inferior turbinate reductions. Mean FQRM Nose scores were 28.1 ± 16.3 before vs. 83.4 ± 17.2/100 after surgery. Mean FQRM Nostrils scores were 61.5 ± 28.6 before vs. 85 ± 21/100 after surgery. Mean NOSE scores were 49.5 ± 36.3 before vs. 14.8 ± 16.6/100 after surgery. All p <0.001. We found no correlation between FQRM Nose and NOSE scores after surgery (ρ = -0.1553, IC95% (-0.41;0.12), p = 0.28). CONCLUSION: Our study showed that VARS is an effective technique, yielding high patient satisfaction in both aesthetic and functional outcomes. LEVEL OF EVIDENCE II: 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.

Sex determination by linear measurements of the bony labyrinth in cone-beam and computed tomography: a practical method.

PURPOSE: The determinism of the sex is of most importance for reconstruction of the biological profile of deceased individuals. In this study, we aim to implement a technique to improve the accessibility of sex determination by the study of the bony labyrinth on cone-beam computed tomography (CBCT) and computed tomography (CT) scans. METHODS: CBCT and CT scans of temporal bones performed between 2014 and 2022 were collected with demographic information. The width of the lateral (LSCw), posterior (PSCw), and anterior semicircular canal (ASCw) was measured. The primary outcome was the diagnostic performance of the individual linear measures and the product of these measures. This analysis is supplemented by establishing thresholds using ROC curves. Inter-judge and intra-judge reliability evaluation was performed blinded in randomly selected exams. RESULTS: One hundred forty-one petrous bones were included for analysis of their imaging. The analysis of the PSCw, ASCw, and ASCw*PSCw for sex determination was associated with area under curves of 0.88 ± 0.11, 0.82 ± 0.14, and 0.84 ± 0.10 respectively and accuracies of 0.74 ± 0.13, 0.78 ± 0.11, and 0.79 ± 0.13 respectively. In ROC-curve analysis, a PSCw*ASCw product > 48.5 allows to determine a male sex with > 95% specificity and a sensitivity of 50.1%. A PSCw*ASCw product ≤ 43 allows to determine a female sex with 88% specificity and 64% sensitivity. Reproducibility analyses showed good to excellent intra-judge and inter-judge reproducibility for ASCw and PSCw. CONCLUSION: Linear measurement of the semicircular canals of the vestibule on CBCT or CT could provide easy-to-use sex determination of the majority of females and males with a good predictive value.

Unidirectional Spin Hall Magnetoresistance in Antiferromagnetic Heterostructures.

Unidirectional spin Hall magnetoresistance (USMR) has been widely reported in the heavy metal/ferromagnet bilayer systems. We observe the USMR in Pt/α-Fe_{2}O_{3} bilayers where the α-Fe_{2}O_{3} is an antiferromagnetic (AFM) insulator. Systematic field and temperature dependent measurements confirm the magnonic origin of the USMR. The appearance of AFM-USMR is driven by the imbalance of creation and annihilation of AFM magnons by spin orbit torque due to the thermal random field. However, unlike its ferromagnetic counterpart, theoretical modeling reveals that the USMR in Pt/α-Fe_{2}O_{3} is determined by the antiferromagtic magnon number with a non-monotonic field dependence. Our findings extend the generality of the USMR which pave the ways for the highly sensitive detection of AFM spin state.

The submucosal approach influences long-term outcomes of refractory obstructive rhinitis: A prospective study and a STROBE analysis.

OBJECTIVE: The surgical approach to refractory hypertrophy of the inferior turbinates is the main therapeutic choice in the management of its symptoms. Although submucosal approaches have demonstrated efficacy, long-term results are debated in the literature and show variable stability. Therefore, we compared the long-term outcomes of three submucosal turbinoplasty methods with regard to the efficacy and stability managing the respiratory disorders. DESIGN: Multicenter prospective controlled study. A computer-generated table was used to allocate participants to the treatment. SETTING: Two teaching and university medical centers. METHODS: We used the EQUATOR network for guidelines describing design, conduct, and reporting of studies and searched the references of these guidelines to identify further relevant publications reporting adequate study protocols. Patients with persistent bilateral nasal obstruction due to lower turbinate hypertrophy were prospectively recruited from our ENT units. Participants were randomly assigned to each treatment and then underwent symptom assessment by visual analog scales, endoscopic assessment at baseline and 12, 24 and 36 months after treatment. RESULTS: Of the 189 patients with bilateral persistent nasal obstruction initially assessed, 105 met the study requirements; 35 were located in the MAT group, 35 in the CAT group and 35 in the RAT group. Nasal discomfort was significantly reduced after 12 months with all the methods. The MAT group presented better outcomes for all VAS scores at the 1-year follow-up, greater stability at the 3-year follow-up for VAS results (p < 0.001 in all cases) and lower disease recurrence (5/35; 14.28 %). At the 3-year follow-up intergroup analysis, a statistically significant difference was confirmed except for RAA scores (H = 2.88; p = 0.236). Rhinorrhea (r = -0.400; p < 0.001) was demonstrated as a predictive factor of 3-year recurrence, while sneezing (r = -0.25; p = 0.011), and operative time needed (r = -0.23; p = 0.016) did not reach statistical significance. CONCLUSIONS: Long-term symptomatic stability varies depending on the turbinoplasty method used. MAT demonstrated greater efficacy in controlling nasal symptoms, presenting better stability in reducing turbinate size and nasal symptoms. In contrast, radiofrequency techniques presented a higher rate of disease recurrence both symptomatically and endoscopically.

Sensibility, specificity, and accuracy of the Sinonasal Outcome Test 8 (SNOT-8) in patients with chronic rhinosinusitis (CRS): a cross-sectional cohort study.

PURPOSE: To analyze as the primary endpoint the accuracy, sensitivity, and specificity of the SNOT-22 assessing CRS severity and to compare the results with a version of the SNOT-8 obtained from the nasal domain items. METHODS: Data were obtained from a prospective multicenter controlled study of dupilumab in adults with moderate-severe CRSwNP. EQUATOR and STROBE network guidelines were adopted. A multivariate logistic regression model was used to evaluate the accuracy of the model with the full (SNOT-22) and reduced (SNOT-8) item set to predict the severity outcome. RESULTS: SNOT-22 demonstrated an AUC of 0.885 (95% CI 0.825, - 0.945), and sensitivity and specificity of 91.49% (83.92-96.25%) and 69.23% (48.21-85.67%), respectively. Interestingly, after stepwise items elimination good outcomes were reported for SNOT-8, with an AUC of 0.818 (95% CI 0.744-0.892), achieving a sensitivity of 93.51% (85.49-97.86%) and specificity of 57.14% (40.96-72.28%). CONCLUSION: Psychometric analyses support the accuracy, sensitivity, and specificity of the nasal domains of SNOT-22 to assess the impact on HRQoL in patients with CRSwNP.

Video-Assisted Septo-rhinoplasty, the Future of Endonasal Rhinoplasty-A Technical Note.

INTRODUCTION: Surgeons have sought to improve outcomes in rhinoplasty through innovative techniques. Although many publications illustrate the advantages of endoscopic septoplasty over conventional methods, few have evaluated the benefits of endoscopy for rhinoplasty. In this article, the authors meticulously describe their own technique that offers a sustainable alternative to open approach rhinoplasty, with high reproducibility and enhanced knowledge for young surgeons. METHODS: The technique involves using video-assisted endoscopy for enhanced visibility and access. Various steps are performed, including hemitransfixion incision, septoplasty if necessary, dorsal reduction, and the development of endoscopic spreader flaps. Nasal tip surgery follows standard endonasal rhinoplasty techniques. RESULTS: This technique has been successfully performed for years in primary and secondary rhinoplasties, resulting in improved aesthetic and functional outcomes without external scars. The endoscopic view enhances understanding for surgeons and residents, while preserving internal valve function and minimizing swelling. Patients express high satisfaction with the procedure. CONCLUSIONS: Video-assisted endoscopic septo-rhinoplasty offers a valuable alternative, providing natural outcomes with improved visualization and reduced complications. It is applicable to various indications and demonstrates its effectiveness compared to traditional approaches. The advanced endoscopic guided septo-rhinoplasty technique combines the benefits of open approach rhinoplasty while avoiding its drawbacks. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Proof-of-concept of a new FFP2 mask adapted to Otolaryngological practice in pandemic: a prospective study.

OBJECTIVE: The objective of this study was to appreciate the tolerance and convenience of a new FFP2 mask allowed the realization of nasal examination in period of pandemic. METHODS: Fifty-one patients were prospectively recruited from two European hospitals to test the FFP2 mask prototype. The following outcomes were evaluated in patients after the clinical examination: fear about coronavirus disease 2019 (COVID-19) infection; easiness of mask placement; tolerability; reassurance; and overall satisfaction about the use of this kind of mask in a pandemic context. Seven otolaryngologists evaluated the mask acceptance and usefulness in patients through a standardized physician-reported outcome questionnaire. RESULTS: Fifty patients completed the evaluation. There were 25 males and 25 females. The mean age of patients was 41 years. Ninety percent of patients considered that the use of the mask reduced the risk to be infected during the examination. Seventy percent of patients reported high or very high satisfaction and should recommend mask to other patients in pandemic period. The realization of nasal examination was easier with optic compared with flexible trans-nasal examination (p = 0.001), which significantly impacted the satisfaction level of physician (p = 0.001). The physician difficulty to perform the examination significantly impacted the satisfactory of patient (p = 0.033). CONCLUSION: The new bioserenity FFP2 mask allows the realization of the trans-nasal endoscopic examination during a pandemic. The use of this mask requires little training period of physician. The use of this mask prototype is well received by patients who reported better perception of self-protection against the virus.

Liquid Spreader Grafts: Internal Nasal Valve Opening with Hyaluronic Acid.

BACKGROUND: Nasal valve disorders frequently give rise to nasal obstruction. Dermal fillers could be used in the internal valve area to generate valve widening. The goal of this study was to report our "liquid spreader" procedure consisting in the injection of hyaluronic acid (HA) at the internal nasal valve in patients complaining of nasal obstruction. METHODS: The procedure described in this paper is suitable for patients with unilateral or bilateral nasal obstruction related to architectural features resulting in narrowing of the internal nasal valve. HA is injected along the internal valve from a single entry point located at the anterior part of the internal valve, thus creating a volume which will induce nasal valve widening. Rhinomanometries and visual analog scales (VAS) regarding nasal obstruction were collected before and after the procedure. RESULTS: Sixteen patients were enrolled (7 females). Mean age was 44 years (min=24 y-o, max=65 y-o). Thirteen presented nasal valve narrowing without septal deviation while 3 patients had high septal deviation. Before injection, mean nasal resistances were 3.4±5.6 sPa/mL (min=0.55, max=19.8). One month after injection, mean nasal resistances were 0.38±0.26 sPa/mL (min = 0.20, max = 0.85). The difference was statistically significant (p=0.049). VAS scores were improved with a trend back to baseline after 12 months. CONCLUSIONS: The liquid spreader is a useful procedure that can be combined with non-surgical esthetic rhinoplasties. Level of Evidence IV 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 .

Cross-cultural adaptation into French and validation of the SCAR-Q questionnaire.

PURPOSE: Most questionnaires designed to evaluate patient-reported outcomes regarding scarring are available in English. The objective was to generate a validated French version of the SCAR-Q questionnaire. METHODS: The SCAR-Q questionnaire (including Appearance, Symptom and Psychological impact scales) was translated into French using a translation-back-translation process in accordance with international guidelines (ISPOR and WHO). For validation, two hundred patients consulting in our tertiary center completed the questionnaire. We tested scale reliability (Cronbach's α), floor/ceiling effects and item redundancy (inter-item correlations). Structural validity was tested using confirmatory factor analysis (CFA) with the robust weighted least squares (WLSMV) estimator and Delta parameterization. Model fit was examined using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker-Lewis index (TLI). Correlations between scales and scale repeatability were tested (Spearman coefficient, Intra-class-coefficient). RESULTS: Four steps were required to obtain a translation consistent with the original version. Two hundred patients completed the questionnaire for validation. Internal consistency analysis found Cronbach's alphas > 0.7 for all scales (0.90 < α < 0.97). No floor or ceiling effect was found for all items (max = 85%). A ceiling effect was observed for all scales. Appearance and psychosocial impact scale items showed redundancy, with many inter-item correlations above 0.7. The CFA of the original structure displayed a reasonable fit, with RMSEA = 0.065, CFI = 0.974 and TLI = 0.972. Scales were positively correlated (0.45 < ρ < 0.65; p < 0.001). Test-retest intra-class correlation coefficients ranged from 0.94 to 0.99 for all scales. CONCLUSION: A French version of the SCAR-Q questionnaire is validated, ready for use.

Transmission of droplet-conveyed infectious agents such as SARS-CoV-2 by speech and vocal exercises during speech therapy: preliminary experiment concerning airflow velocity.

PURPOSE: Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial dissemination of droplets varies according to their initial velocity. After a short literature review, our goal was to determine the velocity of the exhaled air during vocal exercises. METHODS: A propylene glycol cloud produced by 2 e-cigarettes' users allowed visualization of the exhaled air emitted during vocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ and varied vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measured until 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistent with our experimental study. RESULTS: Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice. Voiced consonants like /ʒ/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generated high velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflow velocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shown during a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data. CONCLUSION: Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocal exercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increased risk of contamination when implementing standard recommendations.

Patient and otolaryngologist perceptions of telemedicine during COVID-19 pandemic.

BACKGROUND: The rapid spread of the coronavirus disease 2019 and the implementation of quarantine in many European countries led to a swift change in health care delivery. Telemedicine was implemented in many otolaryngological departments to ensure the continuous care. The purpose of this study is to report our experience about telemedicine in 86 patients consulting virtually in our departments. METHODS: A total of 86 patients benefited from telemedicine consultation from April to Mai May 2020. Patients and physicians were invited to fulfill a satisfaction survey over the 3 days after the consultation. RESULTS: Patients consulted in the following fields: laryngology, voice and swallowing (N=15; 17.4%), head and neck or plastic surgery (N=34; 39.5%), rhinology (N=31; 36.1%) and otology (N=6; 7.0%). Practitioners estimated that the clinical examination would not have changed the consultation issue in 73.2% of cases. The realization of delayed clinical examination was rapidly necessary in 9.3% of cases and useless in 33.7% of cases. Five percent of patients estimated that the consultation did not bring reliable conclusion. Although the majority of patient (87.7%) would recommend telemedicine consultation to friend/family in the context of pandemic, only 44.6% would accept to replace office- consultation by telemedicine consultation outside the pandemic. CONCLUSION: Telemedicine appears to be an interesting alternative approach in situation of pandemic and lock-down. Because the patient motivation to further participate to telemedicine appears to be conditioned by the context, efforts are still required to understand the patient perception, satisfaction and fears in view of future implementation outside pandemic.

Sinus and anterior skull base surgery during the COVID-19 pandemic: systematic review, synthesis and YO-IFOS position.

PURPOSE: The COVID-19 pandemic has caused significant confusion about healthcare providers' and patients' pandemic-specific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic. METHODS: PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID-19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. RESULTS: 15 International publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients' COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited. CONCLUSIONS: Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing the use of PPE is essential with sinus and anterior skull base surgery.

Patient Satisfaction After Non-surgical Rhinoplasty Using Hyaluronic Acid: A Literature Review.

BACKGROUND: Few studies have focused on assessing patient satisfaction after non-surgical rhinoplasty using hyaluronic acid (HA). The main objective of this study was to perform a systematic review assessing patient satisfaction after non-surgical rhinoplasty using HA. METHODS: We conducted a systematic review using the PRISMA model. All articles assessing patient satisfaction using self-questionnaires or scales (visual analogic scales, Likert scale) after non-surgical rhinoplasty were included. We also analyzed injection protocols and complications. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. RESULTS: A total of 674 patients were included in eight studies. Mean age was 29.5 years old (min = 19, max = 67, sex ratio = 0.20). Rates of "satisfied" or "very satisfied" patients were 100% immediately after injection (n = 404/404 patients), 98.2% in the weeks following injection (n = 628/639 patients), 84.7% 3 months after injection (n = 333/393 patients) and 96.4% one year after injection (n = 60/62 patients). Duration of HA effectiveness ranged between 8 and 14 months. One local infection (0.001%) but no skin necrosis and no blindness were reported. Most of authors used less than 1 mL of HA per procedure. CONCLUSIONS: Provided precautions for use and indications are observed, and presuming good anatomical knowledge, non-surgical rhinoplasty is an interesting procedure associated with high satisfaction rates. 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 .

Intra-Individual Aging of the Facial Skeleton.

BACKGROUND: Midface skeletal changes through aging have been conceptualized as a clockwise rotation relative to the cranial base. This finding is mainly supported by cross-sectional population studies based on comparisons between groups of individuals in different age ranges. Few papers have evaluated the intra-individual evolution of the facial skeleton, and those that have included only a limited number of patients. OBJECTIVES: The authors sought to analyze the intra-individual evolution of the facial skeleton. METHODS: We conducted a retrospective study including patients who underwent 2 separate facial computed tomography scans (T1 and T2) with a minimum gap of 7 years. Employing 3-dimensional reconstructions, we measured and compared 7 facial angles (glabellar, orbital, piriform, maxillary, subdental, chin, gonial) and 6 facial distances (lacrimal crest, orbital floor, piriform, zygoma, labiomental, gnathion) on both computed tomography scans. RESULTS: A total of 56 patients (29 males and 27 females) were included. Mean ages at T1 and T2 were 50 and 59 y, respectively. We found a significant decrease between T1 and T2 in facial angles at the midface (glabella, orbital, piriform, and maxillary angles, all P < 0.0001). We found a significant increase in all facial distances between T1 and T2 for the overall population and for men (all P < 0.05). For women, all distances increased, but only piriform and zygoma distances showed significant changes (P < 0.001 and P < 0.04, respectively). Bone remodeling appeared earlier in women. CONCLUSIONS: Our study confirms the clockwise rotation of the midface during aging. This finding could lead to a better understanding of aesthetic medicine practices.