The impact of digital inequities on salivary gland cancer disparities in the United States.

INTRODUCTION: Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC). METHODS: The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality. RESULTS: Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods. CONCLUSIONS: Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.

Facial Onset Sensory and Motor Neuronopathy-Like Syndrome: A Case Report.

OBJECTIVES: Facial onset sensory and motor neuronopathy syndrome (FOSMN) is a rare motor neuron disorder characterized by facial sensory and motor aberrations that progress to the upper limbs. We present a case of FOSMN-like syndrome that has characteristics of FOSMN but is confined to the craniofacial region. METHODS: Retrospective chart review and review of the literature. RESULTS: A 70-year-old woman presented with a 1-month history of progressive bilateral facial sensory loss and weakness affecting the trigeminal and hypoglossal nerves. Within 12 months, she developed debilitating weakness affecting her lower and midface bilaterally. After an extensive workup, a diagnosis of FOSMN-like syndrome was made, as symptoms failed to progress to the upper extremities. CONCLUSIONS: This case demonstrates a unique presentation of FOSMN that we classify as FOSMN-like syndrome. Clinicians must maintain a high index of suspicion when a patient presents with clinical features characteristic of FOSMN syndrome without progression of symptoms distal to the craniofacial region because it may represent a FOSMN-like syndrome.

Quality of Life Outcomes After Facial Feminization Surgery.

Objective: Report a large single-institution cohort of quality of life (QOL) data before and after facial feminization surgery (FFS). Study Design: Case series. Methods: Patients who underwent FFS at our institution between 2017 and 2019 and completed a pre- and postoperative QOL survey were included in this study. Responses were scored on a 5-point scale with 1 corresponding to least agreement and 5 corresponding to most agreement. Paired t-test was used to compare pre- and postoperative mean scores for each response. Two-tailed t-test was used to compare the mean postoperative delta for each response by demographics. Results: One hundred seven of 341 patients completed a pre- and postoperative survey. The average age was 36 years (range 18-67). The mean time to postoperative survey completion was 96 days (interquartile range 43). Significant improvements in all aspects of QOL assessed on the survey were noted after surgery, including self-perceived facial femininity (2.1-3.8, p < 0.001) and publicly perceived facial femininity (2.0-3.6, p < 0.001). Patients also felt less limited in social activities (3.2-2.0, p < 0.001) and professional activities (2.7-1.7, p < 0.001). Conclusion: FFS improves self-perceived and externally perceived facial femininity and reduces limitations in social and professional activities.

Initial outcomes at a nascent tertiary pediatric thyroid surgical center.

OBJECTIVES: Previous studies on pediatric thyroid surgical complications suggest that high-volume centers achieve improved outcomes. We hypothesize that initial outcomes from a nascent pediatric surgical practice may be comparable to higher volume centers. Furthermore, we determine whether a low-volume center can safely transition to an intermediate or high-volume center. METHODS: A retrospective chart review was performed for all pediatric patients undergoing thyroid surgery at a single institution from 2014 to 2020. Surgeries were performed by two pediatric otolaryngologists. All patients were managed postoperatively by a multidisciplinary team of physicians that included pediatric otolaryngologists and endocrinologists. Data collection focused on patient demographics and postoperative complications, including rates of recurrent laryngeal nerve injury and permanent hypoparathyroidism. RESULTS: From 2014 to 2020, a total of 31 patients underwent thyroid surgery at our pediatric thyroid surgery center, 9 of whom underwent neck dissection. The mean age of our cohort was 14.4 ± 3.9 years (range 8 months-20 years). Postoperative pathology results revealed that 15 patients (46.9%) were diagnosed with PTC, 6 (18.8%) with follicular adenoma, and 4 (15.6%) with benign thyroid tissue. One (2.0%) patient had permanent unilateral recurrent laryngeal nerve paralysis and one patient experienced permanent hypoparathyroidism (2.7%). CONCLUSIONS: Our initial low complication rate as a nascent pediatric thyroid surgery center suggests that favorable outcomes can be achieved at lower volume surgery centers. In order to increase patient access to high-volume pediatric thyroid surgery centers, new centers must start with lower volumes before ultimately becoming high-volume centers. Our study shows that this can be safely achieved. LEVEL OF EVIDENCE: IV.

PGY1 Resident-Led Mock Virtual Interviews to Prepare for the 2022 Otolaryngology Residency Virtual Interviews.

Due to the ongoing coronavirus disease 2019 pandemic, virtual interviews are planned for the 2021-2022 residency application cycle. The virtual interview will remain novel to applicants for each match cycle until the graduating medical student class has experience from virtual interviews during their medical school admissions. The virtual interview poses unique challenges that are unique from in-person formats. Given the lack of experience of applicants in the 2022 match, practicing interviewing skills prior to the actual date is vital to success. We describe a postgraduate year 1 (PGY1)-run mock interview session for applicants preparing for the 2021-2022 otolaryngology interview cycle and discuss the methodology. Deliberate practice with PGY1 residents who have just recently undergone the virtual interview process can better prepare applicants for their virtual interviews, improve on-camera behaviors, and ameliorate mental health challenges unique to the virtual format.

Otolaryngology Residency Interviews in a Socially Distanced World: Strategies to Recruit and Assess Applicants.

Due to concerns surrounding travel during the COVID-19 pandemic, the 2020-2021 otolaryngology residency application cycle will be conducted virtually for the first time. Residency programs should consider the logistics of video interviews, drawing on experiences of other programs that have successfully performed virtual interviews in the past. The lack of in-person interviews will create challenges in assessing applicants, and we recommend that programs develop structured and targeted questions and even consider having candidates answer standardized questions prior to the virtual interview day. From an applicant perspective, gauging the intangibles of individual residency programs, such as resident camaraderie, program culture, and program location, will be difficult. To address this, programs should consider hosting informal virtual gatherings, create videos that highlight the resident experience, and ensure that program websites are up-to-date. Ultimately, adaptability, resilience, and innovation will allow residency programs to achieve a successful 2021 otolaryngology match.

Migraine Features in Patients With Recurrent Benign Paroxysmal Positional Vertigo.

OBJECTIVES: To identify migraine features present in a cohort of patients with recurrent benign paroxysmal positional vertigo (BPPV). METHODS: Patients presenting with recurrent BPPV were surveyed. Recurrent BPPV was defined as three episodes or greater in 6 months before presentation, with resolution of symptoms after Epley maneuver. Current or past migraine headache (MH) diagnosis was made according to the International Headache Society guidelines. RESULTS: Fifty-eight patients with recurrent BPPV with a mean age of 53.8 ±â€Š17.4 years were included. Half (29 patients) fulfilled criteria for MH and half (29 patients) did not meet the criteria for MH (non-MH). No statistically significant difference was found in a majority of migraine-related symptoms between the MH and non-MH cohorts with recurrent BPPV. History of migraine medication usage (p = 0.008), presence of a weekly headache (p = 0.01), and duration of dizziness after positional vertigo (p = 0.01) were the only variables that were different on multivariate analysis between the MH and non-MH cohorts. CONCLUSIONS: Half of recurrent BPPV patients suffer from migraine headaches. The other half presented with migraine-related symptoms, but do not meet criteria for MH. The high comorbidity of MH in our recurrent BPPV cohort as well as the absence of a statistically significant difference in a majority of migraine-related features among patients who did and did not fulfill criteria for MH may suggest that recurrent BPPV has a relationship with migraine. Recurrent BPPV may potentially be a manifestation of migraine in the inner ear, which we term otologic migraine including cochlear, vestibular, or cochleovestibular symptoms.