A Rare Case of Temporal Bone Pneumocephalus Tracking through the Internal Auditory Canal.

A 39-year-old male with chronic hydrocephalus requiring biventricular shunts presented with progressive pneumocephalus over several years. He showed no improvement following ventriculoperitoneal (VP) shunt revision and anterior skull base repair for a sphenoid dehiscence. Imaging continued to show worsening pneumocephalus with air tracking along the right facial nerve from the geniculate ganglion to the internal auditory canal (IAC). The patient then underwent tympanomastoidectomy and skull base reconstruction. Based on a search of published literature, this appears to be the first reported case of temporal bone pneumocephalus coursing through the IAC, unlike most cases associated with tegmen defects and middle fossa pneumocephalus.

Sulfono-γ-AA modified peptides that inhibit HIV-1 fusion.

The utilization of bioactive peptides in the development of highly selective and potent pharmacological agents for the disruption of protein-protein interactions is appealing for drug discovery. It is known that HIV-1 entry into a host cell is through a fusion process that is mediated by the trimeric viral glycoprotein gp120/41, which is derived from gp160 through proteolytic processing. Peptides derived from the HIV gp41 C-terminus have proven to be potent in inhibiting the fusion process. These peptides bind tightly to the hydrophobic pocket on the gp-41 N-terminus, which was previously identified as a potential inhibitor binding site. In this study, we introduce modified 23-residue C-peptides, 3 and 4, bearing a sulfono-γ-AA residue substitution and hydrocarbon stapling, respectively, which were developed for HIV-1 gp-41 N-terminus binding. Intriguingly, both 3 and 4 were capable of inhibiting envelope-mediated membrane fusion in cell-cell fusion assays at nanomolar potency. Our study reveals that sulfono-γ-AA modified peptides could be used for the development of more potent anti-HIV agents.

Socioeconomic determinants of moderate and severe obstructive sleep apnea in children: A pre and post COVID analysis.

INTRODUCTION: COVID-19 has disproportionately affected healthcare access of certain minority groups, and thus could contribute to delay in timely evaluation and management of pediatric obstructive sleep apnea (OSA). Socioeconomic status (SES) is known to affect healthcare access in pediatric otolaryngology and may also be a risk factor for OSA and its associated co-morbidities. OBJECTIVES: Our primary objective is to determine the impact of COVID-19 on time to diagnosis (TTD) and time to treatment (TTT) of polysomnography (PSG)-proven moderate to severe pediatric OSA in different socioeconomic classes. Secondary objectives include determining the impact of racial and demographic factors on TTD and TTT. METHODS: This is a retrospective chart review of 120 children; 60 children pre-COVID (February 2018 to February 2020), and 60 children post-COVID onset (March 2020 to March 2022). This study was performed at a pediatric teaching hospital and tertiary referral center, and involved children aged 3-17 years old with outpatient PSG-proven moderate to severe OSA. Approval was obtained from our hospital's institutional review board (IRB). RESULTS: There were a total of 120 children, 60 in each group. The average age was 9.5 years old; females constituted 41.6 % of the sample. TTD increased from 53.7 days pre-covid to 103 days post-COVID onset in all children (p = 0.00), 42.5 days-151.9 days in white children (p = 0.00), 38 days-142.7 days in children with high SES (p = 0.00), 32.1 days-146.5 days in children with private insurance (p = 0.00), and 65.7 days-105.8 days in children with public insurance (p = 0.04). TTT did not change significantly. CONCLUSION: Our results show that TTD of OSA and obesity in advantaged groups were affected to a greater degree than disadvantaged groups. This suggests children of all socioeconomic groups are susceptible to healthcare disparities and the COVID-19 pandemic has uncovered the vulnerability of such populations. Policymakers should consider providing more funding and support for all children, including continued funding for those with lower SES.

Treatment of Laryngeal and Tracheal Stenosis: Cooperative Treatment With Our Pulmonary Interventionalist Colleagues.

OBJECTIVES/HYPOTHESIS: We will describe the treatment of patients with subglottic and tracheal stenosis using instruments and techniques utilized by otolaryngologists and interventional pulmonologists (IP), with a focus on IP-favored approaches that may be less familiar to otolaryngologists. We will present two cases that were treated cooperatively by otolaryngology and IP and will highlight the advantages of certain techniques. STUDY DESIGN: Case series METHODS: This is a case-based presentation highlighting procedures done cooperatively by otolaryngology and IP. Instruments and techniques typically utilized by each specialty will be presented, including rigid and flexible bronchoscopy, laser, balloon dilation, medical adjuncts, fiberoptic electrocautery, fiberoptic cryoablation, and fiberoptic argon plasma coagulation. Patient outcomes for these techniques will also be discussed based on the current literature. RESULTS AND CONCLUSIONS: A dichotomy exists in the approaches typically utilized by otolaryngology and IP to address laryngotracheal stenosis. Our IP colleagues utilize techniques via a flexible bronchoscope that are often not considered in a typical otolaryngology practice. We discussed these techniques to educate otolaryngologists who may be looking to contribute to their armamentarium, as current literature suggests promising patient outcomes. Ultimately, a team approach to these often-complex patients can result in excellent outcomes.

INI1-Intact Sinonasal Carcinoma with Rhabdoid Features.

Sinonasal malignancies are known for their associated poor prognosis and diversity of histologic features. While poor prognosis is largely due to advanced disease at presentation, histologic features also play a significant role. Therefore, accurate pathologic diagnosis is of utmost importance. Here, we describe a 63-year-old male with chronic left-sided nasal obstruction and left-sided epistaxis who was found to have a large mass occupying most of the nasal cavity extending through the nasopharynx to just below the nasopharyngeal surface of the soft palate. During surgical excision, the mass was noted to originate from the floor of the maxillary sinus with erosion of the medial wall of the maxillary sinus. Pathology revealed a diagnosis of INI1-intact poorly differentiated composite carcinoma with rhabdoid phenotype and sarcomatoid and squamous cell carcinoma foci arising within an inverted papilloma. Included in this report is a detailed description of both the patient's medical course and this pathologically novel sinonasal neoplasm. We aim to elucidate this rare tumor's complex features in order to improve future diagnosis and stimulate prospective research on sinonasal malignancies with complex histology.

Inner Ear Proteins as Potential Biomarkers.

OBJECTIVE: The purpose of this manuscript is to identify proteins exclusive to the inner ear based on published research to identify potential candidate biomarkers and guide future inner ear research. DATA SOURCES: Literature on inner ear proteins published on Pubmed, Google Scholar, and Scopus was reviewed using key words such as "inner ear molecule," "inner ear exclusive protein," and several specific protein searches such as "prestin" based on findings from the initial searches. STUDY SELECTIONS: Studies were selected for abstract review based on title relevance, and full text was chosen for review based on abstract relevance. Several related studies cited in initially reviewed literature were also chosen to compile more detailed information on specific molecules with the goal of at least two to three published articles for each protein. DATA EXTRACTION & SYNTHESIS: Proteins that were cited to have only been found within the inner ear were included in this review, including some proteins that were later identified outside the inner ear. Information regarding their size, location, function, and clinical significance was recorded. CONCLUSIONS: Based on this literature search, eight proteins exclusive to the inner ear were identified including otolin-1, otoconin 90/95, prestin, otoancorin, otogelin, α-tectorin, ß-tectorin, and cochlin. Proteins initially found to be exclusive to the inner ear though later identified outside of the inner ear included oncomodulin, otospiralin, and otoraplin. This literature review may serve as a focused guide for future research on proteins exclusive to the inner ear as potential biomarkers for diseases of the inner ear.