Grading systems of oral cavity pre-malignancy: a systematic review and meta-analysis.

PURPOSE: Oral potentially malignant disorders (OPMDs) may have varying degrees of oral epithelial dysplasia (OED). Traditional grading schemes separate OED into three-tiers (mild, moderate, and severe). Alternatively, a binary grading system has been previously proposed that stratifies OED into low-risk and high-risk categories based on a quantitative threshold of dysplastic pathologic characteristics. This systematic review evaluates the predictive value of a binary OED grading system and examines agreement between pathologists. METHODS: This meta-analysis queried 4 databases (PubMed, Ovid-MEDLINE, Cochrane, and SCOPUS) and includes 4 studies evaluating binary OED grading systems. Meta-analysis of proportions and correlations was performed to pool malignant transformation rates (MTR), risk of malignant transformation between OED categories, and measures of interobserver agreement. RESULTS: Pooled analysis of 629 lesions from 4 different studies found a six-time increased odds of malignant transformation in high-risk lesions over low-risk lesions [odds ratio (OR) 6.14, 95% 1.18-15.38]. Reported ORs ranged from 2.8 to 22.4. The overall MTR was 26.8%, with the high-risk and low-risk lesions having MTRs of 57.9% (95% CI 0.386-0.723) and 12.7% (95% CI - 0.210 to 0.438), respectively. Pooled unweighted interobserver kappa values for the binary grading system and three-tiered system were 0.693 (95% CI 0.640-0.740) and 0.388 (95% CI 0.195-0.552), respectively. CONCLUSION: Binary grading of OED into low-risk and high-risk categories may effectively determine malignant potential, with improved interobserver agreement over three-tiered grading. Improved grading schemes of OED may help guide management (watchful waiting vs. excision) of these OPMDs.

Hearing Loss in Patients With Ankylosing Spondylitis: A Systematic Review and Metaanalysis.

OBJECTIVE: To determine the prevalence of hearing loss (HL) in patients with ankylosing spondylitis (AS) and to describe frequency-specific hearing threshold changes in this patient population compared to patients without AS. METHODS: A systematic review querying 4 databases (PubMed, OVID Medline, Scopus, Cochrane) was performed to identify studies evaluating HL in patients with AS. Metaanalysis was performed to identify overall prevalence rate and OR of HL, as well as to compare mean differences in frequency-specific hearing thresholds between patients with and without AS. RESULTS: Our metaanalysis included 14 studies and 1083 patients (598 with AS vs 485 without AS). The pooled prevalence of HL in patients with AS was 42.4% (95% CI 29.2-56.2). Patients with AS had a significantly higher OR of HL than patients without AS (OR 4.65, 95% CI 2.73-7.91). Mean differences in pure-tone hearing thresholds ranged from 0-5 decibels (dB) for frequencies of 0.25-4 kHz, and from 5-15 dB for frequencies of 6-16 kHz. CONCLUSION: Patients with AS have higher odds of having HL than patients without AS. The AS population also presents with significantly impaired hearing thresholds across all conventional and extended pure-tone frequencies. This may manifest as slight to moderate HL. Results of this systematic review might justify increased attention to audiologic manifestations of patients with AS.

Factors Influencing the Development of Pneumonia in Patients With Head and Neck Cancer: A Meta-analysis.

OBJECTIVE: The aim of this study was to identify factors that are associated with the occurrence of pneumonia in patients with head and neck cancer (HNC) after treatment. DATA SOURCES: PubMed, Scopus, OVID, and Cochrane Library from inception to November 26, 2019. REVIEW METHODS: A systematic review in accordance with the PRISMA guidelines and an assessment of bias were performed. Included studies reported on the risk factors of pneumonia development after HNC treatment via odds ratios and subdistribution hazard ratios from regression analysis. RESULTS: Fifteen studies were included, comprising 30,962 patients with a mean age of 70 years (range, 19-95 years). Of these, 71.6% are male. The results of our study indicate that the following were independent risk factors contributing to the development of pneumonia: male sex, habitual alcohol consumption, poor oral hygiene before treatment, pretreatment dysphagia, hypopharynx and nasopharynx tumor sites, use of radiotherapy with or without chemotherapy versus surgery alone, addition of chemotherapy to radiotherapy, reirradiation, neck dissection, increased duration of tracheotomy, and use of sedatives for sleeping. CONCLUSION: Multiple patient-, tumor-, and treatment-specific risk factors were identified in predicting pneumonia. Recognition of these risk factors early on may help prevent or at least detect pneumonia in this vulnerable group of patients.

Systematic review of measures of disease severity in rhinitis.

BACKGROUND: Rhinologists often encounter a broad spectrum of allergic rhinitis (AR) and nonallergic rhinitis (NAR) patients, who can be variably classified based upon timing and severity of disease. Our understanding of the varied quality of life (QOL) impact in different classifications of rhinitis is limited. Thus a more comprehensive understanding of the impact of rhinitis upon our patients, as measured by both patient reported outcome measures (PROMs) and clinical physiologic measures, as well as unique factors associated with disease severity is needed. METHODS: A systematic search of databases was performed to identify AR and NAR studies reporting Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), total nasal symptom score (TNSS), or visual analogue scale (VAS) scores, and physiologic measures including peak nasal inspiratory flow (PNIF) and nasal airflow. Relationships between PROMs, physiologic measures, and associated factors (e.g., allergic status, disease duration) were assessed by weighted correlations and meta-regressions. RESULTS: A total of 171 studies reporting on 33,843 patients were included. Symptoms were more severe in AR than NAR on VAS (p < 0.001). Classification based upon Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines demonstrated differences in PROM severity. There was no significant correlation between PROMs and demographic factors, comorbidities, or physiologic measures. Meta-regression identified a correlation between worse RQLQ scores and shorter disease duration (r = -0.4, p < 0.001). CONCLUSION: Rhinitic patients have more severe impact upon QOL in the presence of allergy with variable impact upon specific symptom subdomains. PROMs do not correlate with common demographic factors, comorbidities, or physiologic measures of nasal airflow.

Bronchoscopy, laryngoscopy, and esophagoscopy during the COVID-19 pandemic.

BACKGROUND: The United States now has the highest death toll due to COVID-19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this study is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic. METHODS: Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use with regard to COVID-19 were included. RESULTS: Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and health care workers. CONCLUSIONS: Summary guidelines based on the literature available at this time are presented in order to decrease transmission of the virus and protect those involved.

Subtotal Petrosectomy and Cochlear Implantation: A Systematic Review and Meta-analysis.

IMPORTANCE: Subtotal petrosectomy (STP) has been more frequently performed to prepare ears with unfavorable conditions for cochlear implantation. OBJECTIVES: To provide an overview of indications for and complications of STP and cochlear implantation and to compare outcomes between single vs multistage procedures and between pediatric vs adult populations. DATA SOURCES: A search of PubMed, Scopus, Ovid, and the Cochrane Library was performed from the databases' inception to January 23, 2020, for studies evaluating STP for cochlear implantation. STUDY SELECTION: Studies with a minimum follow-up of 3 months and no missing data regarding postoperative outcomes were included. Of the initial 570 studies identified, 27 (4.7%) met selection criteria. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently assessed study eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines; discrepancies were resolved by a third reviewer. Extracted data included patient demographics, indications for STP, rates of complications, and cholesteatoma recidivism when applicable. Data were pooled using a random- or a fixed-effects model when appropriate. MAIN OUTCOMES AND MEASURES: The primary study outcome was rate of global complications stratified by patient- and surgery-level characteristics. RESULTS: Twenty-seven unique studies with 377 unique patients (54.2% male; mean age, 50.6 [range, 1-99] years) undergoing 397 STP procedures and cochlear implantation were included. Of these procedures, 299 of 394 cases with the information reported (75.9%) were single procedures and 95 (24.1%) were multistage procedures. Of the total 397 STP procedures, most common indications included chronic otitis media (220 cases [55.4%]), previous open mastoid cavity (141 [35.5%]), cholesteatoma (74 [18.6%]), and cochlear ossification (29 [7.3%]). The overall complication rate was 12.4% (95% CI, 9.4%-15.9%); overall cholesteatoma recidivism rate was 9.3% (95% CI, 4.3%-17.1%). Complication rates did not significantly differ based on stage or age of patients. Cases with cholesteatoma more often underwent multistage vs single-stage procedures (23 of 54 [42.6%] vs 35 of 174 [20.1%]). CONCLUSIONS AND RELEVANCE: Across all age groups, STP has been shown to be an effective surgical operation in preparing an ear with unfavorable conditions for cochlear implantation. The potential indications for which cochlear implantation can be performed have expanded with the use of STP. Presence of cholesteatoma might indicate that a multistage procedure should be performed. Lastly, with complication rates comparable to those in adult patients, STP can be considered in children requiring cochlear implantation to minimize ear-related issues and allow benefit from cochlear implantation.