The Effects of Wildfire Smoke on Asthma and Allergy.

PURPOSE OF REVIEW: To review the recent literature on the effects of wildfire smoke (WFS) exposure on asthma and allergic disease, and on potential mechanisms of disease. RECENT FINDINGS: Spatiotemporal modeling and increased ground-level monitoring data are allowing a more detailed picture of the health effects of WFS exposure to emerge, especially with regard to asthma. There is also epidemiologic and some experimental evidence to suggest that WFS exposure increases allergic predisposition and upper airway or sinonasal disease, though much of the literature in this area is focused more generally on PM2.5 and is not specific for WFS. Experimental evidence for mechanisms includes disruption of epithelial integrity with downstream effects on inflammatory or immune pathways, but experimental models to date have not consistently reflected human disease in this area. Exposure to WFS has an acute detrimental effect on asthma. Potential mechanisms are suggested by in vitro and animal studies.

The Toxicological Effects of e-Cigarette Use in the Upper Airway: A Scoping Review.

OBJECTIVE: While evidence continues to emerge on the negative health effects of electronic cigarettes (e-cigarettes) on the lungs, little is known regarding their deleterious effects on the upper airway. The purpose of this review is to summarize the toxicological effects of e-cigarettes, and their components, on the upper airway. DATA SOURCES: PubMed, SCOPUS, EMBASE databases. REVIEW METHODS: Systematic searches were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from 2003 to 2023. Studies were included if they investigated the toxicological effects of e-cigarette exposure on human or animal upper airway tissue. Two authors independently screened, reviewed, and appraised all included articles. RESULTS: A total of 822 unique articles were identified, of which 53 met inclusion criteria and spanned subsites including the oral cavity (22/53 studies), nasal cavity/nasopharynx (13/53), multiple sites (10/53), larynx (5/53), trachea (2/53), and oropharynx (1/53). The most commonly observed consequences of e-cigarette use on the upper airway included: proinflammatory (15/53 studies), histological (13/53), cytotoxicity (11/53), genotoxicity (11/53), and procarcinogenic (6/53). E-cigarette humectants independently induced toxicity at multiple upper airway subsites, however, effects were generally amplified when flavoring(s) and/or nicotine were added. Across almost all studies, exposure to cigarette smoke exhibited increased toxicity in the upper airway compared with exposure to e-cigarette vapor. CONCLUSION: Current data suggest that while e-cigarettes are generally less harmful than traditional cigarettes, they possess a distinct toxicological profile that is enhanced upon the addition of flavoring(s) and/or nicotine. Future investigations into underexamined subsites, such as the oropharynx and hypopharynx, are needed to comprehensively understand the effects of e-cigarettes on the upper airway.

Large Nasopharyngeal Hairy Polyp Causing Immediate Respiratory Distress at Birth.

This article presents a rare case of a large hairy polyp, a developmental malformation causing a benign tumor, within the nasopharynx. The patient, born with the polyp obstructing the airway, required immediate intubation and a combined transnasal-transoral surgical approach for excision. The case underscores the challenges in diagnosing and managing such polyps, emphasizing the importance of imaging for surgical planning, and the consideration of multiple approaches to ensure complete resection and prevent recurrence. Laryngoscope, 134:4118-4121, 2024.

Comparison of permeable cell culture inserts for use in culture of a human in vitro air-liquid interface model system.

In this study, we compared 12 mm cell culture inserts with permeable polyester membranes (0.4 µm pores) from two different manufacturers: CELLTREAT® and Corning®. Physical dimensions and masses of the inserts were found to be very similar between the two brands, with CELLTREAT® inserts having a slightly smaller diameter and growth area (11.91 mm; 1.11 cm2 ) compared to Corning® Transwells® (12 mm; 1.13 cm2 ). We compared cell differentiation outcomes of human nasal epithelial cells (HNECs) at air-liquid interface grown on inserts from the two different manufacturers, including trans-epithelial electrical resistance, ciliary beat frequency, ciliated area, and gene expression. HNECs from three male donors were used for all endpoints. No statistically significant differences were observed between paired cultures grown on different brands of insert. In conclusion, these inserts are comparable for use with airway epithelial cell model systems and likely do not impact cellular differentiation or cell culture quality.

The Impact of Occupational Exposures on Chronic Rhinosinusitis: A Scoping Review.

Chronic rhinosinusitis (CRS) is a prevalent and burdensome condition worldwide, characterized by inflammation of the paranasal sinuses. Ideally, instead of treating CRS, we would identify ways to prevent the development of this chronic condition. Occupational exposures may be an excellent target for prevention. Occupational exposures have been shown to play a critical role in the pathogenesis of multiple lower airway diseases, such as asthma, silicosis, asbestosis, and hypersensitivity pneumonitis. However, evidence for the association between occupational exposures and the development of upper airway disease, like CRS, is less well-defined. This manuscript examines the association between occupational exposures and CRS. A scoping review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines identified 19 relevant studies. The populations examined and the methods and criteria used for defining CRS diagnosis and occupational variables significantly varied between the studies. Diagnosis of CRS was most often determined by self-reported symptoms or medical record review. Occupational variables ranged from employment status to occupation type to specific exogenous compounds encountered. Overall, substantial evidence demonstrates a general association between occupational exposures and CRS diagnosis; however, limitations in study methodologies, including variations in CRS diagnostic criteria, occupational exposures, assessment methods, and populations, hinder drawing more specific conclusions. Moving forward, rigorous research methodologies and standardized criteria are essential to draw conclusions supported by multiple studies. Critical components of future studies should include large, diverse populations, use of consensus CRS diagnostic criteria, and inclusion of many specific and quantitatively defined exposures. Ultimately, such efforts can help inform preventative measures and interventions for CRS, thus mitigating the burden of CRS on individuals and populations worldwide.

Pediatric Robotic Laryngeal Cleft Repair.

OBJECTIVE: Compare surgical and swallow outcomes in robotic versus traditional laryngeal cleft (LC) repairs. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care pediatric hospital. METHODS: Pediatric patients who underwent robotic or traditional (open or endoscopic) LC repair between 2010 and 2021 were identified. Patient characteristics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow study (MBSS) results were compared. RESULTS: Eighteen robotic and thirty traditional LC repairs were identified. Mean surgical (149 vs 111 min, P < .05) and OR times (207 vs 139 min, P < .002) were increased for robotic type I LC repairs, but were similar for type II and III LC. Mean hospital LOS was increased for robotic type I LC repairs (2.6 vs 1.2 days, P < .006), but was decreased for type II (4 vs 12.2 days) and type III (4.3 vs 94.5 days) LC. Postoperative MBSS results were improved for robotic type I LC repairs at 12 months (82% vs 43%, P = .05), and trended toward improvement at 6 months for type II (75% vs 22%), and type III (67% vs 50%) LC repairs, although significance was limited for type II and III LC due to the number of subjects. A robotic approach was used successfully to revise all recurrent LC that failed traditional repairs. CONCLUSION: Robotic type 1 LC repairs demonstrated increased operative times and hospital LOS but improved postoperative swallow outcomes compared to traditional approaches may be particularly useful in cases of recurrent clefts.

Inhalational exposure history is associated with differential sinonasal gene expression profiles and clinical outcomes in chronic rhinosinusitis patients: A pilot study.

KEY POINTS: Inhalational exposure (IE) history assessment is important and may guide chronic rhinosinusitis disease management. Combined exposure status was the most significant factor across differential gene expression analyse IE history was associated with pro-inflammatory transcriptome changes and worse clinical outcomes.

Transoral robotic surgery for pediatric upper airway pathology: An institutional update.

OBJECTIVE: Provide an update on our institution's experience with utilizing transoral robotic surgery (TORS) in pediatric airway surgery and compare these results to surgery by traditional methods. METHODS: Pediatric patients who underwent TORS for treatment of upper airway pathology between 2010 and 2021 at our institution were retrospectively identified and compared to patients with the same or similar pathology who underwent a traditional (open or endoscopic) surgical approach over the same time period. Outcomes of interest included patient demographics, operative times, adverse events, hospital length of stay (LOS), and modified barium swallow (MBSS) results. RESULTS: Forty children (19M, 21F) underwent 46 TORS procedures. Mean age was 6.4 years (range: 6 days-17 years). Most commonly treated pathology included: laryngeal clefts (LC) (n = 18), lymphatic malformations (n = 9), and base of tongue masses (n = 7). Surgical time was decreased in traditional type I LC repairs (mean: 111 vs 149 min, P = 0.04) and lymphatic malformation excisions (59 vs 120 min, p = 0.005). Hospital LOS was increased in TORS type I LC repairs (2.6 vs 1.2 days, P = 0.04). Adverse event rate was similar between TORS and traditional cohorts (17 % vs 16 % cases, P = 0.9). Postoperative MBSS results were improved for TORS type I LC repairs at 6 months (70 % vs 33 %, P = 0.09) and 12 months (82 % vs 43 %, P = 0.05). CONCLUSIONS: Pediatric TORS is practical and safe and has comparable outcomes to traditional surgery. Robotic-assisted LC repair displayed improved postoperative swallow results versus traditional approaches and may be particularly useful in recurrent cases.

Systematic Review of Pathogenic GJB2 Variants in the Latino Population.

OBJECTIVES: Define the extent to which GJB2-related hearing loss is responsible for non-syndromic hearing loss (NSHL) in the Latino population. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PubMed and MEDLINE were accessed from 1966 to 2019 using permutations of the MeSH terms: "Hearing Loss," "Hearing Impairment," "Deafness," "Latin American," "Latino," "GJB2," and "Genetic." Additionally, countries designated as Latino by the US Office of Management and Bureau were cross-referenced as key terms against the aforementioned search criteria. Exclusion criteria included non-English publications, a non-Latino study population, and literature not investigating GJB2. An allele frequency analysis of pathogenic GJB2 variants in the Latino population was performed and stratified by country of origin and reported ethnicity. RESULTS: One hundred twenty two unique studies were identified of which 64 met our inclusion criteria. Forty three studies were included in the GJB2 systematic review. A total of 38 pathogenic GJB2 variants were identified across 20 countries in the Latino population. The prevalence of pathogenic GJB2 variants varied by country; however, were generally uncommon with the exception of c.35delG (p.Gly12Valfs*) which displayed an allele frequency of 3.1% in the combined Latino population; ranging from 21% in Colombia to 0% in Guatemala. CONCLUSION: Variation in the prevalence of pathogenic GJB2 variants by country likely reflect the heterogeneous nature of ethnic ancestral contributions to the Latino population. Additional research utilizing next generation sequencing might aid in the development of assays for high throughput diagnosis of inherited hearing loss in the multitude of ethnic sub-groups that comprise this and other traditionally marginalized populations.

Optimizing international otolaryngology service trips: Perceptions from learners versus volunteers.

OBJECTIVES/HYPOTHESIS: Optimizing value of medical service trips (MSTs) requires alignment of the services provided with the needs and desires of hosts. Our aim was to understand which MST services Vietnamese otolaryngologists find most beneficial and contrast to those believed most important by volunteers. STUDY DESIGN: Cross-sectional survey. METHODS: Otolaryngologists from a tertiary care institution travel to Vietnam yearly. In March 2018, surveys were distributed to Vietnamese otolaryngology faculty, residents, and US otolaryngology volunteers. The value of 11 MST-provided services were graded on a five-point Likert scale. Services included observing US otolaryngology volunteers perform surgery, US otolaryngology volunteer lectures, paper/electronic lecture material, instrument donation, minifellowships in the United States, among others. Respondents also voted for the single most important service. Responses were analyzed via Kruskal-Wallis analysis of variance and Wilcoxon rank sum test. RESULTS: A total of 153 survey responses were recorded. There were 52% respondents who identified as male and 39% as female. The highest-valued services by Vietnamese otolaryngologists were didactic lectures given by US otolaryngology volunteers (4.6/5 ± 0.6), and reviewing cases with US otolaryngology volunteers in the clinic (4.4/5 ± 0.9). The least important services were instrument donation and seeing US otolaryngology volunteers assist with surgery (≤4.1/5). The highest-value services perceived by US otolaryngology volunteers were reviewing cases in the clinic and sponsoring minifellowships (4.9 ± 0.4). Vietnamese faculty perceived the single most important service to be US volunteer lectures (20/74 votes), whereas Vietnamese residents perceived minifellowships to be most important (13/34 votes) CONCLUSIONS: Vietnamese otolaryngologists desire an education-focused relationship with US otolaryngology volunteers, with didactic lectures and sponsored US fellowships having the highest value and performance of surgeries having less value. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E305-E310, 2020.

Pleural lipomatosis: An often-forgotten intrathoracic tumor.

Lipomas are benign mesenchymal neoplasms that arise from adipocytes. Most lipomas are found in the subcutaneous tissue; however, they can be present throughout the body. Lipomas arising from the thoracic pleura are exceptionally rare, with only approximately 20 cases ever reported in the literature. While typically asymptomatic, pleural lipomas may cause compressive symptoms such as nonproductive cough, chest pain, and dyspnea if they reach adequate size. A CT scan is usually sufficient for the diagnosis and typically reveals well-defined nodules with homogenous fat attenuation of approximately -50 to -150 Hounsfield units. Management is dependent on various factors including tumor size and location, associated symptoms, and age of the patient. Pleural lipomatosis, although exceedingly rare, should be maintained in the differential diagnosis for any well-defined, fat-attenuating pleural mass identified on conventional radiologic studies. Here we report a case of pleural lipomatosis associated with bilateral pleural effusions identified in an 83-year-old male presenting with acute onset dyspnea.

Eagle Syndrome: A Rare Case of Atraumatic, Painful Cervical Neck Swelling.

INTRODUCTION: Painful neck swelling is a common emergency complaint but can present diagnostic challenges. Eagle syndrome is a rare clinical entity in which a pathologically elongated styloid process or ossified stylohyoid ligament produces a constellation of symptoms in the head and neck region. CASE REPORT: We present the case of a 50-year-old male with a spontaneous, atraumatic fracture of an elongated styloid process associated with hematoma formation and radiological findings of airway impingement. DISCUSSION: The classic triad for Eagle syndrome consists of unilateral cervicofacial pain, globus sensation, and dysphagia. Diagnosis of Eagle syndrome should be made based on a combination of physical examination and radiological findings. Treatment options vary based on severity of symptoms. CONCLUSION: Although more likely to be an indolent and progressive complaint, providers in the acute care setting should be familiar with Eagle syndrome due to the potential for a spontaneous fracture of an elongated styloid process to cause acute, painful neck swelling and life-threatening airway compromise.

Extramedullary Hematopoiesis in the Sinonasal Cavity: A Case Report and Review of the Literature.

BACKGROUND: Extramedullary hematopoiesis (EMH) occurs in patients with hematologic disorders, but rarely within the paranasal sinuses. We report a case of EMH in a 17-year-old male with sickle cell disease (SCD) who presented with occipital pain and sinusitis. A computed tomography (CT) scan demonstrated heterogeneous opacification of the right maxillary sinus concerning for allergic fungal sinusitis or a fungal ball with bony erosion. He was taken to the operating room for endoscopic biopsy and a limited endoscopic sinus surgery. Grossly, his maxillary sinus was filled with spiculated osseous tissue. Final pathology demonstrated active hematopoietic bone marrow filling the sinus. METHODS: We present a case report and literature review of sinonasal EMH. RESULTS: We identified 14 articles with 15 patients. EMH was typically associated with SCD or beta thalassemia. The average age of presentation was 30. There was a male sex predilection with a ratio of 11:15. The most common presenting symptom was a headache and nasal obstruction (33% for both). The most common finding on CT was a soft tissue expansile mass (73%). The most commonly affected location was the maxillary sinus (60%). CONCLUSIONS: This case report serves as a reminder to consider EMH as an uncommon cause of sinus opacification, particularly in patients with SCD or beta thalassemia. The expansion of hematopoietic tissue may be identified as a sinus mass on CT. By recognizing the potential manifestations of chronic anemia, an accurate and timely diagnosis can be made.

Systematic Review of Hearing Loss Genes in the African American Population.

OBJECTIVE: Literature review of the genetic etiology of hearing loss (HL) in the African American (AA) population. DATA SOURCES: PubMed, EBSCO, and CINAHL were accessed from 1966 to 2018. REVIEW METHODS: PRISMA guidelines were followed. Search terms included permutations of "hearing loss," "African American," "black," and "genetic"; "African American" was then cross-referenced against documented HL genes. AA subjects included in multiethnic cohorts of genetic HL testing were identified by searching the key terms "hearing loss" and "ethnic cohort" and "genetic." The Q-Genie tool was used in the quality assessment of included studies. An allele frequency meta-analysis of pathogenic GJB2 variants in the AA population was performed and stratified by hearing status. RESULTS: Four hundred seventeen articles were reviewed, and 26 met our inclusion criteria. Ten studies were included in the GJB2 meta-analysis. In the general AA population, pathogenic GJB2 variants are rare, including the 35delG allele, which displayed a carrier frequency of 0.05%. Pathogenic variants were discovered in seven nonsyndromic HL genes (GJB2, MYO3A, TECTA, STRC, OTOF, MYH14, TMC1), eight syndromic HL genes, and one mitochondrial HL gene. Recent comprehensive genetic testing using custom genetic HL testing platforms has yielded only a 26% molecular diagnosis rate for HL etiologies in the AA population. CONCLUSIONS: Investigators should be encouraged to provide an ethnic breakdown of results. Sparse literature and poor diagnosis rates indicate that genes involved in HL in the AA population have yet to be identified. Future explorative investigations using next-generation sequencing technologies, such as whole-exome sequencing, into the AA population are warranted.

Modeling Microdebrider-Mediated Ophthalmic Damage: A Word of Caution in Endoscopic Sinus Surgery.

BACKGROUND: The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. METHODOLOGY/PRINCIPAL: Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. RESULTS: The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ±1.2mm and 1.5 ±0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ±2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. CONCLUSIONS: The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.