Acute Onset of Delayed Facial Nerve Paralysis After an Uncomplicated Total Parotidectomy for an Oncocytoma.

Facial nerve injury is one of the most substantial potential sequelae of parotid surgery. Pulling, stretching, and otherwise disturbing the facial nerve during parotid surgery can lead to post-surgical neural paresis and consequential deficits in facial movement. Furthermore, transection of the main facial nerve trunk or its branches, either purposeful or incidental, can lead to complete paralysis of the related facial musculature. Facial nerve injury is often diagnosed immediately post-operatively as evident by deficits in ipsilateral facial motion on examination of the patient in the recovery unit or, at most, by one week post-operatively. Although delayed onset facial nerve paralysis is seen in traumatic injury and otologic surgery, it is uncommon that facial nerve paralysis presents late after parotid surgery in the absence of hematoma development, viral reactivation, or secondary insult. Here, we present the case of a 70-year-old man developing a delayed acute onset of hemi-facial paralysis 12 days after right-sided total parotidectomy for an oncocytoma; a facial nerve examination done immediately post-operatively and at the one-week post-operative follow-up was found to be normal. The patient was treated with two courses of high-dose oral steroids with close-to-complete resolution.

Oropharyngeal Secondary Syphilis Mimicking Metastatic Lymphoma in an HIV-Positive Patient.

Syphilis is a bacterial infection commonly transmitted by sexual contact. It has variable manifestations and can mimic other disease processes or infections. This report presents the case of a 48-year-old HIV-positive male who was referred to our head and neck clinic with complaints of tonsillar hypertrophy and ulceration accompanied by a one-month history of ipsilateral cervical lymphadenopathy and facial pain in the setting of recent unexplained weight loss and abnormal radiographic imaging of the neck. In-office tonsillar biopsy and fine-needle aspiration of a neck mass revealed a non-diagnostic atypical lymphoid proliferation. Surgical pathology following an open biopsy in the operating room showed Treponema pallidum infection, which was diagnostic for secondary syphilis.

Team Approach: Perioperative Management of Pilon Fractures.

¼: Tibial pilon fractures are devastating injuries requiring complexsurgical management resulting in a challenging postoperativecourse. ¼: A multidisciplinary approach is required to manage these injuries in addition to patients' medical comorbidities and concomitant injuries to achieve optimal outcomes. ¼: The case presented here demonstrates the importance of communication and teamwork between specialties in the management of a patient with a tibial pilon fracture that was medically optimized for surgery using a team-based approach.

An Analysis of Otolaryngology's NIH Research Funding Compared to Other Specialties.

OBJECTIVE: To compare NIH funding in the field of Otolaryngology to other medical and surgical specialties between 2009 and 2019. METHODS: Data was collected from the NIH RePORTER database on funding dollars received by each specialty from 2009 to 2019. Along with data on total active physicians per specialty using the Physician Specialty Data Book, comparisons were drawn between Otolaryngology and other medical and surgical specialties with regards to trends in total funding and NIH funding dollars per physician. The distributions of grant funding, within Otolaryngology from various NIH institutes among principal investigators, organizations, and subspecialties were further explored. RESULTS: There were 3810 grants (1147 unique projects) for a total of $1 276 198 555 funded by the NIH to Otolaryngology departments from 2009 to 2019. Statistically insignificant funding increases (P > .05) caused otolaryngology to fall from first to fourth in funding among studied specialties. The National Institute on Deafness and Other Communication Disorders funded 57% of all unique projects, and 57.2% of all unique NIH projects were otology related. Most projects were basic science related. The top 10 principal investigators obtained 22.3% of the total NIH funding for Otolaryngology. The top 3 organizations over the studied period comprised 26.55% of the total funding, generating a combined 729 grants. Among principal investigators, 63.0% had a PhD degree, 25.3% had an MD, and 9.6% had an MD/PhD. CONCLUSION AND RELEVANCE: NIH funding in Otolaryngology has remained stable and is highly concentrated among a small number of organizations, geographic regions, and principal investigators. Recent initiatives by academic communities have sought to address funding disparities by incorporating diversity and inclusion into clinician-scientist pipelines. We urge our colleagues to strive toward identification of the factors that contribute to successful acquisition of funding and implementation of a more conducive institutional infrastructure to produce research.

Financial Distress Experienced By Privately Insured Pediatric Hearing Aid Patients: A Pilot Study.

The high cost associated with pediatric hearing aids is a major barrier to the acquisition of these medically essential tools. This pilot study describes the experiences of pediatric hearing aid users with their private insurers' hearing aid reimbursement at one academic institution in upstate New York. The families interviewed had purchased an average of 3.6 units for an average price of $2353.40 per unit, resulting in an average cost of $877.62 after insurer reimbursement. These families had an average household income of $150 419.40 per annum and an average monthly family-rated insurance premium of $481.60. Of 36 families, 20 (55.6%) reported previous feelings of financial distress or concerns about future financial distress associated with high costs incurred from purchasing their child's hearing aids. This study reveals the financial distress associated with pediatric hearing aids and the need for expanded research into individual families' experiences and this problem on a broader scale.

Marsupialization of a Floor-of-Mouth Dermoid Cyst to Temporize Airway Distress.

Dermoid cysts are benign masses of embryologic origin that can present in various anatomical locations throughout the human body. This article presents the case of a 30-year-old male who presented to our emergency department with complaints of tongue swelling accompanied by worsening dysphagia and dysphonia in the context of a chronic, midline mass in the floor of the mouth. Computed tomography (CT) imaging and surgical pathology of the mass ultimately revealed findings consistent with a dermoid cyst causing inferior displacement of the mylohyoid muscle. Initial management consisted of bedside drainage to temporize the airway, with marsupialization and in-office follow-up. Definitive treatment was achieved with surgical excision at a later date.

Association of Surrogate Objective Measures With Work Relative Value Units.

Background: The determination of accurate measures of evaluating surgeon work for reimbursement is poorly characterized. This study defines the correlation of surgical work relative value units (work RVUs) with several surrogate objective measures for otolaryngologic work. The defined surrogate objective measures evaluated in this study are length of hospital stay (LOS), operative time, 30-day mortality, 30-day unplanned readmission, 30-day reoperation, and 30-day morbidity. Methods: We collected data on otolaryngologic cases from 2016 to 2018 from the American College of Surgeons National Surgical Quality Improvement Program. Pearson correlation coefficient was used to associate work RVUs with objective measures of surgeon work. Linear regressions were used to identify predictors of work RVUs from the surrogate objective measures. Studentized residuals were used to identify outlying procedures. Results: Work RVUs correlated strongly with operative time (R=0.6775), 30-day readmission (R=0.6100), and LOS (R=0.6083); moderately with 30-day reoperation (R=0.5257) and 30-day morbidity (R=0.4842); and very weakly with 30-day mortality (R=0.1383). The best predictors for work RVUs based on multivariable linear regression analysis were morbidity, reoperation, and operative time. Analysis revealed that the projected work RVU is 12.23 units higher than the current value for excision of bone, mandible (Current Procedural Terminology [CPT] code 21025) and 19.48 units lower than the current value for resection/excision of lesion infratemporal fossa space apex extradural (CPT code 61605). Conclusion: Using objective surrogate measures for time and intensity of physician work in head and neck cases may improve work RVU assignment accuracy compared to the current system of physician survey. Future investigation with additional objective parameters may be beneficial to make work RVU assignments less subjective.

Financial Transactions from Manufacturers to Otolaryngologists in 2018.

OBJECTIVE: To characterize in depth non-research and research payments from industry to otolaryngologists in 2018 with an emphasis on product types. METHODS: Centers for Medicare and Medicaid Services Open Payments program was used for data collection: payment amount, the nature of payments, products associated with the payments, date of the payments, and companies making the payments were studied. Products associated with the payments were classified by categorical type. Descriptive statistics were used to analyze the data. RESULTS: There were 70,172 payments for a total of $11,001,875 made to otolaryngologists in 2018 with a median payment of $19. Food and beverage had the highest number of payments made (89.96%). Consulting fees (33.46%) composed the highest total payment amount. The two companies that contributed the highest amount were Stryker Corporation and Intersect ENT Inc. Sinus conditions had the most products within the top 25 products associated with payments. The top five products with the highest payments received were for balloon sinus dilation, nasal spray, sinus implant, Botox, and cochlear implant. There was a bimodal payment distribution demonstrating a higher number of payments made in the spring and fall. CONCLUSION: Our study is the first to review payments to otolaryngologists in 2018 and classify these payments into product types. The products and companies that contributed the highest payments were associated with sinus conditions. The products that dominated in each subspecialty of otolaryngology coincide with clinical practice trends and emerging technologies. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E388-E394, 2021.

Crystal structure and spectroscopic properties of aqua-dichlorido-{1,1'-[(pyridine-2,6-diyl-κN)bis(methyl-ene)]bis-(4-butyl-4,5-di-hydro-1H-1,2,4-triazole-5-thione-κN 2)}cobalt(II).

The structure of the title compound, [CoCl2(C19H27N7S2)(H2O)], at 173 K has monoclinic (C2/c) symmetry. We report here the synthesis, single-crystal structure, electrospray mass spectrum and NMR spectroscopy of a new six-coordinate cobalt(II) pincer complex. The pincer ligand, in this complex, which is novel, coordinates via three nitro-gen atoms (two triazole and one pyridine). The ligand is ambidentate and can coordinate via three nitro-gen atoms or two sulfur and one nitro-gen atoms. The cobalt(II) metal center has pseudo-octa-hedral geometry and based on the single-crystal structure, the pincer ligand coordinates in a meridional fashion with the metal and adjacent six-membered ring ligands all in a similar plane and forming two slightly distorted boat configurations. The other two coordinated monodentate ligands are one water mol-ecule and two chloride ions with four cobalt(II) complexes in the unit cell. The asymmetric unit of the complex is comprised of half the pyridine ring and water mol-ecule with the CoII atom at the center of the pincer situated about a twofold axis. The Co-N, Co-O, and Co-Cl bond lengths are consistent with single bonds. In the crystal, the complex forms a three-centre bifurcated weak hydrogen-bonding inter-action with a chlorine ion, forming one inter-molecular inter-action with the pincer group and a water mol-ecule and a second intra-molecular inter-action with a C-H group within the pincer group. Crystal packing is also highlighted with C 2 2(6)>aa>a ring motifs, forming a three-dimensional supra-molecular network structure. While some stacking of the pyridine rings in the unit cell is observed, there are no relevant π-π inter-actions in the crystal packing. The 1H and 13C{1H} NMR spectra of the complex are consistent with a plane of symmetry being present. The electrospray mass spectrum, which was collected in positive ion mode, showed the loss of one water mol-ecule and one chloride ligand from the complex. In the future, we plan to screen this cobalt(II) complex for electrocatalysis reactivity.