Trigeminal trophic syndrome: A systematic review.

OBJECTIVES: To systematically report and document Trigeminal Trophic Syndrome (TTS), characterize its clinical presentation, diagnostic tests performed, outline management strategies, outcomes; and highlight the role of otolaryngologists in the tissue diagnosis of this rare syndrome. DATA SOURCES: PubMed/Medline, Scopus, and Cochrane databases. REVIEW METHODS: PubMed/Medline, Scopus, and Cochrane databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all cases of TTS published with an English translation from inception to December 2020. RESULTS: A total of 142 articles describing 214 patients with TTS were included in the analysis. There was a female predominance (62.9 %) and a median age of 57 (range 1-93) years at presentation. A trigeminal neurological insult was identified in 200 (93.5 %) cases. The most common triggers for TTS were treatment for trigeminal neuralgia (35.7 %) and cerebrovascular accident (21.6 %). Self-inflicted trauma occurred in 137 (64 %) patients. Biopsy was done in 123 (57.5 %) patients. Patient education, barrier devices, and medications to address parasthesias were the most common treatment strategies. The majority of patients (72.5 %) received multimodal therapy. Surgery was performed in 35 (22.7 %) patients. Treatment outcomes were discussed in 120 (56.1 %) patients. CONCLUSIONS: TTS is a rare condition with poorly understood pathophysiology. It should be suspected in a patient with non-healing facial ulceration and altered sensation within the trigeminal nerve distribution. Biopsy of the ulcer is important to confirm the diagnosis and exclude malignancy. Treatment options include conservative and pharmacologic measures, and less frequently surgery.

No-Show Rates in an Academic Otolaryngology Practice Before and During the COVID-19 Pandemic.

OBJECTIVE: Our objectives were to determine the no-show and nonattendance rate for an outpatient academic otolaryngology practice, to identify patient and systemic factors associated with nonattendance, and to evaluate the impact that the COVID-19 pandemic had on the rate of nonattendance. METHODS: This is a retrospective review of the Epic practice management and billing reports from all scheduled outpatient visits at a multi-physician, academic, general, and sub-specialty otolaryngology practice from January 2019 to December 2021. RESULTS: Over three years, 121,347 clinic visits were scheduled in the otolaryngology practice. The overall nonattendance rate was 18.3%. A statistically significant increase in nonattendance was noted during the COVID-19 pandemic (16.8% vs. 19.8%, p < 0.001). The rate of nonattendance in patients of younger age (under 18 years) (p <0.001), female gender (p=0.03), afternoon appointments (p=0.04), and extended time between the day of scheduling and the day of appointment (p <0.001) increased. Head and neck clinics were found to have the lowest nonattendance rates, while pediatric otolaryngology clinics had the highest (12.6% vs. 21.3%). On multivariate regression, younger age (p < 0.001), female gender (p=0.01), afternoon appointments (p< 0.001), and online self-scheduling (p< 0.001) were significantly associated with nonattendance. CONCLUSIONS: Both patient and appointment-related factors were found to impact rates of nonattendance in this academic otolaryngology practice. In this study, young age, female gender, afternoon appointments, and online self-scheduling were associated with increased nonattendance. In addition, the COVID-19 pandemic significantly impacted no-show rates across all otolaryngologic subspecialties.

A Rare Manifestation of Infectious Mononucleosis Tonsillitis.

The purpose of this case report is to describe a rare case of infectious mononucleosis (IM) hemorrhagic tonsillitis. Our patient presented with acute tonsillitis complicated by spontaneous tonsillar hemorrhage. This is a single case report with a literature review. A 19-year-old male presented to the emergency department with a 10-day history of worsening sore throat, recurrent fevers, malaise, and dysphagia to solids and liquids, as well as a three-day history of epistaxis and hemoptysis. He tested positive for Epstein-Barr virus and rhinovirus. On exam, a "hot potato" voice was noted along with bilateral tonsillar edema, erythema, and hypertrophy. Both tonsils with dry blood coating and no exudates were visualized. Computed tomography (CT) imaging of the neck demonstrated subcutaneous emphysema isolated to the tonsils. Treatment consisted of intravenous antibiotics and steroids, followed by an oral antibiotic, with subsequent full resolution of symptoms. This case illustrates a rare, severe manifestation of IM tonsillitis that radiographically can mimic other more severe soft-tissue neck infections on imaging, such as cervical necrotizing fasciitis. In patients presenting with hematemesis, hemoptysis, and/or epistaxis, along with tonsillar edema, erythema, and hypertrophy, a diagnosis of spontaneous hemorrhagic tonsillitis should be considered. The radiographic findings of soft-tissue emphysema in the deep spaces of the head and neck region may be seen in the setting of IM, mimicking other soft-tissue infections of the deep neck spaces.

TikTok Influence on Rates of Tonsillectomies for Tonsil Stones.

INTRODUCTION: Tonsillectomy is one of the most common otolaryngologic surgeries and is increasingly being performed for the management of tonsil stones or tonsilloliths. Incidentally, over the years, tonsilloliths have become a popular topic on the social media platform TikTok (ByteDance, Beijing, China) and we propose that this may be influencing the trends of tonsillectomies for tonsil stones.  Objectives: We aim to assess rates of outpatient visits and tonsillectomies for tonsil stones at our institution as well as analyze videos on TikTok regarding tonsil stones. METHODS: A retrospective chart query was performed. Data including the number of patient encounters per month with a diagnosis code of tonsilloliths were collected from July 2016 to December 2021. The number of TikTok videos under the search result "tonsil stones" and the content of these videos were reviewed. RESULTS: There were 126 patients seeking evaluation for tonsil stones with an average age of 33.4 years, and 76% were females. The number of patients who underwent a tonsillectomy for tonsil stones increased from two in the first full year of collection in 2017 to 13 in 2021. Similarly, the average number of patients presenting for tonsil stone evaluation per month increased steadily from 1.0 in 2017 to 3.3 in 2021. TikTok video content under the search result "tonsil stones" varied and the number of videos on this topic has increased in recent years. CONCLUSION: Rates of patients seeking tonsillectomy for tonsil stones increased from 2016 to 2021 in conjunction with the rising popularity of TikTok. Given the numerous TikTok videos featuring tonsil stones, we believe that this social media platform may be influencing the number of patients seeking evaluation for tonsil stones. This data may be used to understand future influence patterns of social media posts on healthcare consumer behavior and patient care practices.

Melatonin: can it stop the ringing?

OBJECTIVES: We sought to report the efficacy of oral melatonin as treatment for chronic tinnitus and to determine whether particular subsets of tinnitus patients have greater benefit from melatonin therapy than others. METHODS: This was a prospective, randomized, double-blind, crossover clinical trial in an ambulatory tertiary referral otology and neurotology practice. Adults with chronic tinnitus were randomized to 3 mg melatonin or placebo nightly for 30 days followed by a 1-month washout period. Each group then crossed into the opposite treatment arm for 30 days. The tests audiometric tinnitus matching (TM), Tinnitus Severity Index (TSI), Self Rated Tinnitus (SRT), Pittsburgh Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were administered at the outset and every 30 days thereafter to assess the effects of each intervention. RESULTS: A total of 61 subjects completed the study. A significantly greater decrease in TM and SRT scores (p < 0.05) from baseline was observed after treatment with melatonin relative to the effect observed with placebo. Male gender, bilateral tinnitus, noise exposure, no prior tinnitus treatment, absence of depression and/or anxiety at baseline, and greater pretreatment TSI scores were associated with a positive response to melatonin. Absence of depression and/or anxiety at baseline, greater pretreatment TSI scores, and greater pretreatment SRT scores were found to be positively associated with greater likelihood of improvement in both tinnitus and sleep with use of melatonin (p<0.05). CONCLUSIONS: Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.

Clinicopathologic predictors of recurrence and overall survival in adenoid cystic carcinoma of the head and neck: a single institutional experience at a tertiary care center.

BACKGROUND: The purpose of this study was to determine factors that impact recurrence and long-term survival of head and neck adenoid cystic carcinoma (ACC). METHODS: We conducted a retrospective review of 87 patients with head and neck ACC who were evaluated between 1992 and 2009. Staining for Ki-67, p53, α-estrogen receptor (αER), and progesterone receptor (PR) was performed. RESULTS: Forty men (46%) and 47 women (54%) were included in this study. Median follow-up for patients was 98 months. Five-year recurrence-free and overall survival (OS) rates were 56% and 81%, respectively. Ki-67 and p53 expression was observed in 5 (6%) and 2 (2%) patients, respectively. αER and PR were all negative. The most important determinants of disease-free survival (DFS) were perineural invasion (PNI; p = .001) and female sex (p = .027). Disease site (major vs minor salivary gland) was the only predictor of worse OS on multivariate analysis. CONCLUSION: Perineural invasion, female sex, and disease site were the most consistent predictors of poor outcome in head and neck ACC.

Quality-of-life outcomes in transoral robotic surgery.

OBJECTIVE: To report long-term, health-related quality-of-life (HRQOL) outcomes in patients treated with transoral robotic surgery (TORS). STUDY DESIGN: Prospective, longitudinal, clinical study on functional and HRQOL outcomes in TORS. SETTING: University tertiary care facility. SUBJECTS AND METHODS: Patients who underwent TORS were asked to complete a Head and Neck Cancer Inventory before treatment and at 3 weeks and 3, 6, and 12 months postoperatively. Demographic, clinicopathological, and follow-up data were collected. RESULTS: Sixty-four patients who underwent TORS were enrolled. A total of 113 TORS procedures were performed. The mean follow-up time was 16.3 ± 7.49 months. The HRQOL was assessed at 3 weeks and at 3, 6, and 12 months, with a response rate of 78%, 44%, 41%, and 28%, respectively. TORS was performed most frequently for squamous cell carcinoma (88%). There was a decrease from baseline in the speech, eating, aesthetic, social, and overall QOL domains immediately after treatment. At the 1-year follow-up, the HRQOL scores in the aesthetic, social, and overall QOL domains were in the high domain. Patients with malignant lesions had significantly lower postoperative HRQOL scores in the speech, eating, social, and overall QOL domains (P < .05). Patients who underwent adjuvant radiation therapy or chemotherapy and radiation therapy had lower postoperative scores in the eating, social, and overall QOL domains (P < .05). CONCLUSION: The preliminary data show that patients who undergo TORS for malignancies and receive adjuvant therapy tend to have lower HRQOL outcomes. TORS is a promising, minimally invasive, endoscopic alternative surgical treatment of laryngopharyngeal tumors.

Effectiveness of a nasal saline gel in the treatment of recurrent anterior epistaxis in anticoagulated patients.

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients.

Outcomes of transoral robotic surgery: a preliminary clinical experience.

OBJECTIVE: To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. STUDY DESIGN: Preliminary clinical data from a prospective TORS study. SETTING: University tertiary care facility. SUBJECTS AND METHODS: Patients who underwent TORS at The Ohio State University Medical Center. Demographic, intraoperative, clinicopathological, and follow-up functional data were collected. RESULTS: Sixty-four patients underwent TORS with a median age of 56.9 years. A total of 113 TORS procedures were performed. Fifty-four patients with squamous cell cancer (SCCA) were included in the final analysis. Mean follow-up time was 11.8 months (range, 2-29). There was a trend toward longer TORS setup time, operative time, estimated blood loss, and hospital length of stay with advanced (T(3)) compared with early-stage tumors (T(1-2)). There were no major intraoperative complications, and none of the procedures were aborted because of inability to remove the tumor. Negative resection margins were achieved in 93% of cases of SCCA. No patients experienced immediate postoperative complications, and all of the patients tolerated an oral diet without any airway compromise on the day of surgery. Forty-nine patients (91%) underwent adjuvant radiation therapy (RT), with 11 patients requiring gastrostomy tube placement during RT. Addition of TORS to overall management of head and neck SCCA spared adjuvant RT or combined chemotherapy and RT (CRT) in 50% of stage I/II tumors and spared chemotherapy in 34% of stage III/IV tumors. CONCLUSION: TORS is a safe procedure with minimal complications and favorable clinical and functional outcomes. It is a promising future alternative surgical treatment for laryngopharyngeal tumors.