House, Trenton

ABSTRACT Objectives To review septal perforation management and outcomes in patients with hereditary hemorrhagic telangiectasia (HHT). Methods Collection and presentation of patient demographic, perforation size, and prior perforation and HHT treatment data over a 20‐year period. Symptom and quality of life treatment outcomes were determined using the Nasal Obstruction Symptom Evaluation (NOSE)‐Perf scale and the 5‐Factor Glasgow Inventory (GBI‐5F), respectively, in patients treated since 2017. Results Nine patients met study criteria. Mean (range) age was 64.4 (52–80) years and seven were biological males. Mean (range) perforation length and height were 1.9 (1.2–2.6) and 1.4 (1.0–1.8) cm. Four patients were treated with a customized septal button, one with posterior septal resection, and four with endonasal bilateral mucosal flap repair supported with an interposition graft. The button prostheses were well tolerated and the surgical closures successful at 8–60 months postoperatively. Subjective responses in the first three patients, and NOSE‐Perf with GBI‐5F scores in the latter six patients, demonstrated symptom and quality of life improvement for all patients. Perforation repair patients demonstrated substantial improvement in mean GBI‐5F subdomain scores for quality of life, self‐confidence, and social involvement and all have undergone sodium tetradecyl sclerotherapy injection postoperatively without re‐perforation. Conclusion Symptom and quality of life improvement can be achieved in HHT patients with a perforation using customized septal buttons, posterior septal resection, or bilateral flap surgical repair. Surgical closure combined with injection sclerotherapy is feasible with a low risk of re‐perforation and represents an effective treatment strategy in selected patients. Level of Evidence 4.

AbstractObjectivePrevious studies synthesizing published data on nasal septal perforation (NSP) repair outcomes have cited the lack of standardization in evaluation and data reporting. The heterogeneity of this literature base limits the quality of available evidence and precludes intercomparison. The aim of this study is to quantitatively characterize trends in NSP evaluation and reporting and identify areas for improvement.Data SourcesPubMed, Scopus, and Web of Science.Review MethodsA comprehensive review of the literature published from 2012 through 2024 investigating NSP repair techniques was conducted, and perforation evaluation and outcome reporting were characterized and compared between contemporary and older cohorts.ConclusionsOutcomes of NSP repair are increasingly studied. The heterogeneity of current literature concerning the evaluation of perforations and the reporting of outcomes precludes high‐quality comparative analyses of outcomes across separate studies. This review demonstrated a lack of progress towards greater standardization over the last 12 years. There remains room for improvement in regard to the evaluation and reporting of etiology, defect size, symptomatology, and objective outcome of repair, allowing for adequate duration of follow‐up.Implications for PracticeThere are many inconsistencies in the collection, organization, and analysis of data implicated in investigations of NSP repair outcomes. The development and agreement upon consensus practice guidelines would engender greater standardization among the evaluation and assessment of treatment outcomes. Based on this review and our institutional experiences, we propose specific measures that would facilitate higher‐quality future research and advance the practice of perforation management.

Objectives To assess the impact of body mass index (BMI) on hypoglossal nerve stimulator (HNS) implantation outcomes in pediatric patients with Down syndrome (DS). We compare outcomes of HNS implantation when comparing children based on overweight or obese status. Methods Retrospective cohort study of patients at a single tertiary pediatric hospital who underwent HNS implantation between 2022 and 2024. Patients with DS under 21 years of age at time of implantation were included. One child with Wolf‐Hirschhorn syndrome was also included. The main outcome measured was reduction in apnea‐hypopnea index (AHI). Results Twenty patients were implanted with HNS during the study period. Eleven patients were implanted with a BMI considered overweight and 8 patients with a BMI considered obese. No significant correlation was found between BMI percentile and AHI reduction ( r = 0.06, p = 0.8). No significant differences were found between obese and non‐obese groups for preoperative AHI, postoperative AHI, or AHI reduction. Both groups responded favorably to HNS therapy with AHI reduction of 83.8% in obese patients and 81.9% in non‐obese patients. Conclusion We demonstrate no difference in postoperative AHI outcomes when comparing patients with obesity defined as BMI >95th percentile compared to those without. Level of Evidence 3 Laryngoscope , 135:1223–1226, 2025

Abstract Objective To describe and illustrate septal perforation shape through the documentation and analysis of length and height measurements. A secondary objective is to correlate perforation size to surgical and nonsurgical etiologies. Stuy Design Retrospective case series. Setting Tertiary academic medical center. Methods Length and height of consecutively treated perforations over a 3‐year period were measured directly or through computed tomography. Mean differences in length and height measurements were compared and regression analysis used to determine perforation shape and the effect of etiology on perforation size. Perforations were classified by length into small (1‐5 mm), medium (6‐15 mm), and large (>15 mm) and correlated to shape and etiology. Results One hundred twenty‐four patients (mean age 50.4 years, 60.5% female) met study inclusion criteria. Height was less than length in 93% of perforations 5 mm or greater in length. Mean perforation height was significantly less than length for medium and large perforations ( P < .001). Mean length and height measurements of nonsurgical perforations were greater than those for surgical perforations ( P < .001). Conclusion Height is less than length in over 90% of septal perforations. Most perforations assume an elliptical shape as they enlarge. Accurate measurement and presentation of length and height is relevant information to perforation management decisions and for the evaluation of treatment outcomes.