Mecham, Jeffrey C.

ABSTRACT Objectives Tongue base obstruction is a cause of persistent sleep apnea after adenotonsillectomy in pediatric patients. The internet is the most used tool by patients for gathering healthcare information. This study aims to assess the quality and readability of websites directed to patients regarding tongue base procedures for pediatric obstructive sleep apnea. Methods Queries for the terms “lingual tonsillectomy,” “posterior midline glossectomy,” “tongue reduction,” “tongue base suspension,” and “hypoglossal nerve stimulator” were entered into Google on September 11, 2023. Thirty sites were pulled for each, and up to 10 sites per query meeting inclusion criteria were included for analysis. The DISCERN tool was used to evaluate quality. Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL) were used to measure readability. Sites were analyzed for mention of pediatrics. Results Thirty‐five unique sites were analyzed. The mean DISCERN score was 44.7 (range 28.5–64.0) or “fair.” The mean FRES was 46.3 (range 9.6–66.6) and FKGL 11.5 (range 7.4–19.2), indicating college and 12th‐grade reading levels. Only 8/35 sites mentioned pediatrics. The average number per query of relevant sites directed towards patients on the first search engine page was 3.6. Despite tongue base procedures being relevant to pediatrics, only one in five sites mentioned children. Conclusion Websites directed at patients regarding tongue base procedures are of “fair” quality and at readability grade levels far above what is recommended. The majority of sites available for tongue base procedures are geared to professionals rather than patients. This study demonstrates a need for high‐quality information for patients about these procedures.

Fungal rhinosinusitis (FRS) can be classified into invasive and non-invasive forms, with the fungal ball (FB) representing a common non-invasive type with generally favorable outcomes post-operatively. The clinical presentation of FB can vary and be non-specific, and it is important to consider a wide differential diagnosis for sinonasal masses, including malignancy. We present the case of a 74-year-old female presenting with a two-year history of nasal obstruction and drainage. She has a history of breast cancer and prior maxillomandibular surgery, and imaging showed a poorly defined mass in the right maxillary sinus with possible hemorrhagic and/or proteinaceous content. Rigid nasal endoscopy revealed a friable mass, and endoscopic sinus surgery findings were consistent with FB. This case exemplifies the need to consider a broad set of differential diagnoses when evaluating sinonasal masses, especially if the patient has a prior malignancy or maxillomandibular surgical history, including FB and metastases to the paranasal sinuses. Given the presence of non-specific symptoms, it is important to consider early imaging for patients with distorted anatomy and a history of malignancy. Endoscopic sinus surgery, with high success rates, is the gold-standard treatment for FB.

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

ObjectiveTo characterize the geographic distribution of US otolaryngology residents based on geographical population density to determine current status and identify potential opportunities for otolaryngology residency program expansion.MethodsThe locoregional population of otolaryngology residency programs was analyzed (as defined by the US Census) and the number of resident trainees per 100,000 people in each region was calculated. Otolaryngology residency program location was determined by mailing address, and program size was determined by AAMC public data.ResultsThe average metropolitan city in the United States contained 2.07 otolaryngology trainees per 100,000 people. Cities with low trainee numbers per population included Phoenix, AZ (0.20 trainees per 100,000 people); Las Vegas, NV (0.26 per 100,000); Dallas, TX (0.26 per 100,000), Atlanta, GA (0.33 per 100,000); and Miami, FL (0.34 per 100,000). Comparing otolaryngology to other surgical subspecialties demonstrated similar distributions. Metropolitan centers with a population over 1 million without full academic representation in otolaryngology were also identified and included Charlotte, NC; Orlando, FL; Austin, TX; Providence, RI; Jacksonville, FL; Raleigh, NC; and Grand Rapids, MI.ConclusionStrategic residency training program expansion should be considered in cities that exhibit a low trainee to population ratio. Although many factors ultimately determine program expansion or development of new training programs, this study provides substantiated population data describing where expansion could be prioritized.Level of EvidenceNA Laryngoscope, 133:1600–1605, 2023

Background The histopathology and microbiology associated with silent sinus syndrome (SSS) have not been well described. Objective This study details the histopathological and microbiological characteristics in addition to radiographic findings of SSS in comparison to those of chronic maxillary sinusitis (CRS). Methods 42 patients diagnosed with SSS at Mayo Clinic Hospital in Arizona were identified. Paranasal computed tomography scans of the 42 SSS patients as well as 42 matched CRS patients were analyzed in order to assess differences in the prevalence of septal spurs/deviation. 20 of the SSS patients and 19 of the matched CRS patients also had histopathology and microbiology reports, which were compiled and summarized. Additionally, 19 SSS and 19 matched CRS patients were contacted via phone survey for a more complete patient history regarding maxillary dental disease/surgery. Results SSS patients have a significantly higher prevalence of septal spurs/deviation than CRS patients. The microbiomes of SSS patients more closely resemble those of healthy controls than those of CRS patients. Analysis of the histopathology of SSS reveals chronic, non-specific inflammation similar to that seen in non-eosinophilic CRS without polyps. SSS patients were significantly more likely to have a history of maxillary dental disease requiring surgery. Conclusion These data support the hypothesis that the pathogenesis of SSS is more likely due to anatomical/mechanical factors than inflammatory/microbiological factors.

Abstract Central giant cell granuloma (CGCG) is a relatively uncommon benign bony lesion accounting for approximately 7% of all non-neoplastic lesions of the jaw. The clinical behavior of CGCG can vary from a slow-growing, painless lesion to fast-growing and locally destructive. When such a lesion involves the mandible, this can be quite debilitating for the patient, inhibiting oral intake and requiring an extensive resection and bone graft reconstruction. The authors present a case of effectively decreasing the surgical morbidity associated with a large and rapidly growing CGCG of the mandible in a pediatric patient. Neoadjuvant immunotherapy with denosumab (human monoclonal antibody) facilitated treatment of the tumor without the need for a large resection which would have otherwise necessitated a vascularized bony mandibular reconstruction. Consideration of neoadjuvant medical management of CGCG as the primary treatment is advocated.

COVID‐19 has created new challenges and opportunities regarding the way in which programs and applicants will interact in the 2020‐2021 otolaryngology residency match cycle. Social media and other virtual platforms offer a flexible and efficient medium for applicants and programs to gain information, communicate, and align interests. In this commentary, we explore ways in which social media may facilitate recruitment and networking in the virtual otolaryngology match.