Paul D. Allen

Objectives: This study examines a combination anesthetic regimen of propofol and dexmedetomidine during drug induced sleep endoscopy (DISE) and its procedure time, VOTE findings, and perioperative hemodynamic profiles when compared to procedures conducted with either anesthetic agent alone. Methods: Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared. Results: With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; p = 0.0001) and 42% shorter than the propofol only (38.4 min; p = 0.0001) cohorts. Recent intra‐system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra‐ and post‐operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; p = 0.0003, p = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, p = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort. Conclusion: This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability. Level of Evidence: 3.

BACKGROUND: Cisplatin is often the cytotoxic drug of choice for chemoradiation therapy (CRT) for head and neck squamous cell carcinoma (HNSCC), but it can lead to irreversible hearing loss. There may be similar oncologic outcomes but different toxicity profiles depending on whether cisplatin is given at 75–100 mg/m ² every 3 weeks or 30–40 mg/mg ² weekly. This study compares cisplatin-induced hearing loss in patients with HNSCC receiving similar cumulative doses of cisplatin administered either on higher-dose or lower-dose treatment schedules. METHODS: Using the Enhancing Cancer Hearing Outcomes (ECHO) dataset from 5 academic centers, we conducted a multicenter retrospective cohort study of adults (≥18 years) with HNSCC receiving cisplatin-based CRT. Participants were grouped by cisplatin dose schedule: every 3 weeks (≥75 mg/m²) or weekly (2 analyses and multivariate regression. Kaplan-Meier curves assessed overall and disease-free survival. RESULTS: Among 564 participants (1,127 ears), lower-dose weekly cisplatin was associated with significantly lower incidence of hearing loss (ASHA criteria: 57% vs. 82%; CTCAE criteria: 39% vs. 69%). CTCAE grade ≥2 hearing loss occurred in 18% of the weekly group versus 50% of the 3-week group. Multivariate analysis confirmed treatment schedule as an independent predictor of ototoxicity. Two-year survival outcomes did not differ between groups. CONCLUSIONS: Weekly low-dose cisplatin significantly reduced the incidence and severity of hearing loss without compromising survival, supporting its broader use in CRT for HNSCC.

Purpose: Balance and vestibular disorders have a profound impact on quality of life. Anxiety (ANX) and depression (DEP) are common with dizziness, vertigo, or imbalance. It is unclear whether self-reported anxiety or depression depends on perceived physical function for individuals participating in vestibular rehabilitation (VPT). We hypothesized that individuals with worse physical function would be more likely to report abnormally high anxiety and/or depression levels. Participants: 170 individuals referred for vestibular rehabilitation (113 female, 57 males, and age 63.7 (21)). Methods: A retrospective chart review extracted age, Patient-Reported Outcome Measurement Information System (PROMIS) scores (ANX, DEP, physical function) and primary diagnoses [benign paroxysmal positional vertigo ( n = 42), unilateral vestibular hypofunction ( n = 39), bilateral vestibular hypofunction ( n = 14), concussion/head injury ( n = 7), dizziness/vertigo ( n = 37), and imbalance ( n = 31)]. Average PROMIS scores and percentage of abnormal scores were calculated for physical function, ANX, and DEP scores and reported using descriptive statistics. Logistic regression was performed to separately examine the odds of abnormal ANX and DEP based on abnormal physical function while controlling for age and sex, on the entire dataset and on diagnosis subgroups. Results: Individuals referred to vestibular physical therapy with self-reported abnormal physical function were more likely to have abnormal ANX (OR 5.1, p < 0.001) or DEP (OR 3.10, p = 0.002). Older adults were less likely to have abnormal ANX (OR = 0.96, p = 0.002). For individuals experiencing BPPV ( n = 42), those with abnormal physical function are more likely to report ANX (OR 9.9, p = 0.009). For individuals with UVH ( n = 39), those with abnormal physical function were more likely to report ANX (OR 10.1, p = 0.008) or DEP (OR 9.9, p = 0.010). Conclusion: Self-reported abnormal physical function corresponds to a higher incidence of abnormal ANX and DEP for individuals referred to VPT. Individuals with benign proximal positional vertigo and unilateral vestibular hypofunction were approximately 10 times more likely to experience abnormally high ANX or DEP compared to all other primary diagnosis. Clinicians seeing patients in VPT should be screening for anxiety and depression especially for those with self-reports of impaired physical function.

Objective: We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC).Methods: Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue‐tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared.Results: Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre‐frenotomy (p < 0.01).Conclusion: Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue‐tie can be one critical intervention to move these patients closer to oral feeding and discharge to home.Level of Evidence: 3 Laryngoscope, 134:5152–5159, 2024

Objective: Topical sinonasal rinse therapies may alter the local microbiome and improve disease control in chronic rhinosinusitis (CRS). The objective of this study was to examine microbiome changes in post‐surgical CRS patients when rinsing with commercially available products containing xylitol or Lactococcus lactis.Methods: A crossover‐type protocol with a washout period was designed. Swab samples from anterior ethmoid cavities of CRS patients were collected prospectively at baseline. Subjects were provided packets containing either L. lactis W136 or xylitol in non‐blinded fashion and instructed to add it to their rinse bottles daily for 28 days, after which another swab was taken. A saline wash‐out period was completed and a third swab taken. A final 28‐day regimen of the opposite product was followed by a final swab. DNA extraction and sequencing of the 16S rRNA gene allowed for global microbiome analysis.Results: We enrolled 25 subjects with CRS and 10 controls resulting in 70 adequate samples. Increased detection of Lactococcus was observed after use of L. lactis. No significant trends in alpha or beta diversity as a result of treatment were observed. SNOT‐22 score did not change significantly following treatment with xylitol, L. lactis, or saline.Conclusion: We did not detect any major clinical or microbiome‐level effect due to treatment with two topical rinse products. Further research is needed to elucidate their clinical utility and possible probiotic effect.Level of Evidence: 3.

One of the earliest observable impairments in autism spectrum disorder (ASD) is a failure to orient to speech and other social stimuli. Auditory spatial attention, a key component of orienting to sounds in the environment, has been shown to be impaired in adults with ASD. Additionally, specific deficits in orienting to social sounds could be related to increased acoustic complexity of speech. We aimed to characterize auditory spatial attention in children with ASD and neurotypical controls, and to determine the effect of auditory stimulus complexity on spatial attention. In a spatial attention task, target and distractor sounds were played randomly in rapid succession from speakers in a free‐field array. Participants attended to a central or peripheral location, and were instructed to respond to target sounds at the attended location while ignoring nearby sounds. Stimulus‐specific blocks evaluated spatial attention for simple non‐speech tones, speech sounds (vowels), and complex non‐speech sounds matched to vowels on key acoustic properties. Children with ASD had significantly more diffuse auditory spatial attention than neurotypical children when attending front, indicated by increased responding to sounds at adjacent non‐target locations. No significant differences in spatial attention emerged based on stimulus complexity. Additionally, in the ASD group, more diffuse spatial attention was associated with more severe ASD symptoms but not with general inattention symptoms. Spatial attention deficits have important implications for understanding social orienting deficits and atypical attentional processes that contribute to core deficits of ASD. Autism Res 2017, 10: 1405–1416. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.