Thomas S. Higgins

Objective: Nasal airway obstruction (NAO) can be due to deviation of the cartilaginous and bony nasal septum. Correcting the caudal cartilaginous septum can be technically challenging. This study aims to evaluate the safety and effectiveness of a bioabsorbable submucosal septal implant (SeptAlign; Spirair Inc.) for minimally invasive correction of cartilaginous nasal septal deviation (NSD). Methods: This was a prospective cohort study conducted at nine otolaryngology clinics in the USA. Subjects underwent placement of the implant alone or with concurrent inferior turbinate reduction (ITR). Percentage reductions relative to baseline in the mean Nasal Obstruction Symptom Evaluation (NOSE) score were calculated at 3 and 6 months postprocedure. Results: In 80 subjects (92.5% with moderate‐to‐severe NSD), NOSE scores decreased by 63.2% (from 67.5 at baseline to 26.0 at 3 months and 23.6 at 6 months; p values < 0.0001). Overall, 85.9% of subjects at 3 months and 89.9% at 6 months were considered responders. The sub‐group with concurrent turbinate reduction had 88.2% responders and the sub‐group with the implant alone had 91.4% responders at 6 months. Subjects returned to work a median of 1 day after the procedure, which was performed in‐office under local anesthesia in 46.3% of cases. Conclusion: The septal implant was an effective treatment for NAO symptoms via NSD repair and was generally safe and well tolerated. It straightens cartilaginous NSD via mechanical traction without the need for resection and may be an attractive alternative to conventional septoplasty. Level of Evidence: 3

Background: Sinus and skull base surgery create areas of demucosalized bone and cartilage in the sinonasal cavity, yet no standardized system exists to describe the progressive healing of these wounds. The goal of this study was to develop the novel Sinonasal Assessment of Reepithelialization (SNARE) and perform parametric testing including inter‐rater and intra‐rater reliability analyses. Methods: Using a modified Delphi method, an 11‐member expert panel comprising 10 rhinologists and one PhD otolaryngology research scientist developed a four‐stage wound healing scale over three iterative rounds, with consensus set at 80%. Consensus scale was as follows: Stage 0: Fully remucosalized; Stage 1: Mostly remucosalized; Stage 2: Extensive healing (granulation) tissue, minimal remucosalization; Stage 3: Minimal healing (granulation) tissue. Fifty‐nine postoperative videos of nasoseptal flap (NSF) harvest sites were reviewed by 14 blinded, fellowship‐trained rhinologists to assess inter‐rater reliability—12 of whom repeated the evaluation after 1 month to assess intra‐rater reliability. Results: Inter‐rater reliability for individual raters was good (intraclass correlation coefficient (ICC)(A,1) = 0.763, Round 1; 0.761, Round 2). Intra‐rater ICC(A,1) values ranged from 0.653 to 0.938 (mean = 0.83), indicating moderate reliability for one reviewer and good‐to‐excellent repeatability for the remainder. Conclusion: The SNARE is a reliable, endoscopically based staging system with good‐to‐excellent inter‐ and intra‐rater reliability for describing remucosalization of sinonasal wounds following sinus and skull base surgery. It provides a reliability‐tested metric for future studies evaluating the effects of postoperative interventions on sinonasal wound healing.

Objective: To evaluate the accuracy, quality, and potential harm or benefit of TikTok videos related to ankyloglossia and to assess how uploader type influences informational reliability and educational value. Methods: A cross‐sectional analysis of TikTok videos was conducted using 4 search terms related to ankyloglossia. Videos posted between January 2021 and August 2024 were screened, yielding 66 eligible videos. Videos were categorized by uploader type (medical provider, influencer, layperson) and content type. Three independent reviewers assessed factual accuracy based on AAO‐HNSF Clinical Consensus Statements, classified videos using a harm–benefit scale, and evaluated quality using the PEMAT‐AV and Global Quality Scale (GQS). Results: Of 66 videos, 78.8% were educational, but only 63.5% were factual. Medical providers produced significantly more factual content than influencers and laypersons (85% vs 50%, P = .045). Medical provider videos demonstrated the highest harm–benefit scores ( P = .025) and the highest PEMAT‐AV and GQS averages, though quality score differences were not statistically significant. Influencer‐generated content achieved higher view counts despite lower accuracy. Views and shares did not correlate with quality or accuracy metrics. Lifestyle and medical advice videos were significantly associated with more negative harm–benefit scores. Discussion: Although TikTok videos on ankyloglossia reach large audiences, misinformation remains prevalent, particularly among non‐medical uploaders. Popularity metrics were poor indicators of educational quality, while videos aligned with the clinical consensus statement demonstrated higher clarity and benefit. Implications for Practice: Medical professionals should play a proactive role in creating accurate, accessible social media content to counter misinformation and guide patient understanding of ankyloglossia. However, given that engagement metrics do not favor accuracy, broader platform‐level strategies and collaborations may be necessary to meaningfully counter health misinformation on social media.

Primary diffuse type 2‐dominant chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nasal cavity and paranasal sinuses associated with significant morbidity. Impaired sense of smell is a cardinal symptom of CRSwNP and one of the most burdensome for patients, impacting quality of life, mental health, and even safety. Mechanisms of smell loss in CRSwNP may be related to conductive losses due to significant burden of nasal polyps, as well as the impact of type 2 inflammatory mediators on olfactory sensory neurons. Initial medical management frequently involves intranasal or oral corticosteroids. Patients whose symptoms remain uncontrolled by medical treatment may be offered sinonasal surgery; however, patients may experience recurrence of smell loss following surgery. Guidelines recommend biologics for certain patients with CRSwNP after undergoing complete endoscopic sinus surgery, and data from clinical trials and real‐world evidence support their effectiveness in improving sense of smell. Given the impact of smell loss, shared decision‐making is important in identifying treatment options best suited to achieving patient goals. This review provides an overview of the importance of smell loss in CRSwNP and its known mechanisms, and reviews the evidence for the efficacy of current treatment options in restoring sense of smell.

Background: The 22-item Sinonasal Outcome Test (SNOT-22) is a widely used patient-reported outcome measure (PROM) for assessing chronic rhinosinusitis (CRS). However, incomplete surveys may impact its predictive utility. Aims: This study explores SNOT-22 completion rates, response trends, and potential factors influencing survey omissions aiming to optimize its predictive utility and practical application. Methods: SNOT-22 surveys were retrospectively collected from patients at various time points throughout their CRS treatment. Surveys with at least one question unanswered were included in the study. Completely unanswered surveys were excluded. Survey response dynamics and trends were analyzed and reported. Results: 1,034 SNOT-22 surveys were collected, 18% of the surveys were incomplete. Questions on “Ear fullness” and “Embarrassed” were most unanswered, while “Need to blow nose” and “Nasal blockage” were least unanswered. Questions later in the survey showed a moderate positive correlation with missing responses. Mean scores per question were higher in incomplete than in complete surveys, though differences in SNOT-22 scores between partially and fully completed surveys weren’t significant. Conclusion: Our study found that a large number of SNOT-22 surveys were incomplete, higher than rates reported in similar PROMs. Mean scores did not differ significantly between partial and complete surveys, suggesting interpretation should prioritize individual responses over total scores. Potential barriers to survey completion include question wording, symptom relevance, and survey length. Future research should further investigate survey completion through qualitative methods and randomized question ordering to refine survey design.

A novel bioresorbable agent on the market is PuraGel® (3‐D Matrix, Tokyo, Japan), a RADA‐16 product that acts as a synthetic hemostatic and space‐filling gel that promotes wound healing and prevents adhesion formation. Given the reported benefits of accelerated wound healing and scar tissue prevention, there are multiple otolaryngologic applications where RADA‐16 might improve outcomes. Our study highlights current utilization and associated post‐operative complications with this product.

Objectives: Chronic rhinosinusitis and related rhinologic disorders are common in routine otolaryngologic practice. Common presenting symptoms include nasal obstruction, facial pain, facial pressure, headache, and a subjective feeling of the face feeling “swollen,” a perceptual distortion. No validated scale exists to assess facial pain in addition to perceptual distortion or headache. The objective was to develop a novel scale for assessment of facial symptoms experienced by patients presenting for rhinologic evaluation. Methods: This was a prospective validation cross-sectional study. A patient questionnaire, the 12-item Facial Complaints Evaluation Scale (FaCES-12), was created to evaluate facial symptoms based on clinical experience and the literature, including severity and timing of facial pain, facial pressure, facial perceptual swelling, and headache. Each item was assessed utilizing an 11-point Likert scale ranging from 0 to 10 in severity. Data was collected prospectively from 210 patients in 1 private and 2 academic otolaryngologic practices from August to December 2019 along with the PROMIS Pain Intensity Scale 3a and 22-Item Sino-nasal Outcome Test. Construct validity was determined using Pearson correlation and exploratory factor analysis. Internal consistency and test-retest reliability were assessed by calculating Cronbach’s alpha and assessing test-retest scores. Results: A new 12-item scale named FaCES-12 was developed. FaCES-12 demonstrated high reliability with a Cronbach’s alpha of .94 and high test-retest reliability ( r = .90). The scale revealed very strong correlation with the PROMIS Pain Intensity Scale 3a ( r = .81) and moderate correlation with the Sino-nasal Outcome Test ( r = .48). Exploratory factor analysis demonstrated the scale contained interrelated variables that measured unique components of facial sensations. Conclusion: The FaCES-12 is a valid and reliable instrument for use in the evaluation of facial symptoms. Further research into the application of this scale is warranted.

Background: Commonly used endoscopic nasal polyp grading scales have been shown to correlate poorly with symptom scores and quality of life metrics. The recently described Postoperative Polyp Scale (POPS) is a grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities by describing incremental recurrence in relation to the surgically opened sinus cavities. Objective: The objective of this study was to determine if the POPS correlated with sinonasal symptoms. Methods: CRSwNP patients were prospectively administered SNOT-22 questionnaires and graded according to the POPS starting at their 1-month postoperative appointments. Total POPS scores (sum of each side) and Max POPS score (larger value of left and right) were correlated with SNOT-22 total scores and subdomains using Kendall correlation testing. Results: A total of 127 patients were enrolled in the study. Both Total POPS or Max POPS were significantly correlated to the SNOT-22 total score ( P < .001, P < .001), Rhinologic ( P < .001, P < .001), Extra-Nasal Rhinologic ( P < .001, P < .001), Ear/Facial ( P < .001, P < .001), and Psychologic ( P = .028, P = .017) subdomains. Kendall’s tau indicated strong correlation (≥0.3) with Rhinologic subdomain, moderate correlation (.21-.29) with Extra-Nasal Rhinologic and Ear/Facial subdomains, and weak correlation (.1-.19) with Psychologic subdomain. Conclusion: Previous endoscopic nasal polyp grading scales poorly correlate with symptoms and patient reported outcome measures. The new POPS moderately correlates with the total SNOT-22 score and strongly correlates with the Rhinologic subdomain, indicating that it may have good potential as a tool to evaluate postoperative CRSwNP patients.

Background: Sphenoid and frontal sinuses have narrow ostia and are prone to stenosis. However, their relative rates of patency are not well established, and descriptive rates of sphenoid stenosis have never been reported. The objective is to measure the patency of the sphenoid and frontal sinus ostia postoperatively. Methods: A prospective multi-institutional cohort study was performed. Ostial patency was measured at surgery and 3 and 6 months postoperatively. Pertinent clinical history such as the presence of nasal polyps and prior history of ESS as well as the use of steroid eluting stents were recorded. Overall stenosis rates were calculated for both the sphenoid and frontal sinuses, and Wilcoxon-Signed Rank Test was used to compare intraoperative and postoperative ostial areas. Factorial Analysis of Variance (ANOVA) was performed to determine effects of 5 clinical factors. Results: Fifty patients were included. The mean sphenoid sinus ostial area decreased 42.2% in size from baseline to 3 months postoperatively (T0 55.2 ± 28.7 mm vs T3 m 31.8 ± 25.5 mm, P < .001). The mean frontal sinus ostial area decreased 39.8% in size from baseline to 3 months postoperatively (T0 33.7 ± 17.2 mm vs T3 m 19.9 ± 15.1 mm, P < .001). Neither the sphenoid nor the frontal sinus ostial patency demonstrated statistically significant change from 3 to 6 months postoperatively. Conclusion: Both sphenoid and frontal sinus ostia routinely narrow postoperatively, predominately from baseline to 3 months. These findings can serve as a reference for both clinical outcomes and future studies of these surgeries.

Objective: Commonly used endoscopic grading scales, such as the nasal polyp scale, inadequately describe the degree of polyposis found postoperatively in the paranasal sinus cavities. The purpose of this study was to create a novel grading system that more accurately characterizes polyp recurrence in postoperative sinus cavities, the Postoperative Polyp Scale (POPS).Methods: A modified Delphi method was utilized to establish the POPS using consensus opinion among 13 general otolaryngologists, rhinologists, and allergists. Postoperative endoscopy videos from 50 patients with chronic rhinosinusitis with nasal polyps were reviewed by 7 fellowship‐trained rhinologists and scored according to the POPS. Videos were rated again 1 month later by the same reviewers, and scores were assessed for test–retest and inter‐rater reliability.Results: Overall inter‐rater reliability for the first and second reviews of the 52 videos was Kf = 0.49 (95% CI 0.42–0.57) and Kf = 0.50 (95% CI 0.42–0.57) for the POPS. Intra‐rater reliability showed near‐perfect test–retest reliability for the POPS with Kf = 0.80 (95% CI 0.76–0.84).Conclusion: The POPS is an easy‐to‐use, reliable, and novel objective endoscopic grading scale that more accurately describes polyp recurrence in the postoperative state which will be useful in the future for measuring the efficacy of various medical and surgical interventions.Level of Evidence: 5 Laryngoscope, 133:2885–2890, 2023