Jason R. Crossley

This study aimed to describe how olfactory neuroblastoma (ONB) recurrences are managed and whether these salvage strategies lead to freedom from disease at the location of recurrence. Retrospective cross-sectional analysis. Single academic hospital in the United States. Patients with recurrent ONB undergoing salvage treatment from April 2006 to February 2021. Persistence or freedom from recurrent disease. A total of 27 cases were identified. Among these cases, 59 recurrences were observed. The mean time to recurrence was 72 months. The mean duration from time of recurrence management to most recent follow-up was 59 months. A total of 19 cases underwent surgery for local sinonasal or local intracranial disease, 20 cases underwent surgery for regional disease, 2 underwent surgery for distant extracranial disease, and no patients underwent surgery for distant intracranial disease. About 22 recurrences were treated with radiation, 8 recurrences were treated with chemotherapy or immunotherapy, and 9 recurrences were treated with radioligand therapy. About 5 patients (20%) had 1-year disease-free survival following salvage treatment and 4 patients (16%) had 5-year disease-free survival following salvage treatment. Surgery, radiation, and radioligand therapy were the most common salvage treatments used for recurrent OBN. Local sinonasal, local intracranial, and regional recurrences were primarily managed surgically, whereas distal intracranial and distant disease were most often treated with radiation or radioligand therapy. This report is the first to characterize treatment strategies and outcomes used for specific locations of recurrences.

Introduction: Medication‐related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti‐resorptive and biologic agents. Here, we present the first case of tyrosine‐kinase inhibitor‐related external auditory canal (EAC) osteonecrosis as well as two cases related to anti‐resorptive therapies.Methods: A retrospective case series.Results: Case one: an 84‐year‐old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally. She had a history of osteoporosis treated with denosumab and risedronic acid. She successfully underwent left EAC reconstruction using an inferiorly‐based pedicle periosteal flap while the right ear canal was managed conservatively. Case two: a 69‐year‐old male presented with osteonecrosis of the right EAC. He had a history of osteoporosis treated with alendronic acid and zoledronic acid. His osteonecrosis is conservatively managed with local debridement and antibiotic application. Case three: a 60‐year‐old male presented with osteonecrosis of the right inferior EAC. He had a history of chronic myelogenous leukemia treated with a tyrosine‐kinase inhibitor, imatinib. After failing conservative therapy, he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.Conclusion: Anti‐resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis. When a local debridement and antibiotic therapy fail, definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.

The prevalence of distant metastases (DM) in human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. A PRISMA systematic review of DM rates in patients with HPV‐related OPSCC was performed. PubMed‐MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched. The primary outcome was prevalence of DM. Data on demographics, tumor classification, and clinical outcomes were also collected. Meta‐analysis of pooled DM rate was determined. Ten articles met inclusion criteria, representing 1860 patients with mean follow‐up of 3.6 years. Overall DM rate was 7.0% (95% CI: 5.9–8.2). T3 or T4 classification disease was associated with a 4.88‐fold (95% CI: 1.92–12.40) risk of DM compared to T1 or T2 classification disease. This study is the first to systematically review the prevalence of DM among patients with HPV‐related OPSCC, where pooled DM rate was found to be 7%.

Objective: To analyze how the COVID‐19 pandemic has influenced trends in head and neck squamous cell carcinoma (HNSCC) presentation and diagnosis—including referral patterns, stage at presentation, and time to diagnosis—over a longitudinal time course.Setting: Multicenter tertiary care academic institution.Methods: A retrospective review of patients with HNSCC presenting between January 1, 2019 and December 31, 2020 was performed. Patients were stratified into pre‐COVID and COVID cohorts based upon presentation date either before or after the COVID pandemic was declared a national emergency. Data was collected on demographics, referral site, symptoms, tumor characteristics, and time to diagnosis.Results: Of 203 patients with HNSCC identified, 77.3% (157/203) were in the pre‐COVID cohort and 22.7% (46/203) were in the COVID cohort. Patients in the COVID cohort were more likely to present through inpatient or ER consultation (26% vs. 11%) than outpatient setting. There was a greater than 50% decrease in new tumor board case presentations per month in the COVID cohort (4.8) relative to the pre‐COVID (10.9) cohort. Cancer stage at presentation was similar between cohorts. Time from presentation to diagnosis was similar between the cohorts at approximately 30 days.Conclusions: These results suggest that patients presenting during the COVID pandemic may have unique referral patterns. A significant decrease in tumor board presentations was noted, which may contribute to more delayed presentations that have yet to be observed. Further investigation with a larger sample size is warranted.Lay Summary: The COVID‐19 pandemic may have changed where and how patients with head and neck cancer initially seek care. We found that patients with newly diagnosed head and neck cancer more often were initially seen in urgent settings than before the pandemic.Level of Evidence: 3

Objective: To describe the academic impact and author characteristics of open‐access journals in otolaryngology.Methods: Original articles from three open‐access (OTO Open, Laryngoscope Investigative Otolaryngology, and World Journal of Otorhinolaryngology) and three conventional subscription‐based otolaryngology specific journals (Otolaryngology ‐ Head & Neck Surgery, The Laryngoscope, JAMA Otolaryngology – Head & Neck Surgery) were assessed. Publication dates of articles from January 2017 to July 2020 were included. Google Scholar and Web of Science citation counts were recorded. H‐indexes of first and last authors were included according to Google Scholar and Web of Science and analyzed.Results: This analysis included 3284 articles. Articles published in open‐access otolaryngology‐specific journals had significantly fewer citations on average (6.8) than articles published in subscription‐based journals (12.4, p < 0.0001). The last authors of articles published in subscription‐based journals had significantly higher h‐indexes (23.50) compared with the last authors of articles published in open‐access journals (19.53, p < 0.0001). The first authors of articles published in open‐access journals had similar h‐indexes (10.26) as the first authors of articles published in subscription‐based journals (10.33).Conclusions: Articles published in open‐access journals in otolaryngology were cited significantly less than those published in subscription‐based journals. The h‐index of the last authors was significantly lower in open‐access journals; however, the h‐index of the first authors was similar between open‐access and subscription‐based journals. As measured by citations, open‐access publications do not yet appear to have the impact of subscription‐based publications.Level of Evidence: NA Laryngoscope, 133:79–82, 2023

Objectives: To present a novel location in which neurosarcoidomatous inflammation is identified and its accompanying presentation. Methods: The authors present a case of bilateral vocal fold paresis associated with non-caseating granulomatous inflammation of the cervical and intra-axial portions of the vagus nerve masquerading as a cranial nerve tumor. Results: Examination revealed bilateral vocal fold paresis and asymmetric palate elevation. MRI demonstrated enhancing bilateral jugular foramen masses, and neck ultrasound demonstrated bilateral thickened appearance of the vagus nerves. Vagus nerve biopsy demonstrated non-caseating granulomas. Conclusions: Neurosarcoidosis may contribute to variable cranial neuropathies. Vocal fold paresis is usually thought to arise from mediastinal compression of the left recurrent laryngeal nerve. Rarely, though, lesions may arise in other parts of the vagus nerve. Failure of response to steroids does not rule out the diagnosis, making tissue diagnosis important in some cases.