Lacey L. Nelson

Objective: The Cochlear Osia 2 system is a bone‐conduction device (BCD) that is effective for conductive, mixed hearing loss, and single‐sided deafness. Limited data exist on Osia 2 outcomes in pediatric patients with microtia. This study aimed to compare Osia 2 implantation performed concurrently with microtia reconstruction versus Osia 2 implantation alone, and to investigate surgical techniques and variables impacting complication rates and outcomes. Study Design: Retrospective case series. Setting: Pediatric tertiary care center. Methods: Patients who underwent Cochlear Osia 2 device implantation between June 2020 and December 2024 were identified. Data was collected on postoperative complications, presence of prior BCD, incision type, coil placement location, and concurrent surgical procedures. Complications were classified as minor or major based upon need for operative intervention. Results: Of the 113 included cases and 129 operated ears, 42.5% (n = 48) underwent Osia implantation alone, 37.2% (n = 42) underwent concurrent microtia repair, and 20.3% (n = 23) underwent other concurrent otologic procedures. Minor complication rate was 10.9%, major complication rate was 14.0%, and device explant rate was 10.1%. Complication rates did not significantly differ between concurrent microtia cases versus Osia alone (19.0% vs 33.8%, RD −14.8%, 95% CI: −35.4% to 9.4%; P = .092), between cases with prior BCD versus those without (42.3% vs 24.1%, RD 18.2%, 95% CI: −8.5% to 44.7%; P = .071), nor between subperiosteal versus subcutaneous coil placement (27.5% vs 27.9%, RD 0.4%, 95% CI: −56.7% to 1.2%; P = .966). Conclusion: Osia 2 implantation is safe to perform concurrently with microtia reconstruction. Factors including prior BCD, coil placement location, and implant physical characteristics may impact postoperative outcomes, however, further studies are needed to better characterize practices and patient factors that influence outcomes.

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 investigate how dexamethasone dosage impacts intratympanic steroid therapy (IST) for treatment of sudden sensorineural hearing loss (SSNHL). Study Design: Retrospective review. Methods: Inclusion criteria identified subjects who received IST between January 1, 2010 and June 1, 2020 for iSSNHL. Subjects with Meniere’s disease, autoimmune inner ear disease, subjects who received injections of non-dexamethasone steroid formulations, and subjects with missing audiogram data were excluded. Subjects were stratified by dexamethasone dosage: low-dose (10 mg/ml) versus high-dose (24 mg/ml), time-to-treatment and oral corticosteroid use. Outcome measures included post-treatment improvement in 4-frequency pure tone average (4F-PTA [500, 1000, 2000,4000 Hz]), low- and high-frequency PTA (250-1000 Hz and 2000-8000 Hz, respectively). Results: Of the 55 included subjects (50.9% male, mean age 48.9 ± 16.4 years), 31 received high-dose while 24 received low-dose injections. 90.9% of subjects were treated with oral steroids prior to or during IST. No significant differences in hearing outcomes were observed between low- and high-dose cohorts or when stratifying by oral steroid use. Time-to-treatment analysis comparing ≤1 month (67.3%) versus >1 month (32.7%) groups demonstrated a significant improvement in post-treatment 4F-PTA ( P = .01) in the ≤1 month group. Conclusions: Hearing recovery was not significantly different between the 10 mg/ml versus 24 mg/ml doses of intratympanic dexamethasone, suggesting that steroid dose may not impact the efficacy of IST. A shorter time-to-treatment was observed to be favorable for hearing improvement.

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