Alloplastic malar implants in aesthetic facial surgery.

PURPOSE OF REVIEW: To examine the recent literature on aesthetic alloplastic malar implants. RECENT FINDINGS: Alloplastic implantation is heavily favored in the oromaxillofacial literature. Recent articles have examined porous polyethylene and silicone implantation. Overall patient satisfaction is high and complications are low. Outcomes are likely comparable with alternative modalities to rejuvenate the face in the appropriate hands. SUMMARY: Alloplastic implantation continues to be a reliable tool for malar augmentation.

Quantitative Analysis of Preoperative and Postoperative Photographs Posted on Social Media by Oculoplastic Surgeons.

PURPOSE: To investigate and quantitatively analyze preoperative and postoperative photographs posted on social media by oculoplastic surgeons. METHODS: Pre- and postoperative blepharoplasty photographs posted by oculoplastic surgeons on the social media platform Instagram were identified over a 4-month period. Photographs demonstrating a frontal pose of the periocular region were selected, and image analysis was performed to compare the preoperative and postoperative photographs. Quantitative image analysis was performed with a semiautomated script using ImageJ (v1.52k) software. Image analysis compared magnification, patient position, luminosity, relative color profiles, and edge detection/sharpness. Three oculoplastic surgeons graded these imaging metrics for the same photoset and the consensus grade was assigned to each category. Finally, the quantitative calculations were then compared with the consensus grades to develop receiver operating characteristic curves for further analysis. RESULTS: The study included 104 posts from 35 members of ASOPRS. Regarding patient positioning, 9 postings were 5%-10% offset from the patients' center, and 6 postings were more than 10% from the patients' center. The majority of photosets demonstrated less than or equal to 2.5% difference in magnification (69/104), with 7 postings demonstrating a greater than 5% difference, and 3 postings exhibiting greater than 10% difference in magnification. In the periocular region, 17.3% (18/104) of postings were found to have a greater than 10% difference in luminosity (>25.5 pixel-value). A more than 5% difference (>12.75 pixel-value) in pre- and postoperative edge-detection measurements was identified in 12 of 104 postings. In 22 of 104 photosets, the mean absolute deviation in color channel ratios was more than 0.01 and 15 of 104 photosets were found to have a mean absolute deviation more than 0.05. CONCLUSIONS: Numerous quantifiable photographic inconsistencies were identified in surgical photographs posted on social media by members of ASOPRS. Adoption of an automated image analysis tool that compares before-and-after surgical photographs could promote standardized oculoplastic surgery photography on social media.

Nasal dorsum reconstruction after pediatric nasal dermoid excision.

BACKGROUND: To review our experience with pediatric nasal dermoids, and discuss reconstructive options for the nasal dorsum after pediatric nasal dermoid removal. METHODS: Retrospective review of pediatric nasal dermoid cases from January 1 2005 through October 1 2016. RESULTS: Twenty-five cases (12 males, 13 females) were identified. Median age at time of surgery was 24 months (7-144). Ten nasal dermoids were superficial; eleven, intraosseous; one, intracranial extradural; three, intracranial intradural. Seven were located on the glabella; fifteen, dorsum; three, nasal tip. Twelve underwent vertical midline incision; ten underwent external rhinoplasty; and three combined approach with craniotomy. There was one recurrence four years postoperatively; which was secondarily resected completely via external rhinoplasty approach. Seven cases utilized endoscopic assistance. Conchal cartilage grafting was utilized in nine cases for dorsal reconstruction. A temporoparietal fascial graft was utilized to reconstruct the soft tissue defect in three patients. Median follow-up was 1.17 years (1 month-10 years). CONCLUSIONS: Nasal dermoid is a rare congenital pathology. Recurrence rate is generally low provided that complete surgical excision is achieved. Achieving complete surgical excision means sometimes compromising the upper lateral cartilages and nasal bones. Conchal cartilage grafting is useful in reconstruction for lesions that significantly disrupt the nasal cartilages and/or nasal bones, wherein the defect is significant and osteotomies may not be sufficient. Temporoparietal fascia is a favorable adjunct for reconstructing soft tissue deficits when the skin is thin. Further studies and longer follow up are needed to adequately assess functional and cosmetic outcomes.

Association of Pediatric Patient Demographic Factors and Scar Anatomic Features With Scar Outcomes After Surgical Repair of Cleft Lip.

IMPORTANCE: Scar outcomes following cleft lip repair are an important component of pediatric patient and family satisfaction and indicate the need for future surgical interventions. OBJECTIVE: To assess the association of pediatric patient demographic factors and scar anatomic features with scar outcomes following cleft lip surgical repair. DESIGN, SETTING, AND PARTICIPANTS: A case-control study was conducted involving 58 pediatric patients who underwent surgical repair of a cleft lip from October 31, 2008, to August 4, 2016, at a tertiary care pediatric specialty hospital. Data on patient demographic factors, cleft type, and the surgical technique used were collected and analyzed from June 11, 2009, to November 21, 2017. Scar outcomes were subjectively rated by 3 physicians at 6-month and 12-month postoperative intervals. MAIN OUTCOMES AND MEASURES: Overall scar outcomes at 6-month and 12-month postoperative intervals were based on rating of scar appearance, color, width, height, and alignment by using a subjective, 5-point scar-assessment scale in which 1 indicated the poorest aesthetic appearance and 5, the ideal aesthetic appearance. RESULTS: A total of 58 pediatric patients who underwent cleft lip repair were evaluated; mean (SD) age at time of repair, 4.8 (3.0) months. Of these, 44 (76%) were male and 14 (24%) were female, 37 (64%) were white, 11 (19%) were black, 7 (12%) were Hispanic, 2 (3%) were Asian, and 1 (2%) was of another race/ethnicity. Scores on the Cohen κ interrater test indicated either a substantial or almost perfect strength of agreement among the physicians grading the scar outcomes. At 12 months, patients with black skin type had worse overall scar outcomes than patients with white skin type (odds ratio [OR], -0.31; 95% CI, -1.15 to -0.14; P = .03). A depressed scar height (OR, -0.54; 95% CI, -1.32 to -0.49; P < .001), and hypopigmented scar color (OR, -0.45; 95% CI, -1.34 to -0.32; P = .002) were associated with worse scar outcomes at 12 months following surgery. The overall median lip scar outcome significantly improved between the 6-month and 12-month follow-up assessments (scar-assessment scale score, 3.3; interquartile range [IQR], 2.7-4.0 vs 4.0; IQR, 3.3-4.3; P < .001). No association was observed between the anatomic type and severity of the cleft lip and scar outcomes (unilateral vs bilateral cleft, complete vs incomplete or microform cleft, and lip height ratio of the unilateral noncleft to cleft lip). CONCLUSIONS AND RELEVANCE: This study's findings suggest that, compared with white pediatric patients, black pediatric patients exhibited worse overall scar outcomes. A depressed scar and a hypopigmented scar also were associated with overall worse scar appearance after surgical repair. Cleft lip scar outcomes were not significantly associated with the type and severity of the cleft lip.

Does anatomic subsite influence oral cavity cancer mortality? A SEER database analysis.

OBJECTIVE: To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites. METHODS: Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5-year cause-specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5-year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05. RESULTS: 20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM. CONCLUSION: Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite-specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite-directed research as a means to improve outcomes. LEVEL OF EVIDENCE: NA Laryngoscope, 129:1400-1406, 2019.

Tonsillectomy in Children with Down Syndrome: A National Cohort of Inpatients.

Objective To describe the cost, length of stay, and incidence of postoperative hemorrhage associated with Down syndrome (DS) patients undergoing tonsillectomy in a national sample of inpatient children. Study Design This study uses a national cross-sectional cohort to analyze children with and without DS undergoing tonsillectomy with or without adenoidectomy. Setting 2012 Healthcare Cost and Utilization Project Kids' Inpatient Database. Subjects and Methods The database was analyzed for postoperative hemorrhage and respiratory compromise, length of stay, and total charges of hospital stay. These outcomes were compared between patients with DS vs patients without DS. Results In total, 7512 patients were identified who underwent tonsillectomy: 7159 patients without DS and 353 patients with DS. The non-DS group was younger with a median age of 3 years (range, 0-18) compared with a DS median age of 4 years (range, 0-20), P = .004. The DS group had a significant increase in postoperative hemorrhage compared with non-DS (10 [2.8%] vs 87 [1.2%], respectively), P = .024. However, the DS and non-DS groups were comparable for respiratory complications (5 [1.4%] vs 106 [1.5%], respectively), P = .922. Median length of stay was significantly increased in the DS group (1 [interquartile range (IQR), 1-3]) compared with the non-DS group (1 [IQR, 1-2]), P < .001. Median charges for hospital stay totaled $17,451 (IQR, $11,901-$24,949) for the DS group compared with $14,395 (IQR, $9739-$21,890) for the non-DS group, P < .001. Conclusion Across the United States, children with DS hospitalized for tonsillectomy have an increased length of stay and cost of care. These data also suggest an increased risk of postoperative hemorrhage during the initial admission without an increased risk of respiratory complications.

Assessment of weight gain following adenotonsillectomy in children with Down syndrome.

INTRODUCTION: Adenotonsillectomy (T&A) has been associated with postoperative weight gain in children. The purpose of this study is to determine whether a similar association exists in children with Down syndrome (DS). METHODS: The medical records of 311 DS patients were reviewed. Subjects were classified into either a control group or surgical group based on whether they had undergone adenotonsillectomy (T&A). Subjects were excluded if they only had one recorded BMI. Cases were analyzed in a pairwise fashion to maximize available data. 113 total patients with DS were identified: 84 (74.3%) in the control group and 29 (25.7%) in the T&A group. Height, weight, BMI, and Z-score data were compared between the control and T&A groups at 6-month intervals over a 24-month period. RESULTS: Children with DS who underwent T&A were comparable by demographics to children with DS who did not undergo T&A. Mean weight gain at 24 months for the T&A group was 8.07 ± 5.66 kg compared with 5.76 ± 13.20 kg in controls. The median Z-score at 24 months for the T&A group was 1.11 (0.10-1.88) compared with 1.17 (0.80-1.75) in controls. Children undergoing T&A had a stable median Z-score change of 0.09 at 24 months (p = 0.861, compared to baseline) while children who did not undergo T&A had a significantly increased median Z-score of 0.52 (p = 0.035, compared to baseline). Despite this, there were no significant intergroup differences between weight change, BMI, nor Z-score at any interval (p > 0.05). CONCLUSIONS AND RELEVANCE: Children with DS did not have an increased rate of weight gain or increased BMI after T&A. BMI Z-scores were shown to stabilize over 24 months in the T&A group and increase in the control group. While this suggests that T&A provides an added benefit of weight control in patients with DS, the results should be interpreted with caution due to the small sample size and the fact that not all patients had complete follow up across a 24-month period.

Cochlear Implantation in Inner Ear Malformations: Systematic Review of Speech Perception Outcomes and Intraoperative Findings.

Objective (1) To analyze reported speech perception outcomes in patients with inner ear malformations who undergo cochlear implantation, (2) to review the surgical complications and findings, and (3) to compare the 2 classification systems of Jackler and Sennaroglu. Data Sources PubMed, Scopus (including Embase), Medline, and CINAHL Plus. Review Methods Fifty-nine articles were included that contained speech perception and/or intraoperative data. Cases were differentiated depending on whether the Jackler or Sennaroglu malformation classification was used. A meta-analysis of proportions examined incidences of complete insertion, gusher, and facial nerve aberrancy. For speech perception data, weighted means and standard deviations were calculated for all malformations for short-, medium-, and long-term follow-up. Speech tests were grouped into 3 categories-closed-set words, open-set words, and open-set sentences-and then compared through a comparison-of-means t test. Results Complete insertion was seen in 81.8% of all inner ear malformations (95% CI: 72.6-89.5); gusher was reported in 39.1% of cases (95% CI: 30.3-48.2); and facial nerve anomalies were encountered in 34.4% (95% CI: 20.1-50.3). Significant improvements in average performance were seen for closed- and open-set tests across all malformation types at 12 months postoperatively. Conclusions Cochlear implantation outcomes are favorable for those with inner ear malformations from a surgical and speech outcome standpoint. Accurate classification of anatomic malformations, as well as standardization of postimplantation speech outcomes, is necessary to improve understanding of the impact of implantation in this difficult patient population.

Adenotonsillectomy outcomes in patients with Down syndrome and obstructive sleep apnea.

OBJECTIVE: To review the literature for studies examining polysomnography (PSG) outcomes in patients with Down syndrome (DS) and obstructive sleep apnea (OSA) following adenotonsillectomy (T&A), and to review our experience with these patients. DATA SOURCES: PubMed-NCBI, Scopus, Ovid, EBSCO, Cochrane, and EMBASE databases; tertiary academic center medical records. REVIEW METHODS: A systematic review of the medical literature identified articles reporting objective outcomes following T&A for OSA treatment in patients with DS. Articles were critically appraised to assess level of evidence and bias, and the results of articles were summarized. A case series of confirmed patients with DS and OSA was conducted, evaluating T&A efficacy by comparing pre- and posttreatment PSG data. RESULTS: Six articles were identified, which demonstrated some improvement after T&A in the treatment of OSA; however, subjects frequently had persistent disease. At our institution, preoperative Apnea-Hypopnea Index (AHI) improved from 13.75 (interquartile range [IQR] = 6.65-23.43) to 3.5 (IQR = 1.96-9.63) postoperatively; P = 0.004. Ten percent of patients had preoperative AHIs < 5; this proportion increased to 60% following surgery. Twenty percent of patients had postoperative AHIs < 1. CONCLUSION: There is little objective data in the medical literature addressing T&A efficacy in treating OSA in patients with DS patients. Patients show objective improvement in sleep parameters following T&A for OSA. Adenotonsillectomy should be suggested as a first-line treatment for children with DS and OSA, keeping in mind that monotherapy may be insufficient. Future studies utilizing objective measures are required to further quantify the effect in this patient population. LEVEL OF EVIDENCE: Laryngoscope, 127:1465-1470, 2017.

Olfactory Outcomes after Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Meta-analysis.

OBJECTIVE: To use combined pre- and postsurgical olfactory outcomes to assess the impact of endoscopic sinus surgery on chronic rhinosinusitis-related olfactory impairment. DATA SOURCES: CINAHL, Cochrane, OVID, EMBASE, PubMed, and SCOPUS. Each database was searched from inception up to October 2015. REVIEW METHODS: Studies were included that reported subjective or objective olfactory data in chronic rhinosinusitis patients before and after endoscopic sinus surgery. RESULTS: Thirty-one studies were used in the meta-analysis. Weighted mean differences of olfactory measures demonstrated significant improvement in mixed CRS patients (those with and without polyps) through visual analog scales (-0.83, P = .001), altered taste/smell item on Sinonasal Outcome Test (-1.32, P < .00001), 40-item Smell Identification Test (3.49, P = .0010), and Sniffin' Sticks identification (0.34, P = .03). Chronic rhinosinusitis mixed patients demonstrated nonsignificant improvements via Sniffin' Sticks threshold (1.60, P = .16) and Brief Smell Identification Test (0.20, P = .32). When separated, polyp patients and dysosmic patients experienced the highest levels of olfactory improvement. Polyp patients improved by 7.87 (P = .006) on the 40-item Smell Identification test, 11.54 (P < .0001) with the Sniffin' Sticks total score, and 2.57 (P < .00001) through Sniffin' Sticks identification. Dysosmic patients improved by 5.75 via the 40-item Smell Identification Test (P = .0001). CONCLUSION: Endoscopic sinus surgery improves nearly all subjective and objective measures of olfaction in chronic rhinosinusitis patients. Patients with nasal polyposis or preoperative olfactory dysfunction improve to a greater degree.

PANDAS: A systematic review of treatment options.

INTRODUCTION: Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is a rare but important condition for pediatric otolaryngologists to recognize. Several treatment options exist including tonsillectomy, antibiotic treatment/prophylaxis, intravenous immunoglobulin (IVIG), and psychiatric medications/therapy. METHODS: A systematic review of the PubMed, EMBASE, and Scopus databases was performed searching for articles that focused exclusively on the aforementioned treatment modalities in the PANDAS population. Review articles, single patient case reports, and studies examining the natural history or diagnostic strategies were excluded. RESULTS: Five articles regarding tonsillectomy treatments with level of evidence (LOE) 4 were found but no clear benefit could be determined. Three articles were selected involving the use of antibiotic therapy. One prospective study and one double-blind randomized control trial (DB RCT) supported the use of antibiotics but a separate DB RCT showed no benefit. Two selected articles described the use of IVIG: one unblinded RCT and one retrospective study. One prospective study on cognitive-behavioral therapy (CBT) showed benefit in PANDAS. CONCLUSION: There is a paucity of high-level studies regarding this rare disorder and no hard treatment recommendations can be made. Tonsillectomy should only be performed in those who are surgical candidates based on current published guidelines. Antibiotics are an option but provide uncertain benefit. CBT remains a low-risk option. Studies support the use of IVIG, however more investigation is needed prior to widespread adoption of this treatment given its potential risks.

Objective Outcomes of Supraglottoplasty for Children With Laryngomalacia and Obstructive Sleep Apnea: A Meta-analysis.

IMPORTANCE: Surgical intervention is the main treatment alternative for patients with severe laryngomalacia. Supraglottoplasty offers effective treatment results not only for laryngomalacia but also for concurrent obstructive sleep apnea (OSA). OBJECTIVE: To quantify the objective outcomes of supraglottoplasty for laryngomalacia with OSA via polysomnography data in the pediatric population. DATA SOURCES: A comprehensive literature search of the PubMed database was performed on May 20, 2015, using the search terms supraglottoplasty, epiglottoplasty, aryepiglottoplasty, laryngomalacia, obstructive sleep apnea, Apnea-Hypopnea Index (AHI), children, and polysomnography. There were no date restrictions. STUDY SELECTION: The literature search identified English-language studies that used polysomnography to evaluate patients with laryngomalacia and OSA after supraglottoplasty. Two reviewers screened titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. DATA EXTRACTION: Numerical polysomnography data were extracted and compared among studies where appropriate. A fixed- or random-effects model was used, when appropriate, to analyze the data and calculate effect sizes. RESULTS: Four studies were included in various subsets of the meta-analysis. After supraglottoplasty, the Apnea-Hypopnea Index (AHI) improved by a mean of 12.5 points in 4 studies (95% CI, -21.14 to -3.78; P = .005), oxygen saturation as measured by pulse oximetry nadir by 9.49 in 4 studies (95% CI, 4.87-14.12; P < .001), and Obstructive AHI by 21 points in 2 studies (95% CI, -50.3 to -8.29; P = .16). Twenty-nine of 33 children (88%) had residual disease. Patients 7 months and older had significant improvement in the AHI (P = .03). CONCLUSIONS AND RELEVANCE: Supraglottoplasty is an effective treatment modality for patients with laryngomalacia and OSA with objectively measurable benefits; however, patients will frequently have residual disease. Additional polysomnography after treatment is advised to ensure adequate resolution of the disorder.

The physiologic role of corticosteroids in Ménière's disease.

Multiple options exist to manage Ménière's disease (MD), ranging from dietary modifications to ablative surgery. Corticosteroids (CS) have long been used to manage MD, but their exact mechanism for disease alleviation is relatively uncertain. Glucocorticoid receptors have been shown to exist in the human inner ear and several studies propose they influence mechanisms of blood flow, fluid regulation, and ion regulation, with recent evidence describing the latter two. Corticosteroids have been shown to upregulate aquaporins and ion channels in the inner ear, and may have a positive effect on labyrinthine blood flow. Additionally, processes have been described in genomic and non-genomic manners. This text will review the literature on the actions of CS on the inner ear relevant to MD.

Interventions to Decrease Postoperative Edema and Ecchymosis after Rhinoplasty: A Systematic Review of the Literature.

BACKGROUND: Today, minimally invasive procedures are becoming more popular because of the fast recovery. Rhinoplasty is a common facial plastic surgery procedure that can be associated with significant postoperative morbidities, especially periorbital edema and ecchymosis. The aim of this review is to summarize the results of published literature that studied interventions that decrease postoperative edema and ecchymosis after rhinoplasty, and provide evidence-based strategies for surgeons to incorporate into practice. METHODS: A systematic review of the PubMed, Scopus, and EMBASE databases was performed to investigate interventions studied to decrease postoperative edema and ecchymosis after rhinoplasty. After inclusion and exclusion criteria were applied, articles were grouped into one of the following categories: corticosteroids, other medications and herbal supplements, interventions to decrease intraoperative bleeding, other postoperative interventions, and surgical techniques. RESULTS: A total of 50 articles were included for review. Fourteen articles studied corticosteroids exclusively, whereas another 10 articles reviewed other medications and herbal supplements. Nine articles evaluated methods to decrease intraoperative bleeding during rhinoplasty, and four articles studied postoperative interventions to decrease edema and ecchymosis. Thirteen articles studied various surgical techniques to decrease postoperative morbidities. CONCLUSIONS: There was a consensus within the literature that steroids, intraoperative hypotension, intraoperative cooling, and head elevation postoperatively decrease postoperative edema and ecchymosis, whereas nasal packing and periosteal elevation before osteotomy increased these postoperative morbidities. Studies of herbal supplements may be incorporated into practice with minimal risk to the patient. More studies must be performed before recommending an external or internal approach to lateral osteotomy.

Mucinous Adenocarcinoma of the Salivary Gland: A Review of a Rare Tumor.

OBJECTIVE: To describe the clinical, demographic, and prognostic features of salivary gland mucinous adenocarcinoma, a rare head and neck malignancy. STUDY DESIGN: Population-based national cancer registry analysis. SETTING: Academic medical center. SUBJECTS AND METHODS: A review was performed with the National Cancer Database from 1998 to 2012. Demographic, clinical, and survival characteristics were compiled and analyzed. Cox multivariate regression was used to identify predictors of survival. Log-rank tests were used to test survival differences unless otherwise specified. RESULTS: A total of 170 cases were identified. The most common site of involvement was the parotid gland. Rates of nodal and distant metastases were 45.9% and 10.6%, respectively. High histologic grade was associated with nodal disease (P < .001) and advanced-stage disease (P = .006). Overall 5- and 10-year survival rates were 60% and 44%, respectively. Multivariate analysis found tumor size ≥2 cm (hazard ratio, 22.6; 95% confidence interval: 4.06-126.09; P < .001) and distant metastases (hazard ratio, 17.6; 95% confidence interval: 3.75-82.68; P < .001) to predict poor outcomes. CONCLUSIONS: Mucinous adenocarcinoma of the salivary gland is a rare otolaryngic cancer. Regional metastases and advanced stage are more common with high histologic grade. Tumor size and distant metastases negatively influence survival.

Twenty-two-item Sino-Nasal Outcome Test in a control population: a cross-sectional study and systematic review.

BACKGROUND: The 22-item Sino-Nasal Outcome Test (SNOT-22) is a commonly utilized outcome measure for chronic rhinosinusitis (CRS). However, what constitutes a normal score remains poorly defined. The goal of this study was to evaluate SNOT-22 scores in a control population without CRS and perform a systematic review and meta-analysis of "normal" values. METHODS: Ninety-nine subjects without CRS were enrolled, with 95 fully completing the SNOT-22 questionnaire. Multivariable linear regression was used to determine whether demographic factors or medical comorbidities influence SNOT-22 scores in a population without CRS. A systematic literature search was performed, identifying studies that evaluated the SNOT-22 in a non-CRS population and estimates for SNOT-22 values were pooled. RESULTS: Thirty-six males and 59 females were included in the primary analysis with a mean age of 53.4 ± 17.3 years (range, 18-88 years). The mean SNOT-22 score was 16.4 ± 15.2. Asthma (p = 0.003) and depression (p = 0.002) were found to be independent predictors of higher SNOT-22 scores. Thirteen articles were identified in the literature search and 1 was provided via author correspondence, with 10 reporting sufficient data to be included in the meta-analysis. Weighted mean SNOT-22 score was 11 ± 9.4 (n = 1517). Our data differed significantly from published data (mean difference = 5.4; 95% confidence interval [CI], 3.4 to 7.5; p < 0.0001) likely owing to differences in comorbidities. CONCLUSION: SNOT-22 scores vary in non-CRS populations depending upon the group queried. Asthma and depression are associated with higher SNOT-22 scores and should be considered when determining what constitutes a normal value.

Case series: A novel technique for the treatment of external auditory canal stenosis.

External auditory canal (EAC) stenosis can exist as an isolated problem, as a component of craniofacial disorders, or in association with genetic syndromes. We present five cases and demonstrate the efficacy of a minimally invasive way of opening the EAC, facilitating better hearing, easier office examination, and allowing for other necessary treatments such as ear tube placement or use of a hearing aid. Follow-up ranged from 1 to 19 months, with all patients demonstrating significant improvement. We believe this is a novel surgical approach which is easy to perform, cost effective, and may be applicable to a wide range of patients.