A Mouse Model of Dysphagia After Facial Nerve Injury.

OBJECTIVE: Dysphagia is common following facial nerve injury; however, research is sparse regarding swallowing-related outcomes and targeted treatments. Previous animal studies have used eye blink and vibrissae movement as measures of facial nerve impairment and recovery. The purpose of this study was to create a mouse model of facial nerve injury that results in dysphagia to enhance translational research outcomes. STUDY DESIGN: Prospective animal study. METHODS: Twenty C57BL/6J mice underwent surgical transection of the main trunk (MT) (n = 10) or marginal mandibular branch (MMB) (n = 10) of the left facial nerve. Videofluoroscopic swallow study (VFSS) assays for drinking and eating were performed at baseline and 14 days postsurgery to quantify several deglutition-related outcome measures. RESULTS: VFSS analysis revealed that MT transection resulted in significantly slower lick and swallow rates during drinking (P ≤ .05) and significantly slower swallow rates and longer inter-swallow intervals during eating (P ≤ .05), congruent with oral and pharyngeal dysphagia. After MMB transection, these same VFSS metrics were not statistically significant (P > .05). CONCLUSION: The main finding of this study was that transection of the facial nerve MT leads to oral and pharyngeal stage dysphagia in mice; MMB transection does not. These results from mice provide novel insight into specific VFSS metrics that may be used to characterize dysphagia in humans following facial nerve injury. We are currently using this surgical mouse model to explore promising treatment modalities such as electrical stimulation to hasten recovery and improve outcomes following various iatrogenic and idiopathic conditions affecting the facial nerve. LEVEL OF EVIDENCE: NA Laryngoscope, 131:17-24, 2021.

The state of diversity based on race, ethnicity, and sex in otolaryngology in 2016.

OBJECTIVE: To compare the representation of women and racial minorities among otolaryngology residents and faculty to other surgical specialties. METHODS: Information from 2016 regarding female and minority representation among medical school graduates, otolaryngology applicants, otolaryngology residents, otolaryngology faculty and residents, and faculty in other surgical specialties was obtained from the publicly available registries from the American Medical Association and the American Association of Medical Colleges. The data obtained was used to explore the differences between the various stages of training in otolaryngology and to compare the female and minority diversity of otolaryngology residents with residents in other surgical specialties. RESULTS: Women and African Americans were underrepresented at the resident level compared with their level of representation as medical school graduates. Women were underrepresented in otolaryngology resident applicants (P < .001), but equally represented between otolaryngology residency applicants and residents (P = .582). African Americans were equally represented between medical school graduates and otolaryngology resident applicants (P = .871), but underrepresented in otolaryngology residents (P < .001). Asian Americans and Hispanics were underrepresented among otolaryngology faculty compared with their representation in otolaryngology residency programs (P < .001, P < .001, respectively). Otolaryngology has the lowest percentage of African-American residents and faculty compared to other surgical specialties. The representation of women in otolaryngology residencies is higher than most surgical specialties but worse than general surgery, integrated plastics, and medical school graduates. CONCLUSION: Otolaryngology lags behind other surgical specialties in representation of minorities and women. Continued efforts should be made to increase diversity in the field of otolaryngology, especially in regard to underrepresented minorities. LEVEL OF EVIDENCE: 3 Laryngoscope, 2019.

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

Pain-only complaint about cochlear implant device: A five-patient pediatric experience.

OBJECTIVES: To present the case histories and management of five pediatric patients who experienced pain at the receiver-stimulator site, but no other indication that the device was failing. Patients were from a sole-surgeon pediatric practice (600 + implant surgeries before June 2013; about even proportions of Advanced Bionics, Cochlear Corporation, and MED-EL devices). METHODS: The University Institutional Review Board-approved review of sole-surgeon pediatric case series. RESULTS: The onset of pain ranged from 2 to 16 years post implantation. Pain, not amenable to conventional medical therapy, was present regardless of whether or not the external appliance was 'on', or even being worn on the head. Four of the five patients were bilaterally implanted, but pain was only at one receiver-stimulator package. Clinical management ultimately included revision surgery in all five cases, with immediate resolution of the pain in four. For those four, the replacement cochlear implant (CI) performed well; the other patient fears pain if her replacement device is used, but continues enjoying her contralateral implant. At analysis by the company, two of five explanted devices exhibited problems: loss of hermeticity; insulation failure. DISCUSSION: Though infrequently reported, pain-only complaint by a CI user is a challenging dilemma. CONCLUSION: Pain may be the sole clinical manifestation of cochlear implant device failure. We offer a flowchart for the care of CI patients with pain, encourage a worldwide registry of such cases, and offer ideas to try to understand better the problem.

Site for bone-anchored hearing system for children younger than 5 years.

OBJECTIVE: To describe in children younger than the present US FDA-approved 5 years of age the thickest part of the temporal bone available for placement of a bone-anchored hearing system. Children with unilateral hearing loss, as with aural atresia, have deficits in at least language comprehension and oral expression. The early provision of hearing to the atretic ear may minimize the potential for auditory deprivation. STUDY DESIGN: Point prevalence descriptive study. SETTING: Tertiary referral pediatric hospital. SUBJECTS AND METHODS: Thirty-eight patients less than 6 years old with congenital aural atresia had undergone temporal bone computed tomography (CT). Bone thickness lateral (ie, superficial) to the sinodural angle, in the topmost axial CT slice that included any adjacent petrous ridge, was measured. RESULTS: The mean bone thicknesses lateral to the sinodural angles of the atretic ears were 5.1, 5.0, 5.9, 5.2, 5.2, and 4.8 mm for the <1, 1-, 2-, 3-, 4-, 5-year-olds, respectively; of the non-atretic ears, thicknesses were 4.1, 4.9, 5.5, 6.7, 4.3, and 4.7 mm. CONCLUSION: Based on this small case series, bone thickness lateral (ie, superficial) to the sinodural angle is sufficient for many children suffering from aural atresia to have bone-anchored hearing devices implanted younger than age 5 years. Use of the sinodural site would require a magnetic bone-anchored hearing system, which could be repositioned posteriorly at age 5 years when pinna construction and atresiaplasty endeavors typically begin.