American Academy Of Otolaryngology-Head And Neck Surgery Research Articles

American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Report on Artificial Intelligence.

This report synthesizes the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Task Force's guidance on the integration of artificial intelligence (AI) in otolaryngology-head and neck surgery (OHNS). A comprehensive literature review was conducted, focusing on the applications, benefits, and challenges of AI in OHNS, alongside ethical, legal, and social implications. The Task Force, formulated by otolaryngologist experts in AI, used an iterative approach, adapted from the Delphi method, to prioritize topics for inclusion and to reach a consensus on guiding principles. The Task Force's findings highlight AI's transformative potential for OHNS, offering potential advancements in precision medicine, clinical decision support, operational efficiency, research, and education. However, challenges such as data quality, health equity, privacy concerns, transparency, regulatory gaps, and ethical dilemmas necessitate careful navigation. Incorporating AI into otolaryngology practice in a safe, equitable, and patient-centered manner requires clinician judgment, transparent AI systems, and adherence to ethical and legal standards. The Task Force principles underscore the importance of otolaryngologists' involvement in AI's ethical development, implementation, and regulation to harness benefits while mitigating risks. The proposed principles inform the integration of AI in otolaryngology, aiming to enhance patient outcomes, clinician well-being, and efficiency of health care delivery.

Approach to otitis externa in Australian general practice.

Acute otitis externa (AOE) is an inflammatory condition of the outer ear seen in Australian general practice and isprevalent in tropical climates like NorthQueensland. This article aims to delineate key facets ofAOE, identify high-risk populations andpropose a streamlined management approach aligned with the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guideline, emphasising the role of primary care inoptimal patient care. Outlined within this article are key elements of AOE, from anatomy to riskfactors, examination, diagnosis, differentials, management, prevention andindications for referral. Emphasis isplaced on topical antibiotic use, drugdelivery techniques and recognising refractory cases. The importance of early intervention is highlighted to prevent complications, particularly in at-risk populations, aligned with AAO-HNS guidelines and enhancing general practice's role in mitigating AOE-related complications.

Evaluation and Treatment of Acute Facial Palsy: Opportunities for Optimization at a Single Institution.

Introduction: Most patients with acute facial palsy initially present to emergency departments (EDs), where clinical practice guidelines (CPGs) recommend steroids, eye care, and follow-up with facial nerve specialists. Objective: To evaluate adherence to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Bell's palsy (BP) CPGs within EDs at a single academic institution. Method: We conducted a retrospective review of all patients diagnosed with acute facial palsy in the EDs of an academic tertiary care center between June 1, 2021, and June 1, 2022. Results: A total of 270 patients met inclusion criteria; most were male (n = 150, 55.9%), diagnosed with BP (n = 243, 90.0%), and presented to community-based emergency rooms (n = 170, 62.96). Although most patients received steroid treatment (n = 243, 90.0%), only 61.5% (n = 166) received the AAO-HNS-recommended course. Older patients and those who received steroids were more likely to receive imaging (p < 0.001, p = 0.03). Treatment with the AAO-HNS-recommended steroid regimen was associated with a higher likelihood of receiving laboratory evaluation (p = 0.02). Providers often advised follow-up; however, only 12.2% of patients were discharged with an electronic referral order. Conclusion: There are opportunities to standardize the treatment of patients in the ED presenting with acute facial palsy according to AAO-HNS CPGs.

Utilization of Artificial Intelligence in the Creation of Patient Information on Laryngology Topics.

To evaluate and compare the readability and quality of patient information generated by Chat-Generative Pre-Trained Transformer-3.5 (ChatGPT) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using validated instruments including Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, DISCERN, and Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). ENTHealth.org and ChatGPT-3.5 were queried for patient information on laryngology topics. ChatGPT-3.5 was queried twice for a given topic to evaluate for reliability. This generated three de-identified text documents for each topic: one from AAO-HNS and two from ChatGPT (ChatGPT Output 1, ChatGPT Output 2). Grade level and reading ease were compared between the three sources using a one-way analysis of variance and Tukey's post hoc test. Independent t-tests were used to compare DISCERN and PEMAT understandability and actionability scores between AAO-HNS and ChatGPT Output 1. Material generated from ChatGPT Output 1 and ChatGPT Output 2 were at least two reading grade levels higher than that of material from AAO-HNS (p < 0.001). Regarding reading ease, ChatGPT Output 1 and ChatGPT Output 2 documents had significantly lower mean scores compared to AAO-HNS (p < 0.001). Moreover, ChatGPT Output 1 material on vocal cord paralysis had a lower PEMAT-P understandability compared to that of AAO-HNS material (p > 0.05). Patient information on the ENTHealth.org website for select laryngology topics was, on average, of a lower grade level and higher reading ease compared to that produced by ChatGPT, but interestingly with largely no difference in the quality of information provided. NA Laryngoscope, 2024.

Utilizing Artificial Intelligence to Increase the Readability of Patient Education Materials in Pediatric Otolaryngology.

Objectives: To identify the reading levels of existing patient education materials in pediatric otolaryngology and to utilize natural language processing artificial intelligence (AI) to reduce the reading level of patient education materials. Methods: Patient education materials for pediatric conditions were identified from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. Patient education materials about the same conditions, if available, were identified and selected from the websites of 7 children's hospitals. The readability of the patient materials was scored before and after using AI with the Flesch-Kincaid calculator. ChatGPT version 3.5 was used to convert the materials to a fifth-grade reading level. Results: On average, AAO-HNS pediatric education material was written at a 10.71 ± 0.71 grade level. After requesting the reduction of those materials to a fifth-grade reading level, ChatGPT converted the same materials to an average grade level of 7.9 ± 1.18 (P < .01). When comparing the published materials from AAO-HNS and the 7 institutions, the average grade level was 9.32 ± 1.82, and ChatGPT was able to reduce the average level to 7.68 ± 1.12 (P = .0598). Of the 7 children's hospitals, only 1 institution had an average grade level below the recommended sixth-grade level. Conclusions: Patient education materials in pediatric otolaryngology were consistently above recommended reading levels. In its current state, AI can reduce the reading levels of education materials. However, it did not possess the capability to reduce all materials to be below the recommended reading level.

An Analysis of the Otolaryngology Workforce in Pennsylvania.

This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania. Retrospective database. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) database and Centers for Medicare and Medicaid Services (CMS) Database. The AAO-HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and nonmetropolitan counties (codes 4-9) and determine county populations. A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training. There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.

Prediction of hearing recovery with deep learning algorithm in sudden sensorineural hearing loss

This study aimed to establish a deep learning-based predictive model for the prognosis of idiopathic sudden sensorineural hearing loss (SSNHL). Data from 1108 patients with SSNHL between January 2015 and May 2023 were retrospectively analyzed. Patients underwent standardized treatment protocols including high-dose steroid therapy and hearing outcomes were assessed after three months using Siegel’s criteria and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. For predicting patient recovery, a two-layered classification process was implemented. Initially, a set of 22 Multilayer Perceptrons (MLP) networks was employed to categorize the patients. The outcomes from this initial categorization were subsequently relayed to a second-layer meta-classifier for final prognosis determination. The validity of this methodology was ascertained through a K-fold cross-validation procedure executed with 10 distinct splits. The prediction model for complete recovery, based on Siegel’s criteria, demonstrated an accuracy of 0.892 and area under the curve (AUC) of 0.922. For the class A prediction, according to AAO-HNS classification, the model showed an accuracy of 0.847 and AUC of 0.918. These results suggest that the model may have the potential to contribute to the establishment of tailored patient management strategies by predicting hearing recovery in patients with SSNHL.

Improving readability and comprehension levels of otolaryngology patient education materials using ChatGPT

ObjectiveA publicly available large language learning model platform may help determine current readability levels of otolaryngology patient education materials, as well as translate these materials to the recommended 6th-grade and 8th-grade reading levels. Study designCross-sectional analysis. SettingOnline using large language learning model, ChatGPT. MethodsThe Patient Education pages of the American Laryngological Association (ALA) and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) websites were accessed. Materials were input into ChatGPT (OpenAI, San Francisco, CA; version 3.5) and Microsoft Word (Microsoft, Redmond, WA; version 16.74). Programs calculated Flesch Reading Ease (FRE) scores, with higher scores indicating easier readability, and Flesch-Kincaid (FK) grade levels, estimating U.S. grade level required to understand text. ChatGPT was prompted to “translate to a 5th-grade reading level” and provide new scores. Scores were compared for statistical differences, as well as differences between ChatGPT and Word gradings. ResultsPatient education materials were reviewed and 37 ALA and 72 AAO-HNS topics were translated. Overall FRE scores and FK grades demonstrated significant improvements following translation of materials, as scored by ChatGPT (p < 0.001). Word also scored significant improvements in FRE and FK following translation by ChatGPT for AAO-HNS materials overall (p < 0.001) but not for individual topics or for subspecialty-specific categories. Compared with Word, ChatGPT significantly exaggerated the change in FRE grades and FK scores (p < 0.001). ConclusionOtolaryngology patient education materials were found to be written at higher reading levels than recommended. Artificial intelligence may prove to be a useful resource to simplify content to make it more accessible to patients.

Is a Simple Checklist Associated With Improvement in Gender Representation at the AAO-HNSF Annual Meeting?

In September 2017, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) added 2 questions querying panel organizers if gender/racial diversity was considered in selecting panel presenters, beginning with the 2018 Annual Meeting (AM). This study examines how this checklist impacted the gender diversity of panel presenters at the AAO-HNS AM. This was a cross-sectional investigation comparing female representation before and after the addition of questions inquiring about diversity in 2018. A review of abstract submissions for the AMs from 2015 to 2021. AM Official Program Abstracts were used to obtain presenter names and specialty area for each panel. The percentage of female presenters, in total and stratified by specialty area, were compared before and after 2018 to quantify changes following the addition of the checklist. There was a significant increase in the proportion of female panel presenters from 22.3% (total n = 1199) in 2015 to 2017 to 33.0% (total n = 1868) in 2018 to 2021 (P < .001) and in all panel specialties. The number of female moderated panels also significantly increased after checklist implementation from 22% to 38% (P < .001). Correspondingly, the number of panels with no female representation decreased from 42% in 2015 to 2017 to 23% in 2018 to 2021 (P < .001). The addition of a checklist asking panel organizers to consider diversity in selecting panelists was associated with an increased proportion of female presenters at the AM. This simple strategy can be implemented by all medical conferences to help close the gender gap.

Intraoperative Hearing Monitoring Using ABR and TT-ECochG and Hearing Preservation during Vestibular Schwannoma Resection.

Background: Quick and appropriate diagnostics and the use of intraoperative monitoring (IM) of hearing during vestibular schwannoma (VS) resection increase the likelihood of hearing preservation. During surgery, various methods of IM can be used, i.e., auditory brainstem responses (ABRs), transtympanic electrocochleography (TT-ECochG), and direct cochlear nerve action potentials. The aim of the study was to evaluate the prognostic values of IM of hearing using ABR and TT-ECochG in predicting postoperative hearing preservation and to evaluate relationships between them during various stages of surgery. Methods: This retrospective study presents the pre- and postoperative audiological test results and IM of hearing records (TT-ECochG and ABR) in 75 (43 women, 32 men, aged 18-69) patients with diagnosed VS. Results: The preoperative pure tone average hearing threshold was 25.02 dB HL, while after VS resection, it worsened on average by 30.03 dB HL. According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Hearing Classification, before and after (pre/post) surgery, there were 47/24 patients in hearing class A, 9/8 in B, 2/1 in C, and 17/42 in D. In speech audiometry, the average preoperative speech discrimination score at an intensity of 60 dB SPL was 70.93%, and after VS resection, it worsened to 38.93%. The analysis of electrophysiological tests showed that before the tumor removal the I-V ABR interlatencies was 5.06 ms, and after VS resection, it was 6.43 ms. Conclusions: The study revealed correlations between worse postoperative hearing and changes in intraoperatively measured ABR and TT-ECochG. IM of hearing is very useful in predicting postoperative hearing in VS patients and increases the chance of postoperative hearing preservation in these patients.

ChatGPT Responses to Frequently Asked Questions on Ménière's Disease: A Comparison to Clinical Practice Guideline Answers.

Evaluate the quality of responses from Chat Generative Pre-Trained Transformer (ChatGPT) models compared to the answers for "Frequently Asked Questions" (FAQs) from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Clinical Practice Guidelines (CPG) for Ménière's disease (MD). Comparative analysis. The AAO-HNS CPG for MD includes FAQs that clinicians can give to patients for MD-related questions. The ability of ChatGPT to properly educate patients regarding MD is unknown. ChatGPT-3.5 and 4.0 were each prompted with 16 questions from the MD FAQs. Each response was rated in terms of (1) comprehensiveness, (2) extensiveness, (3) presence of misleading information, and (4) quality of resources. Readability was assessed using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES). ChatGPT-3.5 was comprehensive in 5 responses whereas ChatGPT-4.0 was comprehensive in 9 (31.3% vs 56.3%, P = .2852). ChatGPT-3.5 and 4.0 were extensive in all responses (P = 1.0000). ChatGPT-3.5 was misleading in 5 responses whereas ChatGPT-4.0 was misleading in 3 (31.3% vs 18.75%, P = .6851). ChatGPT-3.5 had quality resources in 10 responses whereas ChatGPT-4.0 had quality resources in 16 (62.5% vs 100%, P = .0177). AAO-HNS CPG FRES (62.4 ± 16.6) demonstrated an appropriate readability score of at least 60, while both ChatGPT-3.5 (39.1 ± 7.3) and 4.0 (42.8 ± 8.5) failed to meet this standard. All platforms had FKGL means that exceeded the recommended level of 6 or lower. While ChatGPT-4.0 had significantly better resource reporting, both models have room for improvement in being more comprehensive, more readable, and less misleading for patients.

Hearing preservation outcomes using direct cranial nerve eight and auditory brainstem response neuromonitoring in the resection of vestibular schwannomas.

Advancements in microsurgical technique and technology continue to improve outcomes in patients with skull base tumor. The primary cranial nerve eight monitoring systems used in hearing preservation surgery for vestibular schwannomas (VSs) are direct cranial nerve eight monitoring (DCNEM) and auditory brainstem response (ABR), although current guidelines are unable to definitively recommend one over the other due to limited literature on the topic. Thus, further research is needed to determine the utility of DCNEM and ABR. The authors performed a retrospective cohort study and created an interactive model that compares hearing preservation outcomes based on tumor size in patients receiving ABR+DCNEM and ABR-only monitoring. Twenty-eight patients received ABR+DCNEM and 72 patients received ABR-only monitoring during VS hearing preservation surgery at a single tertiary academic medical center between January 2008 and November 2022. Inclusion criteria consisted of adult patients with a preoperative American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) hearing classification of A or B. Tumor size was measured as the maximal medial to lateral length, including the internal auditory canal component. Overall hearing preservation (word recognition score [WRS] > 0%) was achieved in 31 patients with ABR-only monitoring (43.1%) and in 18 patients with ABR+DCNEM (64.3%). Serviceable hearing preservation (AAO-HNS class A or B) was attained in 19 patients with ABR-only monitoring (26.4%) and in 11 patients with ABR+DCNEM (39.3%). There was no difference in overall hearing preservation between the two groups (p = 0.13). Change in tumor size was not associated with the odds of serviceable hearing preservation for the ABR-only group (p = 0.89); however, for ABR+DCNEM, there was some indication of an interaction between tumor size and the association of ABR+DCNEM versus ABR-only monitoring, with the odds of serviceable hearing preservation at p = 0.089. Furthermore, with ABR+DCNEM, every 0.5-cm increase in tumor size was associated with a decreased odds of serviceable hearing preservation on multivariable analysis (p = 0.05). For both overall and serviceable hearing preservation, a worse preoperative AAO-HNS classification was associated with a decreased odds of preservation (OR 0.43, 95% CI 0.19-0.97, p = 0.042; OR 0.17, 95% CI 0.053-0.55, p = 0.0031, respectively). The result of this interactive model study proposes that there may be a higher chance of hearing preservation when using ABR+DCNEM rather than ABR alone for smaller tumors, with that relationship reversing as tumor size increases.

Crossing Borders: 95. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie vom 8. bis 11. Mai 2024 in Essen.

Dear colleagues,Dear readers,We are constantly developing innovative solutions and treatment concepts for our patients in our discipline. In this context, interdisciplinary collaboration is essential. The conference motto "Crossing Borders: interdisciplinary, international, interactive" of the 95th Annual Meeting of the German Society of Otorhinolaryngology, Head and Neck Surgery emphasizes the relevance of interdisciplinary cooperation and global exchange. This year, joint meetings with the European Laryngological Society (ELS) and the Rhinoplasty Society of Europe (RSE) will take place for the first time. The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) and the Confederation of European Otorhinolaryngology - Head and Neck Surgery (CEORL-HNS) are also involved in the scientific program. The interdisciplinary presentations offer insights into the most recent developments in the fields of head and neck oncology, skull base and orbital surgery, among others. They are a great opportunity to expand your own knowledge and exchange the latest research findings.

Female leadership representation within otolaryngology specialty societies

ObjectivesDetermine if women have continued parity in leadership in otolaryngology specialty societies as compared to a paper by Choi and Miller in 2012. Additionally, we wanted insight into obstacles female leaders faced by surveying them directly to better understand their experiences with gender bias. MethodsChi-squared test evaluation was done using the American Academy of Otolaryngology Head and Neck Surgery (AAOHNS) 2020 membership data and directly from various otolaryngology specialty societies. An anonymous survey to assess different experiences of leaders in various Otolaryngology specialty societies was sent to current and past leaders of specialty societies via email. Survey data was assessed using descriptive statistics and multivariate logistical analyses. Study Design: Cross-sectional study and survey study. ResultsFemale members comprised 19.3 % of practicing AAOHNS otolaryngologists. All societies had proportionate female leadership representation except for AAOA, which had greater representation. Compared to data from 10 years ago, female representation in all the societies' leadership has not changed significantly. Survey results demonstrated 64.9 % of respondents felt gender bias exists in Otolaryngology. 45.6 % of respondents personally experienced gender bias during their careers. Survey results showed males are less likely to experience gender bias. ConclusionThere is stability in the proportion of women in otolaryngology leadership positions compared to a decade ago largely due to efforts of leaders in the field. However, women leaders note experiencing gender bias and time away from clinical duties are prospective areas where support can be given. Level of evidence3.

Establishment of Nomogram for Prediction of Hearing Preservation after Retrosigmoid Approach in Patients with Vestibular Schwannoma.

To derive and validate a prognostic nomogram for the prediction of hearing preservation (HP) after retrosigmoid approach (RSA) in patients with vestibular schwannoma (VS) and further assist in clinical decision-making. Retrospective study. Tertiary referral center. A total of 111 patients diagnosed with VS with serviceable hearing from January 2013 to March 2023. All patients underwent surgery via RSA, and hearing outcomes were reviewed 2 weeks postoperatively. Preoperative and postoperative hearing were analyzed and stratified according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). In multivariate analysis of the primary group, preoperative hearing, tumor size, and tumor origin were significantly related to postoperative HP ( p = 0.029, p = 0.043, and p = 0.018, respectively). Factors derived from the multivariate analysis were all assembled into the nomogram. The receiver operating characteristic (ROC) curves showed good predictive accuracy of the nomogram model in both primary and validation groups with area under the ROC curve (AUC) values of 0.802 and 0.797, respectively. Independent predictors of postoperative HP in patients with VS were selected to create the nomogram. The nomogram was able to stratify patients into different risk groups and assist in clinical decision making.

The diagnostic performance of cochlear endolymphatic hydrops and perilymphatic enhancement in stratifying Ménière's disease probabilities: A meta-analysis of semi-quantitative MRI-based grading systems.

The diagnosis of Meniere's Disease (MD) presents significant challenges due to its complex symptomatology and the absence of definitive biomarkers. Advancements in MRI technology have spotlighted endolymphatic hydrops (EH) as a key pathological marker, necessitating a reevaluation of its diagnostic utility amidst the need for standardized and validated MRI-based grading scales. Our meta-analysis scrutinized the diagnostic efficacy of semi-quantitative MRI-based cochlear endolymphatic hydrops (EH) and perilymphatic enhancement (PLE) grading systems in delineating clinically relevant discriminations: "Spotting" the shift from normal or asymptomatic ears to possible/probable MD (pMD), "Confirming" the progression to definite MD (dMD), and "Establishing" the presence of dMD. A thorough literature search up to October 2023 resulted in 35 pertinent studies, forming the basis of our analysis through a bivariate mixed-effects regression model. Using criteria from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and Barany Society, across varying thresholds and disease probabilities; the Establishment model at an EH grade 1 threshold revealed a sensitivity of 85.4% and a specificity of 82.7%. Adjusting the threshold to EH grade 2 results in a sensitivity increase to 92.1% (CI: 85.9-95.7) and a specificity decrease to 70.6% (CI: 64.5-76.1), with a DOR of 28.056 (CI: 14.917-52.770). The Confirmation model yields a DOR of 5.216, indicating a lower diagnostic accuracy. The Spotting model demonstrates a sensitivity of 48.3% (CI: 34.8-62.1) and a specificity of 88.0% (CI: 77.8-93.9), with a DOR of 6.882. The normal ears subgroup demonstrated a notably high specificity of 89.7%, while employing Nakashima's criteria resulted in a reduced sensitivity of 74.9%, significantly diverging from other systems (p-value < 0.001). The PLE grading system showcased exceptional sensitivity of 98.4% (CI: 93.7-99.6, p-value < 0.001). Our meta-analysis supports a tailored diagnostic approach for MD, emphasizing the need for effective grading systems at each stage. For "Spotting," the model shows high specificity but requires improved sensitivity, suggesting additional criteria are needed. The "Confirming" stage highlights the need for refined, sensitive grading systems due to lower diagnostic accuracy. In the "Establishing" stage, an EH grade 1 threshold is effective, but grade 2 enhances sensitivity while reducing specificity, indicating a need for balance. The PLE grading system excels in sensitivity, making it highly reliable. High specificity in the normal ears subgroup confirms accurate non-pathological distinction, though Nakashima's criteria show reduced sensitivity, underscoring variability in grading systems. These findings advocate for a standardized, unified grading system balancing sensitivity and specificity across all MD stages to optimize diagnostics and clinical outcomes.

The Effect of Rivaroxaban in the Complementary Therapy of Sudden Sensorineural Hearing Loss

Abstract Background: Due to the importance of sudden sensorineural hearing loss (SSNHL) and the possible role of blood coagulation in its mechanism and the likely therapeutic effect of anticoagulants and also the lack of studies in this field, this study aimed to evaluate the effect of rivaroxaban (RXA) in the treatment of this disease. Materials and Methods: The present double-blind randomized clinical trial study was performed on 34 patients with SSNHL. Patients were randomly divided into two groups. In the first group, in addition to corticosteroid therapy (CST), RXA 10 mg tablets were used daily for 10 days (RXA group), and in the second group, only CST (CST group) treatment was prescribed. Hearing recovery was then assessed and recorded according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) criteria. Results: This study showed that the grade of hearing recovery in the RXA group (58.8%) was higher than the CST group (47.1%), but this difference was not significant (P value &gt;0.05). Also, RXA treatment increased the odds of hearing recovery, and this difference was not statistically significant (odd ratio (95% confidence interval)(OR (95% CI): 2.327 (0.180–18.082); P value = 0.518). In contrast, delay to treatment, more increased PTA (pure tone average (PTA)), and having vertigo reduced the odds of hearing recovery by 0.138-, 0.019-, and 0.069-fold, respectively (P value &lt;0.05). Conclusion: According to the results of this study, although the percentage of hearing recovery was higher in the RXA group, in general, the results of the two treatments were not significantly different.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2022.

To review new drugs and devices relevant to otolaryngology approved by the Food and Drug Administration (FDA) in 2022. Publicly available FDA data on drugs and devices approved in 2022. A preliminary screen was conducted to identify drugs and devices relevant to otolaryngology. A secondary screen by members of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) Medical Devices and Drugs Committee differentiated between minor updates and new approvals. The final list of drugs and devices was sent to members of each subspecialty for review and analysis. A total of 1251 devices and 37 drugs were identified on preliminary screening. Of these, 329 devices and 5 drugs were sent to subspecialists for further review, from which 37 devices and 2 novel drugs were selected for further analysis. The newly approved devices spanned all subspecialties within otolaryngology. Many of the newly approved devices aimed to enhance patient experience, including over-the-counter hearing aids, sleep monitoring devices, and refined CPAP devices. Other advances aimed to improve surgical access, convenience, or comfort in the operating room and clinic. Many new devices and drugs are approved each year to improve patient care and care delivery. By staying up to date with these advances, otolaryngologists can leverage new innovations to improve the safety and quality of care. Given the recent approval of these devices, further studies are needed to assess long-term impact within the field of otolaryngology.

"The Pedagogical Legacy of Dr. Chevalier Jackson: An Archival Visit to the John Q. Adams History Center at the American Academy of Otolaryngology-Head and Neck Surgery".

This article explores the historic records of the American Academy of Otolaryngology-Head and Neck Surgery's (AAO-HNS) John Q. Adams Center for the History of Otolaryngology-Head and Neck Surgery, with particular attention paid to the Dr. Chevalier Jackson Collection. The library houses diverse materials that would be of interest to medical historians seeking to understand the early innovations in our specialty. With a repository of over 2200 items chronicling over 200-years of otolaryngological history, the library contains special collections dedicated to Drs. Maurice H. Cottle, Samuel Rosen, Adam Politzer, and Chevalier Jackson. An original aim of this visit sought to understand Dr. Jackson's early contributions to the fields of laryngology, bronchology, and esophagology; yet, an intimate review of his works, including autobiographical material, reveals a fascinating pedagogical legacy.

Factors associated with hearing outcomes after a middle fossa approach in 131 consecutive patients with vestibular schwannomas.

The middle fossa approach is an effective option for the treatment of small (Koos grade I and II) vestibular schwannomas (VSs) when the goal is hearing preservation. The authors evaluated the rates of hearing preservation and examined the factors associated with improved hearing outcomes after the middle fossa approach for VSs. In this retrospective, single-center cohort study evaluating the clinical outcomes after resection of small VSs using the middle fossa approach, consecutive adult patients (> 18 years) who underwent surgery between January 2000 and December 2021 were included. Clinical and imaging characteristics were analyzed, including baseline hearing status, duration of surgery, anesthetic parameters, and imaging characteristics of the surgically treated tumors. Among the 131 included patients, 102 had valid and discoverable pre- and postoperative audiology assessments. The mean follow-up was 26 months (range 1-180 months). There were 85 patients with serviceable hearing preoperatively, defined as American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) class A or B, of whom 78% retained class A or B hearing at the last follow-up. Binary logistic regression demonstrated that preoperative hearing AAO-HNS class (OR 0.19, 95% CI 0.05-0.77; p = 0.02), overlap between fundus and cochlea (OR 0.32, 95% CI 0.11-0.96; p = 0.04), and duration of anesthesia (OR 0.98, 95% CI 0.97-0.99; p = 0.03) were independent predictors of hearing outcomes. Additionally, 75% of patients with high diffusion-weighted imaging signal in the tumor (p = 0.009) and 67% of patients with the tumor originating at the modiolus of the cochlea (p = 0.004) had poor hearing outcomes. The hearing preservation rates after microsurgical resection of small VSs using the middle fossa approach are high, with 78% of patients maintaining AAO-HNS class A or B hearing. Poor hearing status at baseline, longer duration of anesthesia, and large overlap between the fundus of the internal auditory canal and the cochlea were independently associated with unfavorable hearing outcomes. Imaging characteristics can be used to stratify patients' risk of hearing loss.