Evaluation of the possible effect of magnetic resonance imaging noise on peripheral hearing organ with the otoacoustic emission
Cevahir Bulut Turay, Fulya Ozer, Tulin Yildirim, Seyra Erbek
In Press, Journal Pre-proof, Available online 20 June 2020
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Abstract
Abstract
Purpose
The aim of this study is to evaluate the effect of noise produced by magnetic resonance imaging (MRI) device on hearing by using objective and subjective audiological assessments.

Methods
A total of 38 patients between the ages of 18 and 50 without hearing loss, and had performed MRI for brain, head, neck or cervical imaging were included in this prospective clinical study. Pure tone audiometry, speech audiometry, high frequency audiometry, transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emission (DPOAE) were performed before and after MRI.

Results
There was no statistically significant difference in TEOAE, pure tone audiogram, high frequency audiogram and speech audiogram thresholds. In DPOAE, the median value before and after MRI at the frequency of the left ear at 4.0 kHz was 13.6 (8.5–19.9) and 15.7 (8.9–20.7) SNR respectively (p > .05). The median value before MRI at the right ear 4.0 kHz frequency was 14.1 (9.1–20.5) SNR, whereas the median value after MRI was 13.2 (8.8–19.8 SNR (p = 0,03). There was no statistically significant difference in other frequencies in DPOAE.

Conclusions
This is the first objective study that examines the MRI noise on speech audiometry and otoacoustic emission together. However, the effect of MRI noise on hearing pathway is still doubt. Based on the difference at 4 kHz frequency on DPOAE; on-earphones may not sufficiently protect the patients from the MRI noise and this issue should deserve further research.

select article Evaluation of the perioperative effects of dexmedetomidine on tympanoplasty operations
Research articleAbstract only
Evaluation of the perioperative effects of dexmedetomidine on tympanoplasty operations
Muge Kosucu, Ersagun Tugcugil, Bengu Cobanoglu, Erhan Arslan
In Press, Journal Pre-proof, Available online 20 June 2020
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Abstract
Abstract
Purpose
This randomized double-blind study aimed to evaluate the effects of dexmedetomidine on hemodynamic parameters and the quality of surgery and recovery criteria in tympanoplasty operations.

Materials and methods
A total of 75 patients 18–55 years undergoing tympanoplasty, who were graded as American Society of Anesthesiologists physical status I-II, were randomly divided into three groups. Group 1 included patients receiving remifentanil alone, Group 2 included patients receiving dexmedetomidine + remifentanil and Group 3 included patients receiving dexmedetomidine + ½ remifentanil. Anesthesia was induced with propofol and cisatracurium. For maintenance of anesthesia, a mixture of 2–2.5% sevoflurane, 40–60% oxygen/air was used. The groups were compared in terms of hemodynamic parameters, surgical area, recovery criteria, modified Aldrete, pain scores, additional analgesic requirements and adverse effects.

Results
Mean arterial pressure and heart rate values of Group 1 were higher at the time of intubation, incision, spontaneous breathing and extubation compared to Group 2 and Group 3. Surgical field satisfaction was higher in Group 2 and Group 3 than Group 1. Spontaneous breathing, eye opening and verbal cooperation times were shorter in Group 3 compared to Group 2. Eye opening and verbal cooperation times were longer in Group 2 compared to Group 1. The 30-minute modified Aldrete scores was higher in Group 3 compared to Group 1. There was no difference between the groups in terms of postoperative pain and adverse effects.

Conclusion
The use of dexmedetomidine during tympanoplasty operations may provide better hemodynamic control and surgical view, may provide faster recovery and may reduce remifentanil consumption.

select article Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease
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Cervical necrotizing fasciitis affects only immunocompromized patients? Diagnostic challenges, treatment outcomes and clinical management of eleven immunocompetent adult patients with a still fatal disease
Giorgos Sideris, Thomas Nikolopoulos, Alexander Delides
In Press, Journal Pre-proof, Available online 20 June 2020
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Abstract
Abstract
Purpose
Cervical Necrotizing fasciitis (CNF) has been reported as an unusual rapidly progressive, life-threatening, inflammatory disease that is known to affect predominately immunocompromised patients. Few case reports have been sporadically published involving immunocompetent adults. This is the first study presents a series of immunocompetent CNF patients.

Materials and methods
A retrospective chart review study was performed on immunocompetent adults with CNF from January 2011 to December 2020. The diagnosis was histologically confirmed. We analyzed epidemiological, clinical, laboratory and imaging findings and discussed them along with the treatment plan.

Results
A total of eleven adult patients were included in the study. The average age was 43 years, ranging from 17 to 62 years. The average hospitalization time was 28 days, ranging from 10 to 129 days. All patients presented with cervical erythema and odynophagia. The causative factors are known in nine patients. Tissue cultures demonstrated mixed flora in six patients. Seven underwent a temporary tracheostomy. Wide neck exploration incisions were performed in all patients as the diagnosis was established after imaging findings. In nine cases the anterior-upper mediastinum was affected but only in two patients extension of the surgical planes to the mediastinum was performed. Four patients developed polyserositis. Nine patients survived and two developed multiorgan failure and died.

Conclusion
There seem to be no differences between immunocompetent and immunocompromised CNF patients, in regards to clinical, imaging and laboratory findings as well as their treatment plan.

select article Otolaryngology-related Google Search trends during the COVID-19 pandemic
Research articleFull text access
Otolaryngology-related Google Search trends during the COVID-19 pandemic
Matthew M. Pier, Luke J. Pasick, Daniel A. Benito, Ghiath Alnouri, Robert T. Sataloff
In Press, Journal Pre-proof, Available online 19 June 2020
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Abstract
Abstract
Objective
To assess trends of Google Search queries for symptoms and complaints encountered commonly in otolaryngology practices during the coronavirus disease 2019 (COVID-19) pandemic when in-person care has been limited.

Materials and methods
In this cross-sectional study, data on Google Search queries in the United States for 30 otolaryngology-related terms were obtained from Google Trends. The means of relative search volume from the COVID-19 period (March 29, 2020 through May 16, 2020) were compared to similar periods from 2016 to 2019 using a t-test of two independent samples.

Results
In total, 16.6% of search terms had significant increases in relative search volume during the COVID-19 period, with the largest percentage increase for “can't smell” (124.4%, p = .006), followed by “allergies” (30.3%, p = .03), “voice pain” (26.1%, p = .008), and “ears ringing” (19.0%, p < .001). Of all search terms, 26.7% had significant decreases in relative search volume, including the largest percentage decrease for “laryngitis” (59.8%, p < .001), followed by “thyroid nodule” (54.4%, p < .001), “thyroid cancer” (45.6%, p < .001), and “ENT” (34.9%, p < .001).

Conclusion
This study demonstrates that Google search activity for many otolaryngology-related terms during the COVID-19 pandemic has increased or decreased significantly as compared to previous years. With reduced access to in-office otolaryngology care in the United States during the COVID-19 pandemic, these are important considerations for otolaryngology practices to meet the needs of patients who lack access to care.

select article Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?
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Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?
M. Tayyar Kalcioglu, Muhammed Zeki Yalcin, Osman Kilic, Ozan Tuysuz, ... Osman Ilkay Ozdamar
In Press, Journal Pre-proof, Available online 19 June 2020
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Abstract
Abstract
Purpose
Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty.

Materials and methods
Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted.

Results
Fourteen patients came for control examination. The follow-up period was between 87 and 135 months (mean 102 months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24 months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500 Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000 Hz.

Conclusions
As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

select article Correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness after treatment
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Correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness after treatment
Jian-Ping Si
In Press, Journal Pre-proof, Available online 18 June 2020
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Abstract
Abstract
Objective
To discuss the correlation between effectual time and the curative effect in patients with all frequency descending sudden deafness.

Methods
According to effectual time, the subjects were divided into first week effectual group and second week effectual group and the curative effect of each group was compared.

Results
In patients with flat descent sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, but there was no significant difference between the two groups (χ2 = 1.584, P = 0.208). Meanwhile, the total significant effective rate of the first week effectual group was higher than that of the second week effectual group, without obvious difference between the two groups (χ2 = 0.227, P = 0.634). Furthermore, in patients with total deafness type of sudden deafness, the curative rate of the first week effectual group was higher than that of the second week effectual group, showing no remarkable difference between the two groups (χ2 = 2.726, P = 0.099). Besides, there was no remarkable difference in the comparison of the total significant effective rate (χ2 = 2.933, P = 0.087), which was higher in the first week effectual group than that in the second week effectual group.

Conclusion
The course of treatment should be at least 2 weeks in patients with all frequency descending sudden deafness after onset.

select article Follow-up after failed newborn hearing screening: Parental and primary care provider awareness
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Follow-up after failed newborn hearing screening: Parental and primary care provider awareness
Jose M. Juarez, Amber D. Shaffer, David H. Chi
In Press, Journal Pre-proof, Available online 18 June 2020
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Abstract
Abstract
Purpose
The current loss to follow-up rate after failed newborn hearing screening (NBHS) is 34.4%. Previous studies have found that lack of parental and primary care provider (PCP) awareness of NBHS results are significant contributors to loss to follow-up. The objective of this study was to identify factors associated with parental and PCP awareness of NBHS results.

Materials and methods
Retrospective cohort study. A survey asking about demographics and knowledge of NBHS testing and results was offered to parents in the waiting room of an urban pediatric primary care office. Included were biological parents ≥18 years of age of children ≤10 years of age born in Pennsylvania. Each child's chart was reviewed for PCP documentation of NBHS results. The odds of knowing NBHS results were evaluated using logistic regression.

Results
The survey was completed by 304 parents. 74.0% were aware of their child's NBHS results. Child age ≥1 year old (OR: 0.49, 95%CI[0.29, 0.82], P = 0.007) and Hispanic ethnicity (OR: 0.38, 95%CI[0.16, 0.89], P = 0.03) were associated with decreased odds of a parent knowing NBHS results. In addition, fewer fathers knew the results of their child's NBHS compared with mothers (OR: 0.33, 95%CI[0.18, 0.62], P < 0.001). However, parental awareness was not associated with birthing facility or insurance type. 222 charts were reviewed for NBHS documentation, revealing PCP awareness in 95.5% of cases and no associations with any of the factors examined.

Conclusions
Factors associated with parents not knowing NBHS results included being the parent of an older child, Hispanic, or the father.

select article Surgical management and outcomes of accessory parotid gland neoplasms: A systematic review
Review articleAbstract only
Surgical management and outcomes of accessory parotid gland neoplasms: A systematic review
Luke J. Pasick, Jane Y. Tong, Daniel A. Benito, Punam Thakkar, ... Arjun S. Joshi
In Press, Journal Pre-proof, Available online 16 June 2020
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Abstract
Abstract
Objective
To evaluate surgical approaches and outcomes associated with accessory parotid gland neoplasms.

Data sources
MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials.

Review methods
A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed. Studies were included if they reported surgical management and outcomes of patients with accessory parotid gland neoplasms.

Results
After screening 3532 records, 15 studies were included with a total of 187 patients. Benign tumors consisted of 61.5% of cases. External open, transoral, and preauricular endoscopic approaches were used for 82.3%, 11.3%, and 6.5% of cases, respectively. Accessory lobe resection alone, concurrent with partial parotidectomy, and concurrent with total parotidectomy were used in 54.8%, 43.0%, and 2.2% of cases, respectively. Complication rates were similar between histology groups (7.8% benign vs. 8.3% malignant, p = 0.82). Accessory lobe resection with concurrent partial parotidectomy had the lowest overall complication rate (6.3%). Resections limited to the accessory lobe were found to have an overall complication rate of 8.7%.

Conclusion
The results offer an overview of the surgical management and complications for accessory parotid gland tumors. Overall surgical complication rates found in these case series may be lower for management of accessory gland tumors than rates available in the literature for tumors within the main parotid gland.

select article Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study
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Acceptance and commitment therapy combined with vestibular rehabilitation for persistent postural-perceptual dizziness: A pilot study
Junya Kuwabara, Masaki Kondo, Kayoko Kabaya, Wakako Watanabe, ... Tatsuo Akechi
In Press, Journal Pre-proof, Available online 11 June 2020
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Abstract
Abstract
Purpose
This study investigated the feasibility of acceptance and commitment therapy for persistent postural-perceptual dizziness and preliminarily verified the long-term effectiveness of the therapy.

Materials and methods
This study implemented the within-group pre–post comparison design. We enrolled 27 adult patients who met the criteria of persistent postural-perceptual dizziness. They underwent a treatment program including acceptance and commitment therapy combined with vestibular rehabilitation once a week for a total of six sessions. The primary outcome was changes in the Dizziness Handicap Inventory score 6 months posttreatment.

Results
All 27 patients completed the acceptance and commitment therapy + vestibular rehabilitation program, and 25 patients (92.6%) could be followed for 6 months posttreatment. For 27 participants, the scores from pretreatment to 6 months posttreatment significantly declined (P < .001), and the Dizziness Handicap Inventory effect size was 1.11 (95% confidence interval = 0.80–1.42). At 6 months posttreatment, 11 patients (40.7%) achieved remission (the score ≤ 14), 16 (59.3%) achieved treatment response (reduction in the score ≥ 18), and 20 (74.1%) achieved remission and/or treatment response.

Conclusions
Acceptance and commitment therapy is feasible for persistent postural-perceptual dizziness and might have long-term effectiveness. However, a randomized controlled trial is warranted.

select article The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results
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The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results
Nurullah Seyhun, Uğur Doğan, Zeynep Aslı Batur Çalış, Mehmet Fatih Kaya, ... Suat Turgut
In Press, Journal Pre-proof, Available online 10 June 2020
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Abstract
Abstract
Purpose
Major salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.

Materials and methods
We retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.

Results
The number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).

Conclusions
FNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.

select article Stapedectomy in patients with dehiscent and prolapsed facial nerve
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Stapedectomy in patients with dehiscent and prolapsed facial nerve
Erol Senturk, Sabri Baki Eren, Fadlullah Aksoy, Nurtaç Dagistanli, ... Orhan Ozturan
In Press, Corrected Proof, Available online 5 June 2020
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Abstract
Abstract
Objective
The aim of this study is to apply the modified stapedectomy technique in cases with dehiscent and prolapsed facial nerve canal, and to compare the postoperative results with those with normal facial nerve canal anatomy.

Material and method
28 patients who underwent primary stapedectomy were included. Of the patients, 17 were in the normal anatomical facial nerve group, and 11 were in the dehiscent and prolapsed facial nerve group. Facial nerve was retracted with micro elevator in dehiscent and prolapsed group. and Titanium-Teflon prosthesis was angled and used in accordance with facial nerve course at this group.

Result
No facial paresis or paralysis was observed in any patient postoperatively. In the first year, no significant difference was found in terms of air-bone gap.

Conclusion
It is safe to retract the facial nerve for a limited time in cases of stapedectomy in cases with dehiscent and prolapsed facial nerve canal. In these cases, modifying the stapedial prosthesis in accordance with the facial nerve course does not cause disadvantage in terms of hearing gain.

select article Incorporation of telemedicine by rhinologists: The COVID-19 pandemic and beyond
Research articleFull text access
Incorporation of telemedicine by rhinologists: The COVID-19 pandemic and beyond
Peter Svider, Michael Setzen, Randall Ow, Adam J. Folbe, ... Andrew P. Johnson
In Press, Journal Pre-proof, Available online 2 June 2020
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Abstract
Abstract
Objectives
The current analysis queries rhinologists' attitudes about the use of telemedicine, including the degree to which it has impacted practice patterns during the COVID-19 pandemic. Our objective was to survey rhinologists and understand the extent to which telemedicine serves as a rejoinder to in-person consultation: appreciation of relevant factors may be important in planning for present and future considerations.

Methods
A 14-question anonymous survey sent out to the American Rhinologic Society (ARS) membership in April 2020. It included demographic factors and detailed questions examining the extent of telemedicine use. Numerous topics including the degree of use, satisfaction with services, and utility of services were evaluated.

Results
There were 134 respondents. Most reported seeing ≤30% of typical in-person volume, with 14.8% not seeing any patients at all. 88.1% used telemedicine; 82.0% reported some level of satisfaction with telemedicine. The vast majority utilized platforms employing audio and video (83.3%), and a plurality reported spending 5–15 min on calls. Numerous reasons were cited for the use of telemedicine, including significant public health benefits amid the crisis (89.7%). Only 12.0% of respondents reported using telemedicine for hospital consultation.

Conclusion
Rhinologists have embraced telemedicine during the COVID-19 pandemic in an attempt to improve accessibility, patient satisfaction, and revenue stream. When utilized appropriately, this technology obviates the need for seeing at-risk patients and performing procedures such as nasal endoscopy. Only a minority of rhinologists was dissatisfied, viewing this as a temporary fix during the pandemic.

select article Transoral floor of mouth lipoma resection: A technical multimedia analysis
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Transoral floor of mouth lipoma resection: A technical multimedia analysis
Christopher L. Kalmar, Vijay A. Patel, Guy Slonimsky
In Press, Corrected Proof, Available online 2 June 2020
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Abstract
Abstract
Lipomas are common benign mesenchymal tumors that originate from mature adipocytes throughout the body, with 13–20% occurring in the head and neck region, however only 1–4.4% affect the oral cavity, where they are found predominately in the cheek, followed by the tongue, lips, palatal mucosa, gingiva, and floor of the mouth. Herein, we present a multimedia analysis of transoral floor of mouth lipoma resection in a 58-year-old female. Learning points include (1) Identification and stenting of Wharton's ducts in order to facilitate their functional preservation and to minimize risk of postoperative sialocele; (2) postoperative observation with airway monitoring due to expected floor of mouth edema; (3) utilization of a midline incision to minimize injury to Wharton's ducts and maximize bilateral access to the floor of mouth.

select article An open-label, multicentre, randomized comparative study of efficacy, safety and tolerability of the 5 plant - extract BNO 1012 in the Delayed Antibiotic Prescription Method in children, aged 6 to 11 years with acute viral and post-viral rhinosinusitis
Research articleOpen access
An open-label, multicentre, randomized comparative study of efficacy, safety and tolerability of the 5 plant - extract BNO 1012 in the Delayed Antibiotic Prescription Method in children, aged 6 to 11 years with acute viral and post-viral rhinosinusitis
Vasyl I. Popovych, Halyna V. Beketova, Ivana V. Koshel, Olha A. Tsodikova, ... Liudmyla I. Vakulenko
In Press, Journal Pre-proof, Available online 1 June 2020
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Abstract
Abstract
Acute rhinosinusitis (ARS) can be characterized as bacterial (ABRS) and require antibiotic therapy only in 0.5–5% of cases. In most cases, the disease is in a viral and post-viral form, which requires pathogenetic and symptomatic treatment.

The study objective was to determine the efficacy of BNO 1012 extract in the technology of delayed antibiotic prescribing in children with acute rhinosinusitis.

Methods
292 children aged 6 to 11 years with ARS were randomized in the multicenter, comparative study. They received an extract of five medicinal plants in addition to standard symptomatic therapy or standard therapy only.

Evaluation criteria
reduction of the sinusitis severity according to a 4-point medical assessment scale (nasal congestion, severity of anterior and posterior rhinorrhea) at each visit, dynamics of self-scoring of rhinorrhea and headache (according to a 10-point visual analogue scale), “therapeutic benefit” in days, frequency of antibiotic prescriptions due to the use of an extract of five plants.

Results
The use of the 5-plant extract BNO 1012 in addition to the standard symptomatic treatment of acute rhinosinusitis provides a clinically significant, adequate reduction in the severity of rhinorrhea, nasal congestion and post-nasal drip, assessed by a physician at V2 (p < 0.005). Significant differences are noted in the patient's self-scoring of rhinorrhea on the second or third day in viral RS, and from the fourth to the eighth day in post-viral RS. Symptoms of similar intensity in control group were observed at V3. Thus, in the first week of treatment, the treatment group compared to the control one showed a “therapeutic benefit” of three days. The use of BNO 1012 in patients with acute rhinosinusitis can 1.81-fold reduce the prescription of antibacterial drugs.

Conclusion
The combination of five medicinal plants is effective for the treatment of acute rhinosinusitis in children aged 6 to 11 years. Its use provides a significant “therapeutic benefit” when administered in addition to standard symptomatic therapy, reducing the need for antibiotic use.

select article 3D-printable headlight face shield adapter. Personal protective equipment in the COVID-19 era
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3D-printable headlight face shield adapter. Personal protective equipment in the COVID-19 era
Jaime Viera-Artiles, José J. Valdiande
In Press, Corrected Proof, Available online 1 June 2020
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Abstract
Abstract
The coronavirus SARS-CoV-2 (COVID19) pandemic has pushed health workers to find creative solutions to a global shortage of personal protection equipment (PPE). 3D-printing technology is having an essential role during the pandemic providing solutions for this problem, for instance, modifying full-face snorkel masks or creating low-cost face shields to use as PPE (Ishack and Lipner, 2020 [1]).

Otolaryngologists are at increased occupational risk to COVID19 infection due to the exposure to respiratory droplets and aerosols, especially during the routine nose and mouth examinations where coughing and sneezing happen regularly (Rna et al., 2017 [2]; Tysome and Bhutta, 2020 [3]). The use of a headlight is essential during these examinations. However, to our knowledge, none of the commercially available or 3D-printable face shields are compatible with a headlight. Hence, using a face shield and a headlight at the same time can be very uncomfortable and sometimes impossible.

To solve this problem, we have designed a 3D-printable adapter for medical headlights, which can hold a transparent sheet to create a face shield as an effective barrier protection that can be used comfortably with the headlight. The adapter can be printed in different materials with the most commonly used nowadays being the cost-efficient PLA (Polylactic Acid) used for this prototype. The resulting piece weighs only 7 g and has an estimated cost of $0.15 USD. The transparent sheets, typically made from polyester and used for laser printing, can be purchased in any office material store with a standard price of 0.4 USD per unit. After use, the transparent sheet can be easily removed.

We trialed the adapter in 7 different headlights. All of these headlights accommodated the printed blocks extremely well. The headlights were used in many different settings, including the ENT clinic, the operating room, the emergency room, the ENT ward and the COVID19 intensive care unit (ICU) for a two weeks period. All doctors using the headlight felt they were fully protected from respiratory droplets, blood, sputum and other fluids. The face shield with the headlight has been found very useful for treating epistaxis, changing tracheostomy cannulas and during routine nasal and oral examinations.

The headlight face shield adapter was designed to solve a specific problem among the ENT community; however other specialist can find it useful as well. Nonetheless, manufacturers should take care of specifics problems like this and provide commercially available products to protect the ENT workforce in this new era.

select article Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty: A case report and literature review
Review articleAbstract only
Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty: A case report and literature review
Lucheng Fang, Jiayuan Xu, Wen Wang, Yideng Huang
In Press, Journal Pre-proof, Available online 1 June 2020
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Abstract
Abstract
Endoscope is an innovative method for otologists in middle ear surgery. Many previous studies have confirmed the safety and efficiency of the endoscopic technique, as a reliable therapeutic option with very low complication rates, clearly supporting the use of endoscopy in ear surgery. Auricular suppurative perichondritis secondary to exclusive endoscopic ear surgery for tympanoplasty is an extremely rare type of those without any previously reported cases. In this report, we describe the course of auricular suppurative perichondritis of a 55-year-old woman. The patient was ultimately healed through surgical debridement and postoperative dressing with no evidence of recurrence at two months follow-up. There were no auricle deformity or external auditory canal stenosis with six months following-up.

select article Effect of late-onset blindness on cervical vestibular evoked myogenic potentials
Research articleAbstract only
Effect of late-onset blindness on cervical vestibular evoked myogenic potentials
Mansoureh Adel Ghahraman, Sahar Shomeil Shushtari, Mahin Sedaie, Shohreh Jalaie, Mojtaba Tavakkoli
In Press, Journal Pre-proof, Available online 1 June 2020
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Abstract
Abstract
Purpose
Approximately 1.3 billion people worldwide have vision impairment. The aim of the present study was to investigate the influence of Late-Onset blindness on cervical vestibular evoked myogenic potentials (cVEMP) responses. Accordingly, this study was performed to investigate and compare the parameters of the cVEMP test in sighted and late-onset blind individuals.

Materials and methods
In this cross-sectional- comparative study, cVEMP was recorded by presenting a tone burst stimulus of 500 Hz with an intensity of 95 dBnHL in 20 sighted and 20 late-onset blind individuals aged between 18 and 30 years old.

Results
cVEMP was observed in all the individuals (100%). The average latency of P13 and N23, amplitude, amplitude ratio, and VEMP threshold did not differ significantly between the two groups (p > 0.05).

Conclusion
The findings of the study revealed that the formation of the neural pathway and reflex arch of cVEMP is similar between late-onset blind and sighted individuals. Thus, cVEMP can be a suitable test for assessing the vestibular function of late-onset blind people.

select article The novel corona virus and rhinology: Impact on practice patterns and future directions
Research articleFull text access
The novel corona virus and rhinology: Impact on practice patterns and future directions
Michael Setzen, Peter Svider, Sean Setzen, Gavin Setzen, ... Andrew P. Johnson
In Press, Journal Pre-proof, Available online 1 June 2020
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Abstract
Abstract
Objectives
To evaluate the impact of the novel coronavirus pandemic on practice patterns, clinical behavior, personal health, and emotional/psychological concerns of rhinologists.

Methods
A 15-question survey was sent out to the American Rhinologic Society's (ARS) membership to determine the impact of COVID-19 during the crisis. Demographic factors and practice patterns were collected and evaluated.

Results
There were 224 total respondents out of 835 ARS members queried (26.8% response rate). Study queries were sent in April 2020. Notably, 17.8% reported illness in themselves or their staff and 74.4% noted a psychological/emotional impact. A plurality of rhinologists noted their practice volume and in-office procedure volume has become 20.0% and 0.0% of their prior volumes, respectively. In addition, 96.2% were noted to be using telemedicine in our subspecialty.

Conclusion
In addition to severely impacting volume and the perception of future decreases in patients and revenue, the COVID-19 pandemic has had a physical and emotional impact on rhinologists in ways that need to be further studied. These data include significantly novel and objective information. The COVID-19 crisis also reveals the important role of telemedicine in rhinology. Guidelines regarding personal protective equipment for in-office visits, nasal endoscopy, and other in-office and operating room procedures would be particularly helpful as future waves are expected.

select article Ultrasound dye-assisted parathyroidectomy (USDAP): Experience of a tertiary center
Research articleAbstract only
Ultrasound dye-assisted parathyroidectomy (USDAP): Experience of a tertiary center
Francesco Chu, Gioacchino Giugliano, Maria Silvia Lazio, Michele Proh, ... Mohssen Ansarin
In Press, Corrected Proof, Available online 29 May 2020
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Abstract
Abstract
Background
Primary hyperparathyroidism is primarily caused by parathyroid adenoma, followed by hyperplasia and parathyroid carcinoma. In the era of minimally invasive, targeted parathyroidectomy, the main challenge remains that of distinguishing intraoperatively pathological parathyroid from normal glands and peri-thyroid fat tissue. The aim of this study is to evaluate the surgical outcomes of a novel minimally invasive technique called ultrasound-guided dye-assisted parathyroidectomy (USDAP).

Methods
We perform a retrospective analysis of patients affected by parathyroid adenoma, treated with USDAP at our institution between 2014 and 2019. Data were collected on patient age and sex, tumor location and size, preoperative investigations, histopathology, perioperative complications and surgical outcomes.

Results
Between January 2014 and June 2019, 43 patients underwent parathyroidectomy in our Institute. Each case was discussed by the Institutional Multidisciplinary Board. All patients undergoing thyroidectomy together with USDAP or patients undergoing USDAP under endoscopic control were excluded from the present study. The final cohort, the largest to our knowledge, consisted of 29 patients. All patients were successfully treated with USDAP and remained disease-free during follow up. In all cases, pathological parathyroid was correctly identified and removed. There was no postoperative allergic reaction, nor were there neurotoxicity complications. USDAP permitted a shortening of operative and hospitalization time.

Conclusions
USDAP is an effective and safe procedure both as first line treatment and as a re-operative procedure after previous surgical failures in selected cases.

select article Treatment of patients with glomus jugulare tumours (GJT) and its subjective effect on quality of life (QoL) measures
Research articleAbstract only
Treatment of patients with glomus jugulare tumours (GJT) and its subjective effect on quality of life (QoL) measures
Andrea L.O. Hebb, Niki Erjavec, David P. Morris, Nael M. Shoman, ... Simon A. Walling
In Press, Corrected Proof, Available online 27 May 2020
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Abstract
Abstract
Cerebellopontine angle (CPA) tumours account for 6–10% of intracranial tumours. The most common CPA tumours are vestibular schwannomas (VS), also known as acoustic neuromas, benign tumours of the vestibulocochlear nerve. Less common but symptomatic skull base lesions are glomus jugulare tumours (GJT), of which approximately 40% are identified as CPA tumours. Initial symptoms for GJT may include hearing loss and tinnitus and progress to various cranial nerve dysfunctions. Three well-accepted treatment modalities for such tumours include surgical resection, radiotherapy and/or conservative management employing serial MR or CT imaging. Patients' quality of life may be impacted by different treatment methods, so treatment decisions should be client centered.