Most patients undergoing otolaryngology procedures are at low risk of VTE, indicating that guidelines for a low-risk population could be adapted to otolaryngology. Patients undergoing high-risk otolaryngology procedures should be considered as candidates for more aggressive VTE prophylaxis.

Objectives (1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS. Data Sources: PubMed and Embase. Review Methods: A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS. Results The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [ P = .96]; 8.1 vs 8.2 days [95% confidence interval −0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts. Conclusions The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.

Based on our experience in combination with the work of others internationally, auditory brainstem implantation is feasible and safe in children younger than 5 years.

SPECT/CT has high sensitivity, specificity, and negative predictive value, but may overestimate relevant nodal basins in sentinel lymph node biopsy.

Our data suggest that patients with asymptomatic superior canal dehiscence at the time of CI surgery have similar albeit decreased speech perception scores compared to non-SCD adult CI users. Subjective rate of dizziness or vertigo following CI surgery was similar in both asymptomatic SCD and non-SCD cohorts, with detailed analyses of a single symptomatic SCD patient revealing improved vestibular function and reduced SCD symptoms following CI.

Rhabdomyosarcoma (RMS) is an uncommon soft tissue malignancy that is typically found in the pediatric population. Here we describe a rare case of widely metastatic alveolar RMS of the right paranasal sinuses in an adult woman who presented with several months of unilateral sinus symptoms that was initially misdiagnosed as acute sinusitis. A middle-aged female presented with two months of right sinus pressure and unilateral epistaxis. She had previously been diagnosed with acute sinusitis and was treated with antibiotics without improvement. Nasal endoscopy demonstrated a fungating right nasal cavity mass. On computed tomography scan (CT), she was found to have metastatic disease in the mediastinum, lungs, bones, pancreas, and right ovary. Pathology of the nasal cavity mass was consistent with alveolar RMS. The patient initially responded well to chemotherapy, but subsequently developed brain and leptomeningeal metastases. This case of sinonasal rhabdomyosarcoma is unique in the extent of metastatic disease at the time of diagnosis and the initial misdiagnosis despite concerning unilateral symptoms and imaging. This thus highlights the importance of maintaining a high index of suspicion for malignancy in patients with unilateral sinus symptoms.

Objective To evaluate factors associated with overall survival (OS) of patients with non‐rhabdomyosarcoma soft tissue sarcomas of the head and neck. Study Design Retrospective cohort study. Methods The National Cancer Database was queried for cases of non‐rhabdomyosarcoma soft tissue sarcomas of the head and neck between 2004 and 2014. Cases were categorized according to the World Health Organization classification of soft tissue tumors. A multivariable Cox proportional hazards model was used to evaluate associations with OS. Results A total of 4,555 patients (63.6% male, 36.4% female, mean age 59.6 years) met inclusion criteria. The majority of tumors were classified as miscellaneous (35.9%), followed by vascular (20.1%), smooth muscle (13.5%), fibroblastic/myofibroblastic (12.1%), peripheral nerve (8.5%), adipocytic (7.4%), and undifferentiated (2.5%) sarcomas. The mean follow‐up was 37.9 months, and overall mortality (MR) was 45.3%. The best prognosis was seen with fibroblastic/myofibroblastic sarcomas (MR = 20.6%, P < .001), whereas vascular sarcomas had the worst prognosis (MR = 67.6%, P < .001). Resection with clear margins had better OS than microscopically positive margins (hazard ratio [HR] = 1.43, P < .001) or grossly positive margins (HR = 2.97, P < .001). Radiation therapy was associated with better OS than no radiation (HR = 0.86, P = .001). Conclusion Non‐rhabdomyosarcoma soft tissue sarcomas of the head and neck are associated with significant mortality. OS differs based on histologic subcategorization. Resection of the primary tumor with clear margins demonstrates improved OS for all histologies, suggesting this modality remains the preferred primary treatment when feasible. Level of Evidence 3 Laryngoscope, 131:E500–E508, 2021

No abstract