In the short term, PRS is safe and effective at controlling growth and clinical symptoms for patients with GJTs, though there exists significant selection bias, inconsistent reporting, and clinical heterogeneity among existing studies.

Objective To describe the resident experience with respect to key indicator cases for each year of training. Study Design Multi‐institution, cross‐sectional assessment. Methods Using an electronic survey, current otolaryngology residents were solicited to complete a survey regarding their experiences with the key indicator cases to that point. The survey was sent to this cohort in the winter of 2017–2018. Results Three hundred and three residents responded, with 293 completing the survey. Twenty‐three percent were PGY1, 19% PGY2, 21% PGY3, 18% PGY4, and 19% PGY5 or higher. The majority of residents progress from resident assistant as a PGY2, to resident surgeon as a PGY3 and self‐assessed competent surgeon as a PGY4 for the majority of the key indicator cases. Less than 50% of the surveyed PGY5 residents had reached independent practice in all the key indicator cases, with stapedectomy (16%), rhinoplasty (18%), and paramedian forehead flap (14.5%) being the cases least frequently performed independently. Ninety‐five percent of the respondent residents felt their program provided adequate training, but 20% of the respondents were either unsure or believed that they would be unable to perform all the key indicator cases by the completion of their training. Conclusions The majority of otolaryngology residents feel confident in their training, but experience with certain cases lags behind and may not currently be taught as resident level cases. These findings raise the question of whether the current key indicator cases are the best option for assessing breadth and depth of residency training. Level of Evidence NA

Purpose: The purpose of this study is to determine if a cognitive test, Self-administered Gerocognitive Examination (SAGE), correlates with speech recognition outcomes 1 year after cochlear implantation in adults over 65 years of age. Methods: Retrospective study was conducted at a single institution. Surgery was performed by two surgeons on adult patients (>65 yrs) with postlingual bilateral sensorineural hearing loss meeting clinical and audiological candidacy for unilateral cochlear implantation. Patients who performed SAGE preimplantation, and speech testing (CNC, AzBio in quiet, AzBio in noise) before and 1 year after implantation were included. Results: Forty patients with a mean age of 78 were included. The overall mean preoperative SAGE score was 17.4 (95% CI 16.2–18.7). Greater than 17 is considered normal. Data demonstrated a statistically significant linear correlation between preoperative SAGE scores with change in speech testing 1 year postoperatively: CNC—Adjusted R-squared: 0.1955, p value: 0.002508; AzBio in quiet—Adjusted R-squared: 0.1564, p value: 0.006686; AzBio in noise—Adjusted R-squared: 0.1543, p value: 0.007053. Multivariate linear regression analysis revealed that age and SAGE scores both statistically correlated with speech testing 1 year after implantation (p = 0.01 for both). Patients who passed the SAGE (≥17) had statistically significant higher CNC, AzBio in quiet, and AzBio in noise scores 1 year postoperatively compared with patients with low SAGE scores (<17) despite statistically similar age means in each group. Conclusion: SAGE can predict speech recognition testing 1 year after cochlear implantation in older adults over 65 years of age.

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Early exposure to ON surgeries may aid in residents' decision to pursue a fellowship in ON. The presence of fellows appears to facilitate residents' ON experience.

Objective To predict the cost-effectiveness of implementing routine gene expression classifier testing for thyroid nodules with indeterminate fine-needle aspiration cytology, by utilizing a real cohort of patients as a comparator. Study Design Cost-effectiveness analysis of a retrospective cohort compared with a simulated cohort. Setting Tertiary academic medical center. Subjects and Methods We reviewed the records of all patients who underwent ultrasound-guided fine-needle aspiration from 2010 to 2014 at a tertiary academic medical center. All patients with Bethesda class III or IV cytopathology had the details of their management catalogued over the subsequent 2 years of care. These patients were assigned to the standard-of-care arm of the study. We compared the third-party payer costs of care and the proportion of patients who underwent surgery with a simulated cohort who underwent gene expression classifier testing after an initial indeterminate fine-needle aspiration (molecular test arm). Results The cost of managing 1 nodule over 2 years was $2399 higher (range, $397-$4399) for the molecular test group than the standard of care group. The molecular test group had a 13.1% decrease (base parameters; range, 0.73%-45.09%) in the number of patients undergoing surgery. Conclusion When applied to a real cohort of patients, routine gene expression classifier is predicted to reduce the number of patients undergoing surgery but will increase cost of care. Cost-effectiveness is heavily dependent on prevalence of malignancy and gene expression classifier specificity.

Objective: To develop a Decision Quality (DQ) tool to measure parents’ DQ concerning ventilation tube (VT) insertion in their children. Method: Parental survey during 2017 to 2018 in a tertiary care pediatric otolaryngology clinic comparing a validated Decisional Conflict (DC) scale with a DQ instrument including Shared Decision-Making (SDM) scale, parental treatment goals, and knowledge about VT. Results: Of 100 parent participants, 83% were mothers and 14% were fathers. 94% elected VT insertion, 6% elected monitoring or deferred the decision. 44% of the patients were <18 months, 42% were 19 months to 3 years, and the rest were older. The mean DC score was 8.26 out of 100 (95% CI 4.82-11.69), indicating low DC. Mean DQ score was 82.45 out of 100 (95% CI 80.18-84.72), including mean SDM of 87.71 (95% CI 83.53-91.88,), mean knowledge score of 87.5% (95% CI 84.56-91.59) and mean values score of 7.16 (95% CI 6.90-7.41). Comparisons between those who elected VT and those who did not showed that electors had lower DC scores (7.15 vs 24.74, P < .001), higher DQ scores (83.00 vs 72.61, P = .028) with higher SDM scores (88.70 vs 70.22, P = .044) and higher values score (7.20 vs 6.36, P = .034). Cronbach alpha for the DQ scale was 0.76. Spearman’s rho for DQ score versus DC score was −0.458, P < .001. Conclusions: DQ, as measured with this tool, was higher when parents chose to place tubes. Our DQ instrument has potential use for study of why parents may decline VT when their child meets criteria for them.

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