Objectives/Hypothesis: The presence of eosinophilia and nasal polyps are well-established prognostic indicators of chronic rhinosinusitis (CRS). The importance of demographic background, such as age, as independent variables has not been elucidated while taking these factors into account. Study Design: Respective review. Methods: CRS patients who underwent primary surgical treatment were subdivided based on age (young adults = age 18-39, adults = age 40-64, and elderly = age 65+). Groups were then subdivided based on tissue eosinophilia and nasal polyposis. Sinonasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy scores, and Lund-McKay (LM) CT scores were compared preoperatively, and postoperatively during a 5-year period. Results: A total of 431 CRS patients identified and then subsequently broken down into 63 young adults (YA), 209 adults (A), and 159 elderly (E). There was no statistical difference between tissue eosinophilia and presence of polyps between the groups. All three groups had similar short- and long-term SNOT-22 patterns postoperatively. At presentation, young adults had significantly higher SNOT-22 score (33.2 YA, 25.3 A, 23.5 E, P = .029) and significantly higher rhinologic scores (1.9 YA, 1.3 A, 1.3 E, P = .0012) than the adult and elderly patients. Objective disease severity using LK endoscopy scores were only significantly higher in young adults at 1-year time ( P = .0026). There was no statistical difference between the groups in regards to preoperative LM CT scores. Conclusions: Young adults are more likely to present with overall higher subjective SNOT-22 scores over adults and elderly patients, despite similar objective findings in the groups. Short- and long-term postoperative improvement holds across all age groups. Level of Evidence: 4

Objective: The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck. Methods: A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded. Results: Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, P < .00001). Patients with OM were more likely to develop distant metastasis (OR = 5.65, 95% CI = 3.36-9.51, P < .00001). Conclusions: Patients with advanced T-stage laryngeal SCC should undergo elective neck treatment. More aggressive treatment for patients with history of OM should be considered due to the risk of subsequent regional and distant metastasis. Level of Evidence: II

Objectives/Hypothesis A number of autoimmune disorders (ADs) are associated with a spectrum of sinonasal manifestations comparable to chronic rhinosinusitis (CRS). Our objective was to study the subjective and objective measurements of sinonasal manifestations of ADs. Study Design Retrospective cohort study. Methods All patients with ADs referred to our tertiary care rhinology clinic from 2008 to 2019 with sinonasal symptoms were compared to randomly selected cohorts of noneosinophilic CRS without nasal polyps (neCRSsNP) and eosinophilic CRSsNP (eCRSsNP). Demographic data, along with the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Lund‐Kennedy (LK) endoscopy score, Lund‐Mackay (LM) computed tomography (CT) score, nasal crusting, and epistaxis were reviewed at presentation. Results Fifty‐three patients with an AD (26 with sarcoidosis, 14 with systemic lupus erythematosus, 10 with granulomatosis with polyangiitis [GPA], and three with pemphigoid vulgaris) were identified, and compared to 75 randomly selected neCRSsNP patients and 75 eCRSsNP patients. Patients with an AD had an average SNOT‐22 score of 44.4 (confidence interval [CI]: 34.6‐51.2) compared to 25 (CI: 24.4‐25.1) and 29.7 (CI: 20.3‐29.7) for neCRSsNP and eCRSsNP patients, respectively (P < .0001), and an average LK endoscopy score of 5.3 (CI: 4.3‐6.3), compared to 3.4 (P = .005, CI: 2.7‐4) in neCRSsNP and 4.4 in eCRSsNP (P = .2, CI: 3.7‐5). There was no significant difference in the CT score compared to both groups. Patients with an AD also scored significantly worse on all four SNOT‐33 subdomains, nasal obstruction, nasal crusting, and epistaxis. Additionally, patients with GPA had the worst symptomatic and endoscopy scores. Conclusions Patients with ADs presenting with sinonasal symptoms have a more severe subjective and objective presentation than patients with CRS without nasal polyps. Level of Evidence 4 Laryngoscope, 131:255–259, 2021

Background/Aims: Spontaneous cerebrospinal fluid (SCSF) leaks are associated with a high body mass index (BMI) and an expanded skull base. The purpose of this study is to determine if a correlation exists between BMI and olfactory fossa depth (OFD) in patients with SCSF leaks and those without. Methods: This is a cross-sectional study evaluating the correlation between OFD and BMI in patients with and without SCSF leaks. OFD was measured on computed tomography obtained in temporal proximity to the BMI. Results: Patients with SCSF leaks had a deeper mean OFD than controls (6.39 vs. 5.46 mm, p = 0.013) and a larger BMI (38.2 vs. 30.5, p = 0.0003). Pearson correlation was positive between BMI and OFD in women from the control group (R = 0.319, n = 93, p = 0.002 on the left; R = 0.313, n = 93, p = 0.002 on the right) but insignificant in men. Conclusions: The olfactory fossa is deeper and the BMI higher in patients with SCSF leaks than in those without. Differences were statistically significant. Higher BMI may predict deeper olfactory fossa in women but not in men. These findings suggest expansion of weak points in the skull base as precursors to the development of SCSF leaks in response to elevated CSF pressures, particularly in women.

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