SARS-CoV-2, and its clinical manifestation as COVID-19, is an ongoing global pandemic. Patients with COVID-19 can present with numerous otolaryngologic conditions, such as Bell palsy (BP). Bell palsy is a unilateral peripheral facial nerve palsy of sudden onset. Several case reports and series have described peripheral facial nerve palsies associated with COVID-19. 1 In addition, since the US Food and Drug Administration's (FDA) emergency use authorization of several COVID-19 vaccines, there have been media reports of BP associated with vaccination. 2 Such concerns could erode vaccine confidence and exacerbate public hesitancy to obtain a COVID-19 vaccine. We used data from a large health research network to estimate the incidence of BP in patients with COVID-19 vs individuals vaccinated against the disease.Methods | The institutional review board at Case Western Reserve University deemed this cohort study exempt from review and waived the requirement for patient informed consent because deidentified information, aggregated counts, and statistical summaries of electronic medical records were used. These data were collected from 41 health care organizations worldwide and accessed through TriNetX, a global federated research network. Queries were made on April 7, 2021, to identify patients diagnosed with COVID-19 (January 1, 2020, to December 31, 2020) with or without a diagnosis code of BP within 8 weeks of the COVID-19 diagnosis. Among these patients, we identified those with a history of BP. To account for vaccination, the queries were restricted from January 1, 2021, to March 31, 2021. Using TriNetX to evaluate BP as our outcome, we matched 63 551 non-vaccinated patients with COVID-19 to those who were vaccinated against the disease and had no history of COVID-19 infection.

Background The ideal timing for melanoma treatment, predominantly surgery, remains undetermined. Patient concern for receiving immediate treatment often exceeds surgeon or hospital availability, requiring establishment of a safe window for melanoma surgery. Objective To assess the impact of time to definitive melanoma surgery on overall survival. Methods Patients with stage I to III cutaneous melanoma and with available time to definitive surgery and overall survival were identified by using the National Cancer Database (N = 153,218). The t test and chi-square test were used to compare variables. Cox regression was used for multivariate analysis. Results In a multivariate analysis of patients in all stages who were treated between 90 and 119 days after biopsy (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.01–1.18) and more than 119 days (HR, 1.12; 95% CI, 1.02–1.22) had a higher risk for mortality compared with those treated within 30 days of biopsy. In a subgroup analysis of stage I, higher mortality risk was found in patients treated within 30 to 59 days (HR, 1.05; 95% CI, 1.01–1.1), 60 to 89 days (HR, 1.16; 95% CI, 1.07–1.25), 90 to 119 days (HR, 1.29; 95% CI, 1.12–1.48), and more than 119 days after biopsy (HR, 1.41; 95% CI, 1.21–1.65). Surgical timing did not affect survival in stages II and III. Limitations Melanoma-specific survival was not available. Conclusion Expeditious treatment of stage I melanoma is associated with improved outcomes.

Objectives: Telemedicine allows for the remote delivery of patient care and has been found to have a wide range of uses in otolaryngology. In order to achieve best practices in telemedicine, a platform must be effective and both patients and providers must be satisfied with the use of technology. As telemedicine becomes more widely used in otolaryngology clinics, particularly in the face of the current COVID-19 pandemic, it is important to assess its applicability in this field. The goal of this study was to evaluate existing literature on telemedicine and assess overall image quality, diagnostic concordance, and patient and provider satisfaction with telemedicine technologies. Methods: A systematic review was conducted on PubMed and MEDLINE according to the PRISMA 2009 guidelines for articles from 1982 to 2019 relating to telemedicine in otolaryngology. English language studies with primary or secondary endpoints pertaining to image quality, diagnostic concordance, or patient or provider satisfaction were included. Descriptive studies, editorials, and literature reviews were excluded. Results: A total of 32 studies were included in our review. Studies assessing imaging quality and diagnostic concordance reported adequate results but with some heterogeneity. Patient and provider satisfaction were consistently high. Conclusions: The literature supports telemedicine delivery of otorhinolaryngologic care as having achieved high rates of patient and provider satisfaction with adequate image quality and heterogeneity in diagnostic concordance. Variability in diagnostic accuracy was reported, but appears improved given proper clinical context. More standardized studies are needed specific to telemedicine in the field of otolaryngology.

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Objective/Hypothesis: The COVID-19 pandemic has resulted in telehealth becoming commonplace in many health care fields. Telehealth benefits include improving access, decreasing costs, and elevating patient's experience. A review of cost minimization (CM) analyses was performed in order to explore scientific studies associated with integrating tele-otolaryngology in clinical practice. Our primary objective was to evaluate published literature for cost related to the implementation of telemedicine across otolaryngology, and to determine CM when compared to in-person visits.Study Design: Systematic Literature Review. Methods: We performed a systematic review using PubMed, EMBASE, and Cochrane in May 2020, to identify studies with a cost analysis of tele-otolaryngology care. Inclusion criteria focused on articles citing CM data from telehealth services. Literature quality was assessed using the MINORS scoring system.Results: From 380 original articles screened only nine evaluated cost in otolaryngology. CM in the US ranged from $68 to $900 per visit. Cost was evaluated in general otolaryngology, sleep medicine, otology, and head and neck cancer surgery, the latter had the most benefit. The most common types of telehealth visits were routine follow-up and screening. Data were insufficient for meta-analysis.Conclusions: Telemedicine has been trialed across various otolaryngology subspecialties; its incorporation is projected to have a meaningful impact on access to specialty care. This research suggests that the delivery of virtual care reduces cost with the potential of increasing net revenue across multiple otolaryngology subspecialties. Further studies are needed to better discern the entirety of cost savings and the best settings for integration.

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Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.

Objective Temporal bone squamous cell carcinoma (TBSCC) is rare and often confers a poor prognosis. The aim of this study was to synthesize survival and recurrence outcomes data reported in the literature for patients who underwent temporal bone resection (TBR) for curative management of TBSCC. We considered TBSCC listed as originating from multiple subsites, including the external ear, parotid, and external auditory canal (EAC), or nonspecifically from the temporal bone. Data Sources PubMed, Cochrane Library, Embase, and manual search of bibliographies. Review Method A systematic literature review conducted in December 2020 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Survival data were collected from 51 retrospective studies, resulting in a pooled cohort of 501 patients with TBSCC. Compared to patients undergoing lateral TBR (LTBR), patients undergoing subtotal (SBTR) or total (TTBR) TBR exhibited significantly higher rates of stage IV disease ( P < .001), positive surgical margins ( P < .001), facial nerve involvement ( P < .001), and recurrent disease ( P < .001). A meta-analysis of 15 studies revealed a statistically significant 97% increase in mortality in patients who underwent STBR or TTBR. On multivariate analysis, recurrent disease was independently associated with worse overall survival ( P < .001). On univariate analysis, facial nerve involvement was also associated with decreased overall survival ( P < .001). Conclusion Recurrent disease was associated with risk of death in patients undergoing TBR. Larger prospective multi-institutional studies are needed to ascertain prognostic factors for a wider array of postoperative outcomes, including histology-specific survival and recurrence outcomes.