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Introduction:Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic manifestations of vestibular disease. However, vestibular rehabilitation is limited by accessibility and time commitment. Recently, virtual reality has been described as a vestibular rehabilitation tool that may circumvent these barriers to treatment. Despite this, the efficacy of virtual reality for vestibular rehabilitation remains unclear. This study aims to review and summarize the current literature on the effectiveness of virtual reality-based vestibular rehabilitation.Methods:A systematic review of the MEDLINE, EMBASE, and Alternative and Complementary Medicine databases was conducted for prospective studies describing virtual reality-based vestibular rehabilitation.Results:Our search identified 382 unique articles. Six randomized controlled trials and four other studies were ultimately included. Study sample sizes ranged from 13 to 70 participants and varied in diagnoses from any unilateral peripheral vertigo to specific pathologies. Different virtual reality interventions were used. Comparator groups ranged from supervised vestibular rehabilitation to independent Cawthorne-Cooksey exercises. Outcomes consisted of validated questionnaires, objective clinical tests, and measurements of balance or reflexes.Conclusion:The studies reviewed in this study are preliminary evidence to suggest the benefit of virtual reality-based vestibular rehabilitation. However, these studies are limited by their inclusion criteria, heterogeneity, comparator design, and evidence-based clinical outcomes. Further research should address these limitations.

Background Cerebrospinal fluid (CSF) rhinorrhea results from abnormal communications between the subarachnoid and sinonasal spaces. Accurate preoperative diagnosis and localization are vital for positive clinical outcomes. However, the diagnosis and localization of CSF rhinorrhea remain suboptimal due to a lack of accurate understanding of test characteristics. Objective This systematic review aims to assess the diagnostic accuracy of various tests and imaging modalities for diagnosing and localizing CSF rhinorrhea. Methods A systematic review of the MEDLINE and EMBASE databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Our search identified 4039 articles—53 cohort studies and 24 case series describing 1622 patients were included. The studies were heterogeneous and had a wide range of sensitivities and specificities. Many specificities were incalculable due to a lack of true negative and false positive results, thus precluding a meta-analysis. Median sensitivities and specificities were calculated for cohort studies of the following investigations: high-resolution computed tomography (HRCT) 0.93/0.50 (sensitivity/specificity), magnetic resonance cisternography (MRC) 0.94/0.77, computed tomography cisternography (CTC) 0.95/1.00, radionuclide cisternography (RNC) 0.90/0.50, and contrast-enhanced magnetic resonance cisternography (CEMRC) 0.99/1.00, endoscopy 0.58/1.00, topical intranasal fluorescein (TIF) 1.00/incalculable, intrathecal fluorescein (ITF) 0.96/1.00. Case series were reviewed separately. Etiology and site-specific data were also analyzed. Conclusion MR cisternography is more accurate than high-resolution CT at diagnosing and localizing CSF rhinorrhea. CT cisternography, contrast-enhanced MR cisternography, and radionuclide cisternography have good diagnostic characteristics but are invasive. Intrathecal fluorescein shows promising data but has not been widely adopted for purely diagnostic use. Office endoscopy has limited data but does not sufficiently diagnose CSF rhinorrhea independently. These findings confirm with current guidelines and evidence.

Background Noise in the operating room (OR) contributes to miscommunication among team members and may negatively impact patient outcomes. Objectives This study aimed to quantify noise levels during endoscopic sinus and skull base surgery. The secondary aim was to understand how OR team members perceive noise during endoscopic sinus and skull base surgery. Methods Noise levels were measured using the validated phone application SoundMeter X 10.0.4 (r1865) (Faber Acoustical, Utah, USA) at the ear-level of the surgeon, scrub nurse, circulating nurse, and anesthesiologist. At the end of each surgery, OR team members were asked to complete a six-question questionnaire about noise during that surgery. Results One thousand four hundred and two noise measurements were recorded across 353 trials. The loudest mean noise measurement was 84.51 dB and maximum noise measurement was 96.21 dB at the ear-level of the surgeon. Noise was significantly higher at the ear-level of the surgeon and scrub nurse in comparison to the circulating nurse (p = .000) and anesthesiologist (p = .000). Forty percent of questionnaire respondents believed noise was a problem and 38% stated that noise caused communication issues during surgery. Conclusion Surgeons and scrub nurses have significantly higher noise exposure in comparison to circulating nurses and anesthesiologists during endoscopic sinus and skull base surgery. For these members of the OR team, noise is also identified as problematic and causing issues with communication. Mechanisms to reduce potential noise may be implemented to improve communication and patient outcomes in endoscopic sinus and skull base surgery.

The objective of this short scientific communication is to describe and test a strategy to overcome communication barriers in coronavirus disease 2019 (COVID-19) era otolaryngology operating rooms. Thirteen endoscopic sinus surgeries, 4 skull base surgeries, and 1 tracheotomy were performed with powered air-purifying respirators. During these surgeries, surgical team members donned headsets with microphones linked via conference call. Noise measurements and survey responses were obtained and compared to pre–COVID-19 data. Noise was problematic and caused miscommunication as per 93% and 76% of respondents, respectively. Noise in COVID-19 era operating rooms was significantly higher compared to pre–COVID-19 era data (73.8 vs 70.2 decibels, P = .04). Implementation of this headset strategy significantly improved communication. Respondents with headsets were less likely to encounter communication problems (31% vs 93%, P < .001). Intraoperative measures to protect surgical team members during aerosolizing surgeries may impair communication. Linking team members via a conference call is a solution to improve communication.