BackgroundThe Cavernous Hemangioma Exclusively Endonasal Resection CHEER classification system was developed to standardize prospective outcome analysis following orbital cavernous hemangioma OCH resection The goal of this study was to retroactively apply the CHEER system to all prior existing reports of endoscopic resection of primary benign orbital tumors BOTs to compare patient presentations perioperative characteristics and outcomes between OCH and other BOTs and determine whether the CHEER categorization regime could be expanded to other BOTs Methods A systematic review of studies reporting exclusively endoscopic resections of OCH and other BOTs eg solitary fibrous tumor schwannoma and meningioma was performed Patient tumor characteristics and operative outcomes were recorded All tumors with adequate reporting were retrospectively assigned a CHEER stage Outcomes were compared using chi-square or Fisher's exact tests Results Ninety-three studies met inclusion criteria and sufficient data were available in studies comprising tumors n =OCHs n = other BOTs Baseline patient and tumor characteristics as well as intraoperative and short-term postoperative outcomes were not signifi-cantly different between OCHs and other BOTs Long-term outcomes eg visual deficits diplopia eye position and recurrence also did not differ when controlling for CHEER stage Conclusion This review represents the largest collection of outcomes data following exclusively endoscopic endonasal resection of BOTs Short-term and long-term outcomes appear similar between OCHs and other BOTs These results suggest that exclusively endoscopic resection of orbital tumors may be effective in a range of benign pathologies Furthermore these results support a broader application of the CHEER system to other benign primary orbital tumors

Objective As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread, high‐quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection. The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices. Methods Data Sources: PubMed, EMBASE, Web of Science. A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted. Articles not reporting orbital reconstruction details were excluded. Patient and tumor characteristics, operative details, and outcomes were recorded. Variables were compared using χ 2 , Fisher's exact, and independent t tests. Results Of 60 patients included from 24 studies, 34 (56.7%) underwent orbital reconstruction following resection. The most common types of reconstruction were pedicled flaps ( n = 15, 44.1%) and free mucosal grafts ( n = 11, 32.4%). Rigid reconstruction was uncommon ( n = 3, 8.8%). Performance of orbital reconstruction was associated with preoperative vision compromise ( p < 0.01). The tendency to forego orbital reconstruction was associated with preoperative proptosis ( p < 0.001), larger tumor size ( p = 0.001), and operative exposure of orbital fat ( p < 0.001) and extraocular muscle ( p = 0.035). There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short‐ or long‐term outcomes when considering all patients. In patients with intraconal tumors, however, there was a higher rate of short‐term postoperative diplopia when reconstruction was foregone ( p = 0.041). This potential benefit of reconstruction did not persist: At an average of two years postoperatively, all patients for whom reconstruction was foregone either had improved or unchanged diplopia. Conclusion Most outcomes assessed did not appear affected by orbital reconstruction status. This general equivalence may suggest that orbital reconstruction is not a necessity in these cases or that the decision to reconstruct was well‐selected by surgeons in the reported cases included in this systematic review.

Objective To assess the high-volume 2020 COVID-19-related surgical literature, with special attention to otolaryngology articles in regard to content, level of evidence, citations, and public attention. Study Design A scoping literature review was performed with PubMed and Web of Science, including articles pertaining to COVID-19 and surgical specialties (March 20–May 19, 2020) or otolaryngologic subspecialties (March 20–December 31, 2020). Setting Scoping literature review. Methods Otolaryngology-specific COVID-19-related articles were reviewed for publication date, county of origin, subspecialty, content, level of evidence, and Altmetric Attention Score (a weighted approximation of online attention received). Data were analyzed with Pearson correlation coefficients, analysis of variance, independent t tests, and univariable and logistic regressions. Results This review included 773 early COVID-19 surgical articles and 907 otolaryngology-specific COVID-19-related articles from 2020. Otolaryngology was the most represented surgical specialty within the early COVID-19-related surgical literature (30.4%). The otolaryngology-specific COVID-19 surgical literature responsively reflects the unique concerns within each otolaryngologic subspecialty. Although this literature was largely based on expert opinion (64.5%), articles with stronger levels of evidence received significantly more citations (on Web of Science and Google Scholar, P < .001 for both) and public attention (according to Altmetric Attention Scores, P < .001). Conclusion Despite concerns of a surge in underrefereed publications during the COVID-19 pandemic, our review of the surgical literature offers some degree of reassurance. Specifically, the COVID-19 otolaryngology literature responsively reflects the unique concerns and needs of the field, and more scholarly citations and greater online attention have been given to articles offering stronger levels of scientific evidence.

Objective To qualitatively explore the broad set of preferences and attitudes patients have about thyroid nodules, which influence the decision‐making process. Study Design A descriptive survey design was administered as interviews. Setting Outpatient thyroid surgery clinic. Methods Semistructured interviews were conducted with 20 patients presenting for initial evaluation of thyroid nodules at a surgeon's office. Probative, open‐ended questions were posed regarding diagnosis, treatment, risk attitudes, and the decision‐making process. Thematic analysis was used to develop code‐transcribed interviews, and an iterative refinement resulted in underlying themes. Results During the diagnostic process, patients integrated emotional responses (fear, anxiety, and shock) with rationale concerns (likelihood of cancer, risk assessment), and ultimately relied heavily on expert opinion and recommendation. Contextualization with other personal or familial health problems served as helpful touchstones for decision‐making. Overtreatment and overdiagnosis were not commonly discussed. When thinking about potential therapies, there was a strong bias to action rather than surveillance among patients. Surgical risk and the possibility of lifelong medication, however, were strong motivators for a subset of patients to seek nonsurgical alternatives. Conclusion Patients describe a decision‐making process that incorporates emotional response and rational consideration of risks, contextualized within the personal experience and physician expertise. The bias for action and intervention is strong, and most patients strongly weighted physicians' recommendations. Themes from this qualitative analysis may serve as the backbone for future stated preference research pertaining to thyroid disease.

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