Objectives The social determinants of health affect a wide range of health outcomes and risks. To date, there have been no studies evaluating the impact of social determinants of health on laryngotracheal stenosis (LTS). We sought to describe the social determinants in a cohort of LTS patients and explore their association with treatment outcome. Methods Subjects diagnosed with LTS undergoing surgical procedures between 2013 and 2018 were identified. Matched controls were identified from intensive care unit (ICU) patients who underwent intubation for greater than 24 hours. Medical comorbidities, stenosis characteristics, and patient demographics were abstracted from the clinical record. Tracheostomy at last follow‐up was recorded from the medical record and phone calls. Socioeconomic data was obtained from the American Community Survey. Results One hundred twenty‐two cases met inclusion criteria. Cases had significantly lower education compared to Tennessee (P = .009) but similar education rates as ICU controls. Cases had significantly higher body mass index (odds ratio [OR]: 1.04, P = .035), duration of intubation (OR: 1.21, P < .001), and tobacco use (OR: 1.21, P = .006) in adjusted analysis when compared to controls. Tracheostomy dependence within the case cohort was significantly associated with public insurance (OR: 1.33, P = .016) and chronic obstructive pulmonary disease (OR: 1.34, P = .018) in adjusted analysis. Conclusion Intubation practices, medical comorbidities and social determinants of health may influence the development of LTS and tracheostomy dependence after treatment. Identification of at‐risk populations in ICUs may allow for prevention of tracheostomy dependence through the use of early tracheostomy and specialized follow‐up. Level of Evidence Level 3, retrospective review comparing cases and controls Laryngoscope, 130:1000–1006, 2020

Objective: To evaluate the predictors of prolonged length of stay (LOS) after vestibular schwannoma resection. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Patients who underwent vestibular schwannoma resection between 2008 and 2019. Interventions: Variables of interest included age, body mass index, comorbidities, symptoms, previous intervention, microsurgical approach, extent of resection, operative time, preoperative tumor volume, and postoperative complications. Predictive modeling was done through multivariable linear regression and random forest models with 80% of patients used for model training and the remaining 20% used for performance testing. Main Outcome Measures: LOS was evaluated as the number of days from surgery to discharge.Results: Four hundred one cases from 2008 to 2019 were included with a mean LOS of 3.0 (IQR ¼ 3.0-4.0). Postoperatively, 14 (3.5%) of patients had LOS greater than two standard deviations from the mean (11 days).

Objective Perioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS). Methods Patients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test. Results Data from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p < 0.015) and satisfaction with their experience (call:8.8 ± 1.4 vs no-call:9.5 ± 1.1, p < 0.028). Patient age may contribute to lack of impact in the rhinology cohort, as compared to the otology group, but socioeconomic status does not seem to differentiate the two samples. Conclusion Though shown in other settings, a significant impact of educational phone calls prior to surgery was not observed in this sample. Patient education calls prior to endoscopic sinus surgery were not associated with changes in postoperative call volume to the clinic. Patient understanding and satisfaction may be related to other factors, such as patient selection or demographics. Future studies may target such patients prior to ESS.

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Objective:To evaluate the predictors of remnant tumor regrowth and need for salvage therapy after less than gross total resection (GTR) of vestibular schwannoma (VS).Study Design:Retrospective chart review.Setting:Tertiary neurotologic referral center.Patients:Patients who underwent VS resection between 2008 and 2019 either with GTR, near total resection (NTR), and subtotal resection (STR).Interventions:Microsurgical resection, salvage radiosurgery.Main Outcome Measures:Regrowth free interval, salvage free interval, tumor doubling rate.Results:Three hundred eighty five cases (GTR = 236, NTR = 77, and STR = 71) from 2008 to 2019 were included. STR cohort had much larger and complex tumors with significant differences in tumor volume, ventral extension and brainstem compression (p < 0.001). On single predictor analysis, tumor volume, ventral extension, brainstem compression as well as STR strategy was associated with significant increased risk of regrowth and need for salvage therapy. Multivariate analysis revealed STR strategy as significant predictor of regrowth (hazard ratio 3.79, p < 0.0005). Absolute remnant volume and extent of resection (EOR) did not predict regrowth. A small proportion of cases (NTR = 4%, STR = 15%) eventually needed salvage radiosurgery with excellent ultimate local tumor control with no known recurrence to date.Conclusions:Conservative surgical strategy employing NTR or STR can be employed safely in large and complex VS. While there is increased risk of regrowth in the STR cohort, excellent local control can be achieved with appropriate use of salvage radiosurgery. No disceret radiologic or operative predictors of regrowth were identified.

Objective The objective of this case series was to describe botulinum toxin therapy as a novel treatment of intractable head pain following lateral skull base surgery. Background Intractable headaches following lateral skull base surgery are described in 23%‐75% of patients and can significantly impact quality of life. Currently, the etiology of the headaches is unclear and treatment options are limited. Botulinum toxin is indicated for a multitude of functional and cosmetic reasons, including chronic migraine, and has been further described in treatment of various postsurgical pain syndromes. Methods In this case series, 4 patients underwent subcutaneous peri‐incisional injections of botulinum toxin for intractable headache and head pain syndromes. Three patients had undergone lateral skull base surgery and the fourth patient had undergone a temporoparietal fascial flap harvest. Average injection dose ranged from 20 to 60 units with an average duration of effect ranging from 2 weeks to 4 months. Results All patients experienced significant relief of chronic head pain and returned for additional peri‐incisional botulinum toxin injections, suggesting meaningful patient‐perceived value. Conclusions Botulinum toxin therapy may represent a novel treatment for intractable head pain following lateral skull base surgery and temporoparietal fascial flap harvest. This study represents a small case series and, although 100% of the patients who were treated significantly improved, future inquiry is necessary to confirm these findings.

known complication of vidian neurectomy owing to disruption of parasympathetic supply to the lacrimal glands, particularly if the sphenopalatine ganglion is compromised. There seems to be potential for regeneration, with restoration of lacrimal secretory function after an average of 15 days, 6 followed by recurrence of rhinorrhea at 1 to 3 years postneurectomy.Conclusions | Vidian nerve injury is an uncommon presentation of fracture of the sphenoid. It may represent an underdiagnosed and undertreated morbidity in basilar skull fractures. Surgeons treating basilar skull fractures should be cognizant of their complications and manage them accordingly.