Objectives: To examine opioid prescribing patterns after endocrine surgeries. To evaluate factors associated with postoperative pain and opioid use.

Objectives: To provide an up-to-date review of honey’s effectiveness and potential applications in otorhinolaryngology. Methods: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. Results: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). Conclusions: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

Background Increased detection of papillary thyroid cancer (PTC) has led to overtreatment of the largely indolent follicular variant (fvPTC). To guide management of non‐aggressive lesions, we investigated whether race predicts PTC variant and tumor behavior. Methods Analysis of 258 973 patients from the National Cancer Database diagnosed with PTC in 2004‐2014. Clinical and tumor information was compared by race. Multivariate logistic regression was used to predict fvPTC, extrathyroidal extension (ETE), and lymph node metastasis (LNM) of fvPTC. Results Blacks had the highest fvPTC rate (40% vs white 30%, Hispanic 26%, Asian 25%, P < .001). Blacks had higher odds of fvPTC (aOR = 1.33, 95% CI: 1.28‐1.37) and lower odds of ETE than whites (aOR = 0.90, 95% CI: 0.82‐0.99) (P < .001). Hispanics and Asians had lower odds of fvPTC (aOR = 0.89, 95% CI: 0.86‐0.92 and aOR = 0.81, 95% CI: 0.79‐0.84) and higher odds of LNM and ETE than whites (P < .001). Conclusions Racial disparities in fvPTC incidence and behavior should be considered to optimize diagnosis and treatment planning.

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ObjectivesTo compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls.MethodsOropharyngeal cancer patients receiving TORS and healthy controls were recruited. Participants underwent posterolateral and whole‐mouth psychophysical taste testing (identification, intensity, and hedonics) at baseline and at 2 weeks postoperatively (patients) or follow‐up (controls). Surgeons reported suspension time and glossopharyngeal nerve injury (GNI) based on the identification and sacrifice of the nerve. A Clinical Global Impression (CGI) of taste symptoms was completed at each session (“My sense of taste bothers me” on a 5‐point scale from Never [1] to Always [5]). A taste disorder (TD) was a CGI of 3 (Sometimes) or worse. Within‐subject changes in CGI and psychophysical scores were computed. “Worsened taste” was a CGI increase by ≥1 point at follow‐up.ResultsOf 69 participants, most (33/37 tumor, 31/32 controls) had normal baseline taste (CGI < 3). 14/33 (42%) TORS patients and no controls developed new TDs at follow‐up. More smokers (7/9) had worsened taste than nonsmokers (19/60, difference = 46% [95% CI 16%–76%]). More patients without GNI (6/22) than with GNI (0/15) had postoperative phantogeusia (difference = 27% [95% CI 9–45%]). Tumor‐ipsilateral taste identification (TI) decreased more in patients (−11.3%) than controls (0.8%, difference = 12.2% [95% CI 5.0–19.3%]). Suspension time was not associated with worsened taste symptoms or psychophysical changes.ConclusionsPatient‐reported taste changes after TORS are frequent. Compared to healthy controls, TORS patients have decreased tumor‐ipsilateral TI. Suspension time and GNI are unlikely to cause symptomatic TDs. Further investigations of the etiology and long‐term symptom burden of TORS‐associated TDs will aid in the management of oropharyngeal cancer patients.Level of EvidenceLevel 3 (non‐randomized controlled cohort study) Laryngoscope, 2023

IntroductionThere is no consensus on gender differences in clinical outcomes of HIV-infected patients. Immunologic, virologic, and survival data for patients receiving antiretroviral therapy (ART) show an inconsistent presence and direction of a gender gap. Gender and sexual behavior-based outcomes analysis is lacking in Guatemala, which has largely sexual transmission of HIV. We examine outcomes of HIV-positive Guatemalans receiving ART over a 9 year period.MethodsRetrospective cohort analysis was conducted using a database of treatment-naïve patients offered free ART at the Clinica Familiar Luis Angel Garcia in Guatemala City from 2004 to 2014. Multivariate Cox regression was used to study gender differences in all-cause mortality, immunologic failure (CD4 <100 cells/µL twice or CD4 < baseline) and virologic suppression (viral load <50 HIV-1 RNA copies/mL within 1 year of starting ART).Results4248 patients were included: 2605 men, 1617 women, and 26 transgender patients (analysed separately). Compared to men, women had higher median CD4 counts (198 vs. 126 cells/µL, p<0.001) and lower median viral loads (6.48 × 104 copies/mL vs. 11.27 × 104 copies/mL, p<0.001) at baseline. In multivariate analysis, mortality decreased with female gender (HR 0.52, 95% CI 0.29–0.93, p=0.029) while it increased with age (HR 1.02, 95% CI 1.003–1.04, p=0.02) and inconsistent condom use (HR 9.36, 95% CI 2.61–33.63, p=0.001). In women alone, these factors did not predict mortality. In men alone, mortality increased with inconsistent condom use (HR 23.26, 95% CI 2.89–187.3, p=0.003), and number of sexual partners (HR 1.02, 95% CI 1.001–1.039, p=0.041). Gender did not predict immunologic failure. Female gender predicted a lower rate of viral suppression (HR 0.6, 95% CI 0.41–0.85, p=0.005).ConclusionWomen receiving ART have lower mortality than men when adjusted for sociodemographic factors and sexual behaviours. Sexual risk factors affect genders differently and can predict treatment outcomes in previously infected patients.

Objective. To explore whether deintensification of adjuvant therapy reduces ototoxicity among patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC).Study Design. Retrospective cohort study. Setting. Single academic center.Methods. The ototoxicity rate among adult patients with HPVrelated OPSCC enrolled in the Minimalist Trial (MINT), a prospective phase 2 trial of surgery followed by risk-adjusted deintensified adjuvant therapy (42 Gy radiation given alone or with a single 100 mg/m 2 dose of cisplatin), was compared to that among a historical cohort treated with standard adjuvant therapy (60-66 Gy radiation with up to three 100 mg/m 2 doses of cisplatin). Ototoxicity was defined as Common Terminology Criteria for Adverse Events v5.0 ≥ Grade 2. Mixed model analysis was performed to investigate the association between deintensified adjuvant therapy and treatment-related hearing loss.Results. A total of 29 patients (58 ears) were analyzed in the MINT cohort, and 27 patients (54 ears) in the historical cohort. The ototoxicity rate was 5% (n = 3/58 ears) in the MINT cohort and 46% (n = 25/54 ears) in the historical cohort (difference, 41%; 95% confidence interval [CI] = 27%-56%). Patients in the MINT cohort demonstrated a 95% decrease in risk of ototoxicity compared to those in the historical cohort (adjusted odds ratio: 0.05, 95% CI = 0.01-0.31). Differences in estimated marginal mean threshold shifts were statistically and clinically significant at frequencies ≥ 3 kHz. Conclusion.The deintensified adjuvant therapy given in MINT led to less ototoxicity than standard adjuvant therapy among patients with HPV-related OPSCC.

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