Silent sinus syndrome (SSS) arises from negative pressure in the maxillary sinus through occlusion of the ethmoidal infundibulum. Convexity of the surrounding bone towards the lumen and a hypoglobus can occur. It may endanger surrounding structures during endoscopic sinus surgery. This research identifies and quantifies radiological changes in inferoposterior anatomical structures associated with SSS. Retrospective case series study. Computed tomography and magnetic resonance imaging scans of 23 patients with SSS who were treated at the University Hospital of Zurich between 2013 and 2023 were evaluated. The volume of the maxillary sinus, the orbital floor and sinus rear wall convexity, the height of the tuber maxillae, and the pterygopalatine fossa dimension were measured. The affected side was quantitatively compared with the healthy side. The extension of the pterygopalatine fossa and the height of the tuber maxillae were significantly larger on the affected side (mean difference = 2.354 mm, 4.99 mm; P < .01 for both). A stronger indentation of the back wall (mean difference = 3.763 mm; P < .01) and the orbital floor (mean difference = 2.268 mm; P < .01) was measured in SSS. In addition, the syndrome reduces the volume of the affected maxillary sinus (mean difference = 8.885 mL; P < .01). SSS causes a marked enlargement of the neighbouring inferoposterior anatomical spaces. Shrinking of the sinus' volume could explain this effect. These findings have direct clinical implications, as the surgeon might inadvertently enter these structures more easily in SSS.

ObjectiveTo estimate the incidence of de novo chronic rhinosinusitis and identify associated risk factors in kidney and liver transplant recipients without pre‐existing sinonasal complaints.Study designRetrospective cohort study.SettingMultisite study across Mayo Clinic Enterprise locations in Arizona, Florida, Minnesota, and Wisconsin.MethodsRecords of all patients who underwent kidney or liver transplantation between November 1, 2021, and November 1, 2022 were reviewed. Patients with documented sinonasal complaints prior to transplantation were excluded. Diagnoses were based on ICD‐10 codes assigned by board‐certified otolaryngologists, with follow‐up extending through November 2024. Demographic and clinical variables were collected, and multivariable logistic regression was used to identify predictors of de novo chronic rhinosinusitis.ResultsAmong 1459 transplant recipients (mean age 55.1 years, 59.8% male), the cumulative 2‐year incidence of de novo chronic rhinosinusitis was 2.4% (24/986) in kidney and 2.3% (11/473) in liver transplant recipients (P = .89). The overall incidence rate was 12.0 cases per 1000 person‐years, exceeding general population estimates. Transplant rejection (OR 3.2, 95% CI 2.5‐3.9, P < .001) and additional organ transplantation (OR 5.0, 95% CI 3.4‐6.5, P = .041) were independently associated with chronic rhinosinusitis development.ConclusionKidney and liver transplant recipients experience a higher incidence of de novo chronic rhinosinusitis compared to the general population. Transplant rejection and additional organ transplantation significantly increase this risk. Early recognition and management of chronic rhinosinusitis in this population may support improved postoperative outcomes.

ObjectiveRecurrent acute rhinosinusitis (RARS) significantly decreases quality of life. Transplant recipients (TR) are particularly vulnerable to rhinologic conditions. There is a lack of guidelines for managing RARS in this population. Our study aims to determine the prevalence of and risk factors for RARS among TR and assess the need for sinus surgery within this group.Study DesignRetrospective cohort.SettingMayo Clinic between 2017 and 2022.MethodsA total of 1116 patients met the inclusion criteria and were divided based on the presence or absence of a new incident RARS diagnosis during the posttransplant period and frequency of sinus surgery. Logistic regression (LR) analysis was performed to identify the odds ratio.ResultsIn total, 111/1116 (9.95%) had RARS. Patients with RARS had an increased history of asthma, viral infection, and rheumatoid arthritis (RA) (P = .003) in the pretransplant period. According to the LR analysis, patients with neutropenia, RA, and mantle cell lymphoma were 1.91, 2.71, and 4.02 times more likely to develop RARS (95% CI: 1.19‐3.05, P = .01), (95% CI: 0.90‐8.14, P = .07), and (95% CI: 1.16‐13.89, P = .02) during the posttransplant period, respectively. In those that developed RARS, only 5.5% failed medical therapy and required surgery.ConclusionThis is the first cohort to investigate the incidence of RARS in TR and the predictive factors associated with its development posttransplant. We found that patients with pretransplant comorbidities such as RA, viral infections, hematologic deficiencies, and malignancies were at an increased risk for developing RARS, though this is not linked to an increased necessity for sinus surgery.

The purpose of this study is to perform the first systematic review and meta-analysis examining the risks of obstructive sleep apnea in head and neck cancer survivors with the goal of determining if there is a statistically significant increase in the risk of obstructive sleep apnea after treatment for head and neck cancer. Additionally, we sought to determine if specific treatment modalities are associated with an increased risk of obstructive sleep apnea. A comprehensive literature search was performed using Embase, Ovid MEDLINE, Web of Science, and Ovid All EBM Reviews. Included studies performed polysomnography in head and neck cancer patients before and/or after treatment. Random effects meta-analyses were used to estimate overall prevalences of obstructive sleep apnea and apnea-hypopnea index change before versus after head and neck cancer treatment. The literature search returned 575 articles for initial review, of which 16 articles met criteria for inclusion and meta-analysis (419 participants). The mean obstructive sleep apnea prevalence in head and neck cancer survivors was 83.7%. Mean prevalence before treatment was 79.9% [70.0%, 88.3%] and after treatment was 88.7% [82.3%, 94.0%]. In random effects meta-analysis, patients had a statistically significant increase in apnea-hypopnea index of 4.28 [0.46, 8.09] after treatment. There is a high prevalence of obstructive sleep apnea in head and neck cancer survivors independent of treatment modality. Therefore, we propose that all head and neck cancer survivors undergo routine validated screening for obstructive sleep apnea.

Laryngectomy is a life‐changing procedure typically performed as a surgical treatment for patients with head and neck cancer. Voice conversion (VC) is a technology that converts one voice into another without changing the linguistic information. Recently, “Save the Voice Project” for patients planning to undergo laryngectomy using our VC technique has been initiated. This study evaluated the speech converted from EL speech using the VC technique in a patient with head and neck cancer who had undergone laryngectomy. Additionally, details of an iPhone/iPad application for voice recording were reported. VC technology would greatly improve the quality of life of patients planning to undergo laryngectomy, especially those with relatively well‐preserved vocal function. To preserve the patient's original normal speech, medical staff should perform voice management before and after laryngectomy, and high‐quality voice recordings are essential.

ObjectiveWhile the etiology of Meniere's disease (MD) is likely multifactorial, genetics are thought to play a role. Several previous studies have yielded inconclusive results, potentially due to phenotypic uncertainty and variable diagnostic criteria. To explore potential genetic bases in a more rigorous context, we assessed the clinical predictors and diagnostic yield of current hearing loss panels in a highly curated cohort of patients with bilateral and/or early‐onset MD.Study DesignRetrospective cohort study.SettingMultidisciplinary tertiary care hearing loss genetics clinic.MethodsData from clinical notes, audiograms, and genetic reports of adult patients diagnosed with bilateral and/or early‐onset (<40 years) MD from October 2019 to June 2025 were analyzed with logistic regression and summary statistics to determine predictive factors and diagnostic yields of existing genetic panels.ResultsOf the 37 patients analyzed (mean age 47.7 + 14.5 years, 54% male), 24 (64.8%) had early‐onset MD, 22 (59.5%) had bilateral MD, and 9 (24.3%) had both. Moderately severe to profound hearing loss prior to 65 was significantly associated with pathogenic or likely pathogenic variants (PLPV) (OR 8.98 [1.17, 101]; P = .046). No significant predictors were found for definitive diagnosis, plausible diagnosis, or negative panels. Eight (22%) patients had a PLPV detected on their hearing loss panel, with 0 definitive diagnoses, 3 (8.1%) plausible diagnoses (MYO15A, SLC17A8, P2RX2), and 6 (16%) completely negative panels.ConclusionsCurrent hearing loss panels show limited diagnostic utility for MD. Future research should prioritize whole genome sequencing to identify novel MD‐associated loci and provide guidance to patients.

ObjectiveWe sought to determine the incidence and outcomes of head and neck cancer (HNC) among patients with schizophrenia.Study DesignCohort study utilizing TriNetX, a database containing millions of deidentified clinical records.SettingMulticenter study utilizing records from 68 healthcare organizations.MethodsA cohort of patients with schizophrenia was analyzed for the annual incidence of HNC diagnosis between 2011 and 2021. TriNetX was queried for adult patients with HNC with and without schizophrenia (or long‐term antipsychotic use, as a surrogate). Cohorts were 1:1 propensity‐matched based on sociodemographic variables to produce matched cohorts of 25,077 patients each. Outcomes included mortality, recurrence in lymph nodes and lung, systemic treatment, failure to thrive, and hospice enrollment. Outcomes are reported as hazard ratio (HR; Cox proportional hazards model) and odds ratio (OR) with 95% CI.ResultsIncidence of HNC in patients with schizophrenia peaked at 0.061% in 2012. HNC patients with schizophrenia have a significantly increased risk of mortality (HR 1.37, 95% CI 1.10‐1.72), locoregional recurrence (OR 1.36, 95% CI 1.30‐1.43), distant metastases to the lung (OR 1.72, 95% CI 1.59‐1.87), chemotherapy (OR 4.26, 95% CI 3.88‐4.69), radiation (OR 2.47, 95% CI 2.19‐2.78), failure to thrive (OR 2.41, 95% CI 2.32‐2.73), and hospice enrollment (OR 3.17, 95% CI 2.66‐3.76) compared to HNC patients without schizophrenia.ConclusionHNC patients with schizophrenia have a significant increase in risk of mortality, recurrence, and poor outcomes compared to those without schizophrenia. These findings support a renewed focus on ensuring safety nets for this vulnerable population to ensure appropriate cancer screening and care.

Analyze the relationship between surgical and non-surgical interventions for otitic barotrauma (OB), and identify underlying medical diagnosis, recurrence rates, and treatment outcomes. Retrospective cohort analysis. TriNetX US collaborative network. The network was queried for patients diagnosed with OB within the past 20 years and a surgical intervention within 1 month. Patients receiving surgical intervention were assigned to the surgical cohort while those that did not receive operative care were assigned to the non-surgical cohort. Cohorts were 1:1 propensity score matched for age and gender. Patients that undergo operative treatment have significantly increased association with previous diagnoses of middle ear pathology, as well as most forms of sinonasal disease (P < .05). Surgical treatment was significantly associated with recurrence of OB, tympanic membrane (TM) perforation, otitis media, as well as mixed hearing loss (P < .05). Our study indicates an association between previous sinonasal and otologic pathology and higher likelihood of undergoing operative treatment for OB. Our findings also indicate that operative treatment is significantly associated with recurrence of the condition. Increasing air travel and participation in recreational activities tied to OB underscore the need to better understand treatment options.

ObjectiveNebulized ciprofloxacin‐dexamethasone (CPD) is an adjuvant, off‐label treatment used to optimize healing after airway surgery, but there is limited data regarding its accessibility. This study examined socioeconomic factors influencing CPD utilization and assessed its cost.Study DesignRetrospective chart review.SettingSingle institution tertiary care center.MethodsAll patients prescribed nebulized CPD after endoscopic airway surgery from 2021 to 24 by a single surgeon were analyzed for associations between CPD access and socioeconomic factors including insurance type and Area Deprivation Index (ADI). The typical regimen was 2 mL CPD ophthalmic solution nebulized twice daily for 4 weeks. A model to estimate CPD cost combined retail pricing from GoodRx with cost‐sharing calculations from Medicare plans including Aetna, Blue Cross Blue Shield (BCBS), and Cigna, incorporating co‐pays, coinsurance, and deductibles.ResultsOut of 59 patients prescribed CPD postoperatively, 52 (88.1%) filled their prescription. Patients with Medicaid and Medicare were less likely to access CPD than those with commercial insurance (P = .037). There was no association between ADI and CPD utilization (P = .514). CPD otic and ophthalmic solutions cost $420 and $255, respectively, utilizing GoodRx without insurance. The estimated price of CPD otic solution for patients with Medicare Advantage PPO plans was $340 (Aetna), $1362 (BCBS), and $47 (Cigna), whereas the ophthalmic solution cost $53, $51, and $40, respectively.ConclusionNebulized CPD was utilized by most patients regardless of ADI, but less accessible for those with Medicaid and Medicare. Prescribing the ophthalmic formulation instead of otic may significantly reduce cost and promote more equitable care postoperatively.