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Our purpose was to classify acute invasive fungal rhinosinusitis (AIFR) caused by Mucor versus Aspergillus species by evaluating computed tomography radiological findings. Two blinded readers retrospectively graded radiological abnormalities of the craniofacial region observed on craniofacial CT examinations obtained during initial evaluation of 38 patients with eventually pathology-proven AIFR (13:25, Mucor : Aspergillus ). Binomial logistic regression was used to analyze correlation between variables and type of fungi. Score-based models were implemented for analyzing differences in laterality of findings, including the ‘unilateral presence’ and ‘bilateral mean’ models. Binary logistic regression was used, with Score as the only predictor and Group ( Mucor vs Aspergillus ) as the only outcome. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were determined for the evaluated models. Given the low predictive value of any single evaluated anatomical site, a ‘bilateral mean’ score-based model including the nasal cavity, maxillary sinuses, ethmoid air cells, sphenoid sinus and frontal sinuses yielded the highest prediction accuracy, with Mucor induced AIFR correlating with higher prevalence of bilateral findings. The odds ratio for the model while integrating the above anatomical sites was 12.3 ( p  < 0.001). PPV, NPV, sensitivity, specificity and accuracy were 0.85, 0.82, 0.92, 0.69 and 0.84 respectively. The abnormal radiological findings on craniofacial CT scans of Mucor and Aspergillus induced AIFR could be differentiated based on laterality, with Mucor induced AIFR associated with higher prevalence of bilateral findings.

Background: Cancer treatment often results in financial burdens for patients including healthcare costs as well as treatment-induced disability leading to “financial toxicity” (FT) and decreased quality of life. The purpose of this review is to describe FT related to head and neck cancer (HNC) treatment, including quantifications of direct and indirect costs and descriptions of measurement tools. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify articles published before April 2022. Full-text published studies were included if they assessed direct or indirect costs of HNC treatment; studies were excluded if they did not focus on HNC or financial burden. The risk of bias was assessed, and the results of the studies were synthesized. Results: Database searches yielded 530 unique studies, and 33 studies met the criteria for inclusion. Medical expenses for patients with HNC were higher than for patients with other cancers or controls in several studies. Major surgical procedures, neck dissection, free-flap reconstruction, and intensive care unit admission increased hospital costs. Trimodal therapy with surgery plus chemoradiation represented the most expensive treatment, and chemoradiation increased complication-related health care costs. In several studies, >50% of patients treated for HNC were disabled and did not return to work. One of the greatest contributors to the indirect cost of HNC treatment is the loss of lifetime wages. Patients with HNC are at risk for depression, anxiety, and social isolation, which are linked to a decreased quality of life and treatment non-adherence. The only tools used to assess FT in patients with HNC are the Comprehensive Score for financial Toxicity (COST) and the Financial Index of Toxicity (FIT). Conclusion: Financial toxicity is highly prevalent among patients with HNC. Further research is needed to validate the assessment tools for quantifying FT in HNC patients.

Objectives To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. Methods Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. Results Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho‐oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. Conclusion Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post‐treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.

The Liver Transplant Society of India (LTSI) has come up with guidelines for transplant centres across the country to deal with liver transplantation during this evolving pandemic of COVID-19 infection. The guidelines are applicable to both deceased donor as well as living donor liver transplants. In view of the rapidly changing situation of COVID-19 infection in India and worldwide, these guidelines will need to be updated according to the emerging data.

Obstructive sleep apnea (OSA) is associated with multiple chronic comorbidities with treatments including continuous positive airway pressure (CPAP), upper airway surgery (UAS), and hypoglossal nerve stimulation (HNS). Given the complexity of the condition and multiple treatment options, there is an ongoing debate to determine the best management. O’Connor-Reina et al. recently published a paper titled “Risk of diabetes in patients with sleep apnea: comparison of surgery versus CPAP in a long-term follow-up study.” In their study, the authors stated that OSA patients who received surgery had a 50% less chance of developing diabetes compared to patients who only received CPAP treatment. However, we would like to point out some limitations that warrant attention and caution interpretation of the findings by physicians and patients.

Head and neck cancers (HNC) are a biologically diverse set of cancers that are responsible for over 660,000 new diagnoses each year. Current therapies for HNC require a comprehensive, multimodal approach encompassing resection, radiation therapy, and systemic therapy. With an increased understanding of the mechanisms behind HNC, there has been growing interest in more accurate prognostic indicators of disease, effective post-treatment surveillance, and individualized treatments. This chapter will highlight the commonly used and studied biomarkers in head and neck squamous cell carcinoma.

Objective The ease of access of online videos and the popularity of visual learning have made YouTube a popular educational resource. We analyzed the utility of YouTube videos for graduate medical education about free flap surgery using a cross‐sectional study design. Methods Using the phrases “free flap surgery” and “free flap head and neck,” YouTube videos for inclusion were identified. Videos were analyzed by free flap surgeons using Modified DISCERN, Global Quality Score (GQS), and JAMA Benchmark metrics of video quality, educational value, and transparency, respectively. Statistical analysis of video metadata and expert‐determined scores was performed. Results In total, 44 videos with 517,227 combined views were analyzed. Most videos were intra‐operative (63.6%), published by physicians (34.1%) or medical institutions (22.7%), and had health professional target audiences (95.5%). The mean Modified DISCERN score was 15.4/25, with most videos classified as “fair” (54.6%). The mean GQS was 4.17/5 and the mean JAMA Benchmark was 2.7/4. Higher Modified DISCERN scores were significantly associated with health professional target audiences (p = 0.04) and webinars (p = 0.03). Higher GQS was also significantly associated with a health professional target audience (p < 0.01), and higher JAMA scores with YouTube verification (p = 0.04). Conclusion Routine YouTube searches may not yield results ideal for resident education in head and neck free flap surgery. While many videos are of good educational value, lower transparency and reliability scores raise concerns of biased information. It is important to consider vetted educational or health care sources for resident surgical education. Level of Evidence Level IV (cross‐sectional study). We analyzed the utility of YouTube videos for graduate medical education about free flap surgery using a cross‐sectional study design. Routine YouTube searches may not yield results ideal for resident education in head and neck free flap surgery. While many videos are of good educational value, lower transparency and reliability scores raise concerns of biased information. It is important to consider vetted educational or health care sources for resident surgical education.

Objective Calcium homeostasis is regulated by the effects of parathyroid hormone (PTH) and vitamin D on the bones, GI tract, and kidneys. Post‐thyroidectomy hypoparathyroidism and resultant hypocalcemia are common complications associated with prolonged hospitalization and higher costs. The long‐term use of proton pump inhibitors has been associated with metabolic disturbances, including hypocalcemia. The purpose of this study is to determine the rate of hypocalcemia following thyroidectomy in patients taking proton pump inhibitors. Materials and Methods Patients treated with total thyroidectomy between 2012 and 2022 were identified via the TriNetX Research Network. The rate of transient (0–6 months following thyroidectomy) and permanent (6–12 months following thyroidectomy) postoperative hypocalcemia was compared between patients with and without a prescription for proton pump inhibitors. Results Of 33,309 patients, 21.3% (n = 7081) took proton pump inhibitors before surgery. 50.9% and 10.76% of thyroidectomy patients taking proton pump inhibitors had hypocalcemia compared to 48.3% and 7.22% of patients without proton pump inhibitors at 0–1 and 6–12 months, respectively. Patients prescribed proton pump inhibitors had a significantly increased risk of experiencing hypocalcemia at 0–1, 1–6, and 6–12 months. Patients taking proton pump inhibitors were also at increased risk of visiting the emergency department at 1 and 6 months following surgery. Conclusions Patients taking proton pump inhibitors may be more likely to experience short‐term and permanent hypocalcemia after thyroid surgery. The current study is the largest to date, indicating an increased risk of hypocalcemia after thyroidectomy in patients taking proton pump inhibitors. Level of Evidence 3. Patients taking proton pump inhibitors may be more likely to experience of short‐term and permanent hypocalcemia after thyroid surgery. The current study is the largest to date, indicating an increased risk of hypocalcemia after thyroidectomy in patients taking proton pump inhibitors.

Objective Lowering hospital readmission rates is a national goal, and presents an opportunity to lower health care costs, improve quality, and increase patient satisfaction. We aim to assess whether discharge disposition is associated with readmission. Methods A retrospective cohort study using logistic regression to quantify risk factors of hospital readmission in patients with confirmed head and neck cancer (HNC) who underwent surgery from 2010 to 2018 contained in the Pennsylvania Health Care Cost Containment Council database, which includes patients treated in Pennsylvania hospitals. Results The readmission rate in this study was 18.1%. Cancers of the hypopharynx had the highest rates of readmission (29.2%). Male sex (odds ratio [OR]: 0.87, 95% CI: 0.75–1.00), emergent admission (vs. elective admission: OR = 1.33, 95% CI: 1.02–1.74), discharge to home health (vs. home: OR = 1.85, 95% CI: 1.59–2.16), discharge to skilled nursing facility (SNF) (vs. home: OR = 2.21, 95% CI: 1.80–2.72), and having 4+ comorbidities (vs. 0–1: OR = 1.39, 95% CI: 1.09–1.76) were significant risk factors for hospital readmission. Conclusion It is necessary to consider the readmission risk associated with HNC patients. Reasons for readmission are multifactorial and can be related to demographics, hospital course, comorbidities, or discharge disposition–this requires further assessment. There is importance in increasing HNC awareness and staff education about the unique needs of this population. Level of Evidence 4. This was a retrospective cohort study using logistic regression to quantify risk factors of hospital readmission in patients with confirmed head and neck cancer (HNC) who underwent surgical treatment, specifically assessing discharge disposition. Reasons for readmission are multifactorial and can be related to demographics, hospital course, comorbidities, or discharge disposition ‐ this requires further assessment. There is importance in increasing HNC awareness and staff education about the unique needs of this population.

Objectives: Mammary analog secretory carcinoma (MASC) is a classification of salivary gland tumors, recently included within the term secretory carcinoma. Previous descriptions of this diagnosis have largely consisted of case reports and case series with few studies investigating its clinical characteristics as compared to non-MASC tumors. Our objective was to use a large patient database to compare the clinical characteristics of mammary analog secretory carcinoma vs. non-mammary analog secretory carcinoma salivary gland tumors. Methods: The National Cancer Database was queried between September and October 2022 for histological diagnosis of mammary analog secretory carcinoma and non-MASC salivary tumors. Patients diagnosed with mammary analog secretory carcinoma and non-mammary analog secretory carcinoma salivary tumors between the period of 2004 through 2019 were included in this analysis. Various demographic and clinical variables were abstracted from the database and compared using Wilcoxon rank sum and chi-square tests. Survival was compared between cohorts using Cox proportional hazards regression. Results: Overall, compared to non-mammary analog secretory carcinoma diagnoses (n = 47668), mammary analog secretory carcinoma tumors (n = 384) affected younger individuals, displayed favorable pathologic staging and tumor grade, and were less likely to invade surrounding tissues. Patients with mammary analog secretory carcinoma tumors also received treatment more quickly following diagnosis compared to patients with non-mammary analog secretory carcinoma tumors. The risk of death was 4.3 times greater for non-mammary analog secretory carcinoma diagnoses when adjusted for patient variables (hazard ratio = 4.3, 95% confidence interval [2.37–7.71], p < 0.001). Conclusions: Clinically, mammary analog secretory carcinoma salivary tumors have a more indolent course compared to other salivary cancers. Additional studies are needed to determine the natural history of this tumor type.