Our objective is to identify novel coronavirus disease 2019 (COVID-19) patients with a diagnosis of sudden sensorineural hearing loss (SSNHL) with an aim to describe possible mechanisms. A systematic review was conducted using PubMed and Google Scholar. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed^. Our search terms included: "Sensorineural Hearing Loss" + "COVID-19" or "Sensorineural Hearing Loss" + "SARS-CoV-2" or "Sensorineural Hearing Loss" + "Coronavirus". Studies that adhered to the inclusion and exclusion criteria were included in the review. Of the 20 articles identified in the initial search, five met the inclusion criteria. The included articles consisted of four case studies and one letter to the editor, with seven total patients analyzed. All patients were COVID-19 positive and exhibited SSNHL, either unilateral or bilateral. Four patients reported tinnitus and two patients experienced vertigo. One patient was treated with hydroxychloroquine and one patient was treated with a variety of medications. Four patients were treated with intravenous and/or oral steroids intended to treat the SSNHL. The current literature describing SSNHL in COVID-19 patients is insufficient to characterize the pattern of hearing loss or advise about the treatment or outcomes. Future studies require a larger database or population study.

Sinonasal renal cell-like adenocarcinoma (SNRCLA) is a newly defined, rare malignant tumor of the nasal cavity. The clinical course and response to treatment remain uncertain. The purpose of this study is to report a new case of SNRCLA and review the literature to determine clinical characteristics, treatment options, and outcomes. A 26-year-old male presented with headache, epistaxis, and nasal obstruction. Physical examination revealed a tumor involving bilateral ethmoid sinuses and MRI revealed extension through the cribriform plate. Surgical excision with endonasal and a bifrontal craniotomy was performed followed by adjuvant radiotherapy (RT). After RT, the patient had persistent disease requiring salvage surgery. There are few previously reported cases of SNRCLA. A literature review yielded 14 previously reported cases with convincing diagnostic evidence of SNRCLA. Common presenting symptoms were epistaxis and nasal obstruction. Surgical excision was the primary treatment in fourteen cases, nine received RT, and none received chemotherapy. However, three cases had persistent or recurrent disease. Surgical excision is the mainstay of treatment for SNRCLA and adjuvant RT has been used in some patients with varying outcomes. The tumor is low grade with no reported cases of metastases or death. The best practice for treatment is yet to be determined.

Objective: To assess financial toxicity experienced by caregivers of children with long-term tracheostomies. Methods: Cross-sectional survey study with comparison group conducted at a tertiary pediatric hospital and outpatient clinic. Pediatric (<18 years) patients with tracheostomies for ≥12 months were recruited for the study. Patients who underwent tympanostomy tube placement or adenotonsillectomy were recruited as controls. Eligible patients’ caregivers were contacted to fill out a questionnaire including the validated Comprehensive Score for Financial Toxicity survey. Results: Surveys were completed for 72 patients, including 31 in the study group (mean age, 6.58 years, 95% confidence interval [CI], 4.85-8.30 years) and 41 controls (mean age, 6.42 years, 95% CI, 5.15-10.52 years) ( P = .864). The mean duration of tracheostomy was 3.98 years (95% CI, 2.91-5.05 years). The mean household income and education level were lower in the study group than in the control group. Caregivers of the study group were more likely to have public health insurance or be uninsured. Caregivers of study patients reported greater financial toxicity, with a lower mean Comprehensive Score for Financial Toxicity (18.23 [95% CI, 15.20-21.25]) than caregivers of controls (34.27 [95% CI, 32.05-36.49]; P < .001). Linear regression analysis showed that survey scores were lower for caregivers who employed home nursing care ( P < .001). Conclusion: Caregivers of pediatric patients requiring long-term tracheostomies experience greater financial toxicity than caregivers of pediatric patients who have typical otolaryngologic surgery.

Objective To understand the use of the flipped classroom (FC) - learning core content prior to an academic session, with class time devoted to applying this content - in otolaryngology residency education. Methods An electronic survey of 107 otolaryngology program directors (PDs), including demographic details, the flipped classroom perception instrument (FCPI), and the otolaryngology programs' current use of FC. Results Forty-four (41%) PDs completed the FCPI. Seventy-one point one (71.1%) of respondents were male, 60% were 30-49 years, and the remainder were older. Sixty-two percent (62%) had fellowships associated with their program, 21.7% of programs used the FC model Very Often, 17.4% Somewhat Often, 28.3% Sometimes, 17.4% Somewhat Rarely, 8.7% Very Rarely, and 6.5% Never. Attitudes toward FC principles were positive with modes "strongly agree" for all, except for "online modules enhance learning" where the mode was "slightly agree" with significantly higher scores for PDs over age 50 than for those younger (4.17 vs. 3.63, p=0.033). There were no other significant differences comparing male vs. female PDs, younger vs. older PDs, smaller vs. larger programs, programs with or without fellowships, programs with 100% vs. <100% board exam pass rates, or programs in different geographical regions. The pre-class activity mean score was 4.34 (95% CI 4.12-4.56) and the in-class mean score was 4.18 (95% CI 3.99-4.37). There was no significant correlation between the likelihood of using a flipped classroom and attitude scores. Conclusion PDs value both the pre-class and interactive in-class principles of FCs but only 37.8% of programs use FC often, suggesting that practical approaches to implementation in this group could improve education in this population.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to many changes in the residency application process. The purpose of this study was to determine the impact of these changes on the cost of applying to otolaryngology residency programs. Materials and Methods: A retrospective, cross-sectional analysis was conducted using the Texas Seeking Transparency in Application to Residency (Texas STAR) Dashboard database to determine the differences in residency application costs from 2019 to 2022. Applicant information and cost data including application fees, interview expenses, away rotation expenses, total expenses, and geographic regions were collected. Median expenses and interquartile ranges were reported for each year and geographic region. Non-parametric comparisons were conducted. Results: Data from 499 otolaryngology applicants were collected from the Texas STAR database. The total expenses, interview expenses, and away rotation expenses of applicants from 2019 to 2022 were significantly decreased (p < 0.001) in all regions of the United States with the greatest decrease between 2020 and 2021. Application fees (p = 0.005) were not significantly different among regions of the United States throughout the time period studied. Conclusion: The COVID-19 pandemic significantly decreased the total expenses of applying to otolaryngology residencies including away rotation and interview expenses.