Objectives: There is a lack of evidence‐based guidelines with regard to eye protection for aerosol‐generating procedures in otolaryngology practice. In addition, some recommended personal protective equipment (PPE) is not compatible with commonly used ENT equipment. This study aims to investigate the degree of eye protection that commonly used PPE gives.Study Design: Simulation model.Setting: Simulation laboratory.Methods: A custom‐built setup was utilized to simulate the clinical scenario of a patient cough in proximity of a health care worker. A system that sprays a xanthan‐fluorescein mixture was set up and calibrated to simulate a human cough. A mannequin with cellulose paper placed on its forehead, eyes, and mouth was fitted with various PPE combinations and exposed to the simulated cough. The degree of contamination on the cellulose papers was quantified with a fluorescent microscope able to detect aerosols ≥10 µm.Results: When no eye protection was worn, 278 droplets/aerosols reached the eye area. The use of the surgical mask with an attached upward‐facing shield alone resulted in only 2 droplets/aerosols reaching the eye area. In this experiment, safety glasses and goggles performed equally, as the addition of either brought the number of droplets/aerosols reaching the eye down to 0.Conclusion: When used with an upward‐facing face shield, there was no difference in the eye protection rendered by safety goggles or glasses in this study. Safety glasses may be considered a viable alternative to safety goggles in aerosol‐generating procedures.

BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur in the absence of known iatrogenic or traumatic injury and without underlying congenital malformation. Holistic treatment of the condition requires meticulous perioperative evaluation of the patient to mitigate underlying risk factors. Similarly, surgery for CSF leaks requires careful consideration of all potential routes of CSF leakage to improve short- and long-term surgical outcomes. OBJECTIVE: To describe our surgical technique in this article, which addresses most of the potential routes of spontaneous CSF otorrhea. Perioperative management of the patients is also described. METHODS: A total of 65 patients underwent CSF leak repair using a middle cranial fossa approach and the techniques described in this paper. Their surgical outcomes are described. RESULTS: Preoperatively, all patients had either biochemically proven beta trace protein–positive CSF otorrhea or the presence of an encephalocele on preoperative imaging. Using this technique, all patients had short-term successful repair of their CSF leak, whereas a long-term success rate of 87.7% was achieved. No major complications were encountered. CONCLUSION: Holistic treatment of spontaneous CSF leaks of the temporal bone, together with using a surgical approach that considers all potential routes of CSF leakage, may help to improve long- and short-term surgical outcomes.

Background/Objectives: Nasopharyngeal cancer (NPC) is prevalent in Southeast Asia, Southern China and North Africa. Up to 46% of NPC patients undergoing cisplatin chemoradiation treatment experience irreversible hearing loss. Prestin is a motor protein in the outer hair cells of the cochlea, and animal studies have shown that blood prestin levels are elevated following cisplatin induced hearing loss. We investigated whether rising serum prestin levels can predict sensorineural hearing loss (SHNL) in NPC patients undergoing induction cisplatin chemotherapy (icCRT). Methods: Serum prestin levels were measured at ten time points during cisplatin chemotherapy. Pure tone audiogram and tinnitus handicap inventory (THI) were measured at baseline and at one and nine months after cisplatin administration. These outcomes were obtained to investigate whether rising prestin levels predict SNHL or worsening THI. Results: Of the 11 patients accrued, there was no association between prestin level and SNHL. An increase in THI was associated with higher prestin levels. There was significant hearing loss at 8 kHz at one (right ear, p = 0.012, left ear, p = 0.043) and nine months (right ear, p = 0.011) after treatment. After completing cisplatin, patients also had increased THI. Conclusions: Prestin was not identified as a biomarker of cisplatin-induced hearing loss in our cohort of NPC patients undergoing icCRT. NPC patients experience worsening of tinnitus with cumulative cisplatin, and hearing loss can persist at nine months post treatment. Future studies should focus on improved novel methods for measuring prestin or other cochlear proteins to better identify potential markers before permanent cisplatin induced hearing loss.

Objective: This study aims to investigate the degree of contamination generated by mastoid drilling and the extent to which this is mitigated by the use of a novel barrier drape, Otodome, which contains the surgical field. Study design: Cortical mastoidectomy with a high-speed self-irrigating drill was performed under three test conditions in the cadaveric lab, including A, without a microscope, B, with a microscope alone and C, with a microscope fitted with the Otodome. Schülke Optics fluorescent solution was used as irrigation fluid. Setting: High-speed irrigation drills used during mastoidectomy create large amounts of droplet dispersion. This study quantifies the amount of droplet dispersion and the extent to which the barrier drape mitigates it. Methods: The degree (mild, moderate or severe), distribution, and distance of contamination of the surroundings were collected in each test condition. The extent of contamination of the surgeon was noted. Results: Condition A had the worst contamination of both the surgeon and surroundings, with the furthest distance and heaviest density of droplet spread after a cortical mastoidectomy. Droplets were dispersed up to 290cm from the surgical field. Using the barrier drape in Condition C significantly reduced the droplet dispersion to a maximum of 78cm from the surgical field. There was a significant reduction in the density of contamination of the surroundings. Most of the heavy contamination was confined within the barrier drape. There was no contamination of the surgeon’s face and head region. Conclusion: Mastoid drilling produces an extensive amount of droplet dispersion. Improvised barrier drapes have been shown to mitigate this problem, but are cumbersome to use. The Otodome is shown to be an effective barrier drape.

Nonsyndromic hearing loss (NSHL) is a highly prevalent, genetically heterogeneous condition, yet its molecular basis in the Singaporean population remains underexplored. We performed whole-exome sequencing and integrative bioinformatics analysis in 115 patients with NSHL to define population-specific genetic biomarkers. A molecular diagnosis was achieved in 57% of cases, with 76% of identified variants classified as pathogenic or likely pathogenic and 24% exhibiting high pathogenic potential. Common East Asian NSHL genes, including GJB2, SLC26A4, and OTOF, were frequently detected alongside less prevalent genes such as ACTG1, CEACAM16, COL11A2, DIAPH1, KCQN4, MYH14, MYO6, MYO7A, MYO15A, SLC17A8, SMPX, STRC, TJP2, TMC1, TMPRSS3, highlighting extensive genetic heterogeneity. Notably, multiple novel variants, including MYO6 c.554-2A>G, and TNC p.N750Y, were identified, expanding the known mutational spectrum of NSHL. Genotype–phenotype correlations revealed that GJB2 variants were primarily associated with mild to moderate hearing loss, whereas SLC26A4 variants correlated with severe to profound phenotypes in the Singaporean populations. Collectively, our study provides important insights into the genetic architecture of NSHL in Singapore’s population. In addition, it supports improved molecular diagnosis yield and informed clinical management decisions as well as the advancement of precision medicine approaches aimed at reducing the burden of hearing loss in the region.