M. Boyd Gillespie’s research while affiliated with University of Tennessee Health Science Center and other places

Objective Macroglossia is a risk factor for obstructive sleep apnea (OSA) and has been linked to an elevated apnea‐hypopnea index (AHI). Obesity may contribute to macroglossia, but its exact relationship is unknown and likely multifactorial, and the degree to which increased adiposity of the tongue affects the development of OSA is not understood. The primary objective of this study was to evaluate how tongue fat and volume relate to the presence and severity of OSA. Data Sources Studies reporting the impact of tongue fat or volume were identified using predefined inclusion criteria from September 2002 to 2022. Review Methods All studies underwent a 2‐stage blinded screening, extraction, and evaluation process. Primary outcomes were the effect of tongue fat and volume on OSA severity and evaluation of study quality. Secondary outcomes included the impact of obesity on tongue fat distribution and OSA severity. Results Out of 930 studies, 6 studies with 219 patients and 133 controls were included in meta‐analysis. All 6 studies were case‐control designs. Included studies showed low (4) and moderate (2) risks of bias. All studies compared tongue volume with an observed significant increase in tongue volume in OSA patients (P < .00001) with a weighted mean difference of 19.00 cm³ [15.53, 22.47]. Two studies compared tongue fat, and there was a significant increase in tongue fat in patients with OSA (P < .00001) with a weighted mean difference of 8.04 cm³ [4.25, 11.82]. Conclusion This meta‐analysis supports increased tongue volume and tongue adipose as important risk factors associated with OSA. Larger studies investigating tongue fat distribution and the effect of weight changes on tongue fat and volume and OSA severity are needed to characterize this relationship better.

Background Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. Objective To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Methods Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m ² ) and non-obese (18.5 kg/m ² ≤ BMI < 30 kg/m ² ) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). Results A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Conclusion Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.

Objective The objective if this study was to investigate phenotypic differences in airway obstruction, as determined by VOTE score, in a cohort of patients with obstructive sleep apnea (OSA) undergoing drug‐induced sleep endoscopy (DISE). Methods Patients older than 18 years of age scheduled for DISE by one surgeon at a tertiary care center from July 2016 to July 2022 were included in a single‐center retrospective cohort study. Patient demographics, body mass index (BMI), apnea‐hypopnea index (AHI), and VOTE scores were extracted. Spearman correlation tests were utilized to determine the relationship between variables, and statistical analyses were performed using R. Results The study included 165 patients (61.24 years, SD 11.57; BMI 31.04 kg/m², SD 6.05). Due to several significant relationships between VOTE scores and patient demographics, a cluster analysis was performed, in which two distinct clusters (phenotype 1 and phenotype 2) arose. Phenotype 1 patients had lower overall VOTE scores (p < 0.001), less obstruction at the velum (p < 0.001) and oropharynx (p < 0.001), significantly more tongue obstruction (p = 0.031), and a significantly lower BMI (p = 0.001). Though not reaching significance, phenotype 1 patients also had more epiglottic obstruction (p = 0.0841) and were older (p = 0.2775). Conclusions Patients suffering from OSA may be categorized into one of two distinct phenotypes of clinical significance. Phenotype 1 patients who are nonobese and have less significant obstruction overall, with increased obstruction at the tongue, may benefit greatly from targeted surgical modalities. Conversely, phenotype 2 patients with worse obstruction on DISE and increased velum and oropharynx obstruction may represent a phenotype of OSA that is increasingly difficult to treat surgically, due to body habitus and severe, multi‐level obstruction.

Objectives Peritonsillar abscess (PTA) is a common deep space head and neck infection, which can be diagnosed with or without computed tomography (CT). CT poses a risk for false positives, leading to unnecessary abscess drainage attempts without benefit, whereas needle or open aspiration without imaging could potentially lead to missed abscess in need of treatment. This study considered the utility and impact of obtaining CT scans in patients with suspected PTA by comparing outcomes between CT and non‐CT usage. Methods Retrospective cohort analysis using TriNetX datasets compared the outcomes of two cohorts: PTA without CT and PTA with CT. Measured outcomes included incision and drainage; quinsy adenotonsillectomy; recurrent PTA; airway emergency/obstruction; repeat emergency department (ED) visits; and need for antibiotics, opiates, or steroids. Odds ratios (OR) were calculated using a cohort analysis. Results The CT usage group had increased odds of receiving antibiotics (OR 3.043, [2.043–4.531]), opiates (OR 1.614, [1.138–1.289]), and steroids (OR 1.373, [1.108–1.702]), as well as a higher likelihood of returning to the ED (OR 5.900, [3.534–9.849]) and developing a recurrent PTA (OR 1.943, [1.410–2.677]). No significant differences were observed in the incidence of incision and drainage, quinsy adenotonsillectomy, or airway emergency/obstruction. Conclusion Our study indicated that CT scans for PTA diagnosis were associated with increased prescription of antibiotics, opioids, steroids, return ED visits, and recurrent PTA. Future prospective trials are needed to determine if the use of CT scans indicates higher patient acuity that explains the potential negative outcomes. Level of Evidence 2 Laryngoscope, 134:4911–4917, 2024

Background Salivary gland cancers (SGC)‐social determinants of health (SDoH) investigations are limited by narrow scopes of SGC‐types and SDoH. This Social Vulnerability Index (SVI)‐study hypothesized that socioeconomic status (SES) most contributed to SDoH‐associated SGC‐disparities. Methods Retrospective cohort of 24 775 SGCs assessed SES, minority‐language status (ML), household composition (HH), housing‐transportation (HT), and composite‐SDoH measured by the SVI via regressions with surveillance and survival length, late‐staging presentation, and treatment (surgery, radio‐, chemotherapy) receipt. Results Increasing social vulnerability showed decreases in surveillance/survival; increased odds of advanced‐presenting‐stage (OR: 1.12, 95% CI: 1.07, 1.17), chemotherapy receipt (OR: 1.13, 95% CI: 1.03, 1.23); decreased odds of primary surgery (0.89, 0.84, 0.94), radiotherapy (0.91, 0.85, 0.97, p = 0.003) for SGCs. Trends were differentially correlated with SES, ML, HH, and HT‐vulnerabilities. Conclusions Through quantifying SDoH‐derived SGC‐disparities, the SVI can guide targeted initiatives against SDoH that elicit the most detrimental associations for specific sociodemographics.

This case report describes a healthy man in his 40s who presented with a 1-year history of snoring, sleep apnea, dysphonia, and dysphagia owing to a a large mass of the posterior pharynx and was diagnosed with an inflammatory rhabdomyoblastic tumor.

Objectives To determine the sialendoscopy findings associated with positive findings on minor salivary gland biopsy. Study Design Single‐center retrospective study. Methods Patients ≥18 years old who underwent sialendoscopy from 2016 to 2022 and were evaluated for SS via labial minor salivary gland biopsy. Biopsy positive and negative patients were compared on the primary outcome measure of sialendoscopy findings. Data were abstracted from the sialendoscopy operative notes and included involved gland, location of ductal pathology, and the presence of scarring, stenosis, mucus plugs, webs, and dilations. Additional characteristics included demographics, presenting symptoms, caffeine or tobacco, use of drying medications, and need for additional treatments. Results The final cohorts included 22 biopsy positive and 21 biopsy negative patients with a total of 42 glands in the biopsy positive and 37 glands in the biopsy negative groups. Biopsy positive patients were found to require dilation at the hilum and distal duct at significantly higher rates than biopsy negative patients (p < 0.0001). However, there was no statistical difference in scarring, stenosis severity, mucus, webs, or dilations between each group. Conclusion The outcomes of this study suggest that there are no distinct sialendoscopy findings associated with biopsy positive patients. The presence of significant distal stenosis on sialendoscopy may be associated with positive minor salivary biopsy. Other endoscopic parameters are likely more consistent with non‐specific chronic sialadenitis. Level of Evidence 3 Laryngoscope, 134:1183–1189, 2024

Purpose: The Oral Health Impact Profile (OHIP) is a previously validated, concise, patient-friendly questionnaire used to determine the impact of oral diseases on patient quality of life. The present study seeks to examine the outcomes of a modified Salivary-OHIP (S-OHIP) survey in patients with chronic salivary disorders. Materials and methods: A prospective cohort of 67 patients with chronic salivary disorders and a control group of 16 patients undergoing septoplasty were surveyed using the modified Salivary-OHIP (S-OHIP) before surgery and six weeks following operative intervention. Additional factors analyzed included age, gender, etiology of salivary disease, general quality of life using the EQ-5D-5L, and general salivary symptoms. Results: There was no difference between treatment and control groups with respect to age or gender. There was a significant difference between the groups regarding change in S-OHIP scores before and after surgery (p < 0.01). Salivary patients had a significant decrease in S-OHIP scores indicating improved salivary quality of life (p < 0.01), with a mean decrease in score of 9.5. The control group showed no change in S-OHIP score (p = 0.47). Conclusion: The S-OHIP allows for a specific, targeted survey of salivary symptoms and is a useful, patient-friendly tool to quantify symptomatic changes in patients with chronic salivary disorders. Level of evidence: Level III.