Dysphagia lusoria: problem or incidentaloma? Purpose of review To address the incidental versus pathogenic nature of dysphagia lusoria and to provide a review of the cause, clinical presentation, diagnosis, and treatment of this condition with respect to recent literature. Recent findings Case reports comprise the majority of recent literature concerning dysphagia lusoria. Many patients with an aberrant right subclavian artery (ARSA) have additional coexisting vascular anomalies. While most individuals present around age 50, some present as children and neonates. Of note, this population may present with dysphagia as opposed to respiratory findings alone, as previously described. In the diagnostic workup, most patients receive a battery of radiologic tests, which may not be necessary. Significantly, dietary modifications and medical management alone may resolve symptoms. Nonetheless, a wide range of operative techniques are available for the treatment of dysphagia lusoria. Summary Clinicians should have a higher suspicion for dysphagia lusoria in patients with known vascular, heart, or chromosomal anomalies. Diagnosis should begin with a barium esophagram followed by a computed tomography angiogram or magnetic resonance angiogram. Avoid unnecessary studies. In many cases, an ARSA may be an incidental finding with comorbid gastroesophageal reflux disease or another medical condition responsible for the symptoms. Medical versus surgical management should be considered on a case-by-case basis. Correspondence to Rebecca Howell, MD, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati Medical Center, Medical Sciences Building, Room 6507, 231 Albert Sabin Way, Cincinnati, OH 45267, USA. Tel: +1 513 558 7333; e-mail: howellrb@ucmail.uc.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pediatric ossiculoplasty: optimizing outcomes Purpose of review Despite years of research, pediatric ossiculoplasty remains a challenging surgery with numerous variables factoring into successful outcomes. The aim of this review is to summarize recent publications on surgical technique, timing, and reconstruction materials. Recent findings The cause behind ossicular discontinuity does not seem to play a role in hearing results after ossiculoplasty; however, revision surgery is associated with worsening outcomes. The status of the ossicles remains an active area of interest, but the data remain mixed in terms of them playing a role in predicting outcomes in adults and pediatric patients. There remains debate regarding the utility of staging the reconstruction and is often undertaken on a case-by-case basis. Other recent publications highlight positive outcomes associated with canal wall-up procedures, titanium prostheses, and partial ossicular reconstruction prostheses. Endoscopic middle ear surgery in ossiculoplasty has been shown to be successful in monitoring and removal of disease and helpful in reconstruction. Summary Pediatric ossiculoplasty remains a challenging yet rewarding procedure. The bulk of publications are retrospective making much of the literature difficult to interpret. There remains a need for prospective and well controlled studies in both adult and pediatric populations. Correspondence to David H. Chi, MD, Department of Otolaryngology, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA. E-mail: David.Chi@chp.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pediatric hereditary angioedema: what the otolaryngologist should know Purpose of review To review pediatric hereditary angioedema for otolaryngologists, with emphasis on articles within the past 12–18 months. Recent findings Biologic therapies are accepted for adult hereditary angioedema (HAE), but have been studied less for pediatric HAE. Recent literature supports expanded use of biologic agents in pediatrics as acute treatment and prophylaxis. Available agents include plasma-derived C1 esterase inhibitors (C1-INH) (Berinert, Haegarda, Cinryze), recombinant C1-INH (Ruconest), bradykinin B2 receptor inhibitor (Icatibant), and kallikrein inhibitors (Ecallantide and lanadelumab). Of these, only Berinert is Food and Drug Administration (FDA) approved for acute therapy for children under 12 years of age. Ruconest is approved for treatment of acute attacks over age 13. Ecallantide also has FDA approval as acute treatment for age 12 and older, while lanadelumab and Haegarda are prophylactic agents for adolescents. Icatibant lacks FDA approval in patients under 18 years of age. Cinryze has FDA approval only for prophylaxis for children as young as 6 years old. Summary Pediatric HAE is a potentially life-threatening disease. Targeted biologic agents have gained acceptance in treatment of acute attacks, and their use as prophylactic agents is changing the focus of management from acute intervention to preventive management. While intubation or surgical airway management may still be necessary, early intervention or prophylaxis can decrease morbidity and improve quality of life. Correspondence to Michele M. Carr, DDS, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, PO Box 9200, Morgantown, WV 26506, USA. Tel: +1 304 293 3233; fax: +1 304 293 4902; e-mail: mmc0040@hsc.wvu.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Otitis media: what is new? Purpose of review To review the latest literature on otitis media diagnosis, guidelines, treatment, and pathophysiology. Recent findings Although otitis media remains one of the most common reasons for outpatient visits, antibiotic prescriptions, and surgery in the United States, little progress has been made in terms of developing novel treatments for the prevention and resolution of this condition, indicating the urgent need to continue investigations into the pathophysiology of this disorder. The recent past has seen the publication of new guidelines for the management of both acute otitis media, chronic otitis media and tympanostomy tube placement. Exciting technologies are being investigated into novel means to improve the diagnosis of otitis media, reviewed herein. Advancements in mucosal immunology and genetics have offered clues as to the underlying pathophysiology influencing otitis media propensity. Future research into modifying these pathophysiologic underpinnings, potentially through the usage of transtympanic drug delivery systems, should greatly influence the management of this condition. Summary Research into novel methods for otitis media pathophysiology, diagnosis and treatment has seen great strides in the recent past. Avenues towards markedly altering the evaluation and management of the condition are likely to be adopted into clinical practice over the coming years. Correspondence to Diego Preciado, MD, PhD, Division of Pediatric Otolaryngology, Head and Neck Surgery, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA. Tel: +1 202 476 3659; fax: +1 202 476 5038; e-mail: dpreciad@cnmc.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Going with the flow No abstract available

Medications and the larynx Purpose of review The larynx is a complex organ that houses some of the most intricate structures of the human body. Owing to its delicate nature, the larynx is affected by different medications to varying degrees. Many of these effects manifest in subjective complaints in one's voice or swallow. This review article invokes the present available literature to describe the effects different medical agents have on the functionality of the laryngeal structures. Recent findings Multiple available studies explore the effects of inhaled corticosteroids on the larynx. While laryngeal candidiasis is a well known complication of chronic steroid use, other rarer fungal infections have also demonstrated themselves as risks. Among anesthetics, the literature suggests that sevoflurane in standard and high doses does not appear to significantly reduce the risk of laryngospasm. The use of topical and intravenous lidocaine appear to have conflicting evidence regarding their use in laryngospasm prevention, whereas postoperative sore throat, hoarseness, and cough may be prevented with preinduction nebulization of ketamine and magnesium sulfate or budesonide. Summary Further study is warranted to explore the effects that these and other classes of agents, such as antibiotics, have on the structure and function of the larynx. Correspondence to Nausheen Jamal, MD, Associate Dean of Graduate Medical Education/DIO, Chief, Division of Otolaryngology – Head & Neck Surgery, Associate Professor of Surgery, 1210 West Schunior Street, EMEBL 3.145, Edinburg, TX 78541, USA. Tel: +1 956 296 1423; e-mail: Nausheen.Jamal@utrgv.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Gastric inlet patches: symptomatic or silent? Purpose of review The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch. Recent findings Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection. Summary Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest. Correspondence to Charles Cock, FRACP, Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University of South Australia, 1 Flinders Drive, Adelaide 5042, SA, Australia. Tel: +61 8 8204 4964; fax: +61 8 8204 4964; e-mail: charles.cock@flinders.edu.au Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Safety of in-office laryngology procedures Purpose of review A wide range of diagnostic and therapeutic laryngology procedures are currently performed in an office setting. In-office laryngology procedures (IOLP) are increasingly seen as standard-of-care, and while generally considered safe, high-quality evidence supporting the latter statement is lacking. This review aims to summarize recent literature regarding the safety of IOLP. Recent findings There is a paucity of guidelines and standardized protocols for IOLP. To date, there is one available safety protocol specific to in-office laser procedures. Haemodynamic changes during IOLP have been documented and the significance of these changes continues to be unclear. Therefore, monitoring of vital signs is recommended. Continuing antithrombotic therapy during IOLP also appears safe, and this decision may be left to surgeon discretion. A protocol for management of antithrombotic therapy prior to in-office laser procedures is available. Actual serum lidocaine levels following topical application of mixed lidocaine preparations falls well below reported toxic levels but persists for longer than previously reported. Summary IOLP are safer that suspension laryngoscopy under general anaesthetic. Although complication rates of IOLP are low, patient characteristics and potential complications of both the procedure and of topical anaesthetic use must be considered. One must be prepared and equipped to deal with these potential complications. Correspondence to Silvia G. Marinone Lares, Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: +64 21 0824 3506; e-mail: smar685@aucklanduni.ac.nz Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.