Introduction The current study evaluated the use of platelet‐rich plasma (PRP), an autologous blood product with supraphysiologic concentrations of growth factors, in the treatment of prolonged coronavirus disease 2019 (COVID‐19)–related smell loss. Methods This multi‐institutional, randomized controlled trial recruited patients with COVID‐19 who had objectively measured smell loss (University of Pennsylvania Smell Identification Test [UPSIT] ≤ 33) between 6 and 12 months. Patients were randomized to three intranasal injections of either PRP or sterile saline into their olfactory clefts. The primary outcome measure was change in Sniffin’ Sticks score (threshold, discrimination, and identification [TDI]) from baseline. The secondary end point measures included responder rate (achievement of a clinically significant improvement, ≥5.5 points TDI), change in individual TDI olfaction scores, and change in subjective olfaction via a visual analog scale. Results A total of 35 patients were recruited and 26 completed the study. PRP treatment resulted in a 3.67‐point (95% CI: 0.05–7.29, p = 0.047) greater improvement in olfaction compared with the placebo group at 3 months and a higher response rate (57.1% vs 8.3%, odds ratio 12.5 [95% exact bootstrap confidence interval, 2.2–116.7]). There was a greater improvement in smell discrimination following PRP treatment compared with placebo but no difference in smell identification or threshold. There was no difference in subjective scores between PRP and placebo. No adverse effects were reported. Conclusion Olfactory function following COVID‐19 can improve spontaneously after 6 months and can improve to a greater extent with PRP injection. These data build on the promise of PRP to be a safe potential treatment option for patients with COVID‐19–related smell loss, and larger‐powered studies will help further assess its efficacy.

Despite promising outcomes for >50 years, nonsurgical orthodontic airway plates (OAP) are only infrequently offered for babies with Robin sequence in a few parts of the world. This article demonstrates possibility of providing functional improvement using an OAP to help these babies overcome their functional and structural difficulties on their own. Two consecutively treated cases are presented exemplifying that OAP treatment that had originated from Europe is reproducible and effective in an institution in the United States.

Objectives/Hypothesis Post‐tonsillectomy hemorrhage (PTH) is a potentially life‐threatening complication. A recent meta‐analysis suggests that ibuprofen may increase the risk of PTH. The aims of this study were to 1) re‐evaluate the effect of ibuprofen on PTH given additional recent evidence and 2) to evaluate a potential dose effect of ibuprofen. Study Design Meta‐analysis and meta‐regression; single‐institution retrospective review. Methods We conducted a systematic review of the literature and a meta‐analysis of 12 studies comparing postoperative ibuprofen analgesia to non‐nonsteroidal anti‐inflammatory drug (NSAID) controls. Next, we performed a meta‐regression analysis to assess for an effect of dose, if any, on rates of PTH. Five studies specifying a dose of 5 mg/kg (828 patients, 1,411 controls) and 7 studies using 10 mg/kg (5,633 patients, 7,656 controls) were included. We then conducted a novel single‐institution, retrospective review of data for 1,046 patients prescribed intermediate‐dose 7.5 mg/kg ibuprofen. Results Ibuprofen was not associated with an increased rate of PTH (log odds ratio [OR], 0.21; 95% confidence interval [CI] −0.15, 0.57). Meta‐regression showed that ibuprofen dose (5 and 10 mg/kg) did not have a statistically significant effect on PTH (OR, 1.32; 95% CI 0.30, 5.84). Uncontrolled, aggregate rates of PTH across all studies were 2.29% (N = 828) for 5 mg/kg and 4.65% (N = 5,633) for 10 mg/kg dosing. The rate of secondary hemorrhage in patients prescribed 7.5 mg/kg ibuprofen was 3.10% (N = 1,046). Conclusion We found no statistically significant increased risk of PTH when ibuprofen is prescribed at the low or high range of commonly used clinical dosages, compared to a non‐ibuprofen regimen. Further studies with less heterogeneity are needed to determine if there is a clinically relevant dose‐dependent difference in PTH with ibuprofen. Level of Evidence 3 Laryngoscope, 132:1473–1481, 2022

ObjectivesThe objective of this study is to determine whether machine learning may be used for objective assessment of aesthetic outcomes of auricular reconstructive surgery.MethodsImages of normal and reconstructed auricles were obtained from internet image search engines. Convolutional neural networks were constructed to identify auricles in 2D images in an auto‐segmentation task and to evaluate whether an ear was normal versus reconstructed in a binary classification task. Images were then assigned a percent score for “normal” ear appearance based on confidence of the classification.ResultsImages of 1115 ears (600 normal and 515 reconstructed) were obtained. The auto‐segmentation task identified auricles with 95.30% accuracy compared to manually segmented auricles. The binary classification task achieved 89.22% accuracy in identifying reconstructed ears. When the confidence of the classification was used to assign percent scores to “normal” appearance, the reconstructed ears were classified to a range of 2% (least like normal ears) to 98% (most like normal ears).ConclusionImage‐based analysis using machine learning can offer objective assessment without the bias of the patient or the surgeon. This methodology could be adapted to be used by surgeons to assess quality of operative outcome in clinical and research settings.Level of Evidence4 Laryngoscope, 133:2413–2416, 2023

We recently published the 3-month follow-up of 2 neonates with Robin sequence whose mandibular hypoplasia and restricted airway were successfully treated with an orthodontic airway plate (OAP) without surgical intervention. Both infants were successfully weaned off the OAP after several months of continuous use. We present the course of OAP treatment in these patients with a focus on breathing, feeding, and facial growth during their first year of life. Both infants demonstrated stable mandibular projection, resolution of obstructive sleep apnea, and normal development.