One of the key challenges with big data is leveraging the complex network of information to yield useful clinical insights. The confluence of massive amounts of health data and a desire to make inferences and insights on these data has produced a substantial amount of interest in machine-learning analytic methods. There has been a drastic increase in the otolaryngology literature volume describing novel applications of machine learning within the past 5 years. In this timely contemporary review, we provide an overview of popular machine-learning techniques, and review recent machine-learning applications in otolaryngology-head and neck surgery including neurotology, head and neck oncology, laryngology, and rhinology. Investigators have realized significant success in validated models with model sensitivities and specificities approaching 100%. Challenges remain in the implementation of machine-learning algorithms. This may be in part the unfamiliarity of these techniques to clinician leaders on the front lines of patient care. Spreading awareness and confidence in machine learning will follow with further validation and proof-of-value analyses that demonstrate model performance superiority over established methods. We are poised to see a greater influx of machine-learning applications to clinical problems in otolaryngology-head and neck surgery, and it is prudent for providers to understand the potential benefits and limitations of these technologies.

We sought to identify an essential component of the TEAD4/VGLL4 transcription factor complex that controls vascular endothelial growth factor A (VEGFA) expression in muscle. A yeast 2-hybrid screen was used to clone a novel component of the TEAD4 complex from a human heart cDNA library. We identified interferon response factor 2 binding protein 2 (IRF2BP2) and confirmed its presence in the TEAD4/VGLL4 complex in vivo by coimmunoprecipitation and mammalian 2-hybrid assays. Coexpression of IRF2BP2 with TEAD4/VGLL4 or TEAD1 alone potently activated, whereas knockdown of IRF2BP2 reduced, VEGFA expression in C(2)C(12) muscle cells. Thus, IRF2BP2 is required to activate VEGFA expression. In mouse embryos, IRF2BP2 was ubiquitously expressed but became progressively enriched in the fetal heart, skeletal muscles, and lung. Northern blot analysis revealed high levels of IRF2BP2 mRNA in adult human heart and skeletal muscles, but immunoblot analysis showed low levels of IRF2BP2 protein in skeletal muscle, indicating post-transcriptional regulation of IRF2BP2 expression. IRF2BP2 protein levels are markedly increased by ischemia in skeletal and cardiac muscle compared to normoxic controls. IRF2BP2 is a novel ischemia-induced coactivator of VEGFA expression that may contribute to revascularization of ischemic cardiac and skeletal muscles.

Objectives: To review evidence regarding the health-related quality of life (HRQoL) and cost-effectiveness of unilateral and bilateral cochlear implantation (CI) among children and adults with severe-to-profound hearing loss. Study Design: Narrative review. Methods: Publications related to quality of life (QoL) and costs of care in CI were acquired through searches in English-language databases. Studies were included if they had identified the HRQoL attainment, cost of care, cost-utility, or cost-effectiveness associated with CI. Results: 57 studies were critically reviewed. The QoL outcome metrics used in these articles were divided into 2 categories - generic and condition specific. In studies investigating children, many reported no significant difference in QoL attainment between CI recipients and normal-hearing peers. In adults, significant improvements in QoL after implantation and higher QoL than in their nonimplanted (hearing-aided) peers were frequently reported. Studies involving an older adult cohort reported significant improvement in QoL after implantation, which was often independent of audiological performance. Overall, the calculated cost-utility ratios consistently met the threshold of cost acceptance, indicating acceptable values for expenditures on CI. Conclusions: Considerable work has been done on the QoL attainment and health economic implications of CI. Unilateral CI across all age groups leads to reported sustained benefits in the recipients' overall and disease-specific QoL. With increased cost associated with bilateral CI, further study is needed to characterize its costs and benefits with respect to the recipients' health, well-being, and contributions to society.

Although surgery remains the mainstay of treatment, our results do not suggest that adding chemotherapy to postoperative radiotherapy confers a survival or control benefit.