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Objective The accuracy and reliability of COVID-19 testing are critical to limit transmission. After observing variability in testing techniques, we otolaryngologists at a tertiary medical center initiated and evaluated the impact of nasopharyngeal and oropharyngeal swabbing training, including video instruction, to standardize sampling techniques and ensure high-quality specimens. Methods Participants in the training were employees (N = 40). Training consisted of an instructional video on how to perform nasopharyngeal and oropharyngeal swabs and a live demonstration. Participants completed pre- and posttraining surveys assessing their knowledge and confidence in performing nasopharyngeal and oropharyngeal swabs. They then performed swabbing on partners, which was graded per a standardized checklist. Results Mean scores for knowledge-based questions and confidence in swabbing were significantly higher after the training session (both P < .001). All participants scored ≥6 of 8 on the posttraining checklist. Ninety-five percent rated the video as very or extremely useful. Discussion Specialized instruction for nasopharyngeal swabbing improved participants’ knowledge—specifically, the appropriate head position and minimum swab time in nasopharynx—and their confidence. After the training, their swabbing execution scores were high. Implications for Practice Video-assisted hands-on instruction for nasopharyngeal swab sampling can be used to standardize teaching. When prompt and accurate testing is paramount, this instruction can optimize procedural technique and should be used early and often. In addition, there may be a professional responsibility of otolaryngologists to participate in such initiatives.

Objective Solid‐organ transplantation (SOT) has become the standard of care for children with terminal organ failure. Long‐term immunosuppression has improved survival substantially but is associated with secondary malignancies and impaired wound healing. Our goal was to review the incidence, outcomes, complications, and rate of posttransplant lymphoproliferative disorder on pathologic examination following tonsillectomy/adenotonsillectomy (T/AT) in children after SOT. Study Design A retrospective cohort study. Setting Tertiary care children's hospital. Methods Data were extracted from charts of children with a history of kidney, heart, or liver transplantation, who underwent T/AT between 2006 and 2021. Results A total of 110 patients met the inclusion criteria, including 46 hearts, 41 kidneys, 19 livers, and 4 liver‐and‐kidney transplants. The mean age at transplantation was 4.2 years, and the mean transplantation‐to‐T/AT time interval was 28.8 months. The posttransplant lymphoproliferative disorder was diagnosed in 52 (47.3%) patients, and 25% of these had no tonsillar hypertrophy. There was no difference in age at transplantation, organ received, transplantation‐to‐T/AT time interval, immunosuppressive medications, tonsil size, or tonsillar asymmetry between patients diagnosed with the posttransplant lymphoproliferative disorder and patients with benign tonsillar/adenotonsillar hypertrophy. Posttonsillectomy complications were similar between the groups. Conclusion The incidence of posttransplant lymphoproliferative disorder undergoing tonsillectomy for any indication was 47.3%. There was no association between preoperative signs and symptoms and the histopathological diagnosis of posttransplant lymphoproliferative disorder. Stratification by organ received and immunosuppressive medications did not identify differences among the groups relative to the incidence of posttransplant lymphoproliferative disorder and other postoperative complications.

OBJECTIVE Patients with fibrous dysplasia (FD) of the anterior skull base can experience progressive visual loss and impairment. The authors reviewed their experience with endonasal decompression of the optic nerve (ON) in this patient population. Endoscopic ON decompression (EOND) is a feasible surgical approach for children with FD and visual deficit due to structural ON compression. METHODS Electronic medical records of children between 1 and 17 years of age with unilateral FD of the anterior skull base and concomitant ON compression, who required EOND between 2017 and 2022 (n = 4), were reviewed for demographic data, both pre- and postoperative imaging, and evaluations by an otolaryngologist, neurosurgeon, and ophthalmologist in a multidisciplinary fashion. RESULTS EOND was found to be a safe and effective surgery for children with FD. Visual acuity was stable in 80% of the eyes postoperatively. Visual fields improved in 40% of the eyes and remained stable in the rest. CONCLUSIONS EOND is beneficial for progressive optic neuropathy that is unresponsive to steroid therapy and can prevent permanent disability if performed prior to irreversible damage to the nerve. EOND can decompress the edematous ON with proper exposure of the optic canal and orbital apex, without any major complications.

INTRODUCTION: Previous research suggests that there is no association between timing of epidural placement and mode of delivery. However, with active labor now defined as beginning at six centimeters cervical dilation, we explored if timing of epidural placement before active labor was associated with higher rates of Cesarean section. Secondary outcomes included rate of operative vaginal delivery and length of the second stage. METHODS: We conducted a retrospective chart review of patients who delivered at an urban, academic hospital between June 2015 and May 2016. Primiparous women delivering live-born, singleton, full-term infants were included. RESULTS: Of 433 women, 284 (66%) had epidurals placed prior to six centimeters cervical dilation, while the remaining 149 (34%) women had epidurals placed after six centimeters. There was no difference in the rate of Cesarean section between those who had epidurals placed prior to (15.8%, N=45) and after (13.4% N=20) six centimeters, as well as no difference in the rate of operative vaginal delivery (4.2% vs. 3.3%, respectively), [Χ2(2, N=433) = 0.701 P=0.704]. Finally, there was no difference in the mean length of the second stage of labor (mean of 88 minutes vs 80 minutes), [F(1, 356) = 0.929, P=0.336]. CONCLUSION: Placement of epidural prior to or after the onset of active labor did not differentiate mode of delivery or length of the second stage. With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary Cesarean section.