Objective: Describe the presentation, work-up, and management of a rare co-occurrence of familial hypocalciuric hypercalcemia (FHH) and primary hyperparathyroidism (PHPT) in a single patient. Additionally, to explore the challenges in diagnosing in such patients, summarize the previous literature on this uncommon occurrence, and explore the possible etiologies for it. Methods: Case presentation from a tertiary care academic medical system. Results: Successful diagnosis and surgical management, returning the patient to his previously asymptomatic FHH baseline. Conclusion: FHH and PHPT are both causes of hypercalcemia. Very rarely, these two conditions can occur simultaneously in the same patient. The relationship between these two entities when they present concurrently is complex, likely the result of particular CASR mutations causing greater parathyroid cellular proliferation and an increased predisposition to developing PHPT. These rare patients can be difficult to diagnose, but when recognized appropriately and managed with surgery for the PHPT component, they can achieve an asymptomatic FHH state. (AACE Clinical Case Rep. 2018;4:e362-e366) Abbreviations: CASR = calcium-sensing receptor gene; CaSR = calcium-sensing receptor protein; DXA = dual-energy X-ray absorptiometry; FEca = fractional excretion of calcium; FHH = familial hypocalciuric hypercalcemia; PHPT = primary hyperparathyroidism; PTH = parathyroid hormone

Objective Characterize the evolution of head and neck (H&N) surgical practices in the United States over two decades by using resident case log data as a surrogate. Methods National residency case log data from all Accreditation Council for Graduate Medical Education‐accredited otolaryngology residency programs was reviewed for the past 20 academic years (1996–2015). Key indicator procedures in each subcategory of H&N were analyzed to characterize standard ablative H&N surgical practices. Mean number of cases completed per resident each year was calculated. Results The proportion of H&N surgeries contributing to the total number of otolaryngology cases performed yearly remained relatively stable during the study period, ranging from 6.4% to 8.7%, indicating concurrent growth of H&N cases with all otolaryngology surgeries. Although each subcategory within H&N demonstrated modest increases in the number of cases performed per resident each year over the study period, the most significant growth occurred in the endocrine surgery subcategory: a 288% increase from 18.4 in 1996 to 71.5 in 2015. The proportion of H&N cases represented by each subcategory decreased, except for endocrine, which more than doubled in proportion from 21% in 1996 to 43% in 2015. Conclusion Our findings suggest that the modern H&N surgeon is increasingly becoming an endocrine and H&N surgeon. The proportion of endocrine surgeries performed in residency, which serves as a surrogate for H&N practices, has more than doubled over the past 20 years and now represents the largest subcategory of H&N surgery. Level of Evidence NA Laryngoscope, 129:1150–1154, 2019

The presenting signs and symptoms of extremely rare primary TMJ tumors are those often seen by otolaryngologists. Contemporary neurotologic skull base surgical techniques can optimize the successful extirpation of these lesions.

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