Otolaryngologic Clinics of North America RSS feed. https://www.oto.theclinics.com/issues?journalCode=otc&publicationCode=otc&rss=yes Elsevier Inc. en © 2026 Published by Elsevier Inc. All rights reserved. Otolaryngologic Clinics of North America 0030-6665 2026-06-17-07:00 © 2026 Published by Elsevier Inc. All rights reserved. permissionshelpdesk@elsevier.com https://www.oto.theclinics.com/article/S0030-6665(26)00079-4/fulltext?rss=yes This review outlines a standardized diagnostic algorithm for balloon dilation of the Eustachian tube (BDET) in obstructive ETD. The algorithm prioritizes excluding differential diagnoses including patulous ETD, temporomandibular joint disorders, and superior canal dehiscence syndrome. Objective tests and patient-reported outcomes help when facing equivocal clinical findings. BDET is indicated for barochallenge-induced ETD, chronic otitis media with effusion, and tympanic membrane retraction pockets after failed medical management, and may adjunct tympanoplasty in adhesive otitis media. Contraindications include patulous ETD and significant Eustachian tube anatomical distortion. Rigorous patient selection remains essential for safe and effective outcomes. Diagnostic Algorithm for Eustachian Tube Dysfunction and Indications for Balloon Dilation of the Eustachian Tube Marta Sandoval, Krittayot Patchanee, In Seok Moon 10.1016/j.otc.2026.04.012 Otolaryngologic Clinics of North America (2026) 2026-06-17 Otolaryngologic Clinics of North America 2026-06-17 https://www.oto.theclinics.com/article/S0030-6665(26)00028-9/fulltext?rss=yes Eustachian tube dysfunction represents a continuum ranging from obstructive Eustachian tube dysfunction to patulous Eustachian tube dysfunction (pETD), and there is considerable overlap of symptoms that present challenges in the differential diagnosis. Careful history, physical, endoscopic examination, and audiological testing are all important in distinguishing between these conditions and other causes of aural fullness. There are many different treatment modalities, but none are optimal. The most common methods have a good safety record, and they are repeatable. There is a need for more randomized, controlled trials of treatments for pETD. Patulous Eustachian Tube Dysfunction Juha Tapio Silvola, Dennis S. Poe 10.1016/j.otc.2026.03.002 Otolaryngologic Clinics of North America (2026) 2026-06-11 Otolaryngologic Clinics of North America 2026-06-11 https://www.oto.theclinics.com/article/S0030-6665(26)00077-0/fulltext?rss=yes The Eustachian tube (ET) it is a complex structure connecting the middle ear cavity with the nasopharynx. Its function is to maintain middle ear ventilation to facilitate transmission of sound from the tympanic membrane to the cochlea. It is located medial to the parapharyngeal space. The ET and tympanomastoid cavities form an anatomic and functional unit that cannot easily be divided, and it plays a fundamental role in the etiology of different clinical entities. However, the underlying pathophysiological mechanisms are not yet fully understood, and further research is needed to address the gaps present in the literature. Revisiting Eustachian Tube Anatomy and Physiology Davide Soloperto, Mohamed Badr-El-Dine, Muaaz Tarabichi, Daniele Marchioni 10.1016/j.otc.2026.04.010 Otolaryngologic Clinics of North America (2026) 2026-06-10 Otolaryngologic Clinics of North America 2026-06-10 https://www.oto.theclinics.com/article/S0030-6665(26)00036-8/fulltext?rss=yes Glottic stenosis may be congenital, such as anterior glottic webs, or acquired, as a result of surgery or prolonged intubation. Glottic-level obstruction may occur as an isolated lesion or as part of multilevel airway stenosis. Careful evaluation is required to distinguish neural causes of impaired vocal fold motion from true mechanical fixation, as the underlying etiology can influences surgical decision-making. When addressing glottic-level stenosis, particular attention must be paid to the potential effects on voice and swallowing while striving to achieve adequate airway caliber. Glottic Stenosis Julina Ongkasuwan, Rebecca Chin-Ping Lee 10.1016/j.otc.2026.03.010 Otolaryngologic Clinics of North America (2026) 2026-06-08 Otolaryngologic Clinics of North America 2026-06-08 https://www.oto.theclinics.com/article/S0030-6665(26)00078-2/fulltext?rss=yes Chronic pediatric middle ear disease is commonly ascribed to Eustachian tube dysfunction (ETD). This article reviews the role of obstructive and patulous ETD in otitis media with effusion, tympanic membrane retraction, cholesteatoma, and perforation. It highlights the lack of reliable diagnostic tests to measure ETD. The contribution of different causes of obstructive ETD is discussed, including the influence of mechanical obstruction, inflammation, allergy, mucociliary dysfunction, and craniofacial anomalies. ETD management has traditionally bypassed the Eustachian tube, for example, with tympanostomy tubes. Balloon dilatation remains controversial in children due to unproven efficacy and safety and the heterogeneous underlying mechanisms of ETD. Eustachian Tube Disorders in Children Maia E. Walsh, Adrian L. James 10.1016/j.otc.2026.04.011 Otolaryngologic Clinics of North America (2026) 2026-06-03 Otolaryngologic Clinics of North America 2026-06-03 https://www.oto.theclinics.com/article/S0030-6665(26)00082-4/fulltext?rss=yes The first thing parents want to hear when their baby is born is a loud, lusty cry. This tells everyone present that the airway is open from the lips to the lungs. A couple of suctions of the nose, and that entrance is open as well. When everything works and stays working, everyone is happy. However, there are many places where these narrow passages can be obstructed, and because of the geometry, these quickly become urgent or emergent, and frightening, situations. Small Passages; Big Problems Sujana S. Chandrasekhar 10.1016/j.otc.2026.05.002 Otolaryngologic Clinics of North America (2026) 2026-06-01 Otolaryngologic Clinics of North America 2026-06-01 Foreword https://www.oto.theclinics.com/article/S0030-6665(26)00083-6/fulltext?rss=yes Cough represents one of the most common reasons for medical consultation globally. Far from a simple symptom, cough profoundly impacts patients’ quality of life, leading to significant physical, psychological, and socioeconomic burdens. Its often-elusive causes, multifactorial nature, and frequent resistance to conventional treatments pose a substantial challenge to clinicians across various specialties. This comprehensive issue addresses this pervasive issue head-on, offering a vital resource for health care professionals seeking to learn the intricate mechanisms and diverse manifestations of cough. Navigating the Complexities of Cough in Clinical Practice Seth E. Kaplan, Kathleen M. Tibbetts 10.1016/j.otc.2026.05.003 Otolaryngologic Clinics of North America (2026) 2026-05-29 Otolaryngologic Clinics of North America 2026-05-29 Preface https://www.oto.theclinics.com/article/S0030-6665(26)00071-X/fulltext?rss=yes Treatment of refractory chronic cough remains a challenge for physicians due to limited therapeutic options. One leading hypothesis regarding the etiology of chronic cough is damage to the vagus nerve, which mediates the cough reflex, after an insult such as a viral infection. This results in hypersensitivity and therefore a reduced cough threshold. Neuromodulators such as gabapentin, pregabalin, and tramadol have been repurposed to treat this hypersensitivity similar to other neuropathic pain conditions. A new class of drugs, P2X3 antagonists, have emerged as another possibility for treating individuals with chronic cough; however, Food and Drug Administration approval is still pending. Pharmacology of Cough Emily Garvey, Joseph Spiegel 10.1016/j.otc.2026.04.004 Otolaryngologic Clinics of North America (2026) 2026-05-29 Otolaryngologic Clinics of North America 2026-05-29 https://www.oto.theclinics.com/article/S0030-6665(26)00048-4/fulltext?rss=yes Refractory chronic cough is a common and challenging condition that results from laryngeal hypersensitivity. Office-based procedures can serve as adjuncts to behavioral or medical therapies or as alternatives for patients with incomplete response or intolerance to these treatments. This article reviews the rationale, techniques, and outcomes of three office-based interventions: superior laryngeal nerve block, laryngeal botulinum toxin injection, and vocal fold injection augmentation. These procedures are safe, cost-effective, and well-tolerated in the clinic setting. Office-Based Procedures for Chronic Cough Mollie C. Perryman, C. Blake Simpson 10.1016/j.otc.2026.03.022 Otolaryngologic Clinics of North America (2026) 2026-05-29 Otolaryngologic Clinics of North America 2026-05-29 https://www.oto.theclinics.com/article/S0030-6665(26)00075-7/fulltext?rss=yes Obstructive eustachian tube dysfunction (ETD) contributes to a spectrum of middle ear disorders, including otitis media with effusion (OME), tympanic membrane retraction, and barochallenge-induced symptoms. This review summarizes evidence-based treatment outcomes, focusing on efficacy derived from systematic reviews and safety from additional sources. Medical management has no proven benefits for obstructive ETD. Tympanostomy tubes and adenoidectomy demonstrate age-specific effectiveness for pediatric OME with accepted risks. Some manifestations of ETD may benefit from balloon dilation of the eustachian tube (BDET), or sinonasal surgery, but much evidence is of low quality; indications, long-term benefits, and safety are not clearly established for BDET. Interventions for Obstructive Eustachian Tube Dysfunction Deepak P. Chandrasekharan, Mohamed Badr-El-Dine, Adrian L. James 10.1016/j.otc.2026.04.008 Otolaryngologic Clinics of North America (2026) 2026-05-27 Otolaryngologic Clinics of North America 2026-05-27 https://www.oto.theclinics.com/article/S0030-6665(26)00073-3/fulltext?rss=yes Cough can result from a variety of etiologies, and rare pulmonary, otolaryngologic, cardiac, neurologic, medication-related, and functional conditions are often overlooked. Pulmonary etiologies, including structural airway abnormalities, endobronchial obstruction, expiratory central airway collapse, and occupational eosinophilic bronchitis, frequently require advanced imaging and bronchoscopy for diagnosis. Otolaryngologic conditions include elongated uvula, tonsillar hypertrophy, and external auditory canal pathology, which can trigger vagally mediated cough reflexes. Obstructive sleep apnea may result in chronic cough through inflammatory and reflux-mediated mechanisms. Cardiac causes include heart failure, airway compression, and arrhythmias. Neurologic, medication-induced, and functional causes should also be considered in refractory cases. Rare Causes of Unexplained Chronic Cough in Adults Nivedita Sabarinathan, Raluca Gray 10.1016/j.otc.2026.04.006 Otolaryngologic Clinics of North America (2026) 2026-05-27 Otolaryngologic Clinics of North America 2026-05-27 https://www.oto.theclinics.com/article/S0030-6665(26)00070-8/fulltext?rss=yes Cough pathophysiology ranges from a simple reflex to a complex neuroimmune disorder involving intricate neural circuitry, peripheral sensitization, and central plasticity. The cough reflex is governed by a complex orchestration of sensory nerves and central brain structures. Chronic cough often results from peripheral and central sensitization, leading to hypersensitivity influenced by various physiologic and environmental factors. This advanced understanding is vital for developing personalized, mechanism-directed therapies for this prevalent condition. Pathophysiology of Cough Peter S. Giannaris, Seth E. Kaplan 10.1016/j.otc.2026.04.003 Otolaryngologic Clinics of North America (2026) 2026-05-27 Otolaryngologic Clinics of North America 2026-05-27 https://www.oto.theclinics.com/article/S0030-6665(26)00054-X/fulltext?rss=yes Congenital tracheal stenosis (CTS) from complete tracheal rings is a rare and potentially life-threatening condition necessitating complex multidisciplinary management. This clinical review explores the anatomic patterns of CTS and discusses diagnostic nuances, emphasizing the use of ultrasmall instrumentation to avoid mucosal trauma. We detail the historical failure of graft-based repairs and the paradigm shift brought by slide tracheoplasty. Current surgical management for long-segment and short-segment disease is discussed, emphasizing the narrowest point philosophy, 45-degree beveled incisions, and internal Grillo sutures. Finally, we address the management of technical complications and the coordinated aerodigestive model of care. Congenital Tracheal Stenosis Yonatan Reuven, Mike Rutter 10.1016/j.otc.2026.03.028 Otolaryngologic Clinics of North America (2026) 2026-05-27 Otolaryngologic Clinics of North America 2026-05-27 https://www.oto.theclinics.com/article/S0030-6665(26)00038-1/fulltext?rss=yes Cough is one of the most common reasons for health care visits. This article seeks to illustrate the classification, appropriate workup, and management of acute and subacute cough. It highlights etiologies such as bronchitis, pneumonia, and exacerbation of heart failure and asthma. There is an emphasis placed on potentially life-threatening pathologies associated with cough and how to appropriate triage cough severity in an emergency setting. The pathophysiology of cough and how it may lead to severe barotraumatic complications such as pneumothorax and Mallory Weiss tears is discussed. Acute and Subacute Cough Erin Hoag, Krishani Patel, Samuel Farris, Ta-Fu Lin 10.1016/j.otc.2026.03.012 Otolaryngologic Clinics of North America (2026) 2026-05-27 Otolaryngologic Clinics of North America 2026-05-27 https://www.oto.theclinics.com/article/S0030-6665(26)00080-0/fulltext?rss=yes Jane Austen’s novel Pride and Prejudice encapsulates how many of us deal with cough. In it, Mrs Bennet scolds one of her daughters by saying, “Don't keep coughing so, Kitty, for Heaven's sake! Have a little compassion on my nerves. You tear them to pieces.” Mr Bennet jumps in to defend his daughter by saying, “Kitty has no discretion in her coughs; she times them ill.” And Kitty fretfully replies, “I do not cough for my own amusement.” Coughs are not only frustrating to the cougher and those around them; they can also be frightening, as they may herald spread of airborne diseases. Otolaryngologic Understanding of Acute and Chronic Cough Sujana S. Chandrasekhar 10.1016/j.otc.2026.04.013 Otolaryngologic Clinics of North America (2026) 2026-05-25 Otolaryngologic Clinics of North America 2026-05-25 Foreword https://www.oto.theclinics.com/article/S0030-6665(26)00074-5/fulltext?rss=yes Eustachian tube dysfunction (ETD) is a commonly suspected cause of aural fullness, otalgia, and hearing loss, but presentation varies among patients. In addition, these symptoms are not specific and can be indicative of other conditions. Some of these conditions are otologic in nature and can be localized to the external, middle, or inner ear. Others arise from outside the ear and can be attributed to functional, neurologic, or structural causes. While presentation may be similar to ETD, differentiation is possible with clinical history, physical examination, and objective testing such as otoscopy, tympanometry, imaging, and specialized vestibular testing. Eustachian Tube Dysfunction Mimics Kelly Lee, Maja Svrakic 10.1016/j.otc.2026.04.007 Otolaryngologic Clinics of North America (2026) 2026-05-20 Otolaryngologic Clinics of North America 2026-05-20 https://www.oto.theclinics.com/article/S0030-6665(26)00072-1/fulltext?rss=yes Cough is one of the most common symptoms prompting medical consultation and represents a diagnostic challenge due to its multifactorial nature and often overlapping etiologies. This review outlines the pulmonologist’s systematic approach to the evaluation and management of cough, emphasizing the importance of classifying cough as acute, subacute, or chronic to guide investigation and treatment. Overall, this article underscores the complexity of cough evaluation and the necessity of a comprehensive, patient-centered approach. This article describes the pulmonologist’s approach to the diagnosis and treatment of cough and how it interplays with the otolaryngologist’s evaluation. The need for an interdisciplinary approach to diagnoses and treat cough is emphasized. The Pulmonologist’s Approach to the Diagnosis and Treatment of Cough David Posner 10.1016/j.otc.2026.04.005 Otolaryngologic Clinics of North America (2026) 2026-05-20 Otolaryngologic Clinics of North America 2026-05-20 https://www.oto.theclinics.com/article/S0030-6665(26)00069-1/fulltext?rss=yes Exercise-induced laryngeal obstruction is a multifactorial disorder involving reversible laryngeal narrowing during exercise, influenced by developmental, physiologic, psychological, and sport-specific factors. A high index of suspicion in youth with exertional dyspnea is needed, as clinical history most strongly supports the diagnosis along with pulmonary evaluation and laryngoscopy to rule out alternative or comorbid pathology. Management is multidisciplinary, with growing evidence for behavioral and physiologic interventions—including laryngeal control therapy and respiratory retraining—alongside cognitive-behavioral strategies targeting anxiety, stress, and performance demands. Collaborative care among otolaryngology, pulmonology, behavioral health, and athletic staff optimizes outcomes and supports safe return to sport. Exercise-Induced Laryngeal Obstruction Pamela Mudd, Lilia M. Andrew, Courtney Long 10.1016/j.otc.2026.04.002 Otolaryngologic Clinics of North America (2026) 2026-05-20 Otolaryngologic Clinics of North America 2026-05-20 https://www.oto.theclinics.com/article/S0030-6665(26)00049-6/fulltext?rss=yes This article provides a practical guide to building a multidisciplinary chronic cough clinic, a model designed to enhance clarity and efficiency in addressing a condition that is often challenging to diagnose and manage. Given that chronic cough frequently stems from overlapping causes and evaluations may be prolonged and fragmented, coordinated assessment is essential. The article highlights the value of otolaryngology and pulmonology jointly assessing patients together at the initial visit, supported by well-defined referral pathways to gastroenterology, allergy, and speech-language pathology. Building and Implementing a Multidisciplinary Cough Clinic Salma Ahsanuddin, Seymour I. Huberfeld, William E. Karle 10.1016/j.otc.2026.03.023 Otolaryngologic Clinics of North America (2026) 2026-05-20 Otolaryngologic Clinics of North America 2026-05-20 https://www.oto.theclinics.com/article/S0030-6665(26)00037-X/fulltext?rss=yes There has been considerable growth in our knowledge of laryngeal tracheoesophageal clefts or laryngeal clefts, an anomalous communication between the airway and the esophagus. The most recent classifications separate laryngeal clefts into 4 major groups differentiated by the depth of the cleft. Presentation includes respiratory and swallowing difficulties and work up includes evaluation in and out of the operating room. Minor grade clefts may be managed in a variety of ways while higher grade clefts will require surgical intervention. A multidisciplinary team is key in all aspects of diagnosis, treatment, and long-term management. Laryngotracheal Clefts Anna Berezovsky, Kaalan Johnson 10.1016/j.otc.2026.03.011 Otolaryngologic Clinics of North America (2026) 2026-05-14 Otolaryngologic Clinics of North America 2026-05-14 https://www.oto.theclinics.com/article/S0030-6665(26)00030-7/fulltext?rss=yes Pediatric airway foreign bodies are common and potentially life-threatening situations. Ingestion of organic material in children under 3 is the most common clinical situation. Typical cases have a history suspicious for a sudden aspiration event supported by physical findings of wheezing or diminished breath sounds with radiological evidence of air-trapping. Rigid bronchoscopy remains the gold standard for diagnosis and treatment and providers should have a low threshold to proceed to the operating room if the clinical suspicion for aspiration is high. Computed tomography (CT) scans may be helpful to further guide decision-making in cases where there is low or intermediate suspicion. Airway Foreign Bodies Mary Catherine Brown, Ann Powers, Michal Trope, Ian Jacobs 10.1016/j.otc.2026.03.004 Otolaryngologic Clinics of North America (2026) 2026-05-14 Otolaryngologic Clinics of North America 2026-05-14 https://www.oto.theclinics.com/article/S0030-6665(26)00076-9/fulltext?rss=yes The contributing authors have agreed to adopt the following nomenclature to ensure consistency and accuracy throughout this monograph. Glossary of Terms 10.1016/j.otc.2026.04.009 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00058-7/fulltext?rss=yes This is a clinical review article summarizing the current literature, which has studied complications from surgical intervention for obstructive Eustachian tube dysfunction, focusing primarily on balloon dilation. Clinical evidence is organized based on the mechanism of injury. Explanations are presented for how complications may have arisen, as well as strategies to avoid them, to both improve clinical outcomes and provide accurate informed consent. Risks and Complications of Balloon Dilation of the Eustachian Tube Alexander J. Saxby, Holger Sudhoff 10.1016/j.otc.2026.04.001 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00057-5/fulltext?rss=yes Pediatric dynamic airway collapse is a complex condition that can impact all levels of the pediatric airway. These conditions can pose life threatening risk to pediatric patients and carry lasting impacts. While traditionally, tracheostomy has been used to address all levels of dynamic collapse, recent advances have allowed for more individualized, anatomy-specific stenting and splinting strategies for treatment. This article covers pathophysiology and the latest evidence on strategies to address nasopharyngeal, oropharyngeal, proximal trachea, and tracheobronchial dynamic collapse. Advanced/Novel Stenting for Pediatric Dynamic Airway Collapse Elle Nuttall, Adam Van Horn, David Zopf 10.1016/j.otc.2026.03.030 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00056-3/fulltext?rss=yes The subglottic region is the narrowest part of the pediatric airway and is susceptible to stenosis both congenitally or through acquired means. Thorough evaluation and correct diagnosis of the airway pathology is critical for choosing appropriate intervention and optimizing outcomes. This review details the pathogenesis, diagnostic tools, preoperative workup, and surgical interventions for pediatric subglottic stenosis. Subglottic Stenosis Aimee A. Kennedy, Matthew M. Smith 10.1016/j.otc.2026.03.029 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00053-8/fulltext?rss=yes Tracheomalacia and tracheoesophageal fistula are two pathologies that are commonly linked. Comprehensive aerodigestive evaluation can inform decision making on the best treatment approach. Patient factors including tracheal characteristics and surrounding anatomy influence the surgical approach. Tracheomalacia and Tracheoesophageal Fistula Douglas von Allmen, Michael J. Rutter 10.1016/j.otc.2026.03.027 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00045-9/fulltext?rss=yes To date, there is no standardized surgical therapy for pediatric unilateral vocal fold paralysis in the pediatric population. Treatment options include observation with voice therapy, vocal fold injection, laryngeal framework surgery, and recurrent laryngeal nerve reinnervation. The latter has been shown to be highly successful in the treatment of dysphonia, aspiration and dyspnea/stridor due to persistent unilateral vocal fold paralysis, and it provides a durable and safe option for this population. Recurrent Laryngeal Nerve Reinnervation Theodore A. Gobillot, Karen B. Zur 10.1016/j.otc.2026.03.019 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00033-2/fulltext?rss=yes There are 2 types of pediatric nasal obstruction: anatomic and physiologic. Anatomic obstruction may be corrected surgically, whereas physiologic obstruction is best managed medically. There are those cases in which surgical correction of anatomic obstruction can enhance the efficacy of topical therapies when managing physiologic obstruction. This article aims to discuss causes and management of pediatric nasal obstruction. Nasal Obstruction Uma S. Ramaswamy, Mark A. Fadel 10.1016/j.otc.2026.03.007 Otolaryngologic Clinics of North America (2026) 2026-05-13 Otolaryngologic Clinics of North America 2026-05-13 https://www.oto.theclinics.com/article/S0030-6665(26)00040-X/fulltext?rss=yes This article explores the relationship between cough and dysphagia. Both are nonspecific symptoms that arise from a variety of heterogenous and frequently multifactorial etiologies. We specifically examine the physiology of cough in relation to swallowing and summarize pertinent existing literature in disorders and diseases of aspiration, cervical diverticula, esophageal motility, eosinophilic esophagitis, and age-related changes in swallowing physiology. Treatment options for specific swallowing disorders that can result in cough are discussed, although robust data for cough outcomes are limited in the existing literature. Dysphagia, Swallowing Disorders, and Cough Zao Mike Yang, Mark A. Fritz 10.1016/j.otc.2026.03.014 Otolaryngologic Clinics of North America (2026) 2026-05-06 Otolaryngologic Clinics of North America 2026-05-06 https://www.oto.theclinics.com/article/S0030-6665(26)00046-0/fulltext?rss=yes Endoscopy remains the gold standard for assessing dynamic airway abnormalities in pediatric patients, but its invasiveness and variable interoperator agreement have driven interest in imaging-based alternatives. Four-dimensional computed tomography (CT) now enables objective quantification of tracheal collapse during free breathing, while photon-counting CT achieves effective doses approaching chest radiography, fundamentally altering the risk–benefit calculus for serial monitoring. MRI approaches—from real-time cine for obstructive sleep apnea localization to retrospectively gated techniques achieving submillimeter resolution without sedation—provide radiation-free dynamic assessment. This article reviews these modalities alongside ultrasound and optical coherence tomography, with guidance for modality selection based on clinical indication. Advanced Imaging to Assess Airway Dynamics Alister J. Bates, Robert J. Fleck, David F. Smith 10.1016/j.otc.2026.03.020 Otolaryngologic Clinics of North America (2026) 2026-05-05 Otolaryngologic Clinics of North America 2026-05-05 https://www.oto.theclinics.com/article/S0030-6665(26)00043-5/fulltext?rss=yes Chronic cough affects approximately 10% of adults. A substantial proportion experience persistent symptoms despite comprehensive medical management, significantly impacting quality of life. Behavioral cough suppression therapy (BCST) delivered by speech-language pathologists (SLP) has emerged as an effective, evidence-based intervention for refractory chronic cough (RCC). This review provides practical guidance regarding referral to an SLP, the SLP evaluation process, and the BCST protocol for RCC. Collaboration between the treating SLP and the medical team is essential for management of patients with chronic cough. Behavioral Cough Suppression Therapy Winston Cheng, Deanna Kawitzky 10.1016/j.otc.2026.03.017 Otolaryngologic Clinics of North America (2026) 2026-05-05 Otolaryngologic Clinics of North America 2026-05-05 https://www.oto.theclinics.com/article/S0030-6665(26)00041-1/fulltext?rss=yes Laryngopharyngeal reflux (LPR) is one of the most common causes of cough. It may not respond to acid suppression trials because non-acidic and weakly acidic reflux are often the etiology in refractory cases. Hypopharyngeal–esophageal multichannel intraluminal impedance with dual pH testing is the gold standard to diagnose LPR and guide personalized treatment of individual patients. Treatments typically involve a combination of barrier agents such as sodium alginate-based agents, acid suppression (when indicated), and diet and lifestyle management. Laryngopharyngeal Reflux and Chronic Cough Gabriela L. Lilly, Thomas L. Carroll 10.1016/j.otc.2026.03.015 Otolaryngologic Clinics of North America (2026) 2026-05-05 Otolaryngologic Clinics of North America 2026-05-05 https://www.oto.theclinics.com/article/S0030-6665(26)00050-2/fulltext?rss=yes Occupational and environmental exposures contribute to a significant, yet often underrecognized, proportion of chronic cough cases. Airway irritants activate sensory neurons through transient receptor potential ion channels, inducing peripheral and central sensitization that persists beyond the exposure period. Common triggers include isocyanates, dusts, fumes, and air pollutants found across diverse industries. Despite recommendations for routine exposure assessment, systematic evaluation remains uncommon in clinical practice. Accurate recognition necessitates detailed exposure histories, temporal correlation with symptoms, and multidisciplinary collaboration, thereby enabling targeted interventions and workplace protections. Occupational, Environmental, and Irritant-induced Cough Benjamin Wajsberg, Michael S. Benninger 10.1016/j.otc.2026.03.024 Otolaryngologic Clinics of North America (2026) 2026-05-04 Otolaryngologic Clinics of North America 2026-05-04 https://www.oto.theclinics.com/article/S0030-6665(26)00042-3/fulltext?rss=yes Upper airway cough syndrome (UACS), formerly known as postnasal drip syndrome, is one of the most common causes of chronic cough. It encompasses a spectrum of upper airway disorders, including allergic rhinitis, nonallergic rhinitis, and chronic rhinosinusitis which stimulate cough through mucosal inflammation and upper airway hypersensitivity. This article reviews the pathophysiology, diagnostic evaluation, and management of UACS from an otolaryngologic perspective. The lack of a clear diagnostic test requires clinical differentiation from other causes of chronic cough. Evidence-based treatment strategies aim to resolve cough through targeted control of airway inflammation and mucus production. Upper Airway Cough Syndrome Nasser Lubega, Kareem Al-Mulki, Janalee Stokken 10.1016/j.otc.2026.03.016 Otolaryngologic Clinics of North America (2026) 2026-05-04 Otolaryngologic Clinics of North America 2026-05-04 https://www.oto.theclinics.com/article/S0030-6665(26)00039-3/fulltext?rss=yes Cough is one of the most common symptoms among children. While most acute cough episodes are viral and resolve within 4 weeks, chronic cough persisting beyond 4 weeks warrants further evaluation. Pediatric-specific cough guidelines emphasizing algorithmic evaluation assist in early and accurate diagnosis for preventing long-term pulmonary complications. This article reviews evidence-based approaches to evaluating and managing acute and chronic cough in children, highlighting key diagnostic strategies and targeted treatment options. Acute and Chronic Cough in Children Douglas Kempthorne, Yann-Fuu Kou 10.1016/j.otc.2026.03.013 Otolaryngologic Clinics of North America (2026) 2026-05-04 Otolaryngologic Clinics of North America 2026-05-04 https://www.oto.theclinics.com/article/S0030-6665(26)00035-6/fulltext?rss=yes Inflammatory and neoplastic conditions of the pediatric airway can result in significant respiratory and vocal impairment. The pediatric airway is inherently small; thus, even minor obstruction results in an exponential increase in resistance to airflow and can quickly lead to life-threatening airway compromise. The broad range of severity and symptom manifestation requires comprehensive history, examination, and endoscopic evaluation to accurately diagnose these conditions. Surgical intervention is often required for diagnosis and management; however, advances in nonsurgical therapies have greatly enhanced outcomes and reduced the need for operative intervention. This article reviews nonsurgical management strategies for several key airway conditions. Non-surgical Management of Neoplastic and Inflammatory Conditions of the Airway Erin R.S. Hamersley, Craig S. Derkay 10.1016/j.otc.2026.03.009 Otolaryngologic Clinics of North America (2026) 2026-04-29 Otolaryngologic Clinics of North America 2026-04-29 https://www.oto.theclinics.com/article/S0030-6665(26)00027-7/fulltext?rss=yes This is a clinical review article summarizing current research into proposed etiologies of obstructive Eustachian tube dysfunction. Evidence investigating and explaining the proposed mechanisms for each association is given. This is followed by a summary of clinical evidence regarding efficacy of management strategies for each etiologic pathology on Eustachian tube function. Alternative Causes of Obstructive Eustachian Tube Dysfunction Alexander J. Saxby, Nicholas Jufas, Jonathan H.K. Kong, Nirmal P. Patel 10.1016/j.otc.2026.03.001 Otolaryngologic Clinics of North America (2026) 2026-04-22 Otolaryngologic Clinics of North America 2026-04-22 https://www.oto.theclinics.com/article/S0030-6665(26)00044-7/fulltext?rss=yes Thank you for reading this issue of Otolaryngologic Clinics of North America. The Future of Pediatric Airway Nikhila Raol, Ryan Ruiz 10.1016/j.otc.2026.03.018 Otolaryngologic Clinics of North America (2026) 2026-04-19 Otolaryngologic Clinics of North America 2026-04-19 Preface https://www.oto.theclinics.com/article/S0030-6665(26)00032-0/fulltext?rss=yes Pediatric vocal fold paralysis (VFP) remains challenging to diagnose and manage. Iatrogenic VFP is the most common subtype, often associated with cardiac surgeries. Unilateral VFP typically manifests as dysphonia, stridor, and feeding difficulties, while bilateral VFP usually presents with more severe stridor and respiratory distress. Flexible laryngoscopy is the gold standard for diagnosis, though vocal fold ultrasound is a reasonable alternative. Injection laryngoplasty can be a short-term treatment for unilateral VFP, and recurrent laryngeal nerve reinnervation for long-term treatment. Bilateral VFP may require tracheostomy, though several different surgical interventions have proven successful in avoiding tracheostomy or facilitating decannulation. Pediatric Vocal Fold Paralysis Patrick Kiessling, Douglas Sidell 10.1016/j.otc.2026.03.006 Otolaryngologic Clinics of North America (2026) 2026-04-19 Otolaryngologic Clinics of North America 2026-04-19 https://www.oto.theclinics.com/article/S0030-6665(26)00034-4/fulltext?rss=yes Congenital laryngomalacia is the most common cause of infant stridor and arises from interacting structural, neuromuscular, and inflammatory mechanisms that produce dynamic supraglottic collapse. Disease severity spans mild stridor to significant obstruction, aspiration, and failure to thrive, often influenced by comorbid medical conditions. Diagnosis relies on flexible laryngoscopy supported by instrumental swallowing studies and microdirect laryngoscopy and bronchoscopy when indicated. Most infants respond to conservative management, particularly targeted feeding modifications, while acid suppression offers benefit in selective cases. Supraglottoplasty provides effective, durable improvement for severe disease and significantly enhances infant outcomes and family quality of life. Congenital Laryngomalacia Inbal Hazkani, Taher Valika, Dana Mara Thompson 10.1016/j.otc.2026.03.008 Otolaryngologic Clinics of North America (2026) 2026-04-09 Otolaryngologic Clinics of North America 2026-04-09 https://www.oto.theclinics.com/article/S0030-6665(26)00029-0/fulltext?rss=yes Neurogenic cough is a diagnosis of exclusion characterized by laryngeal hypersensitivity. More common etiologies of chronic cough should be systematically excluded prior to diagnosis. Although the pathophysiology of neurogenic cough is not fully understood, proposed etiologies typically involve injury to the vagus nerve. Treatment options include neuromodulating medications, behavioral cough suppression therapy, and procedures such as superior laryngeal nerve block. Newer targeted treatments, including P2X3 antagonists, may offer effective treatment alternatives moving forward. Neurogenic Cough Bryan Renslo, Kathleen M. Tibbetts 10.1016/j.otc.2026.03.003 Otolaryngologic Clinics of North America (2026) 2026-04-09 Otolaryngologic Clinics of North America 2026-04-09 https://www.oto.theclinics.com/article/S0030-6665(26)00024-1/fulltext?rss=yes Temporal bone cerebrospinal fluid (CSF) leaks most commonly present as unilateral clear rhinorrhea or otorrhea and are often exacerbated by maneuvers that increase intracranial pressure. While a high index of clinical suspicion is essential, beta-2 transferrin remains the gold standard for confirming CSF in otorrhea or nasal secretions. When the Eustachian tube functions as the primary conduit for CSF egress, Eustachian tube obliteration (ETO) serves as an important adjunctive strategy for the management of high-flow or refractory leaks that fail conservative therapy. The transmastoid approach has historically been the workhorse technique for ETO and continues to be used successfully. Eustachian Tube Obliteration for Temporal Bone Cerebrospinal Fluid Leaks Manick S. Saran, Aparna Govindan, Fred Telischi, Roy R. Casiano 10.1016/j.otc.2026.02.002 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-04-01 Otolaryngologic Clinics of North America 2026-04-01 59 3 S0030-6665(26)X2002-3 643 653 https://www.oto.theclinics.com/article/S0030-6665(26)00005-8/fulltext?rss=yes Although spontaneous cerebrospinal fluid (CSF) leaks from the posterior cranial fossa are uncommon, postoperative CSF leak after surgical treatment of cerebellopontine angle pathology is one of the most common complications of these procedures. In this article, we review the current literature, introduce the host of autologous and synthetic agents available to the surgeon for reconstruction of skull base defects, and provide detailed explanations of one reliable technique, including common variations for closure after retrosigmoid and translabyrinthine approaches. Surgical Management of Temporal Bone Cerebrospinal Fluid Leaks from the Posterior Cranial Fossa Hannah L. Martin, Connor L. Pratson, Howard W. Francis, Eric J. Formeister 10.1016/j.otc.2026.01.005 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-27 Otolaryngologic Clinics of North America 2026-03-27 59 3 S0030-6665(26)X2002-3 613 628 https://www.oto.theclinics.com/article/S0030-6665(25)00179-3/fulltext?rss=yes Although endoscopic surgery has become more prevalent and favorable than open approaches, open and combined approaches remain relevant. Such situations include extensive tumors involving potential flap donor sites, visualization and instrumentation limitations of the frontal sinus, and prior surgery/radiation requiring greater access and alternative flap reconstruction. Combined approaches use the foundation of open craniotomy and endoscopic techniques to preserve the frontal outflow tract and frontal sinus mechanism while repairing cerebrospinal leaks caused by anterior skull base defects. Open and Endoscopic Open-Assisted Repair of Anterior Skull Base Defects Somtochi I. Okafor, Mathew Geltzeiler 10.1016/j.otc.2025.12.011 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-27 Otolaryngologic Clinics of North America 2026-03-27 59 3 S0030-6665(26)X2002-3 601 611 https://www.oto.theclinics.com/article/S0030-6665(25)00176-8/fulltext?rss=yes Idiopathic intracranial hypertension (IIH) causes raised intracranial pressure with no underlying structural etiology and is associated with headache and vision changes. Neuro-ophthalmologic evaluation and monitoring for papilledema and visual field constriction, contrast-enhanced brain MRI with venous imaging, and lumbar puncture are required to diagnose IIH. Weight loss yields remission in most patients. Secondary therapies include carbonic anhydrase inhibitors and surgical options, including venous sinus stenting or cerebrospinal fluid (CSF) diversion for patients with severe vision loss. Otolaryngologists should maintain a high index of suspicion for this condition in patients with skull base CSF leaks. Idiopathic Intracranial Hypertension Ashley Bailey, Shawn M. Stevens, Kerry L. Knievel 10.1016/j.otc.2025.12.008 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-27 Otolaryngologic Clinics of North America 2026-03-27 59 3 S0030-6665(26)X2002-3 485 496 https://www.oto.theclinics.com/article/S0030-6665(26)00026-5/fulltext?rss=yes There is a beauty to the anatomy of an otolaryngology specialty—our field abuts us up against the eye, the teeth, the spine, the lungs, and the brain. But these relationships can pose some hidden and not-so-hidden dangers. Is that “postnasal drip” mucous or cerebrospinal fluid (CSF)? Is that unilateral middle-ear fluid serous otitis media or CSF? Leaving an unattended-to CSF leak in the nose can have terrible consequences. Doing an office myringotomy and discovering that the fluid is CSF opens up an entire can of worms, as it were. Don’t Look Now, But Your Brain Fluid Is Leaking Sujana S. Chandrasekhar 10.1016/j.otc.2026.02.004 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-26 Otolaryngologic Clinics of North America 2026-03-26 59 3 S0030-6665(26)X2002-3 Foreword xv xvi https://www.oto.theclinics.com/article/S0030-6665(26)00023-X/fulltext?rss=yes This article reviews surgical management strategies for temporal bone cerebrospinal fluid leaks arising from the middle cranial fossa. It emphasizes preoperative workup and imaging, surgical techniques-including middle cranial fossa, transmastoid, and combined approaches, as well as subtotal petrosectomy. This article also provides guidance on patient selection, intraoperative management, and postoperative care. Surgical Management of Temporal Cerebrospinal Fluid Leaks From the Middle Cranial Fossa Evan C. Cumpston, Hunter L. Elms, Douglas J. Totten, Rick F. Nelson 10.1016/j.otc.2026.02.001 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-18 Otolaryngologic Clinics of North America 2026-03-18 59 3 S0030-6665(26)X2002-3 629 641 https://www.oto.theclinics.com/article/S0030-6665(26)00003-4/fulltext?rss=yes Spontaneous cerebrospinal fluid (CSF) leaks are increasingly common for otolaryngologists to identify and treat. Patients may present with clinical symptoms of headache, pulsatile tinnitus, aural fullness, muffled hearing, vertigo, clear otorrhea, or salty, metallic-tasting rhinorrhea. Spontaneous CSF leaks are strongly associated with idiopathic intracranial hypertension (IIH) and share common risk factors and demographics with patients with IIH. Otolaryngologists should be aware and skilled at the diagnosis of spontaneous CSF leaks, given its negative impact on quality of life for these patients, along with the significantly increased risk of meningitis if untreated. Clinical Presentation and Epidemiology of Spontaneous Cerebrospinal Fluid Leaks Chad Purcell, Elisa A. Illing 10.1016/j.otc.2026.01.003 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-14 Otolaryngologic Clinics of North America 2026-03-14 59 3 S0030-6665(26)X2002-3 497 508 https://www.oto.theclinics.com/article/S0030-6665(26)00004-6/fulltext?rss=yes Anterior skull base reconstruction has shifted toward minimally invasive, multilayer techniques that pair nonvascularized grafts with, when needed, vascularized flaps to achieve a durable, watertight barrier and preserve sinonasal function. This article reviews autologous (fascia lata, fat, cartilage/bone, and free mucosa), allogenic (cadaveric fascia, acellular dermal matrix), xenogenic collagen matrices, and synthetic options (eg, porous polyethylene), outlining their biology, handling characteristics, indications, limitations, and roles within layered closure algorithms. The authors summarize outcomes across defect sizes and cerebrospinal fluid-flow profiles and highlight emerging biomaterials that may further optimize anterior skull base repair. Grafts and Nonvascularized Repair Materials for Anterior Skull Base Defects Zeina Korban, Yara Yammine 10.1016/j.otc.2026.01.004 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-13 Otolaryngologic Clinics of North America 2026-03-13 59 3 S0030-6665(26)X2002-3 547 563 https://www.oto.theclinics.com/article/S0030-6665(25)00178-1/fulltext?rss=yes A variety of techniques exist for the reconstruction of skull base defects. However, the gold standard for skull base reconstruction is vascularized flaps, especially when there is a cerebrospinal fluid leak. The most frequently used flap is the nasoseptal flap, which has numerous applications, has relatively low morbidity, and is straightforward to harvest. When this flap is unavailable, other options include the inferior turbinate flap, middle turbinate flap, lateral wall flap, pericranial flap, and temporoparietal fascia flap. Vascularized Flaps for Anterior Skull Base Defects Lacy Brame, Aniruddha Parikh, Kibwei McKinney 10.1016/j.otc.2025.12.010 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-13 Otolaryngologic Clinics of North America 2026-03-13 59 3 S0030-6665(26)X2002-3 565 578 https://www.oto.theclinics.com/article/S0030-6665(26)00022-8/fulltext?rss=yes Pediatric balloon dilation of the Eustachian tube is an emerging intervention for children with persistent Eustachian tube dysfunction refractory to medical therapy and prior surgical management. While most pediatric patients outgrow Eustachian tube dysfunction with age, a subset experience chronic symptoms affecting hearing and quality of life. Careful patient selection is essential due to the unique pediatric nasopharyngeal anatomy and potential access challenges. Addressing contributing factors, particularly adenoid hypertrophy, and allergic inflammation, is critical to optimizing outcomes. When appropriately applied, pBDET offers a promising adjunctive option for selected pediatric patients with recalcitrant disease. Balloon Dilation of the Eustachian Tube in Pediatric Patients Shraddha Mukerji, Yi-Chun Carol Liu 10.1016/j.otc.2026.01.010 Otolaryngologic Clinics of North America (2026) 2026-03-11 Otolaryngologic Clinics of North America 2026-03-11 https://www.oto.theclinics.com/article/S0030-6665(26)00009-5/fulltext?rss=yes Pseudomeningocele is a rare complication of lateral skull base surgery or trauma. The diagnosis of pseudomeningocele relies heavily on clinical examination as well as imaging findings, namely computed tomography to identify skull base defects and magnetic resonance imaging to characterize fluid collections. There are limited known modifiable risk factors for the development of pseudomeningocele, and as such, there is significant emphasis placed on intraoperative repair or reconstruction of the dura and skull. A wide variety of techniques and materials are utilized, typically in multilayered fashion. In the event these reconstructions fail, the majority of pseudomeningocele can be managed conservatively. Lateral Skull Base Pseudomeningoceles Harrison Truong-Smith, Maura Cosetti 10.1016/j.otc.2026.01.009 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-07 Otolaryngologic Clinics of North America 2026-03-07 59 3 S0030-6665(26)X2002-3 655 671 https://www.oto.theclinics.com/article/S0030-6665(26)00008-3/fulltext?rss=yes This article reviews contemporary strategies for single-layer endoscopic repair of anterior skull base cerebrospinal fluid leaks, which are important for small defects and when multiple layers using vascularized tissue options are not available. Successful reconstruction requires restoring a watertight barrier between the intracranial compartment and the sinonasal tract, with technique selection guided by defect size, location, flow dynamics, and tissue availability. When appropriately selected, patients undergoing single-layer endoscopic repair achieve closure rates exceeding 90%. The article also discusses factors associated with failure and practical considerations for enhancing durability, highlighting the ongoing relevance of single-layer reconstruction in modern skull base surgery. Single-layer Endoscopic Repair of Anterior Skull Base Defects Jared Johnson, Corinna G. Levine, Adam Folbe 10.1016/j.otc.2026.01.008 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-07 Otolaryngologic Clinics of North America 2026-03-07 59 3 S0030-6665(26)X2002-3 579 590 https://www.oto.theclinics.com/article/S0030-6665(26)00006-X/fulltext?rss=yes Successful and enduring repair of cerebrospinal fluid leaks requires careful consideration of multiple factors beyond the technical execution of the surgery. This begins with thorough preoperative risk assessment and optimization of medical comorbidities, particularly elevated intracranial pressure. It continues intraoperatively with positioning and anesthetic strategies designed to maintain a stable surgical environment. Finally, diligent postoperative management, including activity restrictions, management of associated conditions such as obstructive sleep apnea and obesity, and vigilance for both early and delayed complications, is vital for protecting the repair, and appropriately managing complications. In this article, critical perioperative risk factors and clinical decisions are discussed. Perioperative Considerations and Complications of Skull Base Cerebrospinal Fluid Leaks W. Jack Palmer, Sruti Tekumalla, Mindy Rabinowitz 10.1016/j.otc.2026.01.006 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-03-03 Otolaryngologic Clinics of North America 2026-03-03 59 3 S0030-6665(26)X2002-3 683 699 https://www.oto.theclinics.com/article/S0030-6665(25)00181-1/fulltext?rss=yes Eustachian tube dysfunction (ETD) represents a clinically significant spectrum of disorders, ranging from obstructive to patulous dysfunction, that can lead to chronic middle ear disease, barotrauma, and impaired quality of life. Eustachian Tube Dysfunction Dennis Poe, Muaaz Tarabichi, Holger Sudhoff, Baher Ashour 10.1016/j.otc.2025.12.013 Otolaryngologic Clinics of North America (2026) 2026-02-19 Otolaryngologic Clinics of North America 2026-02-19 Preface https://www.oto.theclinics.com/article/S0030-6665(25)00180-X/fulltext?rss=yes Recurrent cerebrospinal fluid leaks require precise diagnosis, identification of risk factors, and tailored surgical and medical management that is patient-centered. The strongest evidence supports robust vascularized repair, intracranial pressure management in idiopathic intracranial hypertension, and specialized approaches in irradiated patients. Vasculopathy should not be overstated as an independent risk factor. Multidisciplinary care remains the cornerstone of durable outcomes and requires dialogue with appropriate colleagues. Recurrent Cerebrospinal Fluid Leaks in High-Risk Patients Jerlon Chiu, Paul Cowan, Muruggappan Ramanathan 10.1016/j.otc.2025.12.012 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-02-19 Otolaryngologic Clinics of North America 2026-02-19 59 3 S0030-6665(26)X2002-3 673 681 https://www.oto.theclinics.com/article/S0030-6665(26)00007-1/fulltext?rss=yes Cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base can have devastating consequences if diagnosis is delayed or management is inadequate. Delayed recognition may result in serious complications, including recurrent or fulminant bacterial meningitis, pneumocephalus, intracranial abscess, and sepsis, all of which carry significant morbidity and potential mortality. Accordingly, maintaining a high index of suspicion, recognizing predisposing and associated factors, and having a clear understanding of the characteristic signs and symptoms are critical to facilitating timely identification. Contemporary Perspectives on Management of Skull Base Cerebrospinal Fluid Leaks Corinna G. Levine, Christine T. Dinh 10.1016/j.otc.2026.01.007 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-02-13 Otolaryngologic Clinics of North America 2026-02-13 59 3 S0030-6665(26)X2002-3 Preface xvii xviii https://www.oto.theclinics.com/article/S0030-6665(25)00177-X/fulltext?rss=yes Cerebrospinal fluid (CSF) leaks occur when the skull base and dura are breached, allowing CSF to escape into sinonasal or tympanomastoid cavities. Traumatic leaks, historically documented to comprise the majority of CSF leaks, happen due to blunt (e.g., motor vehicle accident) or penetrating injuries. Penetrating injuries carry higher morbidity and infection risks. Iatrogenic leaks stem from medical or surgical interventions such as endoscopic sinus surgery, pituitary, and lateral skull base surgeries, or even certain medications. Both types of leaks can lead to serious complications like meningitis, pneumocephalus, and prolonged hospitalization, emphasizing the need for high clinical suspicion and prompt management. Clinical Presentation and Epidemiology of Traumatic and Iatrogenic Cerebrospinal Fluid Leaks Taylor S. Erickson, Evan J. Patel, Patricia A. Loftus 10.1016/j.otc.2025.12.009 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-02-09 Otolaryngologic Clinics of North America 2026-02-09 59 3 S0030-6665(26)X2002-3 509 518 https://www.oto.theclinics.com/article/S0030-6665(25)00175-6/fulltext?rss=yes Cerebrospinal fluid (CSF) is a colorless body fluid present within the central nervous system. CSF carries out essential functions in the central nervous system through maintenance of homeostasis, protection from trauma, and control of development. Classic experiments on CSF production postulated that CSF is produced in the choroid plexus and absorbed in the arachnoid granulations, but modern studies suggest that CSF is produced and absorbed through the entirety of the neuroaxis, with its movement primarily dependent on the cardiac cycle. This review will cover current concepts of CSF physiology and pathophysiology of CSF leaks of the skull base. Cerebrospinal Fluid Leaks of the Skull Base Ryan K. Thorpe, Jarrett E. Walsh 10.1016/j.otc.2025.12.007 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-02-09 Otolaryngologic Clinics of North America 2026-02-09 59 3 S0030-6665(26)X2002-3 473 484 https://www.oto.theclinics.com/article/S0030-6665(25)00174-4/fulltext?rss=yes The diagnosis of skull base cerebrospinal fluid (CSF) leaks remains challenging and requires a multidisciplinary approach. Clinical evaluation and targeted endoscopic examination are essential, but laboratory confirmation with beta-2 transferrin or beta-trace protein provides the most reliable noninvasive evidence. Imaging modalities such as high-resolution computed tomography (CT), magnetic resonance cisternography, CT cisternography, and radionuclide studies complement detection and localization, guiding surgical planning. Intraoperative fluorescein enhances defect identification. Each diagnostic tool offers unique strengths and limitations, and their judicious combination enables accurate detection, localization, and management of CSF leaks. Diagnostic Tools and Imaging for Skull Base Cerebrospinal Fluid Leak Ian F. Caplan, S. Dillon Powell, Abdulaziz Almohaisin, David A. Gudis, Justin S. Golub 10.1016/j.otc.2025.12.006 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-01-29 Otolaryngologic Clinics of North America 2026-01-29 59 3 S0030-6665(26)X2002-3 519 530 https://www.oto.theclinics.com/article/S0030-6665(25)00169-0/fulltext?rss=yes Cerebrospinal fluid leaks are a complex clinical challenge with variable causes and management. Conservative therapy focuses on lowering intracranial pressure through bed rest, sinus precautions, antiemetics, bowel regimens, and lumbar drainage. Leaks persisting beyond 1 week may require surgical repair due to meningitis risk. Iatrogenic, postoperative, and spontaneous leaks rarely resolve without surgery, while small traumatic leaks tend to have the highest chance of resolution. Prophylactic antibiotics remain controversial. Management should be tailored to etiology, location, and patient-specific factors. Conservative Management of Cerebrospinal Fluid Leaks Tasha S. Nasrollahi, Edward C. Kuan 10.1016/j.otc.2025.12.001 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-01-22 Otolaryngologic Clinics of North America 2026-01-22 59 3 S0030-6665(26)X2002-3 531 545 https://www.oto.theclinics.com/article/S0030-6665(25)00170-7/fulltext?rss=yes Endoscopic endonasal approaches have revolutionized anterior skull base surgery, with multilayer vascularized reconstruction emerging as the gold standard for preventing postoperative cerebrospinal fluid leaks. Compared with free graft or single-layer techniques, multilayer repairs provide watertight closure, address high-flow leaks, and reduce long-term morbidity. The nasoseptal flap remains the primary vascularized option, though alternative flaps and grafts are vital in revision or salvage cases. Success depends on meticulous defect preparation, graft orientation, and material selection tailored to defect size, location, and patient factors. Adjuncts such as sealants and packing may support repairs, but do not independently lower leak rates. Multi-Layer Endoscopic Repair of Anterior Skull Base Defects J. Ari Saravia, Bradford A. Woodworth, Jessica W. Grayson 10.1016/j.otc.2025.12.002 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-01-09 Otolaryngologic Clinics of North America 2026-01-09 59 3 S0030-6665(26)X2002-3 591 600 https://www.oto.theclinics.com/article/S0030-6665(24)00034-3/fulltext?rss=yes WITHDRAWN: This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond T&A – Tongue Base and Larynx Matthew Maksimoski, Carol Li 10.1016/j.otc.2024.02.021 Otolaryngologic Clinics of North America (2024) 2024-03-26 Otolaryngologic Clinics of North America 2024-03-26 https://www.oto.theclinics.com/article/S0030-6665(24)00032-X/fulltext?rss=yes WITHDRAWN: This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal. Comorbid Insomnia and Sleep Apnea Kathleen M. Sarber, Reena Dhanda Patil 10.1016/j.otc.2024.02.019 Otolaryngologic Clinics of North America (2024) 2024-03-26 Otolaryngologic Clinics of North America 2024-03-26 https://www.oto.theclinics.com/article/S0030-6665(24)00033-1/fulltext?rss=yes WITHDRAWN: This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal. Advanced Diagnostic Techniques in Obstructive Sleep Apnea Seckin O. Ulualp, Eric J. Kezirian 10.1016/j.otc.2024.02.020 Otolaryngologic Clinics of North America (2024) 2024-03-21 Otolaryngologic Clinics of North America 2024-03-21 https://www.oto.theclinics.com/article/S0030-6665(26)00065-4/fulltext?rss=yes Acute and Chronic Cough Forthcoming Issues 10.1016/S0030-6665(26)00065-4 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-06 Otolaryngologic Clinics of North America 2026-06 59 3 S0030-6665(26)X2002-3 xiv https://www.oto.theclinics.com/article/S0030-6665(26)00064-2/fulltext?rss=yes Sujana S. Chandrasekhar Contents 10.1016/S0030-6665(26)00064-2 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-06 Otolaryngologic Clinics of North America 2026-06 59 3 S0030-6665(26)X2002-3 ix xiii https://www.oto.theclinics.com/article/S0030-6665(26)00063-0/fulltext?rss=yes SUJANA S. CHANDRASEKHAR, MD, FACS, FAOS, FAAO-HNS Contributors 10.1016/S0030-6665(26)00063-0 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-06 Otolaryngologic Clinics of North America 2026-06 59 3 S0030-6665(26)X2002-3 iii vii https://www.oto.theclinics.com/article/S0030-6665(26)00062-9/fulltext?rss=yes Elsevier Copyright 10.1016/S0030-6665(26)00062-9 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-06 Otolaryngologic Clinics of North America 2026-06 59 3 S0030-6665(26)X2002-3 ii https://www.oto.theclinics.com/article/S0030-6665(26)00061-7/fulltext?rss=yes OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Cerebrospinal Fluid Leaks Corinna G. Levine, Christine T. Dinh 10.1016/S0030-6665(26)00061-7 Otolaryngologic Clinics of North America 59, 3 (2026) 2026-06 Otolaryngologic Clinics of North America 2026-06 59 3 S0030-6665(26)X2002-3 i