Conclusions

Available literature on Ambient AI use in ambulatory settings does not define experiences of otolaryngologists but does report time savings, improved perceptions of usability, and reduced burnout. However, gaps must be addressed in reporting AI model performance and consistent outcome measures. Future studies must include special otolaryngology populations that have communication challenges.

Level of Evidence

N/A.

How I Do It: A Novel Case Series of Office‐Based Laser Complete Excision of Vocal Fold Cysts

Fri, 15 May 2026 22:01:00 -0700

Office-based complete excision of vocal fold cysts using Trublue laser via transnasal flexible endoscopy is a technically feasible alternative to conventional marsupialization, enabling en bloc removal under local anesthesia with excellent procedural tolerability.

Identifying High‐Risk Children Safe for Same‐Day Discharge After Tonsillectomy

Thu, 14 May 2026 20:39:29 -0700

ABSTRACT

Objective

Current guidelines recommend overnight admission for children with severe obstructive sleep apnea (OSA) and obesity undergoing tonsillectomy, although most have uneventful postoperative courses. We aimed to identify low-risk subgroups within this high-risk population who may be candidates for same-day discharge.

Methods

Retrospective cohort study of children aged 2–18 years with obesity (≥ 95th BMI percentile) and severe OSA (AHI ≥ 10 events/h and/or SpO₂ nadir < 80%) undergoing tonsillectomy at a tertiary children's hospital (2021–2024). The primary outcome was a severe perioperative event: ICU admission, prolonged hospitalization (> 48 h), or need for advanced respiratory support. Bayesian logistic regression using informative priors identified predictors. Model-based risk stratification and simplified clinical rules were evaluated using sensitivity, specificity, and negative predictive value.

Results

Among 304 children, 36 (11.8%) experienced a severe event. SpO₂ nadir was the strongest predictor (β = −0.668, 95% CrI [−1.164, −0.172], directional probability 99.6%), followed by Class III obesity (97.0%) and AHI (95.0%). Model-derived stratification identified 33% of patients with < 5% predicted probability of severe events. A clinical rule combining AHI < 25 events/h and SpO₂ nadir > 85% showed sensitivity 85.7% and negative predictive value 99.5%, corresponding to an observed event rate < 5%.

Conclusion

Most obese children with severe OSA do not experience severe perioperative events. Simple polysomnographic criteria can identify very low-risk patients who may be candidates for same-day discharge planning. These findings support a more individualized approach to postoperative admission; prospective validation is needed before implementation.

Level of Evidence

Trends in Industry‐Sponsored Research Payments to Otolaryngologist Principal Investigators

Wed, 13 May 2026 22:21:23 -0700

Industry-sponsored research payments (ISRPs) to otolaryngologists increased 132% from $15.6 million in 2015 to $36.2 million in 2023. The top 20 manufacturers combined accounted for 76% of all ISRPs to otolaryngologists, and 12 of the top 20 products were pharmaceuticals ($55.6 million), followed by implantable devices ($26.3 million).

ABSTRACT

Objectives

Research payments constitute the largest payment category in the Centers for Medicare and Medicaid Services (CMS) Open Payments program (OPP). We sought to characterize the distributions of and trends in industry-sponsored research payments (ISRPs) to otolaryngologists.

Methods

OPP data was used to identify ISRPs to otolaryngologists between January 1, 2015 and December 31, 2023. ISRPs were stratified by recipient entity as covered teaching hospitals, covered physicians, and non-covered entities (NCEs) and evaluated using descriptive analysis and multivariable linear regression.

Results

ISRPs increased 132% from $15.6 million in 2015 to $36.2 million in 2023 (p < 0.001). Payments to NCEs with an otolaryngologist principal investigator (PI) constituted most payments (80%). Male otolaryngologist PIs decreased by −0.2%, while female otolaryngologist PIs increased by 86% (p < 0.01). Annual median payment values per otolaryngologist PI within NCEs increased 111% from $15,239 in 2015 to $32,097 in 2023 (p < 0.001). Among male otolaryngologist PIs within NCEs, total ISRPs increased 109% from $12.9 million in 2015 to $27.0 million in 2023, and median payment value per PI increased 93% from $17,144 in 2015 to $33,155 in 2023 (p < 0.01). Among female otolaryngologist PIs within NCEs, total ISRPs increased 125% from $0.5 million in 2015 to $1.1 million in 2023, but median payment value per PI only increased 14% from $11,973 in 2015 to $13,614 in 2023 (p = 0.1).

Conclusions

ISRPs to otolaryngologists more than doubled from 2015 to 2023, with most payments directed to PIs within NCEs. Median payments to female otolaryngology PIs did not increase, despite an increase in female otolaryngologist PIs.

Objective

Circumferential reconstruction is required for total hypopharyngeal defects to restore swallowing. Reconstructive options differ in conduit biology and anastomotic configuration, particularly the presence of a distal alimentary anastomosis. This study compared postoperative complications, dietary recovery, and survival among three reconstructive strategies.

Methods

This retrospective cohort study included 102 patients who underwent total hypopharyngeal reconstruction between 2015 and 2025 using a free anterolateral thigh (ALT) fasciocutaneous flap (n = 57), gastric pull-up (n = 24), or free ileocolonic flap (n = 21). Postoperative complications, long-term dietary outcomes, and 5-year survival were evaluated. Time to regular diet was analyzed using multivariable Cox proportional hazards models adjusting for age, body mass index, length of hospitalization, and endocrine comorbidities.

Results

Baseline characteristics were similar across groups. Early pharyngocutaneous fistulas were most common in the ileocolonic flap group (23.8%), whereas late fistulas occurred mainly after gastric pull-up reconstruction (12.5%). At 3 years, regular diet was achieved by 63.2% of ALT flap patients, compared with 100% of gastric pull-up and 90.5% of ileocolonic flap patients. After adjustment, gastric pull-up (adjusted HR 1.79; 95% CI, 1.05–3.07) and ileocolonic flap reconstruction (adjusted HR 2.00; 95% CI, 1.06–3.79) were independently associated with faster dietary recovery compared with ALT flaps. Five-year survival did not differ significantly among groups.

Conclusion

Visceral reconstructions yield superior dietary recovery compared with fasciocutaneous flaps for total hypopharyngeal defects. The absence of a distal anastomosis alone did not confer a clear functional benefit, underscoring the importance of conduit biology over anastomotic number.

Level of Evidence

Prognostic Significance of Lymph Node Parameters in Laryngeal Cancer After Laryngectomy

Tue, 12 May 2026 04:48:42 -0700

Lymph node parameters were evaluated as prognostic factors in laryngeal cancer following laryngectomy. Metastatic lymph node count remained an independent predictor of overall survival in multivariable analysis, and an optimal lymph node ratio (LNR) cutoff of 0.045 was identified, with higher values associated with worse outcomes. These findings underscore the prognostic value of lymph node parameters in risk stratification.

ABSTRACT

Objective

The aim of this study was to evaluate the prognostic significance of lymph node yield, lymph node positivity ratio, and metastatic lymph node count in patients with laryngeal cancer undergoing laryngectomy with neck dissection, and to identify optimal cutoff values for these parameters using receiver operating characteristic (ROC) curve analysis.

Methods

This retrospective study included 48 patients who underwent partial or total laryngectomy with bilateral neck dissection at a tertiary referral center between January 2015 and December 2019. Demographic characteristics, TNM stage, lymph node parameters, pathological risk factors, recurrence, and mortality were analyzed. Neck dissection primarily bilateral involved cervical levels II–IV, with additional levels dissected when clinically or radiologically indicated.

Results

Metastatic lymph node count was significantly associated with overall survival in both univariate and multivariable Cox analyses (HR: 1.344, p < 0.001; HR: 1.348, p = 0.007, respectively). An optimal lymph node ratio (LNR) cutoff of 0.045 was identified. LNR ≥ 0.045 was associated with poorer survival (log-rank p = 0.006) and increased mortality in univariate analysis (HR: 4.815; p = 0.013), but not in multivariable analysis (p = 0.325).

Conclusions

In conclusion, the findings of this study demonstrate that lymph node-based parameters are important prognostic indicators in laryngeal cancer. Among these, the absolute number of metastatic lymph nodes emerged as the most robust and biologically meaningful predictor of overall survival.

Level of Evidence

Refining the Multivariable Predictive‐Prognostic PREDICTR‐OPC Model for Survival in Surgical Escalation for Oropharyngeal Squamous Cell Carcinoma

Tue, 12 May 2026 03:05:11 -0700

The PREDICTR-OPC model is the only prognostic classifier for oropharyngeal squamous cell carcinoma (OPSCC) that also predicts surgical outcomes. This study demonstrates that removing survivin from the model preserves its prognostic and predictive performance, with comparable discrimination, calibration, and clinical utility across training and validation cohorts. The simplified three-biomarker model offers a more cost-effective and practical tool for guiding surgical escalation in OPSCC treatment.

ABSTRACT

Objectives

The PREDICTR-OPC model is the only prognostic classifier for oropharyngeal squamous cell carcinoma (OPSCC) also predictive of surgical outcomes. Of the four biomarkers included, survivin contributes minimally and presents practical limitations. This study aimed to refine and simplify the model by removing survivin, then re-assess its prognostic predictive performance compared to the original.

Methods

This retrospective cohort study analyzed a multi-center training cohort (n = 600) and an external validation cohort (n = 385) of OPSCC patients. Tumor biopsies were stained for p16, high-risk human papillomavirus (HR-HPV) DNA, tumor-infiltrating lymphocytes (TILs), and survivin and independently scored by at least three certified pathologists. Cox proportional hazards models assessed overall survival (OS), comparing three-biomarker (p16, HR-HPV, TILs) and four-biomarker models. Hazard ratios (HRs) for OS were estimated in the validation cohort, adjusting for covariates. Discrimination, calibration, and decision curve analysis (DCA) evaluated performance and clinical utility.

Results

Among 985 patients (median age: 57 years), median OS = 8.8 years (95% CI: 6.9–10.5). The three-biomarker model yielded HR = 4.10 (95% CI: 2.41–6.98, p < 0.001) for high- vs. low-risk groups in the validation cohort, comparable to the four-biomarker model (HR = 4.24, p < 0.001). Surgery was associated with improved OS in high-risk (HR = 0.45, p = 0.001) but not low-risk (HR = 0.83, p = 0.72) patients, consistent with the original model.

The models performed similarly across all metrics (e.g., Concordance Index: 0.71 vs. 0.72; Brier Score: 0.22 for both) as was model fit (Likelihood Ratio Test: p = 0.066). DCA revealed comparable clinical benefit.

Conclusion

Removing survivin preserves PREDICTR-OPC's predictive performance, offering a more cost-effective, easier-to-implement tool for OPSCC treatment recommendations.

Level of Evidence

Targeted Bevacizumab Therapy for Recurrent Vocal Fold Hemorrhage: First Case Report

Andrés Lanas Volz, Camila Ramírez Pelayo — Mon, 11 May 2026 23:41:49 -0700

This case report describes the use of targeted intracordal bevacizumab therapy for recurrent vocal fold hemorrhage refractory to conventional treatment. The intervention was associated with resolution of hemorrhagic episodes and sustained clinical improvement over follow-up. These findings suggest a potential role for antiangiogenic therapy in selected cases.

In‐Office Injection for Retrograde Cricopharyngeal Dysfunction Treatment

Michael J. Lahiff, Rachel B. Kutler, Michael J. Pitman, Hayley L. Born — Mon, 11 May 2026 01:46:03 -0700

This “How I Do It” article details an in-office, EMG-guided modified lateral transcervical botulinum toxin injection into the cricopharyngeus muscle for retrograde cricopharyngeal dysfunction. It highlights patient positioning, surface landmarking, and EMG confirmation of correct needle placement using swallow and sniff maneuvers. The technique provides a rapid office-based alternative to the operating room approach and includes practical counseling on expected side effects and the common need for a planned contralateral injection when initial benefit is incomplete or wanes.

Upper Airway Obstruction due to Kaposi Sarcoma—Presenting Sign of HIV: Case Report and Review

Zachary A. Wykoff, Logan F. McColl, Robert A. Baiocchi, Matthew O. Old — Mon, 11 May 2026 01:46:03 -0700

This study presents a case of undiagnosed HIV presenting with Kaposi sarcoma (KS) of the head and neck with acute upper airway obstruction (UAO) and provides an updated scoping literature review to examine the patient characteristics, lesion characteristics, interventions, and outcomes of KS cases with UAO from the pharynx, larynx, and/or trachea.

Endoscopic Repair of a Superior Orbital Roof Blow‐In Fracture: A Rare Case Report

Ergin Eroğlu, Burçay Tellioğlu, Yasin Gökçınar, Serdar Özer — Mon, 11 May 2026 01:46:03 -0700

Isolated superior orbital roof blow-in fractures are rare and may result in functional or aesthetic impairment requiring surgical intervention. This case report demonstrates the successful endoscopic repair of such a fracture, emphasizing the advantages of endoscopic techniques in achieving adequate visualization when direct access to the fracture site is limited.

Implementing the Palatal Plate for Robin Sequence Beyond the Originating Center: How I Do It

Mon, 11 May 2026 01:46:03 -0700

The treatment of upper airway obstruction in newborns with Robin sequence (RS) is challenging. We report our experience implementing the minimally invasive Tübingen palatal plate in a pediatric tertiary care center, detailing a step-by-step protocol and clinical outcomes from our first patient series. Despite a learning curve and need for multidisciplinary coordination, the palatal plate can be safely and effectively integrated outside its center of origin.

Plain Film Acquisition Techniques for Identification of Cochlear Implant Magnet Displacement

Madison V. Epperson, Robert E. Watson Jr, Cindy L. Lange, Matthew L. Carlson — Mon, 11 May 2026 01:46:03 -0700

We describe a simple, reproducible patient-positioning protocol to facilitate acquisition of plain film radiographs that reliably depict CI magnet orientation, thereby minimizing the need for repeat imaging or CT to determine the presence of magnet displacement. This approach leverages widely available imaging equipment and can be easily adopted in multiple patient care settings without specialized hardware or software. The image below depicts plain skull radiographs obtained using the standardized patient positioning protocol demonstrating bilateral cochlear implant magnet position before (A, B) and after (C, D) manual reduction.

Piezosurgery‐Assisted Endoscopic Transpterygoid Approach for Maxillary Ameloblastoma

Mon, 11 May 2026 01:46:03 -0700

The use of piezoelectric instrumentation has been investigated to perform an endoscopic-assisted transpterygoid maxillectomy for a maxillary ameloblastoma. This technology allowed safe disinsertion of the pterygoid root from the cranial base through a precise and clean osteotomy, while minimizing the risk of inadvertent soft-tissue injury. Piezoelectric saws can represent an alternative to high-speed endoscopic drills in selected cases. For posterior maxillary neoplasms, we recommend the employment of endoscopic-assisted maxillectomy, as it offers improved anatomical exposure and a more accurate control of tumor margins.

Acromegaly Presenting With Cricoarytenoid Joint Arthropathy

Samantha Salvi Cruz, Riley Larkin, Ioan Lina, Alexander Gelbard — Mon, 11 May 2026 01:46:03 -0700

Excess growth hormone in acromegaly induces characteristic acral and soft tissue overgrowth (particularly in the face and hands), arthropathies, as well as cardiovascular and metabolic complications. Similar proliferative changes can occur in the larynx, where hypertrophy of the arytenoid and cricoid cartilages may impair vocal fold mobility. We describe a rare case of acromegaly affecting the cricoarytenoid joints (CAJ), leading to proximal airway obstruction and demonstrating that these diarthrodial joints are susceptible to systemic arthropathies.

ABSTRACT

The Evolution in Medical Assistance in Dying for Head and Neck Cancer

Shreya Mandava, Andrew G. Shuman — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2391-2393, June 2026.

New Frontiers in Microvascular Reconstruction of Mandibular Osteoradionecrosis

P. Daniel Knott, Samuel H. Selesnick — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2394-2395, June 2026.

Issue Information

Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2381-2390, June 2026.

Correction to “Washing Illness Away: A Systematic Review of the Impact of Nasal Irrigation and Spray on COVID‐19”

Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2827-2827, June 2026.

Lessons in Otolaryngology: From Mentorship to Sponsorship

Conclusion

Mesna could be used effectively and safely in otologic surgery. Further research is needed to optimize concentration, method of administration, time of contact, and to quantify its effect.

Level of Evidence

Gender‐Affirming Feminization Voice Surgery: A Scoping Review of Preoperative Assessments

Mon, 11 May 2026 01:46:03 -0700

PRISMA flowchart.

ABSTRACT

Objective

To identify the preoperative assessments and criteria surgeons use to assess the suitability of transfeminine patients for voice feminization surgery.

Data Sources

Electronic search of Ovid MEDLINE, Ovid Embase, APA PsycINFO, Cochrane Library, CINAHL, and PubMed excluding MEDLINE records was performed on February 11, 2025 for articles that were published from inception to the search date. No language or date limits were applied.

Study Selection

The inclusion criteria were developed using the PICOTS framework. Inclusion criteria included all studies reporting (1) assessments and surgical criteria used in; (2) transfeminine adult patients who; (3) underwent feminization voice surgery. Studies involving transmasculine patients and those addressing nonsurgical interventions for voice were excluded. Non-feminization voice surgeries were excluded.

Data Extraction

Screening and extraction followed PRISMA-ScR guidelines by two authors. Extracted data included study type, origin, and intervention. Clinical criteria were emphasized, including voice training, acoustic and perceptual parameters, and patient-reported outcomes. Other factors included medical/psychiatric evaluation and hormonal therapy.

Results

Of 520 studies screened, 42 met inclusion. Most were retrospective case series/reports (2000–2025) with sample sizes from 1 to 506. Acoustic parameters, especially fundamental frequency, were commonly assessed. Perceptual tools included GRBAS, CAPE-V, and clinician judgment by speech-language pathologists. Patient-reported outcomes such as the Voice Handicap Index and Trans Woman Voice Questionnaire were also used. Endoscopic evaluation was frequently performed, and CT imaging was often used for cricothyroid approximation cases.

Conclusions

There is significant variability in preoperative criteria across studies, with limited reporting on key factors like prior voice training or psychological evaluation.

Algorithmic Surgical Management of Primary Hyperparathyroidism and Its Variants: A Scoping Review

Fleur Kabala, Todd Falcone, Kourosh Parham — Mon, 11 May 2026 01:46:03 -0700

Primary hyperparathyroidism has varied presentations that demand nuanced approaches. Our review compares the workup and management of variant (i.e., normocalcemic hyperparathyroidism and normohormonal hyperparathyroidism) to classic hyperparathyroidism, taking into account localization studies, surgical considerations, the utility of intraoperative parathyroid hormone, and surveillance. We highlight knowledge gaps that, if addressed, will improve the care of patients with variant presentations.

ABSTRACT

Objective

Primary hyperparathyroidism (PHPT) has varied presentations whose successful surgical management demands integration of the expanding literature within a comprehensive decision-making framework. Our objective is to compare the workup and management of variant (i.e., normocalcemic hyperparathyroidism (NCPHPT) and normohormonal hyperparathyroidism (NHPHPT)) to classic hyperparathyroidism (CPHPT), taking into account localization studies, surgical considerations, utility of intraoperative parathyroid hormone (IOPTH), and surveillance to identify gaps in knowledge that limit management outcomes of variant PHPT presentations.

Data Sources

A comprehensive search of PubMed and Google Scholar was conducted from June 11, 2024, to March 17, 2025, using MeSH terms and free-text queries focused on imaging, surgery, and outcomes in PHPT and reported using PRISMA ScR guidelines.

Review Methods

Peer-reviewed studies addressing surgical management of PHPT in adults, published in English, were included. Two reviewers independently screened all titles, abstracts, and full texts using previously developed inclusion criteria recorded in a shared spreadsheet. Twenty-seven studies were included. Data were synthesized into a flow diagram to identify areas in need of further guidance.

Results

Imaging accuracy was highest with 4DCT and PET scans in both classic and variant PHPT, particularly in the setting of multiglandular disease. Not obtaining ≥ 50% IOPTH drop and/or levels below 40 pg/mL are risk factors for persistence or recurrence.

Conclusions

PHPT has varied presentations that demand nuanced approaches. Our review highlights knowledge gaps that, if addressed, will improve the care of patients with variant PHPT. Further prospective validation of this algorithmic summary is warranted to improve long-term impact and patient outcomes.

In Response to Tracheostomy Dependence in Hypopharyngeal Cancer: Comparative Prognostic Impact of CRT Versus Surgery

Chien‐Yi Yang, Shao‐Cheng Liu — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E96-E97, June 2026.

In Response to An Evaluation of Current Trends in AI‐Generated Text in Otolaryngology Publications

Rachel B. Kutler, Sruthi Surapaneni, Sean A. Setzen, Anaïs Rameau — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E89-E89, June 2026.

In Reference to An Evaluation of Current Trends in AI‐Generated Text in Otolaryngology Publications

Michael E. Dunham — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E88-E88, June 2026.

In Response to Impact of Obesity on the Structured Histopathology of Chronic Rhinosinusitis Patients

Daniel X. Ma, Ali Baird, Peter Papagiannopoulos — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E86-E87, June 2026.

In Reference to Impact of Obesity on the Structured Histopathology of Chronic Rhinosinusitis Patients

Weitao An, Yahong Li — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E84-E85, June 2026.

In Reference to The Role of Hypoalbuminemia in the Development of Reinke's Edema: A Prospective Cohort Study

Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E90-E91, June 2026.

In Response to The Role of Hypoalbuminemia in the Development of Reinke's Edema: A Prospective Cohort Study

Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E92-E93, June 2026.

In Response to Bilateral Sudden on Chronic Hearing Loss as an Auditory Manifestation of Mitochondrial DNA Mutations

Chin‐Nung Liu, Hong‐Yu Yan, Chen‐Chi Wu — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page E100-E101, June 2026.

In Reference to Bilateral Sudden or Chronic Hearing Loss as an Auditory Manifestation of Mitochondrial DNA Mutations

Josef Finsterer — Mon, 11 May 2026 01:46:03 -0700

Both conditioned media and co-culture suppressed myogenic differentiation in rVF-Mbs; increased inhibition was observed in co-culture, as indicated by reduced myotube formation, decreased Myh2 expression, and activation of Smad2/3 signaling. ALK4/5 inhibition abrogated these effects. Differentiating rVF-Mbs attenuated the fibrogenic phenotype of HVOX fibroblasts.

Conclusions

Fibrotic VF mucosal cells can impair myogenic differentiation through TGF-β/Smad2/3-mediated fibroblast–myoblast crosstalk, and myogenic cells may exert reciprocal anti-fibrotic effects. These findings suggest mucosa–muscle interactions may contribute to VF pathology and highlight Smad2/3 as a potential therapeutic target.

Level of Evidence

Study Design

Level of Evidence

Level of Evidence

N/A.

Regenerative Treatment of Middle Ear Mucosa With Topical Retinoid Administration

Mon, 11 May 2026 01:46:03 -0700

Topical administration of retinoids markedly enhanced regeneration of the damaged middle ear mucosa in this animal study, resulting in epithelial recovery with immunohistological and functional characteristics comparable to normal ciliated epithelium. In the retinoid-treated group, 83% of ears exhibited complete or partial healing of the middle ear mucosa without evidence of ototoxicity, whereas no regeneration was observed in the control group. These findings suggest that retinoids may represent a promising and safe therapeutic approach for promoting middle ear mucosal regeneration.

ABSTRACT

Objective

Dysfunction of the middle ear can lead to hearing loss and the development of diseases such as cholesteatoma. Although radical treatment for cholesteatoma involves complete removal of the lesion, incomplete regeneration of the middle ear mucosa may contribute to hearing loss and recurrence of the cholesteatoma. This study aimed to evaluate the regenerative potential of topical retinoid therapy for damaged middle ear mucosa.

Methods

We used a guinea pig model to investigate the regenerative effects of topical retinoids on middle ear mucosal damage. Retinoids, which are known to promote nasal mucosal epithelium regeneration, were applied to the middle ear. Histological analysis was performed to assess epithelial recovery, and auditory function testing was conducted to detect any signs of ototoxicity.

Results

The regenerated mucosa exhibited histological and functional characteristics comparable to those of normal ciliated epithelium. Furthermore, no ototoxicity was observed following the administration of retinoids. In the retinoid group, five of six ears (83%) demonstrated complete or partial healing, whereas none in the control group showed regeneration (p = 0.0183). The regenerated mucosa exhibited histological and functional characteristics comparable to those of normal ciliated epithelium. Furthermore, no ototoxicity was observed following the administration of retinoids.

Conclusion

Topical retinoids may be an effective and novel therapeutic option for promoting the regeneration of middle ear mucosa without inducing ototoxic effects. Further investigations are required prior to clinical application in humans.

Level of Evidence

Level of Evidence

Preoperative SGLT2 Inhibitors and Postoperative Complications After Tracheostomy in Type 2 Diabetes

Sohil Singh, Sagar Singh Matharu, Ankit Choudhury, Ryan Puccia — Mon, 11 May 2026 01:46:03 -0700

ABSTRACT

Objective

To evaluate whether preoperative sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with postoperative complications in adults with type 2 diabetes mellitus (T2DM) undergoing open surgical tracheostomy (OST)

Methods

We performed a retrospective cohort study using a multi-institutional electronic health record network. Adults with T2DM who underwent OST between 2013 and 2024 were identified using CPT and ICD-10-PCS codes. Exposure was defined as an SGLT2i prescription within 180 days before surgery. One-to-one propensity score matching on demographics, comorbidities, preoperative ventilator dependence, medications, and laboratory values generated balanced SGLT2i and non-SGLT2i cohorts. Ninety- and 180-day postoperative complications were compared using odds ratios (ORs) with 95% confidence intervals, with Benjamini-Hochberg false discovery rate (FDR) correction.

Results

Of 36,840 eligible adults (1329 SGLT2i; 35,511 non-SGLT2i), 1327 patients remained in each cohort after matching. At 90 days, SGLT2i use was associated with higher odds of heart failure exacerbation (OR 1.70, 95% CI 1.36–2.14), which remained significant after FDR adjustment. At 180 days, SGLT2i use was associated with increased odds of hypoglycemia (OR 2.01, 95% CI 1.30–3.13) and heart failure exacerbation (OR 1.61, 95% CI 1.30–1.99), both significant after FDR correction. Signals for surgical site infection, tracheostomy stoma malfunction, and dizziness/vertigo did not remain significant after adjustment.

Conclusion

In adults with T2DM undergoing OST, preoperative SGLT2i use was associated with increased postoperative hypoglycemia and heart failure exacerbation. These findings support careful perioperative management of SGLT2is in high-risk airway surgery and justify prospective studies to define optimal discontinuation strategies.

Dysphonia Is Associated With Anxiety and Depression in the All of Us Research Program

Mon, 11 May 2026 01:46:03 -0700

ABSTRACT

Objectives

Previous studies have examined the relationship between dysphonia and mental health, but often in small samples and not across age groups. In this large national epidemiological study, we examine if dysphonia is related to anxiety and depression generally and across cohorts of different ages.

Methods

This is a cross-sectional analysis of adults ≥ 18 years old in the All of Us dataset. The exposure was dysphonia (ICD-10 code R49.0), and the outcomes were anxiety (ICD-10 F41) and depression (ICD-10 F32-33). We performed multivariable logistic regression analyses, controlling for age, gender, race, ethnicity, insurance, education, smoking history, alcohol use, and medical comorbidities. A sub-analysis compared depression and anxiety odds across two and five age groups.

Results

Of 283,137 adults in our sample, the mean age was 56 years (standard deviation 16 years). Sixty-one percent identified as female. Controlling for covariates, those with dysphonia had 1.34 times (95% CI 1.27–1.41) the odds of depression and 1.44 times (1.37–1.52) the odds of anxiety compared to their non-dysphonia counterparts. After stratifying by age, the odds of depression and anxiety were 2.36 times (1.67–3.35) and 1.62 (1.14–2.30) respectively for participants ≥ 18–30 years old, 1.61 (1.37–1.89) and 1.75 (1.49–2.07) for > 30–45 year olds, 1.38 (1.23–1.55) and 1.46 (1.33–1.67) for > 45–60 year olds, 1.33 (1.23–1.44) and 1.46 (1.35–1.58) for > 60–75 year olds, and 1.22 (1.09–1.35) and 1.36 (1.22–1.51) for > 75 year olds.

Conclusions

Those with dysphonia had higher odds of depression and anxiety. Following stratification by age, the odds for each were highest for the youngest age group.

Level of Evidence

Decoding Gender in Cough Sounds: A Transformer‐Based Analysis

Mon, 11 May 2026 01:46:03 -0700

Transformer-based analysis of cough sounds demonstrates that non-speech respiratory acoustics encode gender-discriminative features. Using a HuBERT model with attention-based interpretability, we show improved gender classification with cough series and consistent model attention to the explosive phase of the cough. These findings highlight the relevance of involuntary respiratory sounds in audiomics and gender-affirming voice care.

ABSTRACT

Objective

Various components of speech, such as pitch, volume, and resonance, influence gender perception, but little is known about gender differences in non-speech upper airway sounds such as cough. This gap has implications for gender-affirming voice care, as coughs are harder to modulate. We aimed to explore how cough acoustics differ by gender using a transformer model with self-attention to identify salient cough features for gender classification.

Methods

We analyzed 327 cough recordings (154 male, 173 female) from the Coswara dataset, using a 70/15/15 split for model training, validation, and testing. Preprocessing included resampling, silence removal, normalization, and trimming to uniform length. The HuBERT transformer model was used for its ability to handle unstructured audio. Gender balance was verified through SMD (standardized mean difference) screening across seven variables, all of which showed negligible imbalance.

Results

On the held-out test set, the model achieved an accuracy of 84.0% with an F1 score of 0.8462 when classifying gender from cough series, compared to 71.4% accuracy and an F1 score of 0.7308 when using single-cough/first-cough samples. Attention-aligned cough visualization revealed the highest attention on the explosive phases of the cough, suggesting that these segments encapsulate the most salient gender-distinct acoustic cues.

Conclusion

Cough sounds contain gender-discriminative features detectable by transformer models. Attention to specific cough phases reveals physiologically meaningful segments in cough sounds supporting gender classification. These insights may inform gender-affirming interventions, particularly for non-speech sound production. Future research should explore further socio-demographic factors shaping cough acoustics.

Level of Evidence

Do Children With Cochlear Nerve Deficiency Benefit From Cochlear Implantation?

Rishi K. Vas, Divya A. Chari, Anil K. Lalwani — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2400-2402, June 2026.

Is Open Repair of Congenital Tracheoesophageal Fistula Preferred Over Endoscopic Approach?

Saad Akhtar, Sukgi Choi — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2410-2411, June 2026.

Does Degree of Resection Improve Survival in Laryngeal Chondrosarcomas?

Nrusheel Kattar, Alison Hawkins, Karuna Dewan, Cherie Ann Nathan — Mon, 11 May 2026 01:46:03 -0700

Survival outcomes after resection of laryngeal chondrosarcoma are generally excellent, and contemporary management should aim to optimize laryngeal function and tailor the surgical approach based on subsite (accessibility of resection), initial extent of disease (when and how much to resect), and histologic grade. R0 resection does not appear to improve overall survival and should not usually be prioritized over preserving laryngeal function, especially in cases with a less aggressive oncologic profile.

Do Aspirin and Antiplatelets Need to Be Held for Most Otolaryngologic/Head and Neck Surgery?

Elizabeth A. Borowiec, Richard V. Smith — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2398-2399, June 2026.

GLP‐1 Receptor Agonists for Obstructive Sleep Apnea: An Otolaryngologist's Prescription?

Alina Zgardau, Ryan Chin Taw Cheong, Kenny Peter Pang, Brian W. Rotenberg — Mon, 11 May 2026 01:46:03 -0700

The Laryngoscope, Volume 136, Issue 6, Page 2406-2409, June 2026.

Issue Information

Mon, 11 May 2026 01:38:06 -0700

The Laryngoscope, Volume 136, Issue S3, Page S1-S5, June 2026.

Gender and Academic Rank Disparities in Electronic Health Record Burden Among Otolaryngologists

Mon, 11 May 2026 01:38:06 -0700

In academic otolaryngology, junior and female faculty have a higher electronic health record burden (EHR). At the extremes, female assistant professors spent nearly twice as much time as their male full professor counterparts did in the EHR completing tasks related to ambulatory patient care. The differential likelihood of faculty receiving help with notes and orders may play a role in this disparity.

ABSTRACT

Objectives

The electronic health record (EHR) has benefits but also adds documentation burden that is not equally shared between academic faculty. We hypothesize that male gender and senior academic rank are associated with decreased EHR burden compared to female and junior faculty.

Methods

Demographics from faculty at participating organizations were combined with 3 years of provider efficiency data. Multivariate analyses were performed to evaluate the differences in EHR burden between genders and academic ranks, clustering for otolaryngologist and institution.

Results

Forty-six institutions with 914 otolaryngologists (female, n = 283, 31%) were included for analysis. Median hours per day (h/d) spent in EHR tasks related to outpatient visits were 4.3, 3.5, and 3.4 h/d for female assistant, associate, and full professors, respectively; and 3.4, 2.7, and 2.3 h/d for males, likewise in ascending academic rank. These differences between median h/d in ambulatory time were significant across all six subgroups of gender and academic rank (p < 0.002). Academic seniority, but not gender, was associated with less time in ambulatory tasks after work and on days without scheduled appointments (p < 0.002). Males and otolaryngologists with higher academic rank were more likely to receive help with notes and orders (p < 0.002).

Conclusions

For a typical clinic day, female assistant professors in academic otolaryngology spent nearly twice as much time as their male full professor counterparts did in the EHR completing tasks related to ambulatory patient care. The differential likelihood of faculty receiving help with notes and orders may play a role in this disparity.

Level of Evidence

Does Xylitol Have Additional Benefit Over Saline for Nasal Irrigation in Chronic Rhinosinusitis?

Shahid Iqbal, Adam DeConde, Deborah Watson — Fri, 08 May 2026 19:54:51 -0700

The Laryngoscope, EarlyView.

Objective Structured Assessment of Technical Skills in Mastoidectomy Using 3D‐Printed Temporal Bones

Fri, 08 May 2026 18:44:58 -0700

This study validated a 3D-printed temporal bone model combined with final product analysis as an objective assessment tool for mastoidectomy surgical skills in otolaryngology residency. Performance scores improved significantly with training level, with excellent inter-rater reliability. This approach supports competency-based surgical education through standardized, reliable skills assessment.

ABSTRACT

Objective

To evaluate the use of three-dimensional (3D) printed temporal bone models combined with final product analysis as an objective structured assessment of technical skills tool to assess mastoidectomy performance across levels of otolaryngology residency training.

Methods

In this prospective observational study conducted at a single academic otolaryngology residency program, 32 residents performed 64 mastoidectomies on 3D-printed temporal bone models over a three-year period. Three expert faculty independently and anonymously evaluated each performance using a validated 14-item final product analysis checklist. Statistical analyses included linear regression, ANOVA, Mann–Whitney U, Wilcoxon signed-rank tests, and intraclass correlation coefficient (ICC) for inter-rater reliability.

Results

Median scores improved steadily with training level, from 35.0 in postgraduate year (PGY) 1 to 53.7 in PGY 5 out of 70. Linear regression demonstrated a significant positive association between both training level and duration in residency with performance. Senior residents (PGY 4–5, median score 54.0) significantly outperformed junior residents (PGY 1–3, median score 38.0; p = 0.012). Across all training levels, median scores improved from 43.2 on the first attempt to 52.5 on the third, though this difference was not statistically significant. Inter-rater reliability was excellent (ICC = 0.9210, p < 0.0001). A proficiency cutoff score of 45/70 was established using the contrasting groups method.

Conclusion

The consistency of 3D-printed temporal bones judged by final product analysis allows for fair, objective, and reliable assessment for formative and summative evaluations. By longitudinally tracking skill improvement and differentiating performance across training levels, it supports the transition to competency-based surgical education.

Level of Evidence

N/A.

Effect of Smoking in Oropharyngeal Cancer Treated With TORS: Systematic Review and Meta‐Analysis

Fri, 08 May 2026 18:28:47 -0700

In a systematic review of 12 studies including 2079 patients with predominantly HPV-associated OPSCC treated with TORS, meta-analysis demonstrated no significant difference in recurrence-free survival or disease-specific survival between individuals with and without a smoking history. Individuals with a smoking history appeared to have worse overall survival, although only five studies reported on this outcome.

ABSTRACT

Objective

While smoking has been implicated as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell cancer (OPSCC) treated with definitive chemoradiation, its prognostic impact on surgically treated OPSCC is less clear.

Data Sources

MEDLINE, Embase, CENTRAL, and Scopus.

Review Methods

Articles describing patients with HPV-associated OPSCC treated with transoral robotic surgery (TORS), which reported oncologic outcomes by smoking history, were included.

Results

2079 patients were included across 12 studies. Median age was 58.5 years, and 1808 (87.0%) were male. HPV-associated disease was reported in 1681 (80.9%) patients. T stage was most commonly T2 in 831 (40.0%) and T1 in 764 (36.7%). N stage was N2 in 854 (41.1%), N1 in 544 (26.2%), and N0 in 307 (14.8%). 931 (44.8%) were considered individuals with a smoking history, while 1045 (50.3%) were considered without a smoking history. Median follow up was 33.7 months. Meta-analysis using a fixed effects model demonstrated an overall hazard ratio of 1.4 (95% confidence interval 1.0–2.0) for disease recurrence, 2.7 (95% confidence interval 1.5–4.8) for overall survival, and 1.4 (95% confidence interval 0.4–4.6) for disease specific survival.

Conclusions

In this population of predominantly HPV-associated OPSCC treated with TORS, meta-analysis demonstrated no significant difference in recurrence-free survival or disease-specific survival between individuals with and without a smoking history. Individuals with a smoking history appeared to have worse overall survival, although only five studies reported on this outcome. Further research is required to clarify the prognostic influence of smoking on OPSCC treated with TORS.

How Should Thyroid Nodules and Risk of Thyroid Cancer Be Managed in Patients on GLP‐1 Receptor Agonists?

Cassidy Anderson, Richard V. Smith, Carolyn Debiase — Thu, 07 May 2026 19:20:23 -0700

The Laryngoscope, EarlyView.

The Utility of Macrolide Therapy for Neutrophilic CRSsNP Based on Structured Histopathology

Wed, 06 May 2026 23:19:40 -0700

The Laryngoscope, EarlyView.

Finite Element Analysis of Upper Airway in Ansa Cervicalis Stimulation for Obstructive Sleep Apnea

Mukund Gupta, Songrui Li, Haoxiang Luo, David T. Kent, Yike Li — Wed, 06 May 2026 21:27:05 -0700

We developed a subject-specific FE model to investigate how ACS stabilizes the upper airway in OSA. Simulations demonstrate that caudal traction applied through the hyolaryngeal complex produces coordinated multilevel airway stabilization, with pronounced effects at the retropalatal and retro-epiglottic regions under physiologic loading. This proof-of-concept modeling framework provides mechanistic insight into ACS and supports further hypothesis-driven investigation of neurostimulation-based airway therapies.

ABSTRACT

Objective

To develop a subject-specific, three-dimensional finite element (FE) model of the human upper airway and evaluate how ansa cervicalis stimulation (ACS), a novel neurostimulation for obstructive sleep apnea (OSA), alters upper airway anatomy under physiologic loading.

Methods

Upper airway anatomy was reconstructed from a head-and-neck CT of an adult female using a semi-automated pipeline, including segmentation, smoothing, tetrahedral meshing, and registration. Linear elastic material properties were assigned from the literature. ACS was simulated as a caudal load on the anterior thyroid cartilage, and inspiratory collapse tendency was mimicked with a −70 Pa luminal negative pressure. Structural displacement and cross-sectional area (CSA) changes were quantified at the soft palate, lateral pharyngeal wall, tongue base, and epiglottis.

Results

ACS produced caudal displacement of the thyroid cartilage by approximately 10 mm with coordinated motion of the hyolaryngeal complex and longitudinal pharyngeal wall strain. It also tilted the epiglottis antero–inferiorly and increased its curvature, reducing posterior–inferior motion under negative pressure by more than 50% (5.0 to 2.2 mm). Retro-epiglottic CSA increased by 68.8% without negative pressure (42.43 to 71.63 mm²) and by 2980.3% with negative pressure (0.79 to 24.19 mm²). Retropalatal CSA improved by 34.4% without negative pressure (65.04 to 87.42 mm²) and by 20.3% with negative pressure (16.98 to 20.43 mm²).

Conclusion

This proof-of-concept, subject-specific FE model shows that ACS imparts caudal traction through the hyolaryngeal complex, producing multilevel anatomic stabilization under physiologic loading. The findings establish a quantitative, hypothesis-generating framework for interrogating ACS-mediated airway stabilization mechanisms and support further investigation across broader OSA populations and collapse phenotypes.

Level of Evidence

N/A

In Reference to Quantifying Dehydration Effects of Porcine Vocal Fold Attenuation With Optical Coherence Tomography

K. V. Vijay Kumar, Pankaj Kshirsagar, Mansi Mishra, Surbhi Panwar — Wed, 06 May 2026 21:25:47 -0700

The Laryngoscope, EarlyView.

Peri‐ and Post‐Menopausal Hormone Replacement Therapy and Voice Disorder Risk: A TriNetX Study

Wed, 06 May 2026 21:00:19 -0700

ABSTRACT

Objectives

The aim of this study was to elucidate the risk of developing voice disorders among peri- and post-menopausal female hormone replacement therapy (HRT) users.

Methods

A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Females aged 40–60 years old were included and stratified into two cohorts: HRT users (n = 16,586) and HRT non-users (n = 248,725) while excluding for head and neck radiation/neoplasms, smoking, benign laryngeal lesions, thyroid disorders, gender dysphoria, and any other systemic hormone use. Voice and resonance disorders (VRD) and dysphonia were separately assessed at 3-month intervals post-HRT initiation after propensity score-matching for age, sex, race, and ethnicity. Odds ratios (ORs) with 95% confidence intervals (CIs) and risk differences (RD) were generated to compare outcomes.

Results

HRT users had significantly higher odds of dysphonia, but not VRD, within 0–9 months (OR 1.72; 95% CI (1.01–2.95), OR 1.66; 95% CI (0.99–2.79), respectively). For HRT users with elevated BMI, the 1-year VRD incidence was not significantly different than non-HRT users (RD 0.19%, p = 0.069). Overall, the incidence of VRD and dysphonia within 1 year in both groups was < 0.5% and showed no significant difference at most times between groups.

Conclusions

HRT may not have any significant clinical impact on the peri- and post-menopausal voice. Although higher odds were noted earlier after treatment, HRT users did not have higher odds of voice issues after 1 year. This study highlights the lack of consensus in literature and urges future research to fully understand the impact of HRT on peri- and post-menopausal voice.

Results

Seventeen studies (930 participants) were included, of which 13 were eligible for quantitative synthesis. Systemic steroids significantly reduced TEC/HPF (MD −36.57; 95% CI: −43.94 to −29.20) and %TEC (MD −18.14; 95% CI: −24.88 to −11.39). Reductions were consistent across steroid dose, duration, and concomitant intranasal steroid use. However, low dose (4.2–18.6 mg/day) given in ≤ 7-day regimens showed a non-significant reduction (MD −17.78; 95% CI: −62.62 to 27.05). Adverse events were not statistically different between the steroid and control groups (5.60% vs. 1.12%, odds ratio = 5.22, p = 0.12). No adverse events were reported in studies using low-dose or tapering regimens.

Conclusion

Preoperative systemic corticosteroids significantly reduce TEC in CRSwNP, regardless of the quantifying method. This effect may interfere with histologic assessment when biopsy is taken intraoperatively. To avoid misinterpretation, clinicians may consider either withholding preoperative systemic corticosteroids, using a less suppressive regimen, or obtaining a biopsy prior to steroid initiation.

Level of Evidence

N/A.

Laryngeal Dysfunction Following COVID‐19: A TriNetX Retrospective Cohort Study

Thu, 30 Apr 2026 03:58:18 -0700

COVID-19 is associated with an increased incidence of new-onset laryngeal dysfunction, including chronic cough, dysphagia, voice disorders, vocal fold paralysis, and laryngeal spasm, compared with uninfected controls. Risk peaks one to two years after infection for most outcomes and is influenced by factors such as hospitalization, mechanical ventilation, and vaccination status. These findings highlight the need for long-term surveillance and evaluation of laryngeal symptoms in patients with prior COVID-19 infection.

ABSTRACT

Objective(s)

Long COVID affects multiple organ systems, yet the incidence and risk factors for post–COVID-19 laryngeal dysfunction remain underexplored. This study evaluated the incidence of laryngeal dysfunction following COVID-19.

Methods

A retrospective cohort study was performed using the TriNetX Global Collaborative EHR Network (> 180 million records). Adults without prior laryngeal dysfunction or major comorbidities were stratified by COVID-19 exposure and compared with uninfected controls. Outcomes included chronic cough, dysphagia, voice disorders, vocal fold paralysis, and laryngeal spasm, assessed up to 5 years post-infection. After propensity score matching, odds ratios (OR) and risk differences (RD) with 95% confidence intervals (CI) were calculated.

Results

COVID-19 was associated with significantly increased odds of chronic cough (peak OR 7.12; RD 0.33%, p < 0.0001), dysphagia (peak OR 2.71; RD 0.36%, p < 0.0001), voice disorders (peak OR 3.25; RD 0.12%, p < 0.0001), vocal fold paralysis (peak OR 2.17; RD 0.01%, p < 0.0001), and laryngeal spasm (peak OR 2.79; RD 0.003%, p < 0.0001). Incidence peaked at 1–2 years for most outcomes and at 2–3 years for laryngeal spasm. Hospitalization and mechanical ventilation were associated with increased rates of dysphagia (HR 2.63; HR 5.26), voice disorders (HR 1.15; HR 4.45), and vocal cord paralysis (HR 2.09; HR 9.35), but reduced rates of chronic cough (HR 0.68; HR 0.45). Vaccinated patients showed higher rates of chronic cough (HR 1.36) and voice disorders (HR 1.22).

Conclusion

COVID-19 is associated with increased incidence of new-onset laryngeal dysfunction, most commonly peaking 1–2 years after infection and influenced by hospitalization, mechanical ventilation, and vaccination status.

Level of Evidence

Primary Language Spoken at Home and Speech Outcomes Among Children With Cleft Palate

Thu, 30 Apr 2026 00:00:00 -0700

ABSTRACT

Objectives

Following cleft palate repair, early detection of maladaptive compensatory mechanisms and hypernasality may determine the need for additional intervention. Our goal is to understand if primary language influences rates of subsequent intervention among children with cleft palate in the United States.

Methods

Within a single urban cleft team, patients with a history of palate repair evaluated at least 2 years postoperatively were analyzed using Fisher's exact test.

Results

There were 124 patients representing 6 languages: 101 English, 9 Spanish, and 14 other (Vietnamese, Haitian Creole, Portuguese, and Tamil). Some patients were repaired elsewhere and presented to our clinic secondarily for evaluation. Among English and non-English speaking children, similar rates of symptomatic and asymptomatic postoperative fistula (17.8% vs. 17.4%, p = 1.00), hypernasality and/or audible nasal emissions (ANEs) (44.6% vs. 30.4%, p = 0.25), persistent hypernasality/ANE after speech therapy (ST) (22.8% vs. 13.0%, p = 0.40), and revision surgery (33.7% vs. 17.4%, p = 0.14) were observed. However, higher rates of hypernasality/ANE (45.5% vs. 14.3%, p = 0.04), persistent hypernasality/ANE after ST (23.6% vs. 0.0%, p = 0.04), and revision surgery (33.6% vs. 7.1%, p = 0.06) were noted among English and Spanish speakers. [Correction added on 08 May 2026, after first online publication: The preceding sentence has been revised in this version.]

Conclusion

Within a single urban practice in the United States, lower rates of hypernasality and revision surgery were observed among non-English and non-Spanish speaking patients. Such findings may suggest disparities in resources available for detecting speech abnormalities in this population.

Level of Evidence

Ménière's Disease: A Tri‐Decade Scoping Review of Treatment Trends and Evidence Quality

Ofir Zavdy, Teeraya Piyajarawong, Seamus Boyle, Ross O'Shea, John Rutka — Wed, 29 Apr 2026 04:48:43 -0700

This tri-decade scoping review of Ménière's disease literature reveals a significant increase in high-level evidence and a clinical pivot toward hearing-preserving interventions, such as intratympanic steroids and cochlear implants. However, a significant quality paradox has emerged, where adherence to standardized AAO-HNS reporting and diagnostic criteria has declined to 34% and 73%, respectively. The findings emphasize that enforcing standardized reporting is essential to safeguard the integrity of clinical advancements in the field.

ABSTRACT

Introduction

Ménière's disease (MD) is a complex inner ear disorder defined by endolymphatic hydrops and a triad of episodic vertigo, fluctuating hearing loss, and tinnitus. Despite AAO-HNS diagnostic guidelines, disease heterogeneity and lack of treatment consensus persist.

Objective

This study conducts a tri-decade scoping review (1994–2024) to evaluate the MD evidence base, shifts in management, and methodological rigor regarding AAO-HNS and CONSORT compliance.

Materials and Methods

A systematic search of PubMed, CINAHL, and Cochrane (2014–2024) identified English-language RCTs and prospective cohorts involving adults. Studies were graded via the Oxford CEBM system, with guideline compliance analyzed using IBM SPSS v29.0. A scoping review framework was adopted to map the “Quality Paradox” between evidence hierarchy and reporting standards.

Results

From 1344 publications, 257 studies met inclusion criteria. While research volume surged—with Level 2 studies quadrupling (p < 0.01) and Level 3 studies tripling (p < 0.05)—reporting standards significantly declined. Adherence to AAO-HNS diagnostic and treatment-outcome criteria dropped to 73% and 34%, respectively. Clinically, management shifted toward preservation-focused interventions, including hydrops-visualizing MRI, intratympanic steroids over gentamicin, and increased cochlear implantation, alongside a decline in positive-pressure device use.

Conclusion

The MD evidence base increasingly favors non-ablative, patient-centered interventions. However, the validity of these advancements is threatened by a significant decline in reporting compliance. To safeguard the evidence base, journals must enforce standardized reporting as a nonnegotiable prerequisite for publication.

Level of Evidence

N/A.

Long‐Term Outcomes of Patients Undergoing Cricothyrotomy at a Tertiary Care Level One Trauma Center

Wed, 29 Apr 2026 04:30:35 -0700

This retrospective study of 48 patients undergoing emergent cricothyrotomy (2014–2025) evaluated short- and long-term outcomes and complications. Common complications included dysphagia, pneumonia, and dysphonia, with delayed conversion to tracheostomy associated with increased pneumonia risk; long-term issues included persistent dysphagia, subglottic stenosis, and vocal fold injury. Cricothyrotomy is a critical life-saving procedure but carries substantial morbidity, underscoring the importance of timely tracheostomy conversion and careful postoperative management.

ABSTRACT

Objective(s)

To identify short-term and long-term outcomes and complications for patients who underwent cricothyrotomy.

Methods

A retrospective review was conducted for all patients who underwent cricothyrotomy between 2014 and 2025. Data included demographics, procedural details such as time to tracheostomy conversion and success rates, hospital course, short-term complications (e.g., dysphagia, pneumonia, vocal cord paralysis), and long-term complications (e.g., subglottic stenosis, vocal fold injury).

Results

Forty-eight patients underwent emergent cricothyrotomy. 72.9% were male and the mean age was 57.7 years. Common short-term complications included dysphagia (35.4%), pneumonia (31.3%), and dysphonia (27.1%). Planned conversion to tracheostomy occurred in 83.3% of patients, on average 2.3 days post-cricothyrotomy. Time to tracheostomy was significantly longer in patients who developed pneumonia (3.9 vs. 1.4 days, p = 0.005). In-hospital mortality was 20.8% and 90-day mortality was 29.2%. The mean post-cricothyrotomy hospital length of stay was 19.4 days. Long-term complications included persistent dysphagia (18.8%), subglottic stenosis (12.5%), and vocal fold injury (10.4%). Thirty-day return to the ED visits occurred in 20.8% of patients, with both airway and comorbidity-related presentations. Twenty patients (41.7%) ultimately had their tracheostomy tube removed with a mean time to decannulation of 83.7 days.

Conclusion

Cricothyrotomy remains a vital, life-saving intervention in the difficult airway algorithm but carries a risk of significant post-procedural complications, including dysphagia, pneumonia, dysphonia, subglottic stenosis, and vocal fold injury. These findings highlight the importance of meticulous postoperative care, particularly respiratory management, to reduce delays in conversion to tracheostomy and optimize long-term outcomes.

Level of Evidence

The Statistical Fragility of Saline Nasal Irrigation for Rhinosinusitis: A Systematic Review

Wed, 29 Apr 2026 00:00:00 -0700

This systematic review evaluated the statistical robustness of randomized controlled trials assessing high-volume saline nasal irrigation for rhinosinusitis using fragility analysis. Across eight trials and 38 dichotomous outcomes, results demonstrated moderate-to-high fragility, with a median fragility index of 5, indicating that small changes in outcomes could reverse statistical significance. These findings suggest that current evidence supporting saline nasal irrigation should be interpreted cautiously, highlighting the need for larger, more rigorous trials with improved methodological design.

ABSTRACT

Objective

To assess the statistical fragility of randomized controlled trials (RCTs) evaluating high-volume saline nasal irrigation (SNI) for rhinosinusitis using fragility analysis.

Data Sources

PubMed, MEDLINE, and Embase were searched for RCTs published between May 1976 and January 2026.

Review Methods

This study was reported as per PRISMA guidelines. RCTs that compared high-volume SNI to non-irrigation standard care for acute, recurrent, or chronic rhinosinusitis, and reported ≥ 1 dichotomous outcome, were included. Fragility index (FI), the minimum number of event reversals needed to alter statistical significance, and fragility quotient (FQ), FI normalized to sample size, were calculated for statistically significant dichotomous outcomes. Reverse FI (rFI) and reverse FQ (rFQ) were calculated for non-significant outcomes.

Results

Eight RCTs were included, yielding 38 dichotomous outcomes. Eight outcomes (21.1%) were statistically significant. The overall combined median FI was 5 (FQ 0.062), with similar FI values between significant and non-significant outcomes. In over one-fifth of outcomes, loss to follow-up exceeded FI. Analysis of principal dichotomous outcomes from studies demonstrated a median FI of 6 (FQ 0.092), with five of eight (62.5%) outcomes non-significant.

Conclusion

RCTs evaluating SNI for rhinosinusitis exhibit moderate-to-high statistical fragility, with small outcome changes capable of reversing study conclusions. Because fragility analysis was limited to dichotomous outcomes while many primary endpoints were continuous, our findings should be interpreted as complementary rather than comprehensive appraisals of RCTs. Future RCTs with larger sample sizes, reduced bias, and pre-specified fragility considerations are needed to better define the clinical role of SNI.

Diagnosis and Treatment of Refractory Chronic Cough: An American Broncho‐Esophagological Association Expert Consensus Statement

Tue, 28 Apr 2026 18:45:32 -0700

ABSTRACT

Objective

To develop an expert consensus statement (ECS) on the diagnosis and treatment of refractory chronic cough (RCC) in adults. RCC was defined as cough lasting longer than 8 weeks and refractory to standard management of pulmonary, gastrointestinal, sinonasal, and medication-induced etiologies.

Methods

An expert panel of otolaryngologists used published consensus statement methodology to develop statements guiding the diagnosis and management of RCC from an otolaryngologic perspective. A modified Delphi method was used to iteratively select, eliminate, and refine statements based upon accepted methodology until consensus was achieved.

Results

Three iterative Delphi surveys were performed with discussion rounds between each of the voting sessions. Twenty-seven statements met consensus while six statements did not. The clinical statements were grouped into 9 categories: operational definition, pathophysiology, assessment of prior work-up, phenomenology and symptomatology, four treatment categories (neuromodulators, superior laryngeal nerve blocks, behavioral cough suppression, and emerging treatments), and overall treatment approaches.

Conclusion

The panel reached consensus for 27 statements related to the diagnosis and treatment of adults with RCC from an otolaryngologic perspective. These statements may be used to standardize evaluation and improve quality of care, while also identifying areas for future investigation in the management of RCC.

Electrode Contacts in the Functional Hearing Region for Pediatric Cochlear Implant Recipients

Tue, 28 Apr 2026 18:39:38 -0700

This study reviewed the incidence of electrode contacts within the functional acoustic hearing region in pediatric cochlear implant recipients. Of 69 ears, 90% had at least one electrode contact in this region. For those with speech recognition data, word recognition in quiet was not significantly associated with proximity within the functional acoustic hearing region. Research is needed to understand the effects of electrode contact placement within this region on speech recognition in noise and the long-term effects on hearing preservation.

ABSTRACT

Objectives

Examine the incidence of one or more electrode contacts placed within the region of functional acoustic hearing and the potential influence of electrode positioning on speech recognition for pediatric cochlear implant (CI) recipients.

Methods

A retrospective review for pediatric CI recipients of straight electrode arrays with preserved low-frequency hearing (an unaided threshold of ≤ 80 dB HL at 250 Hz) was conducted at a tertiary referral center. Intraoperative X-rays were used to determine the angular insertion depth (AID) of each electrode. Proximity of contacts to the functional acoustic hearing region was calculated using AID and postoperative unaided thresholds. For electric-acoustic stimulation (EAS) users, the association between proximity values and CNC word recognition in quiet was reviewed at 3-, 6-, and 12-months post-activation.

Results

Among 69 ears, 90% had at least one electrode contact within the functional acoustic hearing region. Proximity values ranged from −131° to 450° (mean: 100°, SD: 120°). For EAS users with speech recognition data (n = 29), proximity values were not significantly associated with post-activation CNC scores (p ≥ 0.212).

Conclusions

Most pediatric CI recipients with hearing preservation had at least one electrode contact in the region of functional acoustic hearing. Proximity was not significantly associated with word recognition in quiet for EAS users, though this subgroup was limited in sample size. Further studies in pediatric EAS users are needed to understand the potential relationship with speech recognition in noise and to determine the benefits of individualizing array selection and/or EAS mapping.

Level of Evidence

The Hidden Hazards of Vaping

Ayaantuu F. Usman, Sobia F. Khaja — Tue, 28 Apr 2026 18:36:05 -0700

A 31 year old male presented with a penetrating oropharyngeal injury following a motor vehicle collision and was found to have a retained metallic foreign body suspected to be part of a vape pen. The foreign body was abutting the carotid artery and was removed via a combined transoral and transcervical approach. This case highlights a novel mechanism of head and neck trauma and emphasizes the importance of understanding a wide spectrum of unique injuries.

Disparities in Hearing Screening Practices in Minnesota Elementary Schools

Tue, 28 Apr 2026 18:29:23 -0700

ABSTRACT

Objective

Identifying and addressing pediatric hearing loss is critical to supporting a child's development. School-based hearing screening is a mainstay of timely identification of hearing loss. The objectives of this study were to characterize the current hearing screening practices in public, charter, and private elementary schools in Minnesota.

Methods

This was a cross-sectional survey with data collected between March and June 2023. Surveys assessed the presence of standardized hearing screening processes and compliance with American Academy of Audiology (AAA) or Minnesota Department of Health (MDH) guidelines.

Results

About 146 public schools, 43 charter schools, and 60 private schools met inclusion criteria and responded to the survey. There was a statistically significant difference in the rate of standardized screening between school types (χ ² = 18.06; p < 0.001). Only 10.44% (n = 26) of schools completed hearing screenings per AAA guidelines, and even fewer, 4.82% (n = 12), completed hearing screenings according to MDH guidelines. The odds of screening per AAA or MDH guidelines were 3.50 times higher in charter schools compared to public schools (95% CI: 1.14, 10.73) and 4.61 times higher in private schools compared to public schools (95% CI: 1.73, 12.26).

Conclusion

There is a lack of standardization in hearing screening processes in Minnesota elementary schools. Adherence to screening per AAA or MDH recommendations is low in all types of elementary schools. Charter and private schools were more likely than public schools to screen per AAA or MDH guidelines. Overall, our data demonstrate an opportunity for improvement in school-based hearing screening.

Level of Evidence

N/A.

The Impact of Etiology on Time to Vocal Fold Motion Recovery in Unilateral Vocal Fold Paralysis

Rishi Suresh, Ted Mau — Tue, 28 Apr 2026 18:25:32 -0700

The time course of vocal fold motion recovery in UVFP reflects the underlying etiologies. This study showed that there was no difference in the time to recovery between UVFP from cardiothoracic versus thyroid/parathyroid surgeries, challenging the long-held assumption that recovery time is proportional to the distance between injury site and larynx. The findings support a model in which the severity of neural injury, not the location of injury, is the principal determinant of time to recovery.

ABSTRACT

Objectives

Spontaneous recovery of vocal fold (VF) motion in unilateral vocal fold paralysis (UVFP) has been shown to follow a bimodal time distribution for peripheral, nonidiopathic etiologies, but recovery time dependencies on UVFP etiology are incompletely characterized. This study aimed to (1) determine recovery time differences between surgically induced, idiopathic, and intubation-related UVFP, and (2) investigate the impact of distance of injury from larynx on recovery time in surgically induced UVFP.

Methods

Retrospective study of 1425 UVFP patients over a 16-year period identified 736 patients with recovery of VF motion. The time to the first laryngoscopic sign of VF motion recovery in surgically induced, idiopathic, or intubation-related UVFP was fit to a bimodal or unimodal mathematical model. Time course of VF motion recovery was also compared using Kaplan–Meier estimates.

Results

Surgically induced UVFP demonstrated a bimodal time-to-recovery distribution, consistent with a previously described two-phase model of recovery. Both idiopathic and intubation-related UVFP followed unimodal recovery patterns. Among surgically induced cases, Kaplan–Meier recovery curves for thyroid/parathyroid and cardiothoracic surgeries were nearly identical despite differing injury locations along the recurrent laryngeal nerve.

Conclusion

Differences in the time course of VF motion recovery in UVFP reflect the underlying etiologies. Among surgically induced UVFP, the recovery time did not correlate with the distance between the injury site and the larynx, challenging a long-held assumption. The findings support a model in which the severity of neural injury, not the location of injury, is the principal determinant of time to recovery.

Level of Evidence

Multi‐Task Assessment of Context‐Specific Gait Changes to Virtual Reality‐Based Visual Perturbations

Tue, 28 Apr 2026 18:20:06 -0700

We developed an immersive virtual reality (VR)-based gait assessment platform incorporating a 10-item multi-task battery to systematically probe balance under controlled visual perturbations. Compared with unperturbed VR conditions, optic flow and flickering light environments elicited context-specific alterations in mediolateral stability, temporal consistency, and spatial gait adaptation, revealing changes that may not be captured by conventional overground walking assessments. This multi-task, perturbation-based framework may therefore enhance sensitivity to subtle gait instability by exposing context-dependent limits of balance control.

ABSTRACT

Objective

Conventional gait assessments often fail to detect early, subclinical balance abnormalities that may become apparent under sensory conflict, such as visual perturbations. We investigated whether instrumented gait analysis combined with virtual reality (VR)-delivered visual perturbations can reveal task-dependent gait adaptations in healthy adults exposed to discordant sensory information.

Methods

Ten healthy adults completed a purpose-designed battery of 10 walking tasks spanning steady-state and balance-challenging conditions (e.g., tandem gait, obstacle negotiation, Timed Up and Go) on an instrumented walkway under four visual conditions: no virtual reality, unperturbed VR, optic flow-perturbed VR, and flickering light-perturbed VR. Spatiotemporal gait parameters were quantified to assess task- and condition-specific changes in dynamic gait control.

Results

Visual perturbations elicited task-dependent gait adaptations rather than uniform effects across the battery. Compared to unperturbed walking, optic flow was associated with selective increases in stride width during tasks involving rapid reorientation and rotational head movements, including pivot turning (0.10 vs. 0.06, p = 0.045) and horizontal head turns (0.12 vs. 0.08, p = 0.027). Temporal and spatial gait variability increased during tandem gait under optic flow (step time variability: 32.23 vs. 12.75, p = 0.036; stride length variability: 27.96 vs. 8.08, p = 0.041), reflecting impaired cycle-to-cycle consistency under heightened precision demands.

Conclusion

VR-delivered visual perturbations revealed task-specific alterations in mediolateral stability, temporal consistency, and spatial gait scaling that were absent during unperturbed walking. A multi-task, perturbation-based assessment framework may therefore enhance sensitivity to subtle gait instability by exposing context-dependent limits of balance control.

Level of Evidence

Should Superior Laryngeal Nerve Block Be Performed for Neurogenic Cough?

Lauren F. Tracy, J. Pieter Noordzij — Tue, 28 Apr 2026 18:13:06 -0700

SLN block may be offered as a treatment for neurogenic cough after guideline-directed evaluation and treatment for other causes have been attempted. There is an ~80% success rate which may require multiple injections. Risks appear limited; however, long-term benefit is not yet determined.

National Trends and Risk Factors for Dysphagia After Anterior Cervical Discectomy and Fusion

Caryn J. Ha, Sraavya G. Anne, Sara Morgan, Fadar Oliver Otite, Kenneth Yan — Mon, 27 Apr 2026 20:45:23 -0700

From 2016 to 2023, inpatient anterior cervical discectomy and fusion (ACDF) volume declined 52.2% while postoperative dysphagia rates increased 11.4% annually. Analysis of 496,425 cases demonstrated that dysphagia risk varied markedly by surgical indication, with cervical diffuse idiopathic skeletal hyperostosis, cervical spine fracture, and pseudoarthrosis emerging as the strongest independent predictors, alongside multilevel surgery and greater comorbidity burden. These findings informed the development of a predictive nomogram and underscore the need for individualized perioperative risk stratification in ACDF candidates.

ABSTRACT

Background

Dysphagia remains one of the most common complications following anterior cervical discectomy and fusion (ACDF), yet recent national trends and risk factors across surgical indications have not been fully characterized.

Objective

To evaluate national trends in ACDF and dysphagia rates and to identify patient, surgical, and indication-specific risk factors for postoperative dysphagia.

Methods

A retrospective analysis of the Nationwide Inpatient Sample identified adult patients undergoing elective ACDF from 2016 to 2022. Multivariable logistic regression was used to determine independent risk factors for dysphagia and develop a predictive nomogram. Separate models were also constructed for single- and multilevel ACDF.

Results

Among 496,425 hospitalizations, dysphagia occurred in 7.7% of patients. Despite a 57.3% decline in ACDF, the odds of dysphagia increased at an estimated 11.4% annually (OR: 1.11, 95% CI: 1.09–1.13; p < 0.001). Cervical diffuse idiopathic skeletal hyperostosis (OR: 5.41; 95% CI: 3.81–7.67), cervical spine fracture (OR: 1.73; 95% CI: 1.31–2.30), and pseudoarthrosis (OR: 1.36; 95% CI: 1.15–1.61) were strong independent predictors of dysphagia. Additional risk factors included racial minority status, higher comorbidity burden, and care at urban teaching hospitals. Risk factors differed between single- and multilevel ACDF. Dysphagia was associated with higher rates of complications, including aspiration pneumonia, percutaneous endoscopic gastrostomy placement, and tracheostomy (all p < 0.001).

Conclusions

These findings represent the first national analysis to demonstrate a decline in inpatient ACDF volumes yet rising postoperative dysphagia rates. Selective surgical indications emerged as key predictors, informing the development of a nomogram for risk stratification and preoperative optimization in ACDF patients.

Level of Evidence

Virtual Reality Mastoidectomy as Precadaver Training for Novices: A Randomized Crossover Study

Mon, 27 Apr 2026 18:55:03 -0700

Virtual reality mastoidectomy training produced significantly lower relative reaction times than cadaveric dissection, indicating reduced cognitive load among novice learners and improved subsequent cadaveric performance. In this randomized crossover study, trainees who completed VR first achieved higher cadaveric mastoidectomy scores, despite similar cognitive load trajectories across modalities. These findings support VR mastoidectomy as a cognitively efficient precadaver training modality that enhances early learning in otologic surgery.

ABSTRACT

Objectives

To compare cognitive load during virtual reality (VR) simulation and cadaveric dissection (CD) mastoidectomy training in novice learners. To determine whether training order influences cognitive load, characterize cognitive load progression during the procedure, and assess whether VR training improves subsequent cadaveric performance.

Methods

In this randomized crossover study, 24 core surgical trainees with no prior mastoidectomy experience performed a cortical mastoidectomy in both VR and CD settings. Participants were randomized to either VR-first or CD-first training sequences. Cognitive load was measured using a bespoke auditory reaction-time device at baseline and 10, 30, and 50 min. Relative reaction time (RRT) served as an objective index of cognitive load. Cadaveric performance was assessed using the Modified Welling Scale by two blinded otologists.

Results

Cognitive load was significantly lower during VR than CD, with mean RRT rising 26% from baseline in VR versus 60% in CD (p < 0.001). Training order did not affect cognitive load in either modality, and RRT increased progressively throughout mastoidectomy in both VR and CD. Participants who began with VR achieved significantly higher cadaveric performance scores than those who began with CD (mean 9.50 vs. 4.96; p < 0.001), and inter-rater reliability for performance scoring was high.

Conclusion

VR mastoidectomy reduces cognitive load and enhances subsequent cadaveric performance in novice trainees, supporting its role as a cognitively optimized precadaver training modality that complements, rather than replaces, cadaveric dissection. These findings suggest VR enhances early learning efficiency and resource utilization in novice otolaryngology training.

Level of Evidence

N/A.

Integrating Augmented Reality Into Otologic Cadaveric Surgical Training

Mon, 27 Apr 2026 18:48:14 -0700

This pilot study developed and implemented a specimen-specific augmented reality (AR) workflow for cadaveric temporal bone dissection, using CT-derived 3D models registered to each specimen and viewed intermittently through a Microsoft HoloLens 2 headset. Four otolaryngology residents completed seven dissections with high dissection performance and favorable user feedback for anatomical orientation, supporting the feasibility of integrating this workflow into a cadaveric dissection course.

ABSTRACT

Objective

Temporal bone dissection poses a significant challenge due to its intricate three-dimensional (3D) anatomy. Traditional learning methods involving cadaver dissections are limited by practical constraints. Augmented reality (AR) offers a potential solution by providing 3D anatomical visualization of key anatomical landmarks based on computed tomography (CT) scans, superimposed directly onto the cadaver specimen. This pilot study evaluated the feasibility of integrating AR to support temporal bone dissection of cadavers and enhance otolaryngology residents' grasp of anatomy.

Methods

Four otolaryngology residents performed a total of seven temporal bone dissections during a dedicated dissection course. AR models were developed using specimen-specific CT data and overlaid onto cadaveric specimens using the Microsoft HoloLens 2 headset. Participants' dissection accuracy and efficiency were evaluated using predefined metrics, and their feedback was collected through questionnaires to assess the system's contribution to learning.

Results

In this pilot feasibility study, the AR system was successfully integrated into the dissection workflow, with participants reporting improved understanding of these complex anatomical structures as well as enhanced spatial orientation. Dissection quality was high, and the participants expressed overall satisfaction with the course.

Conclusion

AR technology shows significant potential as an adjunct to traditional temporal bone dissection training by providing enhanced visualization that leads to greater anatomical understanding.

Level of Evidence

Level of Evidence

N/A.

A Simple Technique for Probe‐Based NIRAF‐Guided Parathyroid Identification in TOETVA

Thu, 23 Apr 2026 21:01:33 -0700

We describe a technique for probe-based near-infrared autofluorescence (NIRAF)-guided parathyroid identification during TOETVA. The probe is mounted on a suction cannula and introduced via the central port, allowing real-time confirmation of parathyroid tissue without device modification. This approach enables integration of NIRAF into remote-access thyroid surgery.

Middle Ear Bacterial Colonization and Recurrence of Radiation‐Induced OME: A Prospective Study

Wed, 22 Apr 2026 21:40:08 -0700

This study investigated the bacteriological features of radiation-induced otitis media with effusion (RI-OME) in nasopharyngeal carcinoma patients after radiotherapy and its association with early recurrence. Compared with non-radiation-induced OME patients, RI-OME patients showed significantly higher middle ear effusion bacterial positivity, with more opportunistic and drug-resistant pathogens. While bacterial colonization was linked to early recurrence within 4 weeks, it did not serve as an independent prognostic factor for overall recurrence over 24 weeks, suggesting the need for further studies on targeted antibacterial interventions.

ABSTRACT

Objective

To define the bacteriological characteristics of otitis media with effusion (OME) in nasopharyngeal carcinoma (NPC) patients following radiotherapy and determine whether bacterial colonization in the middle ear was associated with a higher risk of early recurrence of radiation-induced OME (RI-OME).

Methods

This prospective multicenter cohort enrolled patients with OME (with or without a history of radiotherapy for NPC) undergoing tympanocentesis. Middle ear effusion (MEE) samples were cultured and patients with RI-OME were followed up for 24 weeks. Data on demographics, radiotherapy history, treatment, comorbidities, and effusion characteristics were collected. Recurrence patterns were characterized descriptively throughout the 24-week post-tympanocentesis follow-up.

Results

A total of 93 RI-OME patients and 115 non-radiation-induced (NRI)-OME patients were included. RI-OME patients had a 4.843-fold higher risk of MEE bacterial culture positivity compared to NRI-OME patients (OR = 4.843, p = 0.006). MEE cultures in RI-OME patients showed higher proportions of opportunistic pathogens and drug-resistant bacteria. Mucoid effusion was a significant risk factor for bacterial positivity in RI-OME (OR = 8.553, p = 0.002). Male sex (OR = 12.120, p = 0.002) and bacterial colonization (OR = 10.239, p = 0.035) were associated with early recurrence (≤ 4 weeks post-tympanocentesis) in RI-OME patients; however, neither factor remained an independent predictor over the full 24-week period.

Conclusion

RI-OME patients demonstrated significantly higher MEE bacterial culture positivity rates than NRI-OME patients. Although MEE bacterial colonization significantly impacted early recurrence, it lacked independent prognostic value for overall 24-week recurrence. Thus, whether targeted antibacterial therapy can reduce recurrence rates warrants further investigation.

Level of Evidence

Identifying Stimulation Lead Malfunction After Hypoglossal Nerve Stimulation Implantion

Pearl Doan, Megan L. Durr, Jolie L. Chang — Wed, 22 Apr 2026 21:17:40 -0700

This case series describes four obstructive sleep apnea patients who underwent hypoglossal nerve stimulation implant surgery. After a period of OSA resolution with therapy, these patients presented with symptoms of increased snoring and reduced tongue sensation with implant activation. Impedance testing showed abnormally elevated values on bipolar electrode settings, and electrode reprogramming led to restored therapeutic benefit.

In Response to Quantifying Dehydration Effects of Porcine Vocal Fold Attenuation With Optical Coherence Tomography

Wed, 22 Apr 2026 21:09:49 -0700

The Laryngoscope, EarlyView.

Meniere's Disease and Migraine: Effect of Migraine Medications on Symptoms of Meniere's Disease

Tue, 21 Apr 2026 21:00:31 -0700

Within TriNetX, there is an association between migraine and MD. Migraine patients receiving migraine treatment are more likely to develop MD compared to non-migraine patients. These results affirm the proposed pathophysiological link between migraine and MD, supporting how treatments for migraine may also help MD-related symptoms.

ABSTRACT

Objectives

To observe the incidence of Meniere's disease (MD) and MD-related symptoms (i.e., aural fullness, tinnitus, hearing loss, and vertigo) between (a) non-migraine and migraine patients and (b) migraine untreated and migraine treated patients within the TriNetX database.

Methods

We conducted a retrospective cohort study of (a) non-migraine and migraine patients and (b) migraine treated and untreated patients within the TriNetX database from 2013 till 2025. Patients underwent propensity score matching for sex, age, race, and known lifestyle/disease confounders for MD. Incidence of MD and MD-related symptoms were evaluated 5 years post index date and beyond 5 years post index date.

Results

Migraine patients demonstrated a greater incidence of MD and MD-related symptoms 5 years and more than 5 years post index date. Amongst migraine patients, those not receiving treatment demonstrated a lesser predilection (risk ratio [RR] = 0.43, 95% CI: 0.28–0.66) of developing MD than patients receiving treatment. There was no significant difference in the incidence of hearing loss or aural fullness between migraine untreated and treated subgroups. Migraine patients not receiving treatment had an increased risk of experiencing tinnitus (RR = 1.11, 95% CI: 1.03–1.19).

Conclusions

There exists a connection between migraine and MD. Migraine patients receiving migraine treatment are statistically significantly more likely to develop MD compared to non-migraine patients. These results support the findings of preceding studies that have demonstrated a pathophysiological link between migraine and vestibulocochlear dysfunction.

Level of Evidence

Endoscopic Marsupialization With Periodic Debridement for Petrous Apex Cholesteatoma

Tue, 21 Apr 2026 04:03:05 -0700

In cases where an expanded cholesteatoma has extensively eroded the petroclival bones, marsupialization of the cholesteatoma cavity without matrix removal through an endoscopic transsphenoidal approach is a feasible and safe option. This approach avoids CSF rhinorrhea and injury to critical structures which may be underlying and adherent to the cholesteatoma matrix, and periodic debridements address the disease satisfactorily.

Bronchoscopic Internal Traction for Airway Foreign Body Removal via Tracheotomy Under ECMO

Fri, 17 Apr 2026 23:39:00 -0700

We present a technique utilizing internal traction-assisted mobilization to effectively retrieve objects, such as pen caps, that lack an external grasping surface and resist conventional rigid bronchoscopy. In this case, tracheotomy served as an alternative extraction route for impacted foreign bodies that failed to pass across the glottis or subglottic region. Concurrently, ECMO maintains oxygenation during complex airway manipulation and reduces the risk of hypoxia.

Efficient Suprahyoid Muscle Contraction by Combined Modulated Currents in Mice

Fri, 17 Apr 2026 21:09:57 -0700

The composite wave stimulation, combining amplitude-modulated alternating current with pulse stimulation, facilitated suprahyoid muscle contraction. The effects occurred without a marked reduction in discomfort threshold current intensities.

ABSTRACT

Objective

This study aimed to optimize electrical stimulation modalities for the suprahyoid muscles to improve swallowing function. We hypothesized that novel stimulus patterns (amplitude-modulated, mid-frequency sinusoidal, exponentially amplified, and short-pulse waveforms) would enhance contraction efficiency.

Methods

We delivered 80-Hz rectangular pulse, 2-kHz alternating current (AC) with nth-power sinusoidal modulation (n = 1, 5, 7, 9, 11), and 4- and 8-kHz sine waves. We also tested 2-kHz AC with nth-power sinusoidal modulation combined with short-pulsed currents. These were applied via subcutaneously embedded Ag–AgCl ball electrodes targeting the suprahyoid muscles in anesthetized mice. Threshold intensities were determined using isometric contraction measurements. Discomfort levels for each stimulus were then assessed in awake conditions.

Results

Increasing the power of sinusoidal modulation in AC significantly reduced muscle contraction thresholds. Waveforms combining amplitude-modulated sinusoids and short pulse trains (20 μs duration) further lowered thresholds over non-pulsed stimuli. Discomfort thresholds did not differ significantly across AC and composite stimulation.

Conclusion

Our findings reveal an exponential relationship between amplitude-modulated AC and suprahyoid muscle contraction efficiency, and show that integrating pulsed current with sinusoidal stimulation synergistically optimizes activation. These results provide a foundation for advanced neuromuscular electrical stimulation strategies for swallowing rehabilitation.

Level of Evidence

N/A.

Ear Piercing Complications: Comparing Cartilage and Soft Tissue Piercings in a Large Survey Cohort

Fri, 17 Apr 2026 20:56:49 -0700

Cartilage ear piercings were associated with significantly higher complication rates than lobule piercings and remained an independent predictor of complications after multivariate analysis. Cartilage site also independently predicted piercing removal, with higher removal rates observed compared to lobule piercings.

ABSTRACT

Objectives

To compare complication and removal rates between cartilage and lobule ear piercings in a large adult population.

Methods

An anonymous electronic survey was distributed to all individuals with a University of Iowa email address. Respondents reported demographic characteristics, piercing site, age at piercing, technique, personnel, and specific complications. Multivariate logistic regression evaluated complication and removal rates between cartilage and lobule sites.

Results

Data were analyzed on 9016 ear piercings from 3270 respondents, including 6275 (69.6%) lobule piercings and 2741 (30.4%) auricular cartilage piercings. Complications were reported in 40.2% of cartilage piercings versus 25.4% of lobule piercings (odds ratio [OR] 1.98, p < 0.0001). Infection occurred in 30.3% of cartilage piercings versus 23.8% of lobule piercings (OR 1.39, p < 0.0001). Additionally, cartilage site and presence of any complication each independently predicted piercing removal (OR 1.62, p < 0.0001; OR 12.82, p < 0.0001).

Conclusion

Cartilage piercings carried significantly greater odds of complication and removal compared to lobule piercings. These findings underscore the importance of thorough counseling and informed consent, especially when piercing through auricular cartilage.

Level of Evidence

Endoscopic‐Assisted Transcervical Excision of Second Branchial Cleft Anomalies in Young Children

Thinh T. Kieu, Hosam H. Alkhatib, Shaunak Amin, Sheng Zhou, Kaalan Johnson — Thu, 16 Apr 2026 21:10:37 -0700

We describe an endoscopic-assisted transcervical technique for excision of second branchial cleft anomalies in young children. In three cases (ages 2–8), this approach allowed safe identification and ligation of the tracts while providing improved visualization and allowing smaller incisions. Endoscopic assistance may be an effective alternative to traditional wide transcervical excision.