Otolaryngol Head Neck Surg [JOURNAL]
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200 papers
Socioeconomic Disadvantage and Care Proximity Influence Stage at Presentation in Head and Neck Cancer.
Bridgham K, Kaki P, Hambach B … +5 more , Moroco A, Mastrolonardo E, Crippen M, Cognetti D, Thal A
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42171240 · Full text
OBJECTIVE: To evaluate how patient circumstances that may influence access to care, including area deprivation index (ADI), distance to care center, and rural/urban status affect stage of presentation for HNSCC. STUDY DE...
OBJECTIVE: To evaluate how patient circumstances that may influence access to care, including area deprivation index (ADI), distance to care center, and rural/urban status affect stage of presentation for HNSCC. STUDY DESIGN: Retrospective, single-institution study. SETTING: Urban, academic tertiary care center. METHODS: Patients with a history of HNSCC of the oral cavity, oropharynx, hypopharynx, larynx who presented to our institution between 2018 and 2023 were included. Demographic factors including age, race, sex, ADI, insurance status, distance to tertiary care center, and rural-urban continuum codes were collected. Primary outcome of interest was clinical stage at presentation. RESULTS: 1170 patients met inclusion criteria, of which 675 (57.7%) presented with early-stage disease and 495 (42.3%) presented with late-stage disease. On multivariable analysis, closer proximity to care center, insurance status, current or former smoking status, p16 negativity, and tumor subsite of the oral cavity or hypopharynx were associated with late-stage diagnosis. After sub-stratification for patients within the closest distance quartile, female sex, p16 negativity, non-white and non-black race, and insurance status remained associated with late-stage disease presentation. CONCLUSION: Patient characteristics often associated with socioeconomic disadvantage including minority race, Medicaid, or lack of insurance were associated with a later stage of presentation for HNSCC. Individuals living within the closest distance to our tertiary care center were more likely to present with late-stage disease, highlighting the need for improved access to care for socioeconomically disadvantaged urban populations.
Cochlear Implant Complications and Outcomes: National Trends of the MAUDE Database From 2016 to 2024.
Habib DRS, Bishay AE, Habib MWS … +5 more , Patro A, Langerman AJ, Moberly AC, Haynes DS, Tawfik KO
Otolaryngol Head Neck Surg · 2026 May · PMID 42171210 · Publisher ↗
OBJECTIVE: As cochlear implant (CI) use expands, complications have become a growing concern. While prior studies analyzed CI failures, few have comprehensively assessed national complication temporal patterns and clinic...
OBJECTIVE: As cochlear implant (CI) use expands, complications have become a growing concern. While prior studies analyzed CI failures, few have comprehensively assessed national complication temporal patterns and clinical outcomes. This study evaluates patient and device complication patterns and outcomes from 2016 to 2024. STUDY DESIGN: Cross-sectional. SETTING: Multi-institution database. METHODS: Adverse events related to CIs from 2016 to 2024 were extracted from the US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database using CI-specific product codes. Complications and outcomes were categorized into themes. Poisson and quasi-Poisson regressions assessed trends in raw counts, and Cochran-Armitage tests evaluated proportional changes of specific complications and outcomes to total counts before (2016-2020) and after (2020-2024) a major voluntary field corrective action. RESULTS: From 2016 to 2024, 34,426 patient complications, 33,487 device complications, and 26,377 clinical outcomes were reported. Between 2016 and 2020, all domains exhibited rising incidence and shifting complication proportions. From 2020 to 2024, overall complication counts plateaued or declined; however, specific issues such as healing/skin, infection/inflammation, and device fit/malposition/detachment continued to increase in proportion to the total number of complications. Hospitalizations and life-threatening outcomes also rose in proportion during this period. CONCLUSION: Although overall CI complication reporting has stabilized post-2020, several complication subtypes and adverse outcomes continue to rise. These findings highlight evolving safety profiles of CIs and underscore the need for targeted device and surgical refinements as well as robust post-market surveillance to guide safer innovation.
Interplay Between Rhinosinusitis and Eustachian Tube Dysfunction in Patients Undergoing Functional Endoscopic Sinus Surgery.
Wang JJ, Weng CH, Yao YT … +1 more , Jiang RS
Otolaryngol Head Neck Surg · 2026 May · PMID 42171192 · Publisher ↗
OBJECTIVES: To evaluate the association between chronic rhinosinusitis (CRS) and Eustachian tube dysfunction (ETD) using subjective and objective measures, and the relationship between disease laterality and Eustachian t...
OBJECTIVES: To evaluate the association between chronic rhinosinusitis (CRS) and Eustachian tube dysfunction (ETD) using subjective and objective measures, and the relationship between disease laterality and Eustachian tube function (ETF). STUDY DESIGN: Prospective cohort study. SETTING: Single tertiary medical institution. METHODS: Eighty-five CRS patients who were candidates for FESS underwent comprehensive evaluation. Subjective assessments utilized the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and Sino-Nasal Outcome Test-22 (SNOT-22). Objective evaluations comprised a 9-step inflation-deflation tympanometric test scored by maximal peak pressure difference (MPD), nasal endoscopy using the modified Lund-Kennedy (MLK) system, sinus CT scored via the Lund-Mackay (LM) system, and acoustic rhinometry measuring the second minimal cross-sectional area (MCA). Patients were stratified into fair (<14) and poor (≥14) ETF groups based on ETDQ-7 scores. Correlations were analyzed using Pearson coefficients, receiver operating characteristic (ROC) curves, and Bland-Altman plots, with additional assessment of CRS lateralization effects. RESULTS: Poor ETF (ETDQ-7 ≥ 14) occurred in 36.5% of patients and was associated with higher SNOT-22 (median 48.0 vs 31.5, P < .001). ETDQ-7 correlated moderately with SNOT-22 total (r = 0.65). No significant differences in MPD, MLK, LM, or MCA were found between fair and poor ET function groups. ROC analysis identified optimal cut-offs of ETDQ-7 > 15 (AUC 0.761) and SNOT-22 > 45 (AUC 0.802). Laterality analysis showed no significant side-specific associations. CONCLUSION: In CRS, sinonasal symptom burden shows only a moderate association with patient-reported ETD. Higher ETDQ-7 scores often parallel greater SNOT-22 severity, suggesting that PROMs may help identify patients in whom ETD symptoms are partly influenced by CRS.
The Reliability of Intraoperative Frozen Section for Glottic Lesions Suspected of Early Malignancy.
Levi G, Hamzany Y, Tsur N … +3 more , Strenov Y, Ben-Ner D, Shoffel-Havakuk H
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42171012 · Full text
OBJECTIVE: Glottic lesions suspected of malignancy may be treated by laser cordectomy. Although obviating the preoperative biopsy can expedite treatment and preserve the surgical planes, it poses a risk of mistreatment....
OBJECTIVE: Glottic lesions suspected of malignancy may be treated by laser cordectomy. Although obviating the preoperative biopsy can expedite treatment and preserve the surgical planes, it poses a risk of mistreatment. This study sought to determine if intraoperative frozen section (FS) prior to cordectomy can reliably guide lesion management. STUDY DESIGN: Retrospective chart review, 2017 to 2024. SETTING: Two tertiary university-affiliated referral centers. METHODS: Patients who underwent intraoperative FS sampling of glottic lesions suspected of early malignancy were identified. In all cases, samples were obtained from the area with the most suspicious characteristics using cold instruments. To determine accuracy, the FS results were compared with the final pathology report using 2 binary categorization systems: invasiveness (SCC present/absent) and malignant potential (lesion warrants/does not warrant curative cordectomy). Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. RESULTS: Ninety-one vocal-fold lesions obtained from 70 patients in 81 surgeries were included. FS analysis detected invasive carcinoma with 94.5% accuracy; there were no false-positives. While examining malignant potential, the accuracy was 94.5%, with 37 true-positives, 49 true-negatives, 2 false-positives, and 3 false-negatives. The calculated sensitivity, specificity, PPV and NPV were 92%, 96%, 95% and 94%, respectively. CONCLUSIONS: Intraoperative FS is a reliable tool for the identification of early malignancy in suspicious glottic lesions, especially invasive carcinoma. The high PPV and NPV for high malignant potential suggest that intraoperative FS, combined with clinical judgment, may guide surgeons' decision-making.
Rates and Outcomes of Head and Neck Cancer Among Patients With Primary Immunodeficiency Disorders.
Wenger TA, Collet C, West J … +1 more , Sinha UK
Otolaryngol Head Neck Surg · 2026 May · PMID 42171009 · Publisher ↗
OBJECTIVE: Patients with primary immunodeficiency disorders (PID) have increased hematological cancer risk but the risk of head and neck cancer (HNC) is not well-established. Here, we sought to compare the risk of HNC am...
OBJECTIVE: Patients with primary immunodeficiency disorders (PID) have increased hematological cancer risk but the risk of head and neck cancer (HNC) is not well-established. Here, we sought to compare the risk of HNC among patients with PID to that of the general population. Furthermore, we report overall outcomes among HNC patients with and without PID. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX, a database containing millions of deidentified health records, and Surveillance, Epidemiology, and End Results (SEER) 2017 to 2021. METHODS: A comparative analysis of HNC incidence among patients with PID versus the general population. Outcomes analyses were conducted on 1:1 propensity matched cohorts of patients with HNC with and without PID. RESULTS: Patients with PID had a significantly increased risk of HNC compared to the general population with an overall SIR (95% CI) of 6.55 (5.13-8.13) for oral cavity and pharynx cancer. Among patients with HNC, those with PID had a significantly increased risk of mortality (HR 1.39, 95% CI 1.17-1.66) and malnutrition (OR 1.34, 95% CI 1.21-1.49). CONCLUSION: Patients with PID have significantly increased incidence of HNC compared to the general population. Moreover, HNC patients with PID face an increased risk of post-operative complications and mortality.
The Tinnitus and Hearing Survey-Hebrew and Arabic Translation and Adaptation.
Stern Shavit S, Brand D, Jbarah R … +2 more , Khoury Shoufani S, Adelman C
Otolaryngol Head Neck Surg · 2026 May · PMID 42159253 · Publisher ↗
OBJECTIVE: To translate, validate, and adapt the Tinnitus and Hearing Survey (THS) into Hebrew and Arabic and to evaluate its effectiveness in distinguishing between tinnitus and hearing-related complaints. STUDY DESIGN:...
OBJECTIVE: To translate, validate, and adapt the Tinnitus and Hearing Survey (THS) into Hebrew and Arabic and to evaluate its effectiveness in distinguishing between tinnitus and hearing-related complaints. STUDY DESIGN: The THS was translated following the six-step process outlined in the good practice guide for adapting hearing-related questionnaires. This included preparation, forward translation, back translation, committee review, field testing, and finalization. SETTING: Otology and audiology clinics in a tertiary hospital. METHODS: The study involved 100 Hebrew-speaking and 75 Arabic-speaking adults with and without hearing loss and tinnitus complaints. Participants completed the Hebrew and the Arabic THS and Tinnitus Handicap Inventory (THI) questionnaires, and their audiometric data were collected. RESULTS: The average participant age was 50.4 years. Section A (complaint about tinnitus) of the THS strongly correlated with THI scores in Hebrew and Arabic (r = 0.83, r = 0.78, P < .0001), while Section B (complaint about hearing) showed only a moderate correlation (r = 0.47, r = 0.52, P < .0001). Section B scores, but not A, showed a low to moderate correlation with audiometry results in both languages (section B and SRT: Hebrew, r = 0.43, P < .0001; Arabic, r = 0.39, P = .0006; section B and high-frequency average: Hebrew, r = 0.33, P = .001; Arabic, r = 0.3, P = .01). CONCLUSION: The Hebrew and Arabic versions of the THS are valid and reliable tools for assessing tinnitus and hearing-related complaints. They effectively distinguish between the two complaints, aiding clinicians in determining appropriate interventions.
Longitudinal Evaluation of Otoacoustic Emissions as a Screening Tool for High-Frequency Hearing Loss in Adolescents.
Reijers SNH, Meerkerk-Meijer AE, Vroegop JL … +3 more , Geleijnse G, Kremer B, van der Schroeff MP
Otolaryngol Head Neck Surg · 2026 May · PMID 42159243 · Publisher ↗
OBJECTIVE: To investigate the association between distortion product otoacoustic emission (DPOAE) signal-to-noise ratios (SNRs) and pure-tone audiometry (PTA) thresholds in adolescents, both cross-sectionally at age 18 a...
OBJECTIVE: To investigate the association between distortion product otoacoustic emission (DPOAE) signal-to-noise ratios (SNRs) and pure-tone audiometry (PTA) thresholds in adolescents, both cross-sectionally at age 18 and longitudinally by evaluating whether DPOAE SNRs at age 13 predict high-frequency hearing loss (HFHL) at age 18. STUDY DESIGN: Prospective cohort study. SETTING: The Generation R Study, a population-based birth cohort in Rotterdam, the Netherlands. METHODS: PTA thresholds and DPOAEs were obtained at ages 13 (April 2016 to September 2019) and 18 (October 2020 to May 2024). Participants with abnormal middle ear function, based on tympanometry, were excluded. HFHL was defined as PTA thresholds ≤ 15 dB HL at 500 and 1000 Hz and >15 dB HL averaged across 3, 4, 6, and 8 kHz. Receiver operating characteristic (ROC) curves were used to evaluate the ability of DPOAE SNRs to distinguish between HFHL and normal hearing. Sensitivity and specificity were calculated for different SNR thresholds. RESULTS: Cross-sectional analysis of 3463 ears at age 18 showed that DPOAE SNRs discriminated between ears with and without HFHL, yielding an area under the curve (AUC) of 0.830. Longitudinally, SNR values at age 13 predicted HFHL at age 18, with an AUC of 0.743. CONCLUSION: DPOAE SNRs demonstrate good accuracy for detecting HFHL in adolescents and moderate accuracy for predicting future HFHL. These findings support the potential role of DPOAEs as a noninvasive screening tool to enable early detection of high-frequency cochlear dysfunction suggestive of early-stage noise-related hearing damage in youth.
Clinical Applications of Multimodal Artificial Intelligence in Otolaryngology: A State-of-the-Art Review.
Li YJ, Su F, Banyi N … +3 more , Edgcumbe P, Thamboo A, Amanian A
Otolaryngol Head Neck Surg · 2026 May · PMID 42117403 · Publisher ↗
OBJECTIVE: Artificial intelligence (AI) has advanced to simultaneously process visual, auditory, and textual inputs, providing users with "multimodal" AI. Given the clinical integration potential of these tools, otolaryn...
OBJECTIVE: Artificial intelligence (AI) has advanced to simultaneously process visual, auditory, and textual inputs, providing users with "multimodal" AI. Given the clinical integration potential of these tools, otolaryngologists must stay informed. This study reviews current literature on applications of multimodal AI in otolaryngology. DATA SOURCES: The MEDLINE, EMBASE, SCOPUS, Cochrane Library, Web of Science, and CINAHL databases. REVIEW METHODS: Databases were searched from the date of inception to March 4, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Studies on any application of multimodal AI in otolaryngology were included. CONCLUSIONS: Forty-four studies were included, with 55% (24/44) published in 2024 and 18% (8/44) in 2025. Image and text were the most commonly combined modalities (80%, 35/44), with emerging combinations including video with vector data (2%,1/44) and omics with text and/or image (14%, 6/44). Head and neck cancer was the most common subspecialty of focus (75%, 33/44), followed by general ear, nose, and throat (ENT) (11%, 5/44). All studies applied the models for clinical education (9%, 4/44) or decision support (91%, 40/44), assessing performance in areas such as board-style examination performance (accuracy: 37%-86%) or disease classification and prognostication (area under the receiver operating characteristic curve [AUC] 0.65-0.96). However, most studies were limited to small, single-institution samples and lacked prospective validation. Model error, data set bias, and language limitations underscore the need for further refinement. IMPLICATIONS FOR PRACTICE: The application of multimodal large language models (LLMs) in otolaryngology is rapidly expanding. Clinicians must understand both the capabilities and limitations of these systems. Rigorous validation and ethical oversight will be essential to ensure the safe, equitable, and effective adoption in otolaryngologic care.
Application of Time-Driven Activity-Based Costing for Protocol-Driven Adult Open Airway Reconstruction.
Prince ADP, Ramazani F, Kupfer RA … +3 more , Hogikyan ND, Morrison RJ, Yalamanchi P
Otolaryngol Head Neck Surg · 2026 May · PMID 42106966 · Publisher ↗
OBJECTIVE: To describe a protocol-driven approach to adult open airway reconstruction for benign airway stenosis and apply time-driven activity-based costing (TDABC) methodology to characterize resource utilization and c...
OBJECTIVE: To describe a protocol-driven approach to adult open airway reconstruction for benign airway stenosis and apply time-driven activity-based costing (TDABC) methodology to characterize resource utilization and cost drivers. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic medical center. METHODS: Adult patients undergoing tracheal or cricotracheal resection (TR/CTR) between 2022 and 2024 were reviewed. Multidisciplinary process mapping was performed using a modified Delphi technique. Validated TDABC methodology was applied across the operative admission. Univariate and generalized linear mixed models were used to examine associations between patient and hospital characteristics and the cost of care delivery. RESULTS: Twenty patients (70% female, mean age 41 [±14.8] years, and mean Charlson Comorbidity Index 1 ± 1.1) underwent airway reconstruction. TR was most common (n = 13), followed by CTR (n = 5) and revision CTR (n = 2). Protocol-driven management included clinic evaluation, direct laryngoscopy/bronchoscopy, operative reconstruction, and postoperative intensive care unit (ICU)/floor management. Complications included seroma, tracheitis, and hematoma in one patient. Ten patients required a single post-reconstruction procedure, six required multiple, and four required none. One patient remained tracheostomy dependent at follow-up. Total cost of care delivery across admission was $135,598.08 ± 25,100, with ICU care accounting for 60.5% of costs. ICU length of stay and nursing labor were significant cost drivers (P < .05), while operating room, supplies, and physician effort accounted for only 10% of total costs. CONCLUSION: Protocol-driven open airway reconstruction is resource-intensive, with postoperative ICU care representing the primary cost driver. TDABC provides a granular framework for understanding cost structure and identifying opportunities for future value-based optimization in complex airway surgery.
Risk Reduction of Recurrent Cerebrospinal Fluid Leaks With Postoperative Intracranial Pressure Management: A Systematic Review.
Wilson P, Doucette MM, Hossain R … +4 more , Valencia BA, Bernard CJ, Wang Z, Raymond M
Otolaryngol Head Neck Surg · 2026 May · PMID 42106964 · Publisher ↗
OBJECTIVE: To evaluate whether postoperative intracranial pressure-lowering interventions reduce recurrence of lateral skull base spontaneous cerebrospinal fluid leaks after surgical repair. DATA SOURCES: Ovid MEDLINE, E...
OBJECTIVE: To evaluate whether postoperative intracranial pressure-lowering interventions reduce recurrence of lateral skull base spontaneous cerebrospinal fluid leaks after surgical repair. DATA SOURCES: Ovid MEDLINE, Embase, Cochrane CENTRAL, Web of Science Core Collection, and Scopus were searched from inception through April 7, 2025. REVIEW METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies of adults with lateral skull base spontaneous cerebrospinal fluid leaks undergoing primary repair where postoperative intracranial pressure-lowering interventions were specified. Pooled recurrence rates were calculated by intervention type and compared with cohorts that did not receive intracranial pressure-lowering therapy. RESULTS: Thirty-six studies including 687 patients (737 cases) met inclusion criteria. Six comparative cohorts (34 treated, 155 untreated) showed no significant difference in recurrence (risk ratio 1.16, 95% confidence interval [CI]: 0.14-9.76; I = 0%). Across 82 intervention-only cases, recurrence occurred in three (pooled proportion 0.10, 95% CI: 0.04-0.26; I = 0%). Among 650 control-only cases, 45 recurred (pooled proportion 0.09, 95% CI: 0.07-0.12; I = 0%). No heterogeneity was observed across pooled analyses. CONCLUSION: Available evidence does not support universal postoperative intracranial pressure-lowering therapy after lateral skull base spontaneous cerebrospinal fluid leak repair. Limited observational data suggest acetazolamide may be associated with lower recurrence, whereas lumbar drainage has not demonstrated sustained benefit. Given the heterogeneity in patient selection and intervention practices, postoperative management should be individualized. Future prospective studies are needed to better define the role of targeted therapy in high-risk patients.
Pediatric Tracheostomy Speaking Valve Assessment: A Golden Opportunity for Quality Improvement and Reduction of Healthcare Disparities.
Harris A, Obuekwe F, Almast A … +3 more , White KE, Shaffer AD, Dohar JE
Otolaryngol Head Neck Surg · 2026 May · PMID 42084305 · Publisher ↗
OBJECTIVE: To investigate the association between community socioeconomic distress and timing of speaking valve (SV) assessment among children who underwent tracheostomy placement. STUDY DESIGN: Retrospective cohort stud...
OBJECTIVE: To investigate the association between community socioeconomic distress and timing of speaking valve (SV) assessment among children who underwent tracheostomy placement. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care children's hospital. METHODS: Children who underwent tracheostomy between 2016 and 2022 were included. Associations between the Distress Community Index (DCI) and time to SV assessment were evaluated using regression models adjusted for covariates and stratified by intensive care unit (ICU) type. RESULTS: A total of 147 patients with a mean age at tracheostomy of 4.5 years were included. The cohort was 83.0% white, 11.6% black, and 5.4% Other. DCI breakdown was 19.7% Distressed, 25.2% At Risk, 23.8% Mid-Tier, 18.4% Comfortable, and 12.9% Prosperous. Overall, 71.4% of patients completed the SV assessment. Community distress was not associated with completion of the SV assessment. Higher community distress and younger age at tracheostomy were associated with longer time to SV assessment (P < .001 and P = .003, respectively), with trends in community distress consistent across all ICU types. Patients in the pediatric intensive care unit (PICU) received SV assessments sooner than patients in the neonatal intensive care unit (NICU) (median 18 vs 121 days, P < .001). Stratifying by DCI quintiles, patients from Prosperous communities were 2.41 times more likely to receive a timely SV assessment compared to patients from Distressed communities (hazard ratio [HR] = 2.41, P < .001). CONCLUSION: Higher community distress, younger age at tracheostomy, and stay in the NICU were associated with longer delays in SV assessment. Standardized protocols and support systems are needed to ensure timely SV assessments and thus optimal physiologic, cognitive, and social development for all children with tracheostomy.
Does Total Inferior and Middle Turbinectomy Always Lead to Empty Nose Syndrome?
Jha N, Speers J, Odeh A … +8 more , Wu Z, Mihalich J, Gastineau LE, Hittle B, Otto BA, Kelly KM, Wiet GJ, Zhao K
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42084302 · Full text
OBJECTIVE: Empty Nose Syndrome (ENS) is a rare and paradoxical complication often associated with aggressive turbinate reductions. Previous computational fluid dynamic (CFD) modeling has indicated that distorted nasal ai...
OBJECTIVE: Empty Nose Syndrome (ENS) is a rare and paradoxical complication often associated with aggressive turbinate reductions. Previous computational fluid dynamic (CFD) modeling has indicated that distorted nasal airflow patterns could contribute to ENS. However, no data have shown that aggressive turbinate reductions consistently lead to ENS. STUDY DESIGN: Retrospective case series. SETTING: Tertiary. METHODS: We retrospectively recruited 6 nasal obstruction patients who underwent turbinate reduction surgery, and performed total inferior and middle turbinectomies on all patients using a published virtual surgical simulator. We compared the CFD modeling results to that of patients' presurgery and postsurgery and published 27 ENS patients. RESULTS: As expected, the virtual turbinectomy significantly expanded nasal airway cross-sectional area, more than that of actual surgery (inferior: 0.9 ± 0.4 to1.8 ± 0.3 cm, middle: 0.6 ± 0.3 to 1.0 ± 0.3 cm, all P < .01); however, it does not create the same distorted nasal airflow patterns as seen in ENS patients, with no significant difference in nasal resistance after actual surgery (0.12 ± 0.04 Pa/mL*s) versus virtual surgery (0.10 ± 0.03 Pa/mL*s) nor ENS (0.11 ± 0.04 Pa/mL*s, all P > .05). However, all had significantly higher inferior wall shear force (WSF) distribution, an important indicator of air/mucosa stimulation, than that of ENS patients (baseline 54.0 ± 11.9%, surgery: 51.5 ± 15.1%; virtual: 46.5 ± 11.5%, P > .05; ENS: 32.2% ± 12.5%, P < .001). The opposite was seen for the middle turbinate region-WSF among all actual or virtual surgeries conditions was significantly lower than that of the ENS group (baseline: 36.1 ± 11.0%; virtual: 30.2 ± 13.1%; ENS: 43.8 ± 10.1%; all P ≤ .05). CONCLUSIONS: ENS cannot be solely attributed to aggressive turbinate reduction surgeries with various factors potentially playing a role.
Barriers and Facilitators to Parental Shared Decision Making for Adenotonsillectomy and Tympanostomy Tube Placement.
Luther E, Hong P, Khan U … +5 more , Bohm L, Graham ME, Meister KD, Shin JJ, Cassidy C
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42084286 · Publisher ↗
OBJECTIVE: To identify barriers and facilitators to parents' participation in shared decision making (SDM) for adenotonsillectomy or tympanostomy tube surgeries. STUDY DESIGN: A qualitative study. SETTING: Semi-structure...
OBJECTIVE: To identify barriers and facilitators to parents' participation in shared decision making (SDM) for adenotonsillectomy or tympanostomy tube surgeries. STUDY DESIGN: A qualitative study. SETTING: Semi-structured interviews with parents who had attended a surgical consultation to discuss adeno/tonsillectomy or tympanostomy tube placement for their child. METHODS: Data were analyzed using the Theoretical Domains Framework to identify behavioural determinants related to parents' capability, opportunity, and motivation for engaging in SDM. Thematic coding of interviews was performed by 2 separate reviewers. RESULTS: A total of 11 interviews were conducted. Data saturation was confirmed following thematic analysis. Themes were grouped into 4 meta-themes identifying dominant factors shaping parents' participation in SDM: (1) Having adequate information about the condition and available options, (2) Having time to consider and discuss the decision beyond the initial consultation, (3) The demeanor of the surgeon, and (4) Comfort participating in decision-making. CONCLUSION: Parents agree that SDM is a good ideal for guiding consultations about adeno/tonsillectomy or tympanostomy tube surgery, but not all parents prefer the same role in decision-making. Parents are not equally aware of treatment options before or after attending a consultation, and their comfort discussing options is impacted by surgeons' behaviour. Design of SDM supports for this clinical context would beneficially include provision of information before the consultation, tools to support explicit and supportive conversation about parents' preferences and treatment options, and clinical infrastructure for continued communication and emotional support after the consultation.
Adjuvant Radiotherapy and Local Control After Total Laryngectomy With Preoperative Tracheotomy: A Systematic Review and Meta-Analysis.
Uralov D, Pace GM, Canali L … +6 more , Teriaca A, Franzese C, Mercante G, Ferreli F, Spriano G, Costantino A
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42080460 · Publisher ↗
OBJECTIVE: To evaluate the impact of postoperative radiotherapy (PORT) on local and peristomal recurrence in patients undergoing primary total laryngectomy (TL) with a preoperative tracheotomy. DATA SOURCES: A systematic...
OBJECTIVE: To evaluate the impact of postoperative radiotherapy (PORT) on local and peristomal recurrence in patients undergoing primary total laryngectomy (TL) with a preoperative tracheotomy. DATA SOURCES: A systematic search of PubMed, Scopus, and Google Scholar was conducted. REVIEW METHODS: A single-arm meta-analysis of proportions was performed to estimate pooled local/peristomal recurrence rates. The inverse variance method was used to calculate effect sizes and 95% confidence intervals (CIs). RESULTS: A total of 4339 patients undergoing primary TL without preoperative radiation therapy were included. Preoperative tracheotomy was performed in 879/4339 (20.3%) cases. The pooled local/peristomal recurrence rate was 7.0% (95% CI: 5.3-9.2) in patients without preoperative tracheotomy and 17.9% (95% CI: 12.8-24.6) in those with tracheotomy. Among patients with preoperative tracheotomy, those who received PORT had a lower recurrence rate of 12.5% (95% CI: 7.8-19.5) compared to 34.8% (95% CI: 16.4-59.2) in those who did not receive PORT. CONCLUSIONS: Preoperative tracheotomy is associated with a markedly increased risk of local/peristomal recurrence following primary TL. Our findings suggest that PORT may reduce this risk and can be considered in patients undergoing TL with a preoperative tracheotomy.
Longitudinal Cochlear Implant Use in Pediatric Patients With Unilateral Hearing Loss.
Octeau D, Watson G, Wajsberg B … +3 more , Cantrell L, Dunn C, Anne S
Otolaryngol Head Neck Surg · 2026 May · PMID 42080439 · Publisher ↗
OBJECTIVE: To characterize longitudinal cochlear implant (CI) usage patterns in children with unilateral hearing loss (UHL) and evaluate the impact of age at implantation and duration of deafness on device use. STUDY DES...
OBJECTIVE: To characterize longitudinal cochlear implant (CI) usage patterns in children with unilateral hearing loss (UHL) and evaluate the impact of age at implantation and duration of deafness on device use. STUDY DESIGN: Retrospective cohort study. SETTING: Two academic tertiary care centers. METHODS: Pediatric CI recipients with UHL implanted between 2018 and 2024 were included. Datalogging information was obtained at 3, 6, 12, 18, and 24 months postactivation. Patients were categorized as regular users (>6 h/day) or moderate users (>4 h/day). Usage patterns were analyzed using regression. RESULTS: Fifty-three patients with datalogging available at 3 months postactivation (mean age at implantation: 7.3 years; SD 3.6) were included. At 3 months, 81% were regular users and 83% were moderate users, with mean usage of 8.2 h/day (SD 3.4). Usage remained stable over time: at 24 months, among 27 patients with available data, 64% were regular users and 82% were moderate users, with mean usage of 6.8 h/day (SD 2.9). Among regular users with sustained use at 6 months, mean usage decreased from 9.10 to 8.63 h/day by 24 months (P = .033). No patients achieving 4-hour usage at 6 months subsequently dropped below this threshold. Neither age at implantation nor duration of deafness correlated with usage changes. Most patients lost to follow-up demonstrated at least moderate use at their last visit. CONCLUSION: Children with UHL demonstrate high sustained CI usage through 24 months. Although usage declined over time, this averaged only about 30 minutes per day. Early usage patterns appear predictive of long-term device adoption.
The Effectiveness of Tranexamic Acid in Pediatric Posttonsillectomy Hemorrhage (A Systematic Review and Meta-Analysis).
Ahmad MS, Alosamey F, Luu K
Otolaryngol Head Neck Surg · 2026 May · PMID 42080438 · Publisher ↗
OBJECTIVE: To systematically review the literature regarding the effectiveness of tranexamic acid (TXA) in the management of pediatric post-tonsillectomy hemorrhage (PTH). DATA SOURCES: Comprehensive searches across PubM...
OBJECTIVE: To systematically review the literature regarding the effectiveness of tranexamic acid (TXA) in the management of pediatric post-tonsillectomy hemorrhage (PTH). DATA SOURCES: Comprehensive searches across PubMed, Embase, and Web of Science were conducted through December 2024 in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. REVIEW METHODS: Studies evaluating TXA (any route) for PTH in children aged 2 to 18 years were reviewed. Study characteristics, patient demographics, tonsillectomy technique, postoperative day on presentation, patient exam, route of TXA administration, and dosage were extracted. The primary outcome of interest was the rate of reoperation for hemostasis; secondary outcomes of interest included need for blood transfusion and adverse effects. RESULTS: Eight studies (n = 801) met inclusion criteria. TXA administration was associated with a significant reduction in reoperation rates for hemostasis (pooled RR = 0.62, 95% CI 0.49-0.78), with no significant difference between routes of administration. There was no statistically significant difference in transfusion risk (RR = 0.76, 95% CI 0.26-9.45). Across all studies, no adverse effects attributable to TXA were reported. CONCLUSION: TXA use in managing pediatric PTH is associated with a significant reduction in reoperation rates, with both intravenous and nebulized formulations demonstrating similar effectiveness. Nebulized TXA offers practical advantages in pediatric patients and provides potential targeted oropharyngeal delivery. The available evidence is limited by retrospective study designs, small sample sizes, and risk of bias. These findings support the need for prospective studies to standardize assessment and treatment algorithms, optimize management, inform clinical practice guidelines.
Contrast Swallow for Detecting Pharyngocutaneous Fistula After Total Laryngectomy: A Systematic Review.
Ryan ME, Milinis K, Ahamed M … +2 more , Sidat FI, Fleming JC
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42080427 · Publisher ↗
OBJECTIVE: To evaluate the diagnostic performance of contrast swallow utilised to identify pharyngocutaneous fistula (PCF) following laryngectomy. DATA SOURCES: A systematic search of databases was conducted (MEDLINE, EM...
OBJECTIVE: To evaluate the diagnostic performance of contrast swallow utilised to identify pharyngocutaneous fistula (PCF) following laryngectomy. DATA SOURCES: A systematic search of databases was conducted (MEDLINE, EMBASE, and PubMed). REVIEW METHODS: Studies including adult patients (≥18 years old) who had undergone total laryngectomy (salvage or primary) or pharyngolaryngectomy and had postoperative diagnostic imaging of any modality (eg, ultrasound, CT, MRI) performed to assess for presence of PCF were eligible for inclusion. The diagnostic accuracy (ie sensitivity, specificity, etc.) for identifying PCF was extracted. RESULTS: A total of 13 studies involving 1456 patients recruited across a 43-year period from (1979 to 2022) were included. Diagnostic accuracy ranges of contrast swallow were reported as a sensitivity of 0.26 to 1.00, specificity of 0.55 to 0.99 and positive and negative predictive values of 0.14 to 0.85 and 0.75 to 1.00 respectively. CONCLUSIONS: The accuracy of contrast swallow as a screening tool in detecting PCF varies significantly in the reported studies with overall poor performance. Studies displayed a varied positive predictive value range, with a high number of false positives potentially causing unwarranted delays in commencing oral feeding. Positive predictive values must be interpreted cautiously given the literatures variation of how pharyngeal leaks were managed, potentially preventing progression to clinical PCF. While the heterogenicity within the data from the studies prevents definitive conclusions, the review calls into question the utility of the contrast swallow and highlights the need for more superior diagnostic pathways.
Poster Presentations.
Otolaryngol Head Neck Surg · 2026 Mar · PMID 42077172 · Publisher ↗
Abstract loading — click title to view on PubMed.
Association Between Postoperative NSAID Use and Bleeding Following Transoral Robotic Surgery.
Seliger B, Beiriger J, Berry M … +4 more , Patel N, Cannon RB, Monroe MM, McCrary HC
Otolaryngol Head Neck Surg · 2026 Apr · PMID 42059270 · Publisher ↗
OBJECTIVE: To evaluate the safety and outcomes of NSAID use following transoral robotic surgery (TORS). STUDY DESIGN: Retrospective cohort study using propensity score matching. SETTING: Multi-institutional database (Tri...
OBJECTIVE: To evaluate the safety and outcomes of NSAID use following transoral robotic surgery (TORS). STUDY DESIGN: Retrospective cohort study using propensity score matching. SETTING: Multi-institutional database (TriNetX). METHODS: Patients undergoing TORS were identified using ICD-10 codes. Two propensity-matched cohorts were compared: (1) patients receiving NSAIDs (ketorolac, celecoxib, ibuprofen) within 14 days postsurgery (n = 3639) versus controls (n = 3639) and (2) patients receiving ketorolac day-of-surgery (n = 1901) versus controls (n = 1901). Primary outcome was postoperative hemorrhage. Secondary outcomes included critical care admission, emergency department visit, and feeding device placement within 14 days. RESULTS: Postoperative bleeding rates were similar between NSAID and control groups (P = .150). Patients treated with NSAIDs had lower rates of critical care admission (P < .001) and feeding tube placement (P < .001). Emergency department visits showed no significant difference (P = .813). Day-of-surgery ketorolac versus control showed no increased bleeding (P = .460). Ketorolac patients demonstrated significantly lower rates of critical care admission (P < .001) and feeding tube placement (P < .001), with no increase in emergency department visits (P = .312). CONCLUSION: NSAID administration following TORS was not associated with increased postoperative hemorrhage. NSAID use was associated with reduced critical care utilization and feeding tube requirements. These findings support the safety of NSAIDs in multimodal analgesia protocols for TORS patients.
Noise, Hearing, and Communication in the Operating Room: A Mixed-Methods Study.
Hughes SE, Manojlovich M, Lee EY … +7 more , Bolze AS, Stegink C, Jain D, McCaslin DL, Sheetz KH, Reddy RM, Brenner MJ
Otolaryngol Head Neck Surg · 2026 Apr · PMID 42059269 · Publisher ↗
OBJECTIVE: To evaluate noise-related communication barriers in the operating room and to identify strategies for overcoming them. STUDY DESIGN: Cross-sectional mixed-methods survey. SETTING: Tertiary academic medical cen...
OBJECTIVE: To evaluate noise-related communication barriers in the operating room and to identify strategies for overcoming them. STUDY DESIGN: Cross-sectional mixed-methods survey. SETTING: Tertiary academic medical center. METHODS: An anonymous 21-item electronic survey was distributed to operating room personnel, including surgeons, anesthesiologists, residents, medical students, nurses, and allied health professionals. Items assessed hearing difficulties, baseline hearing loss, communication barriers, coping strategies, and intervention preferences. Quantitative data were analyzed using descriptive statistics, chi-square tests, and logistic regression; open-text responses underwent thematic analysis. RESULTS: Among 225 survey respondents 80.4% (181/225) reported difficulty hearing in the OR and 14.7% (33/225) reported difficulty every case. All respondents with suspected or confirmed hearing loss reported hearing difficulty during surgery. Respondents with ≥5 years of OR exposure had higher odds of diagnosed hearing loss versus <5 years (OR 3.0, 95% CI 1.2-7.9; P = .024); there was no association by age (P = .89). Among hearing aid users, 88% struggled to understand speech in the OR. Communication was most challenging in orthopedic cases (31%), with environmental noise sources (suction, drills, music, alarms) frequently cited (29%), and during robotic surgery (24%). Common self-accommodations included asking for repetition, anticipating steps, environmental adjustments, and positioning. Qualitative themes emphasized challenges arising from ambient noise, physical barriers, and psychosocial factors such as hierarchy or lack of psychological safety. CONCLUSION: Noise-related hearing and communication barriers were reported across all OR roles. Interventional studies are needed to assess the role of acoustic, cultural, and technological strategies for overcoming hearing barriers and promoting effective teamwork.
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