Otolaryngol Head Neck Surg [JOURNAL]
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200 papers
Psychometric Validation of the Overall Symptom Severity Score for Chronic Rhinosinusitis.
Lee CW, Agard IH, Parail N … +3 more , Wilson K, Phillips KM, Sedaghat AR
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42015604 · Publisher ↗
OBJECTIVE: Overall symptom severity (OSS) is a global metric of chronic rhinosinusitis (CRS) symptom severity. We sought to establish psychometric validity for the OSS, which has not been previously demonstrated in the l...
OBJECTIVE: Overall symptom severity (OSS) is a global metric of chronic rhinosinusitis (CRS) symptom severity. We sought to establish psychometric validity for the OSS, which has not been previously demonstrated in the literature. STUDY DESIGN: Prospective, observational. SETTING: Academic medical center. METHODS: Adult patients with CRS (N = 647) recruited and completed an OSS score (measured using a visual analog scale [VAS]), 22-item Sinonasal Outcome Test (SNOT-22), and 5-level EuroQol (EQ-5D) questionnaires. A subset of participants completed these questionnaires at a second time point to establish test-retest reliability (N = 65) and responsiveness to change (N = 225). Psychometric validation was performed by establishing criterion validity, test-retest reliability, and responsiveness in these CRS patients. RESULTS: The OSS score was significantly correlated with SNOT-22 (r = 0.73, 95% CI: 0.69-0.76, P < .001) and EQ-5D VAS scores (r = -0.39, 95% CI: -0.46 to -0.33, P < .001) at enrollment, demonstrating criterion validity. For the subset of participants who completed the OSS at a second time point ranging between 31 and 143 days later, the change in OSS was correlated with changes in SNOT-22 score (r = 0.72, 95% CI: 0.65-0.78, P < .001), and EQ-5D VAS (r = -0.30, 95% CI: -0.42 to -0.18, P < .001). The OSS score also demonstrated excellent test-retest reliability (r = 0.92, 95% CI: 0.87-0.95, P < .001). Using a distribution-based and four different anchor-based calculations, the minimal clinically important difference (MCID) for improvement and worsening for the OSS score was determined as ≥1.6 (or >1.5). CONCLUSION: The OSS score is a psychometrically valid measure of CRS symptom severity, with excellent criterion validity, test-retest reliability, and responsiveness. The MCIDs for improvement and worsening are proposed to be ≥1.6 (or >1.5).
Risk of Complications in Patients Undergoing Thyroidectomy for Graves' Disease (LUNA Study).
Canu GL, Medas F, Cappellacci F … +18 more , Lanzolla G, Rossi L, Di Filippo G, Chorti A, Pliakos I, Lazzari G, Morelli E, Dekova K, Sacco L, Fantina L, de Manzini N, Boi F, Bakkar S, Dobrinja C, Papavramidis T, Materazzi G, Calò PG, LUNA Study Collaborative Group
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42015597 · Publisher ↗
OBJECTIVE: To evaluate the risk of complications in patients with Graves' disease undergoing thyroidectomy by high-volume surgeons. STUDY DESIGN: Retrospective, multicenter, international study. SETTING: Data were obtain...
OBJECTIVE: To evaluate the risk of complications in patients with Graves' disease undergoing thyroidectomy by high-volume surgeons. STUDY DESIGN: Retrospective, multicenter, international study. SETTING: Data were obtained from 5 centers in Europe. METHODS: Patients undergoing total thyroidectomy between 2019 and 2023 were analyzed. Enrolled patients were divided in 2 groups: GD Group, including those with Graves' disease, and C Group (control group). Complications were assessed after performing propensity score matching (1:1). RESULTS: Based on inclusion/exclusion criteria, 8518 patients were enrolled: 1067 in GD Group and 7451 in C Group. Following propensity score matching, the study population consisted of 1068 patients: 534 in GD Group and 534 in C Group. In GD Group, there were 84 (15.73%) cases of postoperative hypoparathyroidism (65, 12.17%, temporary and 19, 3.56%, permanent), 15 (2.81%) unilateral recurrent laryngeal nerve lesions, 1 (0.19%) bilateral recurrent laryngeal nerve lesion, 15 (1.40%) temporary recurrent laryngeal nerve lesions, 2 (0.19%) permanent recurrent laryngeal nerve lesions, 22 (4.12%) neck hematomas (17, 3.18%, managed conservatively and 5, 0.94%, requiring surgical revision of hemostasis), and 2 (0.37%) wound infections. Overall postoperative hypoparathyroidism, permanent hypoparathyroidism, unilateral recurrent laryngeal nerve injury, and temporary recurrent laryngeal nerve injury were significantly greater in GD Group. Other complications were comparable. CONCLUSION: Complications were greater in patients with Graves' disease, however occurrence rates were low. Based on our findings, it can be stated that thyroidectomy in patients with Graves' disease, even for high-volume surgeons, represents a more challenging procedure, but it can nevertheless be considered a valid therapeutic option.
Long-Term Benign Paroxysmal Positional Vertigo: Recurrence, Residual Symptoms and Risk of Falls.
Martin-Sanz E, Chaure-Cordero M, Fernández-Navarro C … +2 more , Solis-Fesser A, Riestra-Ayora J
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42015594 · Publisher ↗
OBJECTIVE: To assess long-term outcomes in patients successfully treated for benign paroxysmal positional vertigo, focusing on recurrence rates, residual symptoms, fall risk, and quality of life over a 7-year follow-up p...
OBJECTIVE: To assess long-term outcomes in patients successfully treated for benign paroxysmal positional vertigo, focusing on recurrence rates, residual symptoms, fall risk, and quality of life over a 7-year follow-up period. STUDY DESIGN: Ambispective cohort study combining retrospective data collection with prospective follow-up of the same patient cohort extended through 2024. SETTING: Tertiary referral center treating 361 benign paroxysmal positional vertigo patients between May 2011 and March 2017. METHODS: Patients diagnosed with canalithiasis or cupulolithiasis underwent canal-specific repositioning maneuvers and were followed weekly until symptom resolution. Residual instability was assessed 1 month postresolution using computerized dynamic posturography. Vestibular rehabilitation was administered when indicated. Long-term follow-up included telephone interviews and clinical evaluations, with Dizziness Handicap Inventory scores collected. Statistical analyses examined associations between clinical variables and outcomes including recurrence, residual dizziness, and falls. RESULTS: Mean age was 63.3 ± 15.6 years with female predominance (2.2:1). The posterior canal was most affected (86.7%). Recurrence occurred in 47.1% of patients over 7 years. Residual dizziness increased from 29.6% at 1 month to 37.6% at long-term follow-up. Falls were reported by 18.9% of patients. Requiring multiple repositioning maneuvers (OR = 3.89, P = .033) and vestibular rehabilitation (OR = 2.41, P = .022) predicted recurrence. Residual dizziness was associated with increased fall risk (OR = 5.7, P = .017) and elevated Dizziness Handicap Inventory scores. CONCLUSION: Benign paroxysmal positional vertigo demonstrates significant long-term morbidity despite successful initial treatment, with high recurrence rates and persistent residual symptoms affecting quality of life and increasing fall risk, particularly in elderly patients requiring ongoing monitoring and rehabilitation.
Management of Temporal Bone Fractures: Optimizing the Role of Otolaryngology Consultation.
Wen CZ, Pope P, Christou AS … +5 more , Hassan B, Grant MP, Vakharia KT, Justicz NS, Kaufman AC
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42015592 · Publisher ↗
OBJECTIVE: Determine which patients can be safely seen on an outpatient basis after a temporal bone fracture without inpatient otolaryngology consultation. STUDY DESIGN: Single-center retrospective cohort study. SETTING:...
OBJECTIVE: Determine which patients can be safely seen on an outpatient basis after a temporal bone fracture without inpatient otolaryngology consultation. STUDY DESIGN: Single-center retrospective cohort study. SETTING: Primary Adult Resource Center for Trauma. METHODS: Patients with a radiographically confirmed temporal bone fracture between 2018 and 2022 were included. Facial nerve function, presence of cerebrospinal fluid (CSF) leak, and inpatient interventions were assessed. Clinical and radiographic factors were analyzed for effectiveness in screening patients that required inpatient otolaryngology intervention. RESULTS: Of 171 included patients, 37 (21.6%) had bilateral fractures. Most were male (n = 126, 73.7%) with average age 41.3 years (SD 17.8). 12 (7%) had otic capsule involvement. Three patients required inpatient surgical intervention. 31 patients had immediate or delayed facial weakness and 14 had CSF otorrhea. Utilizing acute facial nerve paresis or paralysis, clear otorrhea, bloody otorrhea, or otic-capsule involvement to screen for otolaryngology consultation resulted in the highest sensitivity (93.5%) and negative predictive value (97.3%, NPV) for post-traumatic facial nerve dysfunction and 100% sensitivity and 100% NPV for any post-traumatic CSF otorrhea. This would result in 73 (42.7%) fewer inpatient otolaryngology consults. Utilizing only acute facial injury and clear otorrhea as criteria resulted in fewer consultations; while specificity for CSF leak and facial nerve injury increased, sensitivity and NPV both decreased. CONCLUSION: Patients with temporal bone fractures who can safely follow-up as outpatients without inpatient otolaryngology consultation can be effectively identified. This will decrease unnecessary inpatient consultation volumes, optimize primary team workflow, and may result in potential cost savings.
Imaging for Nonspecific Dizziness in the Emergency Department is Associated With Delayed Time to First Otolaryngology Evaluation.
Sattah NG, Kim JK, D'Anniballe VM … +1 more , Formeister EJ
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41989075 · Publisher ↗
OBJECTIVE: To identify differences in time to first otolaryngology evaluation for patients presenting to the emergency department (ED) with nonspecific dizziness. STUDY DESIGN: Retrospective cohort study between 2015 and...
OBJECTIVE: To identify differences in time to first otolaryngology evaluation for patients presenting to the emergency department (ED) with nonspecific dizziness. STUDY DESIGN: Retrospective cohort study between 2015 and 2024. SETTING: Single tertiary care academic center. METHODS: Patients with International Classification of Disease code R42 (dizziness and giddiness) during their ED visit who later were seen by otolaryngologists in the outpatient setting were grouped based on whether imaging was received in the emergency department. Demographic characteristics were analyzed. The median time to otolaryngology evaluation and the diagnoses rendered by otolaryngology were assessed. RESULTS: Of the 2272 patients seen in the ED for dizziness and who subsequently followed up with otolaryngology, imaging was obtained at the initial ED visit in 580 patients (25.5%). The most common imaging modalities were CT brain (415, 18.3%), MRI brain (291, 12.8%), and CT head and neck (139, 6.1%). Patients were first seen by otolaryngology at a median (Q1, Q3) of 26.6 (4.4, 119.1) weeks after their index ED visit. Patients who required imaging had a significantly longer median time to evaluation of 74.9 weeks (12.7, 175.7), compared to 16.5 weeks (3.6, 90.4) for patients who did not require imaging (P < .001). The most common diagnoses at the time otolaryngology evaluation included benign paroxysmal positional vertigo (299, 13.2%), migraine (98, 4.3%), vestibular neuritis (66, 2.9%), and Ménière's disease (61, 2.7%). CONCLUSION: Dizzy patients receiving imaging in the ED may experience delays in otolaryngology evaluation, potentially predisposing them to increased morbidity and contributing to high healthcare costs.
Mucosal Margin Shrinkage in Oral Cavity Cancer: A Systematic Review.
Sridhar S, Larson DP, Topf MC
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41989070 · Full text
OBJECTIVE: Tissue shrinkage can make planning of surgical margins challenging. While shrinkage of resected oral cavity mucosa is well-described, current data quantifying these effects are variable. The aim of this system...
OBJECTIVE: Tissue shrinkage can make planning of surgical margins challenging. While shrinkage of resected oral cavity mucosa is well-described, current data quantifying these effects are variable. The aim of this systematic review was to summarize current evidence on margin shrinkage in oral cavity cancer after resection and formalin fixation. DATA SOURCES: PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews. REVIEW METHODS: A systematic review was performed according to PRISMA guidelines to identify all published reports describing margin shrinkage in surgically resected oral cavity cancer. Only prospective cohort and cross-sectional studies were included. Non-English language studies, studies on non-human subjects, and studies describing cancer of sites other than the oral cavity were excluded. RESULTS: Ten studies met inclusion criteria, accounting for 352 patients who underwent resection of oral cavity cancer. Mean percent margin shrinkage from preresection to postresection ranged from 14.9% to 23.9%, from postresection to postfixation ranged from 3.7% to 32.9%, and from preresection to postfixation ranged from 11.3% to 59.0%. In studies reporting preresection, postresection, and postfixation margins (4 studies), preresection to postresection shrinkage was significantly larger than postresection to postfixation shrinkage. There was conflicting evidence on shrinkage by T stage and tumor subsite. There was no association between margin shrinkage and other clinicopathologic factors such as age, sex, or other adverse pathological factors. CONCLUSION: Oral cavity tissue undergoes shrinkage both after surgical resection and after fixation with formalin, with the most significant shrinkage occurring immediately after resection. Tissue shrinkage should be an important consideration in the planning of surgical margins.
National Characterization of Bell's Palsy Management in the Emergency Department 2006 to 2022.
Renne A, Leu GR, Nellis JC … +1 more , Boahene KDO
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41989066 · Publisher ↗
OBJECTIVE: The emergency department (ED) is frequently the first point of care for patients presenting with acute facial paralysis. Characterizing current practice patterns may reveal opportunities in adherence to eviden...
OBJECTIVE: The emergency department (ED) is frequently the first point of care for patients presenting with acute facial paralysis. Characterizing current practice patterns may reveal opportunities in adherence to evidence-based guidelines for management of acute Bell's palsy. This study evaluates ED management of Bell's palsy using a nationally representative sample of visits. STUDY DESIGN: Retrospective cross-sectional study. SETTING: National Hospital Ambulatory Medical Care Survey (NHAMCS), 2006 to 2022, capturing nationwide US ED visits. METHODS: Independent variables include sex and race/ethnicity. Primary outcomes assess adherence to guideline-recommended management, including corticosteroid therapy (with or without antivirals) and use of diagnostic neuroimaging. NHAMCS provided demographic, diagnostic, procedural, and treatment data. Management differences were evaluated using chi-square testing and multivariable logistic regression, adjusting for age, insurance status, comorbidities, and urban/rural location. RESULTS: An estimated 1.68 million Bell's palsy ED visits occurred from 2006 to 2022. Corticosteroids were administered in 64.1% of total visits, and 6.3% (N = 104,848 visits) received antivirals alone. Diagnostic imaging was performed in 49.8% of visits, despite guideline recommendations against routine imaging, with variation by race and ethnicity (P = .016); imaging was most frequent among Asian and White patients. Female and Black or Hispanic patients had lower adjusted odds of receiving imaging compared to male and White patients, respectively. Most visits (86.1%) resulted in referral for follow-up care, though referral practices varied. CONCLUSIONS: As the ED serves as the primary entry point for most Bell's palsy cases, these findings highlight important opportunities to improve adherence to evidence-based management across all demographic groups. LEVEL OF EVIDENCE: IV.
Histopathological Signatures Associated With Postoperative Recurrence in Pediatric Chronic Rhinosinusitis With Nasal Polyps.
Cheng S, Tong Z, Meng L … +6 more , Zeng H, Zhang H, Zhang J, Xie Z, Xie S, Jiang W
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979412 · Publisher ↗
OBJECTIVE: Pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits a high rate of postoperative recurrence, yet the histopathological determinants are not well defined. This study investigated recurrence-ass...
OBJECTIVE: Pediatric chronic rhinosinusitis with nasal polyps (CRSwNP) exhibits a high rate of postoperative recurrence, yet the histopathological determinants are not well defined. This study investigated recurrence-associated pathology to elucidate persistent disease mechanisms. STUDY DESIGN: A retrospective clinical study. SETTING: Recurrent group and non-recurrent group. METHODS: 228 pediatric CRSwNP patients were included, and clinical variables and histopathological features were systematically assessed. All patients were followed for more than 2 years and classified as recurrent CRSwNP (rCRSwNP) or nonrecurrent CRSwNP (non-rCRSwNP). Associations between clinicopathological characteristics and postoperative recurrence were evaluated using Cox regression and Kaplan-Meier survival analyses. RESULTS: Based on follow-up results, 153 pediatric patients were categorized into the rCRSwNP group and 75 patients were divided into non-rCRSwNP group. Baseline demographic did not differ significantly between groups, while comorbid allergic rhinitis was more frequent in rCRSwNP group. Histopathological analysis revealed that goblet cell hyperplasia and basement membrane thickening were more pronounced in the rCRSwNP group compared to the non-rCRSwNP group. Cox regression analyses identified the severity of goblet cell hyperplasia as an independent risk factor for CRSwNP recurrence. Kaplan-Meier analysis further showed that moderate to severe goblet cell hyperplasia was associated with significantly higher postoperative recurrence risk. CONCLUSION: Histopathological profiling indicated that pediatric rCRSwNP was characterized by basement membrane thickening and goblet cell hyperplasia. The degree of goblet cell hyperplasia independently predicts postoperative recurrence, providing a clinically actionable marker for identifying high-risk patients.
Recurrence After Subtotal Resection of NF-2-Associated Versus Sporadic Vestibular Schwannomas: A Matched-Cohort Analysis.
Younan S, Chang-Chien C, Kaufman L … +11 more , Ramesh R, Al-Adli N, Limb CJ, Sharon JD, McDermott MW, Goldschmidt E, Cheng YS, Theodosopoulos P, Na B, Morshed RA, Jiam NT
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979396 · Publisher ↗
OBJECTIVE: This study compares recurrence patterns after subtotal resection (STR) of neurofibromatosis type 2 (NF-2)-associated versus sporadic vestibular schwannomas (VSs) and aims to identify independent predictors of...
OBJECTIVE: This study compares recurrence patterns after subtotal resection (STR) of neurofibromatosis type 2 (NF-2)-associated versus sporadic vestibular schwannomas (VSs) and aims to identify independent predictors of recurrence. STUDY DESIGN: Retrospective matched-cohort study. SETTING: Single tertiary academic medical center. METHODS: We identified patients who underwent STR for VS between 2004 and 2024. A cohort of 21 NF-2 patients was matched to 79 sporadic controls based on age, sex, and tumor size (Koos grade). Preoperative and postoperative tumor volumes were calculated and included as covariates in survival analyses. The primary outcome was recurrence-free survival, analyzed using Kaplan-Meier methods and Cox proportional hazards regression. RESULTS: The NF-2 cohort experienced a higher overall recurrence rate than the matched sporadic cohort (42.9% vs 16.5%). In a multivariable Cox regression model adjusting for clinical and volumetric covariates, NF-2 status emerged as a strong, significant independent predictor of recurrence (adjusted hazard ratio [aHR] 4.83; 95% CI 1.25-18.62; P = .022). This association was absent in the full, unmatched cohort, highlighting the importance of the matched design. No other variables, including postoperative adjuvant radiation, were significant predictors in the final matched model. CONCLUSION: In this matched-cohort analysis, the intrinsic biology of germline NF2 is a powerful, independent driver of tumor recurrence following STR. This finding, unmasked by controlling for key confounders, suggests that the elevated recurrence risk in NF-2 patients is a direct consequence of the underlying genetic disorder. These results underscore the distinct natural history of NF-2-associated tumors and support the need for lifelong surveillance.
Reply to "Inferior Turbinate Outfracture Alone Has Not Been Studied in Randomized Controlled Trials".
Jones NN, Song SA, Camacho M
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979394 · Publisher ↗
Abstract loading — click title to view on PubMed.
Predictors of Recurrence in Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma.
Jackert EP, Wong S, Shen K … +6 more , Zalin M, Tang L, Kwon D, Kokot N, Sinha U, Han AY
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979392 · Publisher ↗
OBJECTIVE: Despite improved survival for patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC), up to 30% of cancers recur. This study elucidates independent predictors of recurrence and surviva...
OBJECTIVE: Despite improved survival for patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC), up to 30% of cancers recur. This study elucidates independent predictors of recurrence and survival in HPV+ OPSCC patients. STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary care center. METHODS: Patients diagnosed with HPV+OPSCC from 2014 to 2024 were included. Electronic health records were manually searched for demographic, oncologic, treatment, and outcomes data. The primary outcome was recurrence within 5-years of completion of primary treatment. The secondary outcome was 5-year survival. Kaplan-Meier and log-rank tests were performed for univariate analyses. Cox regression analysis identified independent predictors of recurrence and mortality. RESULTS: Of the 239 patients included, 61 (25.5%) experienced recurrence within 5 years after completion of definitive treatment. Of recurrent cases, over one-third involved distant metastases, predominantly to the lung, with a subset involving atypical sites such as bone, liver, and skull base. On multivariable Cox regression analysis, perineural invasion was independently associated with any recurrence (HR: 2.440, 95% CI: 1.330, 4.477) and distant metastatic recurrence (HR: 3.107, 95% CI: 1.097, 8.794). The overlapping oropharynx tumor subsite was significantly associated with mortality (HR: 2.102, 95% CI: 1.053, 4.198). CONCLUSION: Our results highlight distinct patterns of recurrence and survival which support the consideration of more individualized surveillance approaches, especially in HPV+ OPSCC patients with perineural invasion.
Recurrences and Survival in Oropharyngeal Squamous Cell Carcinoma According to p16 Status and Extranodal Extension.
Boscolo-Rizzo P, Giudici F, Polesel J … +19 more , Tagliabue M, Sia E, Rampinelli V, Stellin M, Emanuelli E, Vaira LA, Zucchini S, Golusinski P, Dequanter D, Chiesa-Estomba C, Maniaci A, Lentini M, De Berardinis R, Szewczyk M, Lechien JR, Piazza C, Nicolai P, Ansarin M, Tirelli G
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41979391 · Publisher ↗
OBJECTIVE: Extranodal extension (ENE) is a recognized adverse prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). However, most evidence concerns clinical ENE, whereas data on pathologic ENE (pENE) are li...
OBJECTIVE: Extranodal extension (ENE) is a recognized adverse prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). However, most evidence concerns clinical ENE, whereas data on pathologic ENE (pENE) are limited. With the renewed role of surgery in the management of OPSCC, this study evaluates the prognostic significance of pENE according to HPV status. STUDY DESIGN: Multicenter retrospective cohort conducted from 2010 to 2021. SETTING: Specialized otolaryngology-head and neck surgery European departments. METHODS: Patients aged 18 years or older who underwent primary surgery for OPSCC of the tonsil or base of tongue were included. HPV status was based on p16 expression assessed by immunohistochemistry. pENE was classified as present or absent. We estimated overall survival (OS), disease-free survival (DFS), and recurrence patterns, adjusting for competing risks. RESULTS: Among 650 patients, 284 (43.7%) were p16-positive and 166 (25.5%) reported presence of pENE. In p16-negative patients, those with pENE showed a worse 5-year DFS (35.6% vs 43.5%; adjusted HR [aHR], 1.64; 95% CI, 1.09-2.46) and OS (43.3% vs 52.0%; aHR, 1.76, 95% CI, 1.14-2.73) than those without. Cumulative incidence of recurrence was significantly higher in p16-negative patients with pENE (55.8% vs 37.0%). pENE was significantly associated with increased risk of distant metastases only in p16-negative patients (21.0% vs 7.6%; aHR, 2.52; 95% CI, 1.03-625). CONCLUSIONS: The prognostic role of pENE in OPSCC appears to differ by HPV status. These findings underline the importance of considering HPV status when interpreting the prognostic significance of pENE.
Canal Cholesteatoma Presentation and Management: A Systematic Review and Meta-Analysis.
Walker AM, Cheung M, Nguyen SA … +4 more , Bonham K, Harvey EA, Labadie RF, Meyer TA
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979387 · Full text
OBJECTIVE: To evaluate current understanding of external auditory canal cholesteatoma (EACC), its symptomatic burden, clinical features, diagnostic approach, and management strategies to reduce delays in diagnosis. DATA...
OBJECTIVE: To evaluate current understanding of external auditory canal cholesteatoma (EACC), its symptomatic burden, clinical features, diagnostic approach, and management strategies to reduce delays in diagnosis. DATA SOURCES: PubMed, CINAHL, COCHRANE Library, and SCOPUS. REVIEW METHODS: A comprehensive literature search was completed in March 2025. The search identified 2117 English-language articles, of which 30 studies reported patients diagnosed with EACC. Meta-analyses of mean difference (Δ), proportions (%), and continuous measures with 95% confidence intervals (CI) were performed using random and fixed effects models. RESULTS: A total of 1007 patients were included with a mean age of 43.9 years (range 6-89). Most were diagnosed with Stage III EACC (60.7%, CI 43.5-76.7). Nicotine use (33.1%, CI 15.2-54.1) and cotton swab abuse (24.3%, CI 16.7-33.7) were common risk factors. Patients most often presented with otalgia (39.9%, CI 30.5-49.7) or otorrhea (50.3%, CI 37.8-62.7), though 15.7% (CI 4.5-31.6) were asymptomatic. Conservative treatment with serial debridement was used in most patients (69.6%, CI 44.5-89.7). Canalplasty (68.6%, CI 48.3-85.7), tympanoplasty (24.7%, CI 3.7-56.1), and mastoidectomy (33.7%, CI 17.4-52.3) were the most common surgical approaches. Recurrence was low (4.5%; 95% CI 2.3-8.0). CONCLUSION: Patients with EACC are frequently diagnosed at advanced stages. Recognizing risk factors and symptoms can expedite detection and guide management. This review highlights how tailored interventions achieve low recurrence rates and reduce morbidity linked to delayed diagnosis.
Glucagon-Like Peptide-1 Receptor Agonist Utilization Among Sleep Surgery Clinic Patients.
Kutler RB, Lin A, Zhang L … +5 more , Trackey P, Rivera-Diaz A, Jelic S, St-Onge MP, Cai Y
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41979383 · Publisher ↗
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved to treat obstructive sleep apnea (OSA), yet their use in an OSA population has not been characterized. This study evaluates GLP-1 RA use in pa...
OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are approved to treat obstructive sleep apnea (OSA), yet their use in an OSA population has not been characterized. This study evaluates GLP-1 RA use in patients presenting to a sleep surgery clinic. STUDY DESIGN: Retrospective. SETTING: Tertiary care institution. METHODS: Patients with OSA who presented to our sleep surgery clinic between October 2023 and March 2025 with available sleep studies were included (n = 384). Demographic data, body mass index (BMI), apnea-hypopnea index (AHI), OSA history, GLP-1 RA prescription data, and usage details were collected through chart review. Eligibility for GLP-1 RA was defined by FDA drug labeling criteria, with diabetes, obesity, or BMI ≥ 27 kg/m² with a weight-related comorbidity. RESULTS: The cohort had mean age 53.3 ± 14.8 years, BMI 29.4 ± 5.7 kg/m, and AHI 28.7 ± 24.2 events/h. Most patients (52.1%) had tried CPAP. Among the full cohort (n = 384), 249 patients (64.8%) met FDA-approved drug labeling criteria for GLP-1 RA use, and there were 70 (28.1%) current GLP-1 RA users among eligible patients. Semaglutide (54.8%) and tirzepatide (27.4%) were the most prescribed. The most common reasons for discontinuing or changing GLP-1 RA types were insurance-related issues and adverse effects. Among eligible patients, having Medicaid was associated with lower likelihood of using GLP-1 RAs (adjusted odds ratio 0.25, P = .04) while BMI ≥30 kg/m (adjusted odds ratio 3.45, P < .001) was associated with higher likelihood. CONCLUSION: Among sleep surgery clinic patients, a large proportion were eligible for GLP-1 RA use, and utilization was high compared to that of the general population.
Perioperative Opioid Use and Risk of Persistent Use After Common Otolaryngologic Procedures.
Liu M, Lee A, Hayek S … +1 more , Li S
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979364 · Full text
OBJECTIVE: The objective of this study was to evaluate the incidence of perioperative opioid prescription and the development of new persistent opioid usage in patients prescribed perioperative opioids for common otolary...
OBJECTIVE: The objective of this study was to evaluate the incidence of perioperative opioid prescription and the development of new persistent opioid usage in patients prescribed perioperative opioids for common otolaryngological procedures. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX US Collaborative Research Network. METHODS: The TriNetX US Collaborative Research Network was queried to create cohorts of opioid-naive adult patients who underwent tonsillectomy, sinus surgery, parotidectomy, septoplasty, tympanoplasty, rhinoplasty, or parathyroidectomy between 2010 and 2024. Patients prescribed perioperative opioids (2 weeks before to 1 month after surgery) were compared with those not prescribed opioids. Persistent opioid use was defined as opioid prescription between 3 and 9 months after surgery. Propensity score matching was performed based on demographics, smoking status, mental health diagnoses (eg, mood, anxiety, personality, and substance use disorders), preoperative pain conditions (eg, back, neck, and joint pain), as well as other medical comorbidities, and healthcare utilization. RESULTS: We identified 319,395 opioid-naive patients who underwent the selected otolaryngological procedures. Of these patients, 273,898 (85.8%) received perioperative opioids. The rate of perioperative opioid usage was highest for parotidectomy. Across all procedures, patients who received perioperative opioids were more likely to develop new persistent opioid use. The highest risk ratios (RR) were observed for parotidectomy (RR: 2.64; 95% CI: 1.94, 3.59) and tympanoplasty (RR: 2.01; 95% CI: 1.53, 2.66). CONCLUSIONS: Perioperative opioid prescription following common otolaryngological procedures is associated with a higher risk of new persistent opioid use. These findings highlight the need for careful opioid prescribing to reduce long-term opioid dependence.
Nanopore Sequencing for HPV in Oropharyngeal Squamous Cell Carcinoma and Benign Tonsil Specimens.
Hubbard MG, Lei GS, Emerson R … +3 more , Schreiber D, Davis TE, Chen DW
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41979363 · Full text
OBJECTIVES: Human papillomavirus (HPV) accounts for the majority of oropharyngeal squamous cell carcinoma (OPSCC) cases in the United States but understanding the prevalence of high-risk HPV in oropharyngeal tissue remai...
OBJECTIVES: Human papillomavirus (HPV) accounts for the majority of oropharyngeal squamous cell carcinoma (OPSCC) cases in the United States but understanding the prevalence of high-risk HPV in oropharyngeal tissue remains poor. We evaluated nanopore sequencing, a novel rapid, and long-read sequencing platform, on OPSCC tissue and tested it in benign tonsils from pediatric and young adult patients. STUDY DESIGN: Cross-sectional study. SETTING: Academic tertiary referral center. METHODS: Formalin-fixed, paraffin-embedded (FFPE) specimens of HPV-positive and negative OPSCC diagnosed from 2013 to 2023 were sequenced on the nanopore MinION platform using an amplicon-based approach. Nanopore sequencing was subsequently performed on FFPE tissue from benign tonsillectomy in patients ages 30 and younger performed from 2016 to 2023. RESULTS: In 54 OPSCC cases, nanopore sequencing detected HPV DNA in all 27 HPV-positive specimens with 96% of cases exhibiting high abundance (HPV reads >1000). HPV DNA was also detectable in all 27 HPV-negative specimens, but 89% had a low abundance. By interpreting high HPV abundance as HPV-positive, nanopore sequencing demonstrated a 96% sensitivity, 89% specificity, 90% positive predictive value, and 96% negative predictive value rate. In 150 benign tonsillectomy cases, 27% had HPV DNA detected by nanopore sequencing, all in low abundance, including 37% of patients younger than 10 years old. HPV DNA sequences detected belonged to subtype 16. CONCLUSIONS: Nanopore sequencing demonstrated high sensitivity and specificity for HPV DNA in FFPE OPSCC tissue. High-risk HPV prevalence in pediatric and young adults may be higher than previously studied.
Mastoid Obliteration Using Granules of S53p4 Bioactive Glass: Systematic Review and Meta-Analysis.
Canali L, Di Bari M, Sheppard SC … +4 more , Alciato L, Sterkers O, Delille H, Bernardeschi D
Otolaryngol Head Neck Surg · 2026 Jul · PMID 41940705 · Publisher ↗
OBJECTIVE: This study used a systematic review and meta-analysis to evaluate the tolerance and rate of postoperative complications associated with using granules of S53P4 bioactive glass (BAG) for mastoid obliteration su...
OBJECTIVE: This study used a systematic review and meta-analysis to evaluate the tolerance and rate of postoperative complications associated with using granules of S53P4 bioactive glass (BAG) for mastoid obliteration surgeries. DATA SOURCES: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. REVIEW METHODS: This systematic review and meta-analysis was performed according to the PRISMA statement. Data from eligible studies were extracted and used to calculate the pooled rate of postoperative complications and pooled audiologic outcomes. RESULTS: A total of 12 studies (583 patients; 54.1% males; median age 41.6 years) was included. The mean follow-up was 28.8 months (95% CI: 18.5-39.1). We found a pooled complication rate of 16% of patients (n = 542; 95% CI: 0.11-0.22) for postoperative transient or persistent otorrhea, 2% (n = 529; 95% CI: 0.01-0.05) for surgical wound infection and 1% (n = 570; 95% CI: 0.01-0.03) for extrusion of BAG granules into the external auditory canal. The pooled rate was 6% (n = 239, 95% CI: 0.01-0.30) for Merchant grade 2 or 3 at last follow-up, indicating persistent or uncontrolled otorrhea. Pooled audiologic outcomes revealed that bone conduction remained stable between the preoperative and postoperative setting. CONCLUSIONS: S53P4 BAG granules seem a safe material for mastoid obliteration, with a low rate of postoperative complications and good inner-ear tolerance. Further multicenter prospective studies are warranted to confirm these findings.
Redefining Research Productivity: Rethinking Applicant Evaluation With the Arms Race Control Score.
Warrier A, Castillo A, Amoateng B … +8 more , Raman R, Lee A, Napoleon D, Patel AM, McCrary HC, Gurgel R, Bowers C, Eloy JA
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41940703 · Publisher ↗
OBJECTIVES: The residency application "arms race" for research productivity has intensified following the Step 1 pass/fail transition, with applicants increasingly evaluated by total publication counts. The Total Number...
OBJECTIVES: The residency application "arms race" for research productivity has intensified following the Step 1 pass/fail transition, with applicants increasingly evaluated by total publication counts. The Total Number of Residency Applicant Publications (TNRAP) has become the dominant metric but doesn't consider authorship position or study quality, leading to inflated and misleading measures of productivity. This study evaluates the Arms Race Control Score (ARCS), a novel effort-adjusted metric, compared to TNRAP in assessing otolaryngology residency applicants. STUDY DESIGN: Retrospective cohort. SETTING: National sample of otolaryngology residency applicants across 5 application cycles (2020-2024). METHODS: A total of 542 matched applicants from 30 programs (10 per US News ranking tier) with PubMed-indexed publications were analyzed. ARCS was calculated by weighting publications by study type, authorship position, and journal impact factor. Trends in TNRAP, cumulative Publication Value Units (cPVU), match characteristics, and ARCS were compared using t-tests, Pearson correlation, and ROC analysis. RESULTS: TNRAP rose significantly from 2020 to 2024 (mean 5.0-8.0; P = .002), while ARCS remained stable (mean ≈ 10; P = .055). ARCS re-ranked 64% to 98% of applicants annually and provided greater discrimination among applicants with identical TNRAP values. ROC analysis demonstrated that ARCS outperformed TNRAP in predicting top 10 match status. CONCLUSIONS: ARCS better reflects research effort and quality than raw counts, offering fairer applicant stratification and stronger predictive consistency for competitive matches. ARCS may mitigate superficial publication, promote meaningful scholarly engagement, and restore balance to the current "arms race" while offering an equitable framework.
Prognostic Utility of Hematological Inflammatory Markers in Stratifying Cancer Risk in Laryngeal Premalignant Lesions.
Puente-Vérez M, Martín-González R, Pedregal-Mallo D … +3 more , García-Pedrero JM, López F, Rodrigo JP
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41940701 · Publisher ↗
OBJECTIVE: To evaluate the prognostic utility of systemic inflammatory markers derived from complete blood count (neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio [MLR], platelet-to-lymphocyte ratio [PL...
OBJECTIVE: To evaluate the prognostic utility of systemic inflammatory markers derived from complete blood count (neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio [MLR], platelet-to-lymphocyte ratio [PLR], and systemic immune-inflammation index [SII]) in predicting malignant transformation of laryngeal dysplasia, compared with conventional histological grading. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral university hospital. METHODS: A retrospective analysis was conducted on 146 patients diagnosed with histologically confirmed laryngeal dysplasia between 2009 and 2019, who had a preoperative complete blood count (CBC) performed within 30 days before diagnosis. The primary endpoint was the development of invasive carcinoma at the index site, confirmed by histopathology. Transformation-free survival was analyzed using Kaplan-Meier curves and Cox proportional hazards models to estimate adjusted hazard ratios (HRs). Model discrimination was assessed with AUC/c-index, and time-dependent ROC analyses were performed. RESULTS: During a median follow-up of 85.4 months, 45 of 146 patients (30.8%) developed invasive carcinoma. On multivariable Cox analysis, higher NLR was independently associated with an increased risk of malignant transformation (HR = 3.80; 95% CI 1.56-9.26; P = .003), whereas histological grade showed no significant association (P = .89). Daily alcohol intake correlated positively with NLR and MLR values. CONCLUSIONS: Preoperative NLR is an independent prognostic marker for malignant transformation in laryngeal dysplasia, providing incremental prognostic value beyond histological grade. Prospective validation using time-to-event modeling and prespecified cut-off points is warranted.
Communication of Cost in Thyroidectomy: A Mixed-Methods Analysis of Financial Toxicity.
Kao DD, Crowley EV, Jensen CB … +4 more , Bacon EM, Bradley SE, Thomas JD, Pitt SC
Otolaryngol Head Neck Surg · 2026 Jun · PMID 41940688 · Publisher ↗
OBJECTIVE: To assess cost information provided to patients undergoing thyroidectomy. STUDY DESIGN: Explanatory sequential mixed-methods study. SETTING: Single academic medical center. METHODS: Adults who underwent thyroi...
OBJECTIVE: To assess cost information provided to patients undergoing thyroidectomy. STUDY DESIGN: Explanatory sequential mixed-methods study. SETTING: Single academic medical center. METHODS: Adults who underwent thyroidectomy between 1/2021 and 1/2024 completed a survey about financial toxicity. Purposive sampling identified survey respondents for semi-structured interviews to explore experiences related to cost communication. Qualitative data were thematically analyzed. RESULTS: Of 167 survey respondents, most were female (77.8%), white (83.8%), and underwent total thyroidectomy (65.3%). Nearly one-third experienced moderate to severe financial toxicity. Forty-one percent felt "not at all" informed about costs, while 20% sought preoperative cost information, most commonly from insurers (82.4%). Education was significantly associated with feeling cost-informed, while lowest- and highest-income, younger, and female patients trended toward greater cost-seeking behavior. Thirty-five respondents were invited for an interview; 20 consented. Almost all participants recalled no cost discussion with their care team. Several felt like they "had to" have surgery, regardless of cost, and many were surprised by copays, missed work, and medication costs. Some wished they had received estimates or information about financial resources. Participants identified insurers as a source for cost information but received vague communication regarding coverage. A few stated that while better cost information would not have changed their treatment decision, it would have better prepared them for the financial impact. CONCLUSION: Patients undergoing thyroidectomy appear to be insufficiently informed of costs before surgery. Improved cost communication by care teams and hospital systems could improve preparedness and mitigate financial toxicity, as reliance on insurers alone appears inadequate.
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