Otolaryngol Head Neck Surg [JOURNAL]
Sun
200 papers
Pediatric Drug-Induced Sleep Endoscopy Directed Surgery Outcomes With Trisomy 21 Subgroup Comparison: A Meta-Analysis.
Ibrahim AF, Khan S, Hoang-Tran C … +3 more , Nanu DP, Nguyen SA, Carr MM
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696993 · Publisher ↗
OBJECTIVE: To evaluate the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in improving polysomnographic outcomes in pediatric obstructive sleep apnea (OSA), and to compare its impact in children...
OBJECTIVE: To evaluate the effectiveness of drug-induced sleep endoscopy-directed surgery (DISEDS) in improving polysomnographic outcomes in pediatric obstructive sleep apnea (OSA), and to compare its impact in children with Trisomy 21 (T21) pediatric population. DATA SOURCES: PubMed, Scopus, and CINAHL databases were systematically searched from inception through January 1, 2025, in accordance with PRISMA guidelines. REVIEW METHODS: Studies were included if they reported pre- and postoperative apnea-hypopnea index (AHI), obstructive AHI (oAHI), or oxygen nadir in patients ≤21 years undergoing DISEDS. Meta-analyses were performed using random-effects models to calculate mean differences with 95% confidence intervals (CIs). Subgroup analyses were conducted for patients with T21. Risk of bias was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist and the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Forty-one studies (n = 3404; 320 with T21) met inclusion criteria. DISEDS was associated with significant improvements in AHI (mean difference [MD]: 9.63; 95% CI: 7.54-11.73), oAHI (MD: 11.46; 95% CI: 9.13-13.80), and oxygen nadir (MD: -4.37; 95% CI: -5.36 to -3.39; all P < .00001). Improvements were more pronounced in the T21 subgroup, particularly for AHI (MD: 14.78; 95% CI: 9.99-19.56). Publication bias was minimal. CONCLUSION: DISEDS significantly improves OSA severity and oxygenation in pediatric patients, with greater benefits observed in children with T21. These findings support earlier DISE use to guide individualized, anatomy-based surgery in pediatric OSA.
Preoperative Imaging for Cochlear Implantation: A Global Consensus.
Alzhrani F, Alahmadi A, Alshalan A … +44 more , Abdelsamad Y, Alsanosi A, Acharya A, Kim AH, Macias AR, Gantz B, Buchman C, Jiang D, Cuda D, Jankunaite D, Sprinzl G, Olze H, Anderson I, Shami I, Saunders JE, Gavilan J, Kutz W, Brown KD, Rak K, Telmesani L, Lassaletta L, Bance M, Caversaccio M, Kameswaran M, Zernotti M, Verhaert N, Adunka O, Connolly PF, Van de Heyning P, Caye-Thomasen P, Skarzynski P, Briggs R, Hagen R, Khalil S, Ghossaini SN, Plontke SK, O'Leary SJ, Agrawal SK, Yamasoba T, Lenarz T, Stöver T, Topsakal V, Van Rompaey V, Hagr A
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696991 · Full text
OBJECTIVE: Preoperative imaging is vital for cochlear implant surgeries, aiding diagnosis, and surgical planning. This study evaluated global practices and the value of preoperative imaging through an international surve...
OBJECTIVE: Preoperative imaging is vital for cochlear implant surgeries, aiding diagnosis, and surgical planning. This study evaluated global practices and the value of preoperative imaging through an international survey. METHODS: A cross-sectional survey was conducted among international cochlear implantation experts using a 112-item questionnaire. The study explored imaging modalities, anatomical targets, evaluated parameters, and different imaging approaches' perceived value and risks. Participants were recruited from a global consortium of otolaryngology, otology, neurotology, and cochlear implant surgery professionals. RESULTS: Thirty-nine practitioners from 36 centers in 16 countries completed the survey (95.1% response rate). All used computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative evaluation; MRI was deemed more valuable for diagnosis and candidacy assessment, while CT was preferred for surgical planning. Nearly half utilized additional imaging modalities, with functional MRI being the most common (20.5%). Additionally, 79.5% of respondents reported using image-based surgical planning software. DISCUSSION: Results show a universal reliance on CT and MRI for cochlear implant evaluations, with MRI aiding diagnosis and CT focusing on surgical planning. Advanced imaging techniques may emerge in specific clinical cases. IMPLICATIONS FOR PRACTICE: Modern imaging practices and their potential changes can enhance protocol development and improve preoperative evaluations, ultimately boosting patient safety and outcomes in cochlear implantation.
Contemporary Management of Malignancies of the Parotid Gland: A State-of-the-Art Review.
Tang A, Helou V, Sridharan SS … +8 more , Ferrarotto R, Geiger JL, Zandberg DP, Bell D, Skinner H, Spector ME, Myers EN, Contrera KJ
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696986 · Full text
OBJECTIVES: To provide a systematic update on the contemporary management of malignancies of the parotid gland (MPG), focusing on evidence-based practices and emerging therapeutics. DATA SOURCES: PubMed literature search...
OBJECTIVES: To provide a systematic update on the contemporary management of malignancies of the parotid gland (MPG), focusing on evidence-based practices and emerging therapeutics. DATA SOURCES: PubMed literature search. REVIEW METHODS: A search protocol was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) process for articles published between August 1, 2019, and August 1, 2024. Primary exclusion criteria were non-English text, abstracts, and case reports/series. Secondary inclusion criteria were articles specific to MPG diagnosis, histology, outcomes, and management, including surgery, radiotherapy, chemotherapy, immunotherapy, and targeted therapy. CONCLUSION: A total of 1614 articles were identified, and 137 articles were included in the final review. Most studies on low-grade MPG found that surgery alone was noninferior to surgery and adjuvant radiotherapy for local control. Elective neck dissection provided survival benefits for high-grade, but not low-grade, MPG. Most MPG are chemotherapy-resistant. Adjuvant chemotherapy provides limited survival benefits while significantly worsening quality of life and, thus, should be used only in select patients. Immunotherapy and targeted therapies for markers, including HER-2, TRK, and androgen receptors, have shown promising results in the treatment of advanced MPG. IMPLICATIONS FOR PRACTICE: Advances in the treatment of MPG have improved survival while minimizing treatment toxicity and improving quality of life. Future studies are needed to emphasize personalized oncologic treatment for patients with these rare malignancies.
Interventions for the Diagnosis and Management of Otosclerosis: An Umbrella Review.
Chau IJ, McCray LR, Nguyen SA … +3 more , Labadie RF, Der C, Dillard LK
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696966 · Full text
OBJECTIVE: Perform an umbrella review (a systematic review of systematic reviews) to identify interventions for the prevention, diagnosis, and management of otosclerosis, to inform the development of the World Health Org...
OBJECTIVE: Perform an umbrella review (a systematic review of systematic reviews) to identify interventions for the prevention, diagnosis, and management of otosclerosis, to inform the development of the World Health Organization (WHO) Package of Ear and Hearing Care Interventions (PEHCI). DATA SOURCES: PubMed, Scopus, and Ovid MEDLINE databases were searched from January 1, 2014, to February 4, 2025. REVIEW METHODS: Two independent reviewers screened articles and extracted data, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 tool was used to assess study quality and risk of bias. RESULTS: Eleven systematic reviews, including 163 studies and 6235 patients, met inclusion criteria. Computed tomography scans demonstrated variable diagnostic performance (60%-95% sensitivity, 75%-100% specificity). Endoscopic and microscopic stapedotomy showed similar air-bone gap closure rates, but endoscopic surgery showed reduced risk of dysgeusia and reduced need for chorda tympani nerve manipulation. Cochlear implantation for advanced otosclerosis generally yielded favorable hearing outcomes. Evidence for medical treatment (eg, sodium fluoride, bisphosphonates) and stapedotomy techniques (eg, laser techniques, crimping, piston diameters) were equivocal in terms of audiological outcomes and superiority of specific techniques. CONCLUSION: This review identifies and synthesizes evidence-based interventions for otosclerosis. Treatment options are effective for most otosclerosis patients, but research is required to determine the utility of medications and superiority of specific stapedotomy techniques. These findings will inform the WHO PEHCI, which aims to promote integration of ear and hearing services, including those related to otosclerosis, into national health systems and policies.
Conductive Hearing Loss Pathologies are Associated With Dementia in the All of Us Research Program.
Powell SD, Weinstein HNW, Tucker LH … +3 more , Denham MW, Gurgel RK, Golub JS
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696962 · Publisher ↗
OBJECTIVE: Recently, conductive hearing loss (CHL) has been associated with dementia in two large independent cohorts. However, the disease-specific association with dementia is unknown. We investigate the association of...
OBJECTIVE: Recently, conductive hearing loss (CHL) has been associated with dementia in two large independent cohorts. However, the disease-specific association with dementia is unknown. We investigate the association of specific CHL pathologies and dementia in a large national cohort. STUDY DESIGN: Cross-sectional epidemiologic study. SETTING: NIH All of Us Research Program. METHODS: Participants were ≥18 years old (n = 396,194). The exposures were CHL pathologies defined by ICD-10 code: cholesteatoma (H71.X), tympanic membrane (TM) perforation (H72.X), and otosclerosis (H80.X). The outcome was all-cause dementia defined by ICD-10 codes (F01, F03, G30-32). The odds of dementia in subjects with and without a CHL pathology were assessed with multivariable regression including age, sex, education, race, and ethnicity. Additional analyses included treatments. RESULTS: The mean (SD) age was 55 years (±17). After controlling for covariates, the odds of dementia were 1.77 times (1.08-2.73; P = .015) higher for cholesteatoma compared to those without, 2.09 times (1.68-2.59; P < .001) higher for TM perforation, and were nonsignificant for otosclerosis. After adding surgical treatment, odds of dementia dropped to 1.40 (0.82-2.27; P = .198) for cholesteatoma and 2.01 (1.60-2.50; P < .001) for TM perforation. CONCLUSIONS: Cholesteatoma and TM perforation were associated with dementia in the All of Us Research Program. Treatment attenuates these relationships. Given the general implausibility for dementia to cause these CHL pathologies, reverse causation-that dementia causes hearing loss-is an unlikely explanation for the association. This study adds to the evidence that cognition is impacted by sensory deprivation but extends to correctable conductive causes.
Assessing Preventative and Postoperative Interventions for Temporal Wasting Following Neurosurgical Intervention: A Systematic Review.
Rothka AJ, Eberly HW, Tucker J … +2 more , Lorenz FJ, Lighthall JG
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41696941 · Publisher ↗
OBJECTIVE: To evaluate preventative and corrective techniques for postoperative temporal wasting. DATA SOURCES: PubMed, Cochrane, Web of Science, and SCOPUS databases. REVIEW METHODS: Included studies mentioned temporal...
OBJECTIVE: To evaluate preventative and corrective techniques for postoperative temporal wasting. DATA SOURCES: PubMed, Cochrane, Web of Science, and SCOPUS databases. REVIEW METHODS: Included studies mentioned temporal wasting and its synonymous terms, were associated with a neurosurgical intervention, or discussed preventative or corrective techniques for temporal wasting. RESULTS: A total of 57 studies were included, comprising 2378 patients with a mean age of 42.03 years. Patient sex was reported in 52 papers, and 52.8% (1091/2078) were female. Most studies were case reports and case series (n = 29). The most common operative interventions performed were craniotomy (648/2378, 27.2%) and craniectomy (307/2378, 12.9%). Temporal wasting was noted in 397 of 1241 (32.0%) patients following neurosurgical procedures. Of patients receiving preventative techniques such as modified approaches to pterional craniotomy or customized implants, 17.7% (191/1077) reported temporal wasting. Reconstructive techniques included implants (n = 20 studies), autologous fat grafting (n = 5 studies), free or pedicled flap (n = 7 studies). Patient satisfaction was mentioned in 19 studies (565 patients). Within this cohort, 31 (5.5%) patients experienced postoperative temporal wasting. However, 448 (79.3%) were satisfied with their postoperative outcomes. Complications after both preventive and corrective techniques were reported in 124 (5.2%) patients, of which need for an additional reconstructive procedure was most common (29/124, 23.4%) followed by infection (23/124, 18.5%) and wound dehiscence (23/124, 18.5%). CONCLUSION: Temporal wasting is a common outcome after neurosurgical procedures. Fat grafting, implants, and free flap procedures have been used to achieve satisfactory outcomes.
Radiofrequency Ablation Versus Laser Neurolysis of the Posterior Nasal Nerve in Patients With Chronic Rhinitis.
Lin CC, Hwang YL, Liao JY … +3 more , Teng HL, Shih TY, Huang CY
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649252 · Full text
OBJECTIVE: To compare the clinical outcomes of radiofrequency ablation of the intraturbinate segment of the posterior nasal nerve (RAPN) alone versus combined RAPN with CO₂ laser posterior nasal nerve neurolysis (RPN3) i...
OBJECTIVE: To compare the clinical outcomes of radiofrequency ablation of the intraturbinate segment of the posterior nasal nerve (RAPN) alone versus combined RAPN with CO₂ laser posterior nasal nerve neurolysis (RPN3) in patients with chronic rhinitis refractory to medical therapy. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary care center. METHODS: Adult patients with chronic rhinitis unresponsive to medical treatment for over 6 months who underwent either RAPN or RPN3 between February 2023 and May 2024 were included. Inclusion criteria were 24-hour reflective total nasal symptom score (rTNSS) ≥ 3, rhinorrhea score ≥1, and NOSE score ≥11. Exclusion criteria included chronic rhinosinusitis, nasal polyps, and coagulopathy. Demographics and comorbidities were documented. Primary endpoints were changes in rTNSS, NOSE scores, and response rate (≥30% improvement from baseline) at 1-, 3-, and 6-months posttreatment. RESULTS: A total of 101 patients were analyzed (RPN3: 76; RAPN: 25). Baseline rTNSS and NOSE scores were comparable between the two groups (P = .144 and .414, respectively). Both groups demonstrated significant improvements in rTNSS and NOSE scores at all follow-up points (P < .001). From 1 to 6 months, RPN3 achieved significantly greater improvements compared to RAPN (P = .039-.045), particularly in the rhinorrhea and nasal itching sub-scores (P = .003-.039). Response rates for rTNSS ranged from 91% to 100% in the RPN3 group and 84% to 96% in the RAPN group. CONCLUSION: Both RAPN and RPN3 are effective in treating chronic rhinitis unresponsive to medication. The addition of CO₂ laser posterior nasal nerve neurolysis (RPN3) provides superior symptomatic relief, particularly for rhinorrhea and nasal itching.
Clinical and Socioeconomic Predictors of 60-Day Rehospitalization After Oncologic Head and Neck Surgery.
Abdul-Rahman NH, Sridharan S, Spector ME … +1 more , Snyderman CH
Otolaryngol Head Neck Surg · 2026 May · PMID 41649247 · Full text
OBJECTIVE: Evaluate the association between clinical characteristics and neighborhood socioeconomic disadvantage and 60-day re-presentation after oncologic head and neck surgery. STUDY DESIGN: This retrospective cohort s...
OBJECTIVE: Evaluate the association between clinical characteristics and neighborhood socioeconomic disadvantage and 60-day re-presentation after oncologic head and neck surgery. STUDY DESIGN: This retrospective cohort study involved 1,088 patients who underwent oncologic head and neck surgery from August 2012 to November 2024. SETTING: Tertiary academic center. METHODS: The main outcome measure was 60-day Emergency Department (ED) visit or readmission after primary hospital discharge following surgery. Patient demographics, clinical characteristics, and neighborhood socioeconomic disadvantage, as measured by state-level area deprivation index (ADI). RESULTS: Predictors of re-presentation within 60 days of discharge on univariate analysis include tumor stage 4 (OR: 1.52, 95% Cl: 1.01-2.31, P = .044), longer primary length of stay (OR: 1.03, 95% Cl: 1.01-1.05, P < .001), and residency in the 4th quartile state ADI (OR: 1.54, 95% Cl: 1.03-2.31, P = .037). Multivariable logistic regression identified laryngeal cancer (OR: 1.60, 95% Cl: 1.16-2.21, 0.004) and discharge with home health or other care facilities (2.22, 95% Cl: 1.67-2.96, P < .001) as predictive factors. Patients from low ADI neighborhoods (Q1-3) were more likely to be discharged home, whereas those from high ADI neighborhoods (Q4) where almost twice as likely to be discharged with home health or to care facilities than home alone (18.70% vs 10.29%, P = < .001). CONCLUSION: Our study demonstrates that clinical and systemic factors contribute to re-presentation to the hospital after major oncologic head and neck surgery. Addressing these factors through targeted policies and institutional initiatives may help mitigate the morbidity and cost associated with representation.
The Impact of Mandated Universal Screening for Congenital Cytomegalovirus: The Minnesota Experience.
Holden L, Carlson AM, Jayawardena A … +6 more , Meyer A, Roby B, Lunos S, Novak J, Rabusch S, Redmann AJ
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649243 · Publisher ↗
OBJECTIVE: To investigate trends in evaluation and management of patients with cCMV at a major pediatric center following the institution of universal cCMV screening. STUDY DESIGN: Retrospective cohort study. SETTING: Te...
OBJECTIVE: To investigate trends in evaluation and management of patients with cCMV at a major pediatric center following the institution of universal cCMV screening. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic hospital. METHODS: Patients <18 years with a diagnosis of cCMV between January 2021 and February 2024 were examined. Three cohorts were analyzed: 2021 and earlier (before screening guidelines), 2022 (screening recommended but not mandated), and 2023 and later (universal screening). Patient charts were reviewed for workup and treatment of cCMV. RESULTS: 132 patients met criteria. There was a significant difference in age at first audiology visit following cCMV diagnosis between cohorts 1 (0.71 ± 1.8), 2 (0.26 ± 0.23), and 3 (0.07 ± 0.06) (P = .02). There was a significant increase in the absolute number of mild hearing loss diagnoses in 2023 and later compared to 2022 (8 and 2, P < .01), but no difference in severe to profound hearing loss diagnoses between the cohorts (5 and 3, P = .2). Between cohorts 2 and 3, there were increases in the absolute number of patients undergoing ID consultation (11 vs 24), ENT consultation (9 vs 22), and treatment with antiviral therapy (7 vs 9) (P < .01). CONCLUSIONS: Universal cCMV screening decreased the age at first audiology visit following cCMV diagnosis. Universal screening increased the number of diagnoses of mild hearing loss. The number of patients undergoing workup for cCMV also increased. Additional research is needed to assess the long-term audiologic outcomes and benefits of universal screening.
Optimizing Cochlear Implant Care: A Time-Driven Activity-Based Costing (TDABC) Analysis of Audiologist and Otolaryngologist Workflow.
Kim EK, Pullakhandam K, Barry B … +6 more , Zhang MH, Reed MP, Arenberg JG, Page C, Lewis RM, Jiam NT
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649242 · Publisher ↗
OBJECTIVE: Despite cochlear implants' (CIs) effectiveness, only a small minority of eligible US adults receive them, with significant socioeconomic disparities in access. Understanding time and cost requirements for CI c...
OBJECTIVE: Despite cochlear implants' (CIs) effectiveness, only a small minority of eligible US adults receive them, with significant socioeconomic disparities in access. Understanding time and cost requirements for CI care delivery is essential for improving access and supporting clinical teams. This study quantifies personnel time and costs for preoperative and postoperative CI care to identify opportunities for workflow optimization and enhanced audiologist support. STUDY DESIGN: Multi-institutional time-driven activity-based costing (TDABC) analysis. SETTING: Academic tertiary neurotology cochlear implant centers. METHODS: TDABC analysis of CI programs at 2 tertiary centers (University of California San Francisco and Massachusetts Eye and Ear) was conducted in 2023 to 2024. Direct observation captured time requirements for standard CI care pathways: 2 preoperative audiology evaluations, 1 preoperative otolaryngology consultation, 1 postoperative surgical follow-up, and 2 postoperative audiology visits (activation and programming). Personnel costs were calculated using national salary data. RESULTS: The complete preoperative and postoperative care pathway required 397.5 minutes (6.6 hours) of direct clinician time, costing $316.65 in personnel expenses. Audiology services comprised 80% ($254.45) of total costs requiring 361 minutes. Preoperative audiology evaluations alone consumed 2.6 hours. Individual visit times ranged widely: preoperative otology consultations (8-66 minutes), first audiology evaluations (26-112 minutes), and CI activation visits (74-124 minutes). CONCLUSION: Audiologists invest nearly 6 hours of direct patient care per CI recipient in the perioperative period, representing 80% of personnel costs. Wide time variations suggest opportunities for standardization. Supporting audiologists through administrative assistance, streamlined documentation, and optimized scheduling could improve both clinician satisfaction and patient access.
Unsupervised Phenotyping to Stratify Surgical Outcomes in Obstructive Sleep Apnea.
Kim D, Lee SJ, Rha MS … +1 more , Cho HJ
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649241 · Publisher ↗
OBJECTIVE: Surgical outcomes after upper-airway surgery for obstructive sleep apnea vary widely because of clinical heterogeneity. This study aimed to identify distinct obstructive sleep apnea phenotypes using unsupervis...
OBJECTIVE: Surgical outcomes after upper-airway surgery for obstructive sleep apnea vary widely because of clinical heterogeneity. This study aimed to identify distinct obstructive sleep apnea phenotypes using unsupervised clustering and evaluate their association with surgical outcomes. STUDY DESIGN: Retrospective prognostic cohort study. SETTING: Single-centre study. METHODS: Two hundred fourteen adults who underwent upper-airway surgery for obstructive sleep apnea were analysed across 50 clinical and polysomnographic variables. The Leiden clustering algorithm was used to identify patient subgroups. Baseline characteristics and surgical outcomes, including changes in the apnea-hypopnea index and oxygen saturation, were compared across the identified clusters. RESULTS: The analysis revealed 3 distinct patient phenotypes. Cluster 0 (n = 91) comprised older patients with lower BMI and a high frequency of respiratory effort-related arousal. Cluster 1 (n = 73) was characterised by younger patients with higher BMI and severe apnea-dominant obstructive sleep apnea. Cluster 2 (n = 50) was defined by significant anatomical obstruction and hypopnea-dominant breathing patterns. The reductions in the apnea-hypopnea index and oxygen desaturation index were significantly less pronounced in Cluster 0 than in Clusters 1 and 2 (P < .01). Conversely, Cluster 1 showed the greatest improvement, with a significantly larger reduction in the apnea index and a greater increase in the lowest oxygen saturation compared to the other 2 clusters (P < .01). CONCLUSION: Unsupervised clustering of multidimensional data revealed obstructive sleep apnea phenotypes with distinct surgical prognoses. Integrating this approach into preoperative evaluations may help inform surgical counseling and shared decision-making.
Intraoperative Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.
Caraway J, Millay D, Zarrella D … +8 more , Kim HE, Wrozek T, Yang A, Zamani M, Watson N, Heckman C, Garrett S, Orestes M
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649240 · Publisher ↗
OBJECTIVE: Currently, there is a lack of consensus regarding the superiority of specimen-based versus tumor bed-based intraoperative margin analysis in oral cavity squamous cell carcinoma (OCSCC). The purpose of this stu...
OBJECTIVE: Currently, there is a lack of consensus regarding the superiority of specimen-based versus tumor bed-based intraoperative margin analysis in oral cavity squamous cell carcinoma (OCSCC). The purpose of this study is to perform the first meta-analysis examining intraoperative margin assessment methods in OCSCC with the goal of determining if there is a significant difference in patient outcomes between specimen-driven and tumor bed-driven margin analysis. DATA SOURCES: A comprehensive search of the literature was performed using PubMed, Embase, and Web of Science. REVIEW METHODS: Studies met inclusion criteria if they conducted intraoperative specimen-driven and tumor bed-driven margin analysis in patients with OCSCC and reported patient outcomes. Random effects meta-analyses were used to analyze the compiled data. RESULTS: The literature search returned 1988 articles for initial review of which 9 (1240 participants) met criteria for inclusion and meta-analysis. Meta-analysis revealed that a specimen-based approach is associated with higher intraoperative re-resection rate (P < .05), significantly lower final positive margin rate (P < .05), and decreased local recurrence when compared to the tumor bed-based approach (P < .05). However, there was no significant difference in overall recurrence when comparing intraoperative margin analysis methods (P > .05). Additionally, none of the included studies noted a significant difference in survival outcomes between tumor bed versus specimen-based methods. CONCLUSION: Specimen-based frozen margin analysis in OCSCC results in lower false negative rates and improved local control; however, there is no significant difference in overall recurrence or survival when comparing specimen-based vs tumor bed-based techniques.
Geographic Disparities in Sinonasal Masses: A Single Institution Experience.
Elwell Z, Narendran NH, Gallego CJ … +3 more , Davis K, Wehbi N, Le CH
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649231 · Publisher ↗
OBJECTIVE: To identify, describe, and understand geographic disparities in the presentation, treatment, and outcomes of patients with sinonasal masses in southern Arizona. STUDY DESIGN: Retrospective cohort study of 86 p...
OBJECTIVE: To identify, describe, and understand geographic disparities in the presentation, treatment, and outcomes of patients with sinonasal masses in southern Arizona. STUDY DESIGN: Retrospective cohort study of 86 patients with sinonasal masses treated at the University of Arizona between January 2010 and December 2024. SETTING: Single tertiary academic medical center. METHODS: Patients were stratified into urban (n = 41), suburban (n = 12), or rural (n = 33) locations based on home location population size. We analyzed patient demographics and clinical data to determine the influence of geographic location on diagnostic delays, treatment, and survival. Statistical significance was defined as P < .05. RESULTS: The mean age at presentation was 62.3 years across all locations. Diabetes was more common in rural locations (36.4%) (P = .006). Patients from rural locations exhibited the highest tobacco exposure (21.2% current smokers, 33.3% former smokers) (P = .044). Squamous cell carcinoma was the most common subtype (33.7%). The longest interval from symptom onset to diagnosis was in rural locations (342.7 days) (P = .29). Geographic location was the strongest predictor of diagnostic delays, with urban locations independently associated with a 205-day shorter time to diagnosis than rural locations (P = .021). Patients from urban locations received the most radiation therapy (82.9%) (P = .047). Race and geographic location significantly influenced the risk of death (Likelihood ratio χ²(6) = 24.21, P < .001). CONCLUSION: This study identifies significant geographic disparities in diabetes, smoking, diagnostic delays, treatment, and racial and ethnic risk of death. Prospective studies are required to investigate these factors further and improve equitable access to comprehensive care for patients with sinonasal masses.
Auditory and Vestibular Recovery in Otosclerosis Surgery: Clinical Efficacy and Predictive Modeling of Intraoperative Corticosteroid Use.
Aliyeva A, Muradova A, Hashimli R
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649228 · Publisher ↗
OBJECTIVE: To evaluate the effect of intraoperative local corticosteroid application on hearing, tinnitus, and dizziness outcomes after stapes surgery for otosclerosis, and to assess predictive modeling for treatment res...
OBJECTIVE: To evaluate the effect of intraoperative local corticosteroid application on hearing, tinnitus, and dizziness outcomes after stapes surgery for otosclerosis, and to assess predictive modeling for treatment response. STUDY DESIGN: Retrospective multicenter cohort study. SETTING: Three tertiary referral hospitals. METHODS: Two hundred primary stapedotomy patients were analyzed: Group 1 (n = 100) received topical triamcinolone acetonide (40 mg/mL) applied to the oval window/footplate; Group 2 (n = 100) underwent standard surgery without steroids. Preoperative and 3-month postoperative evaluations included pure tone thresholds, air-bone gap (ABG), speech discrimination score (SDS), Tinnitus Handicap Inventory (THI), and Dizziness Handicap Inventory (DHI). Machine learning algorithms identified predictors of a favorable response. RESULTS: The steroid group achieved significantly greater hearing gains at all frequencies, most pronounced at 8000 Hz (28.13 ± 6.7 vs 19.09 ± 5.4 dB; P < .001), higher SDS (+6.37% vs -1.52%; P = .006), and superior ABG closure (P = .004). THI and DHI scores improved significantly (P < .001). Machine learning models achieved an AUC of 0.92 for outcome prediction. CONCLUSION: Intraoperative corticosteroids significantly enhance auditory and vestibular recovery in stapes surgery and, combined with predictive modeling, may support personalized patient care.
Gender Representation on the National Otolaryngology Stage: Leadership Roles and Moderator-Panelist Trends at Recent Conferences.
Grewal MR, Faust C, Eljamri S … +6 more , Daniels K, Stapleton AL, Simons J, Pulsipher A, Smith KA, Padia R
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649224 · Full text
OBJECTIVE: Academic meetings provide opportunities for collaboration and career advancement in the national spotlight. We sought to explore sponsorship opportunities by gender by investigating committee leadership, keyno...
OBJECTIVE: Academic meetings provide opportunities for collaboration and career advancement in the national spotlight. We sought to explore sponsorship opportunities by gender by investigating committee leadership, keynote speakership, and panelist-moderator ratios from prior American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and Combined Otolaryngology Sections Meeting (COSM) conferences. STUDY DESIGN: Cross-sectional review of publicly available program conferencing. SETTING: Literature review. METHODS: Gender breakdowns of committee leadership and keynote speakerships were recorded from official AAO-HNS conference programming from 2013 to 2021. Panelist-moderator gender ratios were calculated for the AAO-HNS conferences from 2023 to 2024. Society leadership representation and panelist-moderator gender ratios were also investigated from recent COSM conferences between 2018 and 2024 via official programming. RESULTS: Between 2013 and 2021, analyses of the AAO-HNS national conferences determined that women comprised on average of 29.6% of annual directorship roles (range 12.5-37.55), 35.6% of board member positions (26.3%-47.4%), and 25.2% of keynote speaker appointments (0%-40%). Between 2019 and 2023, in COSM, women held on average 23.3% of available society chair/secretary positions and 19.0% of society president roles. The ratio of female:total panelist was positively correlated with female moderators. CONCLUSION: Female representation in AAO-HNS and COSM leadership and keynote speakerships has improved over time in recent years, and appears to be on par with academic otolaryngology workforce composition. However, male moderators presenting panels at both conferences had significantly fewer female panelists versus female moderators. This difference in national panel participation opportunities may impact career advancement and national reputation for female otolaryngologists.
Association Between Conflict of Interest and Published Position on Bioabsorbable Nasal Valve Implants.
Gardiner L, Liao EN, Riccardi A … +2 more , Magana L, Gillman G
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41649205 · Publisher ↗
OBJECTIVE: To examine the association between published position on absorbable nasal valve implants (favorable vs neutral/unfavorable) and the financial conflict of interest (FCOI) of listed authors. STUDY DESIGN: Retros...
OBJECTIVE: To examine the association between published position on absorbable nasal valve implants (favorable vs neutral/unfavorable) and the financial conflict of interest (FCOI) of listed authors. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: Research publications based in the United States. METHODS: We performed a retrospective cross-sectional analysis of research publications identified on Google Scholar and PubMed reporting on outcomes of bioabsorbable nasal valve implants from 2016 to 2023. Articles were independently reviewed and coded as favorable or neutral/unfavorable. FCOI for physician authors was gathered from declared disclosures in the publication and the Centers for Medicare and Medicaid Services Open Payments Database (CMS-OPD). RESULTS: Twelve articles (7 favorable, 5 neutral/unfavorable) with 32 unique authors contributing to 51 total authorships were evaluated. An FCOI was identified in 28/34 (82%) authorships from favorable articles and in 3/17 (18%) authorships from neutral/unfavorable articles, a difference which was statistically significant (P < .0005). Nondisclosures of FCOI were identified in 17/34 (50%) of favorable articles and 1/17 (6%) of neutral/unfavorable articles. The median sum of author payments for favorable articles was $305,660, and for neutral/unfavorable articles was $637. CONCLUSION: Our findings suggest that FCOI with the product manufacturer is associated with a favorable published position on outcomes of bioabsorbable nasal implants for nasal valve collapse. The high rate of undisclosed FCOI highlights the need for more diligent reporting on behalf of authors and greater scrutiny from editorial reviewers.
How does Frailty Impact Peri-Operative and Speech Recognition Outcomes for Cochlear Implants in Veterans?
Brooks KA, Lovin BD, Sweeney AD … +2 more , Peng AS, Lindquist NR
Otolaryngol Head Neck Surg · 2026 Mar · PMID 41622784 · Full text
OBJECTIVE: To investigate the association of frailty with post-cochlear implant (CI) admission, morbidity, and CI-aided word recognition outcomes in veterans. STUDY DESIGN: Retrospective cohort. SETTING: Single-instituti...
OBJECTIVE: To investigate the association of frailty with post-cochlear implant (CI) admission, morbidity, and CI-aided word recognition outcomes in veterans. STUDY DESIGN: Retrospective cohort. SETTING: Single-institution tertiary care Veterans Health Administration (VHA) hospital. METHODS: Veterans who underwent cochlear implantation between 1998 to 2024 were included. The Modified 5-Item Frailty Index (mFI-5) score was used to characterize preoperative frailty. Outcomes of interest were admission from post-anesthesia care unit (PACU), relative risk (RR) of admission among frail patients, and relationship between frailty and post-CI word recognition score (WRS). Ordinal data were analyzed via logistic regression and Chi square tests; a multivariate linear regression was used to assess nominal data. Significance was set at P < .05. RESULTS: Ninety-one patients (median age 71 years, range 35-92 years) resulted in 41 (39.4%) admissions out of 104 surgical encounters. Admission rate initially increased from 2016 to 2020 (48.9%), then decreased (29%) in 2021. Forty-two (46%) patients met criteria as being frail, while 26 (28.6%) were prefrail. While frail patients were more readily admitted (43% vs 36%; RR 1.15) and had higher rates of dizziness (20% vs 15%; RR 1.23) when compared to the combined cohort of nonfrail and prefrail patients, these relationships were not significant. Preoperative frailty was significantly negatively associated with post-CI WRS at 6- and 12-month post-CI in a multivariate analysis including patient age (P < .05). CONCLUSION: The prevalence of frailty is high among veterans undergoing cochlear implantation. Patient frailty is significantly associated with post-CI speech recognition but did not appear to impact likelihood of admission or complications.
Heterogeneity in Survival Over Time by Age, Sex, and Subsite in Early-Onset Oral Cavity Cancer.
Useche M, Alkhatib HH, Rodriguez CP … +7 more , Shih L, Liao JJ, Panjwani N, Futran N, Marchiano E, Ferrandino R, Barber B
Otolaryngol Head Neck Surg · 2026 Apr · PMID 41618839 · Full text
OBJECTIVE: To understand temporal trends in presentation and survival among patients with early-onset oral cavity squamous cell carcinoma (EO-OCSCC). STUDY DESIGN: Retrospective cohort study. SETTING: National Cancer Dat...
OBJECTIVE: To understand temporal trends in presentation and survival among patients with early-onset oral cavity squamous cell carcinoma (EO-OCSCC). STUDY DESIGN: Retrospective cohort study. SETTING: National Cancer Database (NCDB), 2004 to 2022. METHODS: Adult patients younger than 50 years diagnosed with OCSCC in the NCDB. Annual case distributions by subsite, sex, and stage were modeled with logistic regression, reporting odds ratios (ORs) per calendar year over time. Kaplan-Meier and Cox proportional hazards analyses assessed 5-year overall survival (OS), stratified by age group, subsite, and stage. RESULTS: Among 178,140 OCSCC cases, 21,630 (12.1%) were EO-OCSCC with median age of 44 years. Tongue was the most common subsite (66.9%) and increased over time (OR/year = 1.03; 95% CI, 1.02-1.04). Female cases rose steadily (OR/year = 1.01; 95% CI, 1.01-1.02), narrowing the male-female gap. Advanced-stage disease increased by 5% annually in tongue tumors and 3% in non-tongue tumors. Five-year OS was higher in tongue (73.7%) than non-tongue tumors (61.5%, P < .001) and improved over time, with annual reductions in mortality risk of 1.1% for tongue and 1.9% for non-tongue tumors. By age group, survival was highest for patients 20-29 years and lowest for those 40-49 years. CONCLUSION: EO-OCSCC is increasingly presenting as tongue primaries and in female patients, with a rising burden of advanced-stage disease. Despite this unfavorable shift, survival has improved modestly across subsites, ages, and stages, underscoring the heterogeneity of EO-OCSCC and the need for earlier detection and awareness.
Juvenile-Onset Recurrent Respiratory Papillomatosis and Human Papillomavirus Vaccine Uptake: A 19-Year Retrospective Cohort Study.
Corbin AF, Sahlollbey N, Varavenkataraman G … +3 more , de Santana Hager M, Bacon BR, Carr MM
Otolaryngol Head Neck Surg · 2026 Mar · PMID 41618836 · Publisher ↗
OBJECTIVE: To evaluate 19-year trends in juvenile-onset recurrent respiratory papillomatosis incidence and treatment utilization in the context of increasing human papillomavirus vaccine uptake. STUDY DESIGN: Retrospecti...
OBJECTIVE: To evaluate 19-year trends in juvenile-onset recurrent respiratory papillomatosis incidence and treatment utilization in the context of increasing human papillomavirus vaccine uptake. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX United States Collaborative Network. METHODS: Children 18 years of age or younger with juvenile-onset recurrent respiratory papillomatosis diagnosed between January 1, 2006, and December 31, 2024, were identified using International Classification of Diseases codes. Annual encounter-based incidence per 100,000 patients was calculated for both juvenile-onset recurrent respiratory papillomatosis and human papillomavirus vaccination. Within the pediatric juvenile-onset recurrent respiratory papillomatosis cohort, annual utilization of major treatment modalities, including bevacizumab, cidofovir, lesion excision, and tracheostomy, was assessed. RESULTS: A total of 1854 children met inclusion criteria (mean age 7.9 ± 5.7 years). Juvenile-onset recurrent respiratory papillomatosis incidence declined by 65.2%, from 3.1 cases per 100,000 in 2006 to 1.1 cases per 100,000 in 2024 (P < .001). Human papillomavirus vaccine incidence increased by 1448.1%, from 45.5 to 704.4 cases per 100,000 patients over the same period (P < .001). Annual juvenile-onset recurrent respiratory papillomatosis incidence was inversely correlated with human papillomavirus vaccine incidence (r = -0.892; P < .001). Within the pediatric juvenile-onset recurrent respiratory papillomatosis cohort, use of bevacizumab and cidofovir increased significantly, whereas lesion excision and tracheostomy incidence remained stable. CONCLUSION: Rising human papillomavirus vaccine uptake is associated with a significant reduction in encounter-based juvenile-onset recurrent respiratory papillomatosis incidence at the population level. Surgical excision remains the predominant management approach, with limited adoption of adjuvant therapies despite recent increases.
How do Patient Comorbidities Influence Adult Cochlear Implant Outcomes?
Spector B, Nguyen T, Bandaru P … +3 more , Simmons S, Moberly AC, Tamati TN
Otolaryngol Head Neck Surg · 2026 Mar · PMID 41618831 · Full text
OBJECTIVE: To evaluate the relationship between weighted comorbidity indices and post-cochlear implant (CI) speech recognition and patient-reported outcome measures (PROMs). STUDY DESIGN: Retrospective cohort. SETTING: T...
OBJECTIVE: To evaluate the relationship between weighted comorbidity indices and post-cochlear implant (CI) speech recognition and patient-reported outcome measures (PROMs). STUDY DESIGN: Retrospective cohort. SETTING: Tertiary Neurotology Center. METHODS: Adults with bilateral hearing loss who received CIs from 2017 to 2022 were included. Comorbidities were extracted via chart review of anesthesia notes, medication lists, and clinical encounters. Three comorbidity scores were calculated: the Charlson Index (10-year mortality), Elixhauser Index (30-day hospital readmission), and a basic sum index assigning equal weight to 31 conditions. Spearman correlations evaluated bivariate associations. Multivariable linear regression was used to evaluate independent contributions of each index to CI outcomes, adjusting for clinical covariates. Early (1- or 3-month post-CI) and long-term (6- or 12-month post-CI) outcomes included Consonant-Nucleus-Consonant word recognition (CNC) and AzBio sentence recognition in quiet (AzBioQ), and PROMs. RESULTS: 346 patients were included. The Charlson Index was negatively associated with both early and long-term speech recognition outcomes (CNC and AzBioQ; r = -0.16 to -0.31, all FDR-adjusted P < .05). The Elixhauser Index negatively correlated with early AzBioQ scores (r= -0.22), while the basic sum index negatively correlated with early CNC and long-term AzBioQ. No indices were associated with PROMs. In multivariable models, only the Elixhauser Index independently predicted early (β = -1.03, P = .005) and long-term (β = -0.65, P = .050) AzBioQ. CONCLUSION: Our findings highlight the influence of cumulative comorbid disease burden on speech recognition performance and suggests a differential impact of individual comorbidities on CI outcomes.
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