OBJECTIVES: Frailty indices, including the modified frailty index (mFI-5) and the risk analysis index-administrative (RAI-A), are increasingly used to stratify surgical risk; however, their comparative utility in otology...OBJECTIVES: Frailty indices, including the modified frailty index (mFI-5) and the risk analysis index-administrative (RAI-A), are increasingly used to stratify surgical risk; however, their comparative utility in otology/neurotology remains understudied. This study compares the predictive performance of RAI-A versus mFI-5 for postoperative outcomes in a large otologic and lateral skull base cohort. METHODS: A retrospective analysis of 2862 otologic surgery patients was performed. Primary outcomes included 30-day mortality, Clavien-Dindo (CD) complications, surgical site infection (SSI), nonhome discharge, and extended length of stay (eLOS). Frailty was assessed using validated indices, and predictive performance was evaluated using multivariate logistic regression and ROC curves. RESULTS: Across the full cohort, RAI-A demonstrated superior discrimination (C-statistic) compared to mFI-5 for mortality (0.809 vs. 0.722, p = 0.021), CD II complications (0.793 vs. 0.788, p = 0.048), and SSI (0.721 vs. 0.712, p = 0.047). On multivariable analysis, RAI-A was significantly associated with CD II (OR 7.545; CI 2.367-24.048), CD IIIb (OR 17.925; CI 1.641-195.753), and eLOS (OR 40.623; CI 4.966-336.395). In the skull base subset, RAI-A was associated with higher odds of mortality (OR 14.47, 95% CI 3.02-69.31), serious complications (CD IV; OR 3.56, 95% CI 1.36-9.31), and nonhome discharge (OR 18.20, 95% CI 6.35-52.17). CONCLUSION: RAI-A outperforms mFI-5 in predicting postoperative outcomes in otologic surgery, with similar findings for high-risk lateral skull base cases. These findings support incorporating RAI-based frailty assessment into preoperative planning to improve risk stratification and patient counseling.
OBJECTIVES: To characterize the structure, resources, and educational practices of temporal bone laboratory training across ACGME-accredited U.S. otolaryngology residency programs. METHODS: A national cross-sectional sur...OBJECTIVES: To characterize the structure, resources, and educational practices of temporal bone laboratory training across ACGME-accredited U.S. otolaryngology residency programs. METHODS: A national cross-sectional survey was distributed to program directors and faculty responsible for temporal bone education. Survey domains included curriculum structure, training frequency, faculty involvement, assessment practices, and access to laboratory resources. Descriptive statistics and univariable regression analyses were performed to explore associations between program characteristics and neurotology fellowship pursuit. RESULTS: Thirty-seven programs responded (28.2%). Laboratory structure varied widely, including longitudinal (monthly or weekly) and condensed (annual or 2-3 courses/year) formats. Programs with longitudinal sessions reported more annual lab hours than condensed formats (median 42 vs. 16 h/year, p = 0.003). All programs had access to cadaveric temporal bones (mean 2.25 ± 1.13 bones per resident/year), though five reported fewer bones than residents. The mean drill-to-resident ratio was 0.59, with 10.8% reporting a 1:1 ratio. Formal performance evaluation was used by 43.2% of programs. On exploratory univariable analysis, longer otology rotation duration was associated with having at least one neurotology fellow within five years (p = 0.025). Larger resident cohort size (p = 0.048) and older laboratory instruments (p = 0.043) were associated with producing more than one fellow. CONCLUSION: There is substantial variability in temporal bone education across U.S. otolaryngology training programs. Programs differ in curricula, resources, and access to cadaveric and simulation-based training. Standardization of core components may improve educational equity and training consistency. LEVEL OF EVIDENCE: N/A.
OBJECTIVE: Pharyngolaryngeal venous malformations (VMs) can cause airway obstruction and bleeding. This study evaluates the effectiveness of suture ligation combined with sclerotherapy for VM management. METHODS: We retr...OBJECTIVE: Pharyngolaryngeal venous malformations (VMs) can cause airway obstruction and bleeding. This study evaluates the effectiveness of suture ligation combined with sclerotherapy for VM management. METHODS: We retrospectively analyzed 53 patients with pharyngolaryngeal VMs treated between January 2017 and September 2024. Preoperative evaluation included fibreoptic laryngoscopy and imaging. Suture ligation aimed to transfix and obstruct the VM, followed by intralesional bleomycin injection. RESULTS: The study included 23 males and 30 females (mean age 50.19 years). Most cases (71.7%) were solitary lesions. A single procedure achieved complete VM resolution in 79.25% of patients, with only one case showing minimal (less than 50%) reduction. Reoperation achieved complete regression in an additional 16.98% (nine cases). No prophylactic or emergent tracheostomy was necessary. One patient had a pre-existing tracheostomy. No serious postoperative complications occurred. CONCLUSION: Suture ligation combined with sclerotherapy offers a safe, minimally invasive, and effective approach for treating pharyngolaryngeal VMs. This technique achieves high success rates with minimal complications, promoting patient satisfaction.
OBJECTIVE: To evaluate temporalis muscle transfer (TMT) in restoring smile and eyelid outcomes in patients with facial nerve paralysis (FNP), emphasizing surgical techniques and clinician-graded outcomes. DATA SOURCES: M...OBJECTIVE: To evaluate temporalis muscle transfer (TMT) in restoring smile and eyelid outcomes in patients with facial nerve paralysis (FNP), emphasizing surgical techniques and clinician-graded outcomes. DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), CINAHL, and Web of Science were searched from inception to December 19, 2025. REVIEW METHODS: Two independent reviewers completed screening and data extraction. Planned primary outcomes included reduction in smile asymmetry, improvement in oral commissure displacement, and reduction in lagophthalmos, assessed using objective measurements or clinician-graded outcome scales. Secondary outcomes were surgical techniques and complications. Risk of bias was assessed using the Joanna Briggs Institute Checklist and the Newcastle-Ottawa Scale. This review protocol was not registered on PROSPERO. RESULTS: Fifty-three studies (n = 1354) were included. Temporalis muscle transfer significantly reduced smile asymmetry (mean difference [MD]: 9.61 mm; 95% CI 7.16-12.06), improved oral commissure displacement (MD: 7.30 mm; 95% CI 5.92-8.68), and reduced lagophthalmos (MD: 5.62 mm; 95% CI 4.71-6.53). Orthodromic temporalis transfer with multi-point fixation was the most common surgical technique in 31 studies, with the emergence of minimally invasive, intra-oral approaches in recent literature. A balanced smile was achieved in 71% of cases and complete eyelid closure in 56%. Complications (n = 161) included infections, hematomas, flap issues, and aesthetic deformities. CONCLUSIONS: TMT can provide dual eyelid and smile improvement in a single-stage procedure. As the surgical landscape continues to evolve, future research should standardize clinician graded outcome measures and assess long-term results to improve patient-centered care.
OBJECTIVE: Nasopharyngeal carcinoma carries a significant health burden in Asia, with incidence reaching up to 25 per 100,000. Post-radiotherapy otitis media with effusion develops in 32.4% of NPC patients, representing...OBJECTIVE: Nasopharyngeal carcinoma carries a significant health burden in Asia, with incidence reaching up to 25 per 100,000. Post-radiotherapy otitis media with effusion develops in 32.4% of NPC patients, representing the most frequent otologic toxicity. This meta-analysis provides the first quantitative synthesis of post-radiotherapy OME risk in NPC patients with technique-specific estimates for clinical decision-making. DATA SOURCES: PubMed, Embase, and Cochrane Library were searched from inception through April 23, 2025, using controlled vocabulary terms related to nasopharyngeal carcinoma, radiotherapy modalities, and otitis media with effusion. Additional articles were identified through reference screening. REVIEW METHODS: Observational studies published as full-length English articles reporting OME development in NPC patients following radiotherapy were included. The Newcastle-Ottawa Scale assessed bias. Random-effects modeling with risk difference (RD) as the effect measure was used, with Hartung-Knapp adjustment applied to mitigate small-study effects. Findings were reported per PRISMA guidelines. RESULTS: Eight studies comprising 10 cohorts (582 patients, mean age 50.4 years) were included. Among all NPC patients undergoing radiotherapy (n = 962), the overall RD was 0.08 (95% CI: 0.01-0.15, p = 0.0078). For OME-naïve patients, the relative risk of acquiring OME post-RT was 0.18 (95% CI: -0.06 to 0.42, p < 0.0001). Technique-specific analysis revealed conventional two-dimensional radiotherapy (2D-RT) risk of 0.18 (95% CI: -0.24 to 0.60), three-dimensional conformal radiotherapy (3D-CRT) risk of 0.18 (95% CI: -0.13 to 0.49), and intensity-modulated radiotherapy (IMRT) risk of 0.19 (95% CI: 0.01-0.27). Chemotherapy exposure and NPC stage showed no significant association. CONCLUSION: Radiotherapy significantly increases OME risk in NPC patients with marked technique-specific variation, enabling personalized counseling and evidence-based surveillance protocol development. TRIAL REGISTRATION: CRD420251012963.
Zhang D, Brucchi F, Colombo C
… +2 more, Cirocchi R, Dionigi G
Laryngoscope
· 2026 Jul · PMID 41917688
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OBJECTIVE: To compare the cost-utility of major intraoperative neuromonitoring (IONM) strategies in thyroidectomy across commercial platforms, and to quantify the impact of continuous IONM (CIONM), automated nerve trend...OBJECTIVE: To compare the cost-utility of major intraoperative neuromonitoring (IONM) strategies in thyroidectomy across commercial platforms, and to quantify the impact of continuous IONM (CIONM), automated nerve trend monitoring, postoperative laryngoscopy policy, and technical failure on total episode costs and medicolegal burden. METHODS: A decision-analytic cost-utility model of 6000 thyroidectomies was developed using full pathway micro-costing and QALY outcomes. Strategies included visual identification, intermittent IONM, CIONM, needle-based IONM, and automated EMG trend monitoring, evaluated in low- and high-utilization settings and stratified by manufacturer. The model incorporated RLN injury costs, routine versus EMG-guided selective laryngoscopy, and modality-specific technical failure rates. RESULTS: Higher neuromonitoring utilization substantially reduced monitoring costs (€420 to €260 per case), with routine CIONM achieving the lowest values (~€240). Intermittent IONM and CIONM lowered permanent/transient RLN palsy rates from 2.0%/6.0% (visual identification) to 1.2%/4.0% and 0.8%/3.0%, reducing RLN-related costs from €650 to €430 and €310 per case. Total per-case costs were €4400 (no monitoring), €4250 (intermittent), and €4100 (CIONM), with CIONM remaining cost-effective (ICER ≈€8000). Selective EMG-guided laryngoscopy reduced laryngoscopy costs by up to 65% and improved ICERs. Technical failures increased costs by €90-€110 per case but were mitigable. Manufacturer analyses showed similar per-case costs (€250-€310) in high-utilization settings. CONCLUSION: Routine CIONM in high-volume centres is the most economically favorable strategy, yielding substantial savings and ICERs within accepted thresholds. Selective EMG-guided laryngoscopy and minimizing technical failures further enhance cost-utility. Automated trend-monitoring platforms offer a pragmatic, near-equivalent alternative where full CIONM deployment is limited.
Haase C, Håkansson KEJ, Schwarz P
… +5 more, Aanæs K, Tidemandsen J, Ulrik CS, Esbensen BA, Backer V
Laryngoscope
· 2026 Mar · PMID 41916727
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OBJECTIVE: To investigate cumulative corticosteroid (CC) burden in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with or without coexisting asthma (global airway disease, GAD), referred for biologic tr...OBJECTIVE: To investigate cumulative corticosteroid (CC) burden in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), with or without coexisting asthma (global airway disease, GAD), referred for biologic treatment, and to assess the prevalence of CC-related comorbidities, including secondary adrenal insufficiency, osteopenia and/or osteoporosis. METHODS: Prospective cohort study of adults with chronic rhinosinusitis with nasal polyps and/or GAD referred to tertiary care for biologic treatment evaluation: Assessments included DXA scan, corticosteroid case history, Synacthen test, and analyses of cumulative CS exposure (systemic [SCS], inhaled [ICS], and nasal [NCS]) using prescription data. RESULTS: Of 90 referred patients, 87 (97%) had complete data set and were included in the final cohort. The prevalence of Type 2 diabetes was significantly higher among patients with CRSwNP only compared with GAD (26% vs. 4%, p = 0.019), whereas subclinical adrenal suppression was detected only in the GAD group (6%, 4/70). Rates of osteopenia or osteoporosis were comparable (47% vs. 43%). Higher CC exposure was associated with lower bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip (all p < 0.02). Notably, these rates are considerably higher than those reported for the general Danish population aged ≥ 50 years, in which approximately 21.1% of women and 6.5% of men are estimated to have osteoporosis. CONCLUSION: Patients with CRSwNP and GAD had a substantial CC burden from combined systemic, inhaled, and nasal steroid use. This was associated with subclinical adrenal suppression and reduced BMD, while Type 2 diabetes was more prevalent in patients only with CRSwNP.
Herzog A, Patel I, Leyden K
… +3 more, Preece J, Lahey S, Gildener-Leapman N
Laryngoscope
· 2026 Mar · PMID 41914725
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OBJECTIVES: Surgery is the definitive treatment for most thyroid cancers. However, anaplastic thyroid carcinoma (ATC) and other undifferentiated thyroid cancers are often unresectable and carry high mortality. Case repor...OBJECTIVES: Surgery is the definitive treatment for most thyroid cancers. However, anaplastic thyroid carcinoma (ATC) and other undifferentiated thyroid cancers are often unresectable and carry high mortality. Case reports and series have described neoadjuvant therapies, including chemotherapy, targeted therapy, radiation, and radioactive iodine, to improve resectability. This review evaluates the efficacy and safety of neoadjuvant therapy in unresectable thyroid cancers. DATA SOURCES: PubMed, Embase, and Web of Science. REVIEW METHODS: A comprehensive literature search was performed through August 2025 following PRISMA-ScR guidelines. English-language studies reporting patient-specific data on thyroid cancer diagnosis and neoadjuvant treatment were included. Using Covidence, patient demographics, neoadjuvant therapies, surgical interventions, and outcomes were extracted from 87 studies following inclusion and exclusion criteria. RESULTS: Individual patient data were available for 122 patients from 61 studies. The most common cancers were papillary thyroid carcinoma (PTC), ATC, and differentiated thyroid carcinoma (DTC). The median age was 61 years, 54% female. TNM staging was 68% T4, 69% N1, and 51% M0. Frequent mutations included BRAFV600E (N = 31), RET (N = 18), TERT (N = 12), and TP53 (N = 12). Lenvatinib (N = 46) and dabrafenib and trametinib (N = 26) were the most used. Total thyroidectomy occurred in 53% of patients. Post-neoadjuvant therapy outcomes included partial response (64%) and complete response (10%), with subsequent R0 (N = 62), R1 (N = 38), and R2 (N = 10) surgical resections. CONCLUSION: Neoadjuvant therapy shows promise in improving resectability for unresectable and poorly differentiated thyroid cancers, with 51% of patients achieving R0 resection. Future studies should investigate optimal therapy selection, timing, dosing, and long-term outcomes, including disease-specific survival and patient-reported measures. LEVEL OF EVIDENCE: NA.
Laryngoscope
· 2026 Mar · PMID 41910336
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OBJECTIVES: The human startle response is a generalized flexion response elicited by an unexpected stimulus, whether auditory, somatosensory, vestibular, or visual in nature. This is the first report of a laryngeal compo...OBJECTIVES: The human startle response is a generalized flexion response elicited by an unexpected stimulus, whether auditory, somatosensory, vestibular, or visual in nature. This is the first report of a laryngeal component to the human auditory startle response, termed the laryngeal auditory startle reflex (LASR). METHODS: Case series of seven subjects (five females, two males; mean age 41 ± 12 years). Intralaryngeal hook wire electrodes were inserted specifically into the lateral cricoarytenoid (LCA) muscles to collect electromyographic (EMG) data. Surface EMG data were collected from masseter, mentalis, orbicularis oculi, sternomastoid, strap musculature, and abductor pollicis brevis. A sudden, loud auditory stimulus was time-locked with EMG recording equipment. RESULTS: Activation of LCA muscles in response to the auditory stimulus was obtained in all subjects. Mean laryngeal response latency was 56 ms versus 61 ms for the sternocleidomastoid. Amplitude and duration varied across all muscles. All subjects displayed LASR habituation over time. Distraction techniques enhanced the startle reflex in all groups. One subject exhibited distinct early and late laryngeal components, with the late component occurring at 97 ms. CONCLUSION: The human larynx exhibits an adductor startle reflex response to auditory stimuli, which is modulated by central pathways. This laryngeal behavior may serve various purposes depending on developmental age and may contribute to diseases involving inappropriate and prolonged laryngeal adduction. LEVEL OF EVIDENCE: N/A.
Tschopp S, Meinert F, Mantokoudis G
… +2 more, Caversaccio M, Borner U
Laryngoscope
· 2026 Mar · PMID 41906272
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OBJECTIVE: To compare patient-reported outcome measures (PROMs) across different palatopharyngeal surgical modifications without tonsillectomy for snoring and obstructive sleep apnea (OSA). DATA SOURCES: MEDLINE, Embase,...OBJECTIVE: To compare patient-reported outcome measures (PROMs) across different palatopharyngeal surgical modifications without tonsillectomy for snoring and obstructive sleep apnea (OSA). DATA SOURCES: MEDLINE, Embase, Web of Science, ClinicalTrials, CINAHL, Cochrane Library, ICTRP. REVIEW METHODS: We conducted a systematic review and meta-analysis, including original studies of adult patients undergoing palatopharyngeal surgery without tonsillectomy for snoring and OSA. To reduce confounding, we excluded tonsillectomy, as tonsil size is a major predictor of outcome. Primary PROMs included changes in daytime sleepiness, as measured by the Epworth Sleepiness Scale (ESS), and snoring intensity, assessed on a visual analog scale, analyzed by surgical technique using random-effects models. RESULTS: Fifty-five studies with 1815 patients were included. Overall, palatopharyngeal surgery without tonsillectomy reduced ESS by a mean of 3.3 points (95% CI, 2.7 to 3.9) and snoring intensity by 4.1 points (95% CI, 3.7 to 4.6). Among surgical techniques, suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and powered instruments showed the largest reductions in both daytime sleepiness and snoring. Meta-regression analyses showed no evidence for declining treatment effectiveness with longer follow-up durations for both PROMs. Heterogeneity across studies was considerable, with a moderate overall risk of bias. CONCLUSION: Palatopharyngeal surgery without tonsillectomy effectively improves patient-reported daytime sleepiness and snoring intensity, with outcomes varying by surgical techniques. Suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and the use of powered instruments appear to be most effective in improving PROMs. These results inform surgical planning and counseling in patients seeking surgical treatment for snoring and daytime sleepiness. TRIAL REGISTRATION:PROSPERO: CRD42024559063.
Platukus A, Kaki P, Kaffenes A
… +7 more, Tippabhatla U, Robinson J, Kim J, Creighton E, Crippen M, Boon M, Huntley C
Laryngoscope
· 2026 Mar · PMID 41906254
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OBJECTIVES: To establish how celecoxib use after tonsillectomy and adenoidectomy (T&A) and modified uvulopalatopharyngoplasty (UPPP) affect pain scores and opioid consumption. METHODS: Patients undergoing T&A or UPPP wit...OBJECTIVES: To establish how celecoxib use after tonsillectomy and adenoidectomy (T&A) and modified uvulopalatopharyngoplasty (UPPP) affect pain scores and opioid consumption. METHODS: Patients undergoing T&A or UPPP with tonsillectomy (May-October 2024) completed surveys on postoperative days (POD) 0, 1, 5, and 10 to assess pain scores and opioid use. All patients received a multimodal pain regimen, and cohorts were based on the prescription of celecoxib. The noncelecoxib cohort was a historical control group obtained via study data from Butkus et al. (December 2020-January 2023). Wilcoxon rank-sum and chi-squared tests were performed using R Studio. RESULTS: Eighty patients were included (mean 33.0 years [SD = 12]), 66% female; 34% male; 55% Caucasian. The celecoxib cohort (N = 38) consumed an average of 66.2 mL (SD = 62.1) of opioids, and the non-celecoxib cohort (N = 42) received an average of 118.4 mL (SD = 91.6) (p = 0.021). There were no significant differences in pain scores reported on POD 1, 5, or 10 (p = 0.5, p = 0.2, p = 0.6, respectively). CONCLUSION: The addition of postoperative celecoxib resulted in a significant decrease in mean opioid consumption. Our data also demonstrate that postoperative pain was controlled similarly based on patient reported pain scores, regardless of celecoxib consumption. Further investigation is warranted with larger sample sizes to determine the efficacy of postoperative celecoxib use.
Pearlman AN, Chung S, Caplan IF
… +1 more, de Mille P
Laryngoscope
· 2026 Mar · PMID 41906250
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OBJECTIVES: We seek to examine the effects of septoplasty with inferior turbinate reduction (ITR) on objective measurements of exercise physiology and how they may correlate with subjective measures such as patient-perce...OBJECTIVES: We seek to examine the effects of septoplasty with inferior turbinate reduction (ITR) on objective measurements of exercise physiology and how they may correlate with subjective measures such as patient-perceived improvement and disease-specific quality of life (DSQOL). METHODS: Thirteen subjects with deviated nasal septum and inferior turbinate hypertrophy limiting exercise tolerance underwent pre and 3-month postoperative exercise testing. Measurements included heart rate (HR), tidal volume (V), maximum oxygen consumption relative to body weight (VO), lactate, and rating of perceived exertion (RPE), and peak nasal inspiratory flow (PNIF) testing, in addition to two validated surveys including the NOSE instrument and SNOT-22 questionnaire. RESULTS: The population included 54% women with an average age of 33.8 years. Postoperative improvement was shown in PNIF (99.6 vs. 146.7 L/min, p = 0.002) NOSE scale (13.2 vs. 2.1, p < 0.001), total SNOT-22 score (29.1 vs. 11.4, p = 0.003), and subjective improvement at Stages 3, 4, and 6 of exercise testing. There was improvement at Stage 6 in HR (177.3 vs. 171.7 bpm, p = 0.046) and lactate (lactate 5.84 vs. 4.71 mmol/L, p = 0.004). There was no change in relative VO or V. CONCLUSION: This is the first study to directly assess the role of septoplasty/ITR in relation to exercise performance. Participants did not show improvement in cardiovascular fitness but did have subjective improvements in performance and DSQOL. These findings support the effectiveness of septoplasty/ITR in improving tolerance to exercise independent of cardiovascular fitness level.
Turri-Zanoni M, Schiavo G, Valentini M
… +4 more, Presta A, Russo F, Vinciguerra A, Battaglia P
Laryngoscope
· 2026 Mar · PMID 41895813
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This technical note introduces a novel endoscopic strategy that integrates a laterally based endonasal mucosal flap with a bioabsorbable steroid-eluting implant to prevent restenosis following revision of Draf type III f...This technical note introduces a novel endoscopic strategy that integrates a laterally based endonasal mucosal flap with a bioabsorbable steroid-eluting implant to prevent restenosis following revision of Draf type III frontal sinus surgery. The vascularized flap is stabilized and maintained in close apposition to the underlying bone by a self-expanding bioabsorbable stent, which simultaneously provides sustained local corticosteroid delivery to reduce postoperative inflammation. By combining mechanical stabilization with targeted anti-inflammatory therapy, this technique represents a potentially innovative solution to promote mucosalization and maintain patency of the frontal neo-ostium in complex revision cases.
Laryngoscope
· 2026 Mar · PMID 41887935
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OBJECTIVE: The purpose of this study is to use optical coherence tomography (OCT) to characterize the effect of dehydration on the optical attenuation coefficient of porcine vocal fold (VF) tissue. Assessing laryngeal hy...OBJECTIVE: The purpose of this study is to use optical coherence tomography (OCT) to characterize the effect of dehydration on the optical attenuation coefficient of porcine vocal fold (VF) tissue. Assessing laryngeal hydration is clinically relevant for evaluating vocal function; however, no reliable noninvasive methods currently exist to quantify it. METHODS: Six porcine larynges were bisected into 12 halves, yielding 12 VFs. Each specimen underwent serial dehydration using a vacuum oven to approximately 5%, 10%, and 15% mass loss, with OCT scans obtained at each interval using a 1300 nm wavelength system. Attenuation coefficients were extracted from OCT B-scans through custom MATLAB processing, and the relationship between tissue dehydration and attenuation was modeled using a linear mixed-effects model. RESULTS: Across VFs, attenuation decreased by approximately 0.08 mm for each 1% increase in tissue mass loss (b = -0.079, 95% CI [-0.105, -0.054]). Attenuation decreased linearly with increasing tissue dehydration. The true VF exhibited consistently higher attenuation values than the false folds by an average of 1.47 mm (p < 0.001). Interfold variability was low (ICC = 0.041), indicating strong reproducibility across specimens. CONCLUSIONS: OCT-derived attenuation provides a quantitative, reproducible indicator of VF dehydration. The linear relationship between attenuation and tissue mass loss supports the feasibility of OCT as a noninvasive optical biomarker of VF hydration. Future multi-wavelength and in vivo studies will be critical to translate this approach into clinical monitoring of VF hydration, edema, and lesion formation. LEVEL OF EVIDENCE: NA.