Laryngoscope [JOURNAL]
Sun
200 papers
Characterizing a Department's Transition to Intracapsular Tonsillectomy: A Mixed Methods Analysis.
Ling E, Giroux K, Sher AC … +18 more , Pingree G, Maynard J, Komara M, Kistler I, Vanek A, Gach A, Meyer W, Adamson T, Quillin K, Demian N, Galavotti C, Koppera S, Walz P, Jatana K, Grischkan J, Elmaraghy C, Pattisapu P, Chiang T
Laryngoscope · 2026 Jun · PMID 42290630 · Publisher ↗
OBJECTIVES: Despite many reports of reduced postoperative complications and equivalent long-term outcomes compared to total tonsillectomy (TT), there is still limited adoption of intracapsular tonsillectomy (IT). Changin...
OBJECTIVES: Despite many reports of reduced postoperative complications and equivalent long-term outcomes compared to total tonsillectomy (TT), there is still limited adoption of intracapsular tonsillectomy (IT). Changing surgical techniques can be challenging, particularly for common procedures that already have good outcomes. To examine the barriers to adopting IT, we performed a mixed methods study of an otolaryngology department's transition from TT to IT, describing the timeline, postoperative outcomes, and surgeon-specific motivators. METHODS: We used an explanatory sequential mixed methods model. Demographic and surgical data for all pediatric patients undergoing tonsillectomy between January 1, 2017 and December 31, 2022 at a single institution were included. Charts of patients who returned to the hospital within 30 days of tonsillectomy were reviewed. We then conducted semi-structured interviews to qualitatively evaluate surgeon-specific motivators for transitioning to IT. RESULTS: Over 6 years, 13,899 patients who underwent tonsillectomy met inclusion. The proportion of IT increased from 2.3% in 2017 to 80.8% in 2022. While 10% (n = 994) of TT patients returned to the ED within 30 days of tonsillectomy, only 3.1% (n = 133) of IT patients returned. Five themes were identified in the qualitative analysis, grouped into two motivating factors (Data Transparency and Individual Surgeon Experience) and three transition concerns (Interaction with Patient Families, Training and Skill Acquisition, and Impact on Partners). CONCLUSION: We define the prominent agents of surgical change for IT. Transition to newer, safer techniques is scalable in the setting of departmental data transparency and a culture that promotes best outcomes.
Electrophysiological Monitoring of Multifurcated Recurrent Laryngeal Nerve With Motor Multibranches.
Gurleyik E
Laryngoscope · 2026 Jun · PMID 42287099 · Publisher ↗
Extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) is common anatomical variation, but the multifurcation of the RLN with more than three branches is quite rare. Intraoperative neuromonitoring evaluating f...
Extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) is common anatomical variation, but the multifurcation of the RLN with more than three branches is quite rare. Intraoperative neuromonitoring evaluating functional status of the nerve branches shows that the branched RLN may have functional variation. Identification and electrophysiological monitoring of the RLN can localize motor fibers within nerve branches and help preserve motor function.
Multifocal Laryngotracheal Rosai-Dorfman Disease: 48-Month Remission After Surgical Resection.
Li R, Yan S, Ni L … +1 more , Xia S
Laryngoscope · 2026 Jun · PMID 42287066 · Publisher ↗
A rare case of multifocal subglottic-tracheal Rosai-Dorfman disease (RDD) achieved sustained 48-month remission through surgical resection alone, without adjuvant therapy. This outcome suggests that surgery alone may ser...
A rare case of multifocal subglottic-tracheal Rosai-Dorfman disease (RDD) achieved sustained 48-month remission through surgical resection alone, without adjuvant therapy. This outcome suggests that surgery alone may serve as a viable alternative for select cases of multifocal airway RDD characterized by completely resectable lesions, no systemic involvement, and favorable anatomical accessibility.
Robotic-Assisted Electrode Insertion for Pediatric Cochlear Implantation: A Multicenter Study.
Lindquist NR, Holbert LC, Dunn CC … +12 more , Fiorentino K, Gantz BJ, Gastal S, Isaacson B, Kwon S, Kutz JW, Lee K, Sagarang K, Sweeney M, Traboulsi H, Vilela RJ, Claussen AD
Laryngoscope · 2026 Jun · PMID 42285778 · Publisher ↗
OBJECTIVE: To evaluate the safety and use of a robotic-assisted electrode insertion system for cochlear implantation in pediatric patients aged 4 to 12 years. METHODS: Fourteen pediatric patients (ages 4-12 years) underw...
OBJECTIVE: To evaluate the safety and use of a robotic-assisted electrode insertion system for cochlear implantation in pediatric patients aged 4 to 12 years. METHODS: Fourteen pediatric patients (ages 4-12 years) underwent unilateral cochlear implantation with robotic-assisted electrode array insertion in this prospective, non-randomized, multicenter study. The primary outcome was the incidence of device-related serious adverse events (SAEs) through 30 days after cochlear implant activation. Secondary outcomes included successful electrode insertion using the robotic-assisted system, insertion time and speed, and evaluation of electrode position. RESULTS: All 14 patients underwent successful robotic-assisted electrode insertion with no device-related serious adverse events through 30 days post-activation. Seven adverse events were reported, all non-device related and resolved without sequelae. Surgeons reported successful device setup, use, and detachment in 93% of cases. Anatomic considerations unique to pediatric cases-such as smaller mastoid cavities and thinner cortex at the mounting site-were successfully managed with preoperative planning and intraoperative modifications. CONCLUSIONS: Robotic-assisted cochlear implant electrode insertion in children aged 4-12 years was safe across multiple centers, with high procedural success rates and no device-related SAEs. Awareness of unique pediatric anatomic constraints and technical adjustments can support safe device mounting and controlled insertion. Given the lifespan and potential for new or emerging technologies for the pediatric population, the potential of robotic assistance to reduce intracochlear trauma is an important consideration.
Association Between Prednisone and Delayed Facial Nerve Palsy After Acoustic Neuroma Resection.
Iqbal S, Illahi S, Genel O … +3 more , Suresh K, Schwartz MS, Friedman RA
Laryngoscope · 2026 Jun · PMID 42283161 · Publisher ↗
OBJECTIVE: To evaluate whether discharge with a prednisone taper is associated with a reduced incidence of delayed facial nerve palsy (DFP) following acoustic neuroma resection. METHODS: We conducted a retrospective weig...
OBJECTIVE: To evaluate whether discharge with a prednisone taper is associated with a reduced incidence of delayed facial nerve palsy (DFP) following acoustic neuroma resection. METHODS: We conducted a retrospective weighted case-control study of patients undergoing acoustic neuroma resection via middle fossa, retrosigmoid, or translabyrinthine approaches. Inclusion was restricted to patients with normal facial nerve function (House-Brackmann grade I) preoperatively and at discharge. Cases were patients who developed DFP after discharge, defined as new-onset House-Brackmann grade ≥ II occurring ≥ 72 h postoperatively. Controls were patients without DFP from the same source population. The primary exposure was discharge with a standardized oral prednisone taper (60 mg daily for 9 days followed by a 10 mg/day taper). Inverse probability weighting (IPW) based on propensity scores was used to adjust for confounding by indication. Weighted logistic regression was performed to estimate the association between prednisone taper and DFP. RESULTS: The study included 74 cases and 187 controls. Steroid taper was prescribed to 44.6% of cases and 51.3% of controls. In unadjusted analysis, prednisone taper was not associated with a reduction in DFP risk. After IPW adjustment, prednisone taper was not associated with DFP (OR 0.99, 95% CI: 0.48-2.07). Covariate balance was achieved after weighting (SMD < 0.1). Steroid attributable side effects were documented in 10% of treated patients. CONCLUSION: Discharge with a prednisone taper was not associated with a reduced incidence of delayed facial nerve palsy following acoustic neuroma resection. These findings do not support prophylactic corticosteroid use for prevention of DFP.
Improving Measurement Efficiency of the Cough Severity Index With Item Response Theory.
DeVore EK, Carroll TL, Dwyer CD … +7 more , Stanlie A, Pérez MLG, Alkhatib S, Rosen CA, Bellmunt AM, Wee J, Shin JJ
Laryngoscope · 2026 Jun · PMID 42283152 · Publisher ↗
OBJECTIVE: The larynx is central to voice, breathing, swallowing, and cough-such that routinely tracking related outcomes can introduce burden. Within these assessments, the Cough Severity Index (CSI) is frequently deplo...
OBJECTIVE: The larynx is central to voice, breathing, swallowing, and cough-such that routinely tracking related outcomes can introduce burden. Within these assessments, the Cough Severity Index (CSI) is frequently deployed. We thus utilized item response theory (IRT) to determine: (1) which items confer the most information, (2) if proposed 5-item scales yield substantially differing discrimination and location parameters, compared to the 10-item instrument, and (3) whether a subset of items has more favorable characteristics as an initial assessment (i.e., for whether all 10 items are needed). METHODS: Item discrimination, location, and information parameters were calculated from 4240 consecutive CSI responses. Based on these data, 5-item subsets were proposed, evaluated, and compared with each other and the 10-item instrument via information function curves and receiver-operator characteristic (ROC) analyses. Performance of 5-item mean scores < 1 as a potential initial assessment for the full results was also assessed. RESULTS: Discrimination parameters ranged from 0.65-2.76, with the greatest discrimination in items about embarrassment or avoiding places due to cough. These data, along with residual item correlations and location parameters, delineated a 5-item subset, which also incorporated cough when lying down, affecting voice, and upset by cough for comparative analysis. ROC-AUCs revealed no difference between the 5-item subset and parent 10-item instrument in ability to discriminate cough-specific clinical diagnoses. One 5-item subset performed better as an initial assessment (mean 4.9, 95% CI 4.7-5.2). CONCLUSION: IRT data identified a 5-item CSI subset which reflects the cough trait and provides an initial efficient assessment mechanism.
Antigen Removal Approach to Murine Larynx Engineering Optimizes Extracellular Matrix Preservation.
Hardy EG, Myers CE, Richards AM … +4 more , Yeleswarapu S, Skinner J, Griffiths L, Lott DG
Laryngoscope · 2026 Jun · PMID 42283142 · Publisher ↗
OBJECTIVE: To compare antigen removal processing with conventional sodium dodecyl sulfate decellularization for generating laryngotracheoesophageal scaffolds, focusing on preservation of extracellular matrix integrity an...
OBJECTIVE: To compare antigen removal processing with conventional sodium dodecyl sulfate decellularization for generating laryngotracheoesophageal scaffolds, focusing on preservation of extracellular matrix integrity and removal of immunogenic material. METHODS: Laryngotracheoesophageal complexes were harvested from C57BL/6 mice and processed using either antigen removal or sodium dodecyl sulfate-based protocols. Scaffolds were analyzed for residual double-stranded DNA content, collagen preservation, glycosaminoglycan retention, and ultrastructural integrity via histology, quantitative image analysis, and scanning electron microscopy. RESULTS: Both antigen removal and sodium dodecyl sulfate protocols achieved effective decellularization, with comparable dsDNA removal relative to native controls (p = 0.001; p < 0.001). Antigen removal scaffolds demonstrated better collagen preservation compared to sodium dodecyl scaffolds, which exhibited marked collagen depletion (Muscle: Collagen I, p < 0.001; Collagen III, p < 0.01; Cartilage: Collagen I, p < 0.05; Collagen III, p < 0.01). Both antigen removal and sodium dodecyl sulfate groups showed significant glycosaminoglycan depletion compared with controls (p < 0.001). Scanning electron microscopy confirmed superior ultrastructural preservation in antigen removal-treated scaffolds, characterized by intact fibrillar architecture and lacunar morphology, while sodium dodecyl sulfate scaffolds demonstrated collapsed lacunae and irregular extracellular matrix organization. CONCLUSION: Antigen removal processing generates laryngotracheoesophageal scaffolds with enhanced extracellular matrix preservation compared with conventional sodium dodecyl sulfate decellularization, while maintaining equivalent levels of antigen elimination. Retention of collagen and ultrastructure suggests antigen removal scaffolds may provide superior biomechanical and biologic performance for laryngeal tissue engineering. Although glycosaminoglycan depletion remains a limitation in both approaches, antigen removal scaffolds represent a promising pathway toward clinically translatable alternatives to immunosuppression-dependent laryngotracheoesophageal repair. LEVEL OF EVIDENCE: Preclinical.
Rare But Risky: Clinical Impacts of Pneumothorax After Thyroidectomy and Parathyroidectomy.
Jishu JA, LaForteza A, Bruce D … +5 more , Riccio I, Liao M, Bashumeel YY, Kandil E, Shama MA
Laryngoscope · 2026 Jun · PMID 42283140 · Publisher ↗
OBJECTIVE: Postoperative pneumothorax (PPTX) after thyroidectomy (TD) or parathyroidectomy (PT) is rare and primarily described in case reports with limited data on its prognostic significance in large populations. We ai...
OBJECTIVE: Postoperative pneumothorax (PPTX) after thyroidectomy (TD) or parathyroidectomy (PT) is rare and primarily described in case reports with limited data on its prognostic significance in large populations. We aim to assess the incidence of PPTX and its association with clinical outcomes following TD or PT. METHODS: We queried the TriNetX United States Research Network, identifying patients ≥ 18 years of age who underwent open TD or PT between January 2000 and December 2025. Patients were separated by development of PTX within 7 days postoperatively. Outcomes were assessed at 3 and 6 months using odds ratios (ORs) and at 1 year using hazard ratios (HRs), with 95% confidence intervals (CIs). The primary outcome was all-cause mortality; secondary outcomes included risks for pneumonia, dysphagia, vocal cord paralysis, and need for mechanical ventilation as well as healthcare utilization rates. RESULTS: Among 228,340 patients undergoing surgery, 237 (0.10%) developed PPTX. At 1 year, PPTX was associated with increased risk of all-cause mortality (HR 16.44, 95% CI 11.16-24.23), pneumonia (HR 6.14, 95% CI 3.48-10.83), dysphagia (HR 4.86, 95% CI 3.23-7.33), vocal cord paralysis (HR 5.19, 95% CI 3.31-8.15), and need for mechanical ventilation (HR 18.13, 95% CI 10.89-30.17). PPTX was also associated with higher rates of hospital readmission (HR 15.12, 95% CI 11.97-19.10) and emergency room visits (HR 2.09, 95% CI 1.33-2.28) (all p < 0.01). All outcomes were also significant at 3 and 6 months after surgery. CONCLUSION: PPTX after TD or PT is exceedingly uncommon but associated with significantly worse mortality and morbidity.
Economic Impact of a Deep Learning Algorithm for Automated Head and Neck Surgery Referral Triage.
Younan S, Doan P, Xin K … +4 more , Jiam ML, Ha PK, Wai KC, Jiam NT
Laryngoscope · 2026 Jun · PMID 42277577 · Publisher ↗
OBJECTIVE: To quantify the comprehensive financial impact from implementing a deep learning algorithm for assistive patient triage within a high-volume Head and Neck Surgical Oncology center operating under a fee-for-ser...
OBJECTIVE: To quantify the comprehensive financial impact from implementing a deep learning algorithm for assistive patient triage within a high-volume Head and Neck Surgical Oncology center operating under a fee-for-service framework. METHODS: A prospective cost-benefit analysis compared a deep learning algorithm to standard manual triage on all incoming new patient referrals (n = 214) in one fiscal quarter (FY24 Q3). Financial impact was calculated using a model aggregating two economic components: (1) annualized labor displacement savings, and (2) revenue impact of reallocating verified non-indicated clinic slots to appropriate surgical candidates. RESULTS: Automated head and neck referral triage demonstrated a net annual operating gain of $535,989, yielding a 14.9× return on investment. Directly measured labor savings ($236,788.80; 5.6× ROI) represent the conservative estimate; capacity value is modeled, contingent on slot reallocation. The AI-assisted workflow displaces 1951.20 h of manual work (0.94 FTEs) annually per 6-provider division processing 30 referrals/week, and up to 351,936 h (169.20 FTEs) per hospital system. Furthermore, the algorithm's superior accuracy identified 80 verified recoverable clinic slots per year for the division; reallocating these to appropriate candidates generated an additional $6.2 million in downstream revenue. CONCLUSION: The integration of a deep learning algorithm for Head and Neck Surgical Oncology referral triage delivers substantial financial benefits through the dual mechanisms of direct reduction of administrative labor and the strategic optimization of clinical capacity. By identifying non-indicated referrals, the system allows for the reallocation of limited resources to patients requiring high-acuity surgical oncological care, offering a scalable model for financial sustainability. LEVEL OF EVIDENCE: NA.
Management of Auricular Hematoma With Bolster Versus Quilting: A Retrospective Cohort Study.
Cheng CF, Neevel A, Brenner MJ … +1 more , Rudy SF
Laryngoscope · 2026 Jun · PMID 42277574 · Publisher ↗
OBJECTIVE: Auricular hematomas commonly result from soft tissue trauma and require prompt drainage and pressure dressing to prevent recurrence and deformity. Both bolster and quilting suture techniques are used post-drai...
OBJECTIVE: Auricular hematomas commonly result from soft tissue trauma and require prompt drainage and pressure dressing to prevent recurrence and deformity. Both bolster and quilting suture techniques are used post-drainage, but direct comparisons are lacking. The objective of this study is to compare outcomes between bolster dressings and through-and-through mattress quilting sutures in the management of auricular hematomas. METHODS: A 15-year retrospective chart review was conducted for patients age > 10 years presenting to the Emergency Department with auricular hematoma. Exclusion criteria included developmental delay, anticoagulant use, infectious etiology, or subsequent diagnosis of relapsing polychondritis. Cases were analyzed for complications and recurrence. RESULTS: Forty-three patients met inclusion criteria (95% male; mean age 33 years). Thirty (73%) were managed with bolsters and 13 (27%) with quilting sutures. Recurrent hematoma occurred in 30% (9/30) of the bolster group and 0% (0/13) of the quilting group, including 11 primary cases and 2 salvage cases (p = 0.036). No significant differences were observed between the two groups in terms of complications (p = 1.0) or scarring (p = 0.29). CONCLUSIONS: Quilting suture technique had lower rates of recurrence compared to bolster dressings for auricular hematoma management. These findings support quilting as an acceptable option following hematoma drainage, with controlled studies necessary to determine comparative efficacy.
Hearing Preservation Rates After Cochlear Implantation Using Soft Surgery Techniques.
Huang TC, Lunos S
Laryngoscope · 2026 Jun · PMID 42273910 · Publisher ↗
OBJECTIVES: To determine if hearing preservation rates after cochlear implantation varied over time with soft surgery techniques. METHODS: The hearing preservation rate over time in adult cochlear implant patients over 1...
OBJECTIVES: To determine if hearing preservation rates after cochlear implantation varied over time with soft surgery techniques. METHODS: The hearing preservation rate over time in adult cochlear implant patients over 10 years was analyzed. The association between hearing preservation rate and sex, age, perioperative steroid dose, and type of electrode was analyzed. Low frequency hearing preservation was analyzed separately. RESULTS: There was no statistical difference with sex, age, or type of electrode. There was a statistically significant improvement in hearing preservation with a higher dose of perioperative steroid on univariate analysis (36.4% vs. 15%). There was a small but significant correlation (r = 0.22) between improved rate and later year of implantation. However, no statistically significant correlation was identified for any factor on multivariate analysis. Date of surgery and steroid dose were correlated and, when the correlation was modeled, there was still no correlation with hearing preservation. For low frequency hearing preservation, a higher dose of perioperative steroids and time were also found to be significant on univariate analysis (33% vs. 14.8%). Multivariate analysis did not show significance for any factor, but the date of surgery and steroid dose were noted to be correlated. Model based on the correlation showed that date of surgery and steroid dose were significantly correlated with hearing preservation (r = 0.21). CONCLUSIONS: There was a small but significant correlation between the hearing preservation rate over time with the use of soft surgery techniques including a significant difference with the use of a higher steroid dose.
Women Pioneers in Laryngology: The First Female Fellows of the American Laryngological Association.
Khoury CJ, Tai K, Drake AF … +5 more , Friedman EM, Garrett CG, Woodson G, Cunningham M, Rameau A
Laryngoscope · 2026 Jun · PMID 42272149 · Publisher ↗
OBJECTIVE: To identify the first women inducted into the American Laryngological Association (ALA), highlight their prolific careers, and explore their experiences as nationally celebrated female pioneers in laryngology....
OBJECTIVE: To identify the first women inducted into the American Laryngological Association (ALA), highlight their prolific careers, and explore their experiences as nationally celebrated female pioneers in laryngology. METHODS: ALA transaction records were reviewed to identify the first women elected as fellows. Virtual interviews were conducted with each featured surgeon except Dr. Joyce Schild (deceased), inquiring about experiences related to being early women in laryngology and nationally recognized pioneers. Additional primary sources included publications authored by the featured surgeons, Triological theses, news reports, podcast appearances, and research manuscripts. Secondary sources included published historical research about the featured women, including Dr. Schild's obituary. Materials were reviewed for contributions to research, innovation, mentorship, and leadership. RESULTS: The first five women inducted to the ALA were Drs. Joyce Schild (inducted in 1984), Gayle Woodson (1994), Ellen Friedman (1995), Amelia Drake (2002), and Gaelyn Garrett (2002). Although they encountered episodic gender bias, each emphasized the pivotal role of supportive male mentors who championed their professional advancement and underlined the importance of belonging to national societies. Despite the scarcity of female role models, these surgeons led prolific careers, becoming champions of female excellence in laryngology. CONCLUSION: The female pioneers of the ALA succeeded through personal dedication, impactful mentorship, and institutional support. While their individual qualities were undeniable, their advancement was strengthened by support from male colleagues' advocacy and the legitimizing platform of national societies. Through their Triological theses, these women contributed innovative scientific insights and established an inspiring precedent for generations of women laryngologists.
Rotational Chair vs. Manual Maneuvers for Non-Complex BPPV: A Prospective Randomized Study.
Chaure-Cordero M, Martin-Sanz E
Laryngoscope · 2026 Jun · PMID 42267460 · Publisher ↗
OBJECTIVE: To evaluate the clinical efficacy and diagnostic precision of the Thomas Richard Vitton (TRV) chair compared to conventional maneuvers in uncomplicated Benign Paroxysmal Positional Vertigo (BPPV), identifying...
OBJECTIVE: To evaluate the clinical efficacy and diagnostic precision of the Thomas Richard Vitton (TRV) chair compared to conventional maneuvers in uncomplicated Benign Paroxysmal Positional Vertigo (BPPV), identifying risk factors for recurrence and impact on quality of life. METHODS: A prospective, randomized, open-label study was conducted. 102 patients were assigned to TRV chair or manual maneuvers. Clinical resolution, number of maneuvers, and recurrences were monitored over a 12-month follow-up. Quality of life was assessed via dizziness handicap inventory (DHI) and visual analog scale (VAS). RESULTS: Eighty-nine patients completed follow-up (TRV = 44; manual = 45). No significant differences were found between groups in mean maneuvers for resolution (TRV: 2.25 ± 1.78; manual: 1.82 ± 1.23; p = 0.190). Both groups showed progressive reductions in DHI scores (TRV: 47.2 ± 25.1-10.6 ± 18.6; manual: 41.4 ± 22.2-11.6 ± 18.2; p < 0.001) and VAS scores (TRV: 5.3 ± 2.4-0.86 ± 1.4; manual: 4.3 ± 2.3-0.86 ± 1.4; p < 0.001), with no inter-group differences (p > 0.05). Notably, a trend toward faster resolution was observed in patients over 65 treated with the TRV chair. Advanced age and head trauma predicted increased maneuver requirements. Osteoporosis and prior BPPV episodes were associated with higher recurrence (p = 0.002). An inverse correlation was found between initial episode duration and time to first recurrence (ρ = -0.539, p = 0.005). CONCLUSION: For uncomplicated BPPV, mechanical rotational chairs offer comparable efficacy and quality-of-life improvement to manual maneuvers. While not statistically superior for the general population, the TRV chair is a valuable tool for patients with mobility constraints.
Idiopathic Subglottic Stenosis in Pregnancy: A Case-Control Study of Management and Maternal Safety.
Saeedi N, Lopez-Fay DC, Collins SL … +7 more , Motz KM, Malka RE, Chan-Li Y, Akst LM, Best SR, Bienstock JL, Hillel AT
Laryngoscope · 2026 Jun · PMID 42267438 · Publisher ↗
OBJECTIVE: To evaluate safety and clinical course in pregnant idiopathic subglottic stenosis (iSGS) patients and to identify variables associated with operative dilation requirement during pregnancy. BACKGROUND: Pregnanc...
OBJECTIVE: To evaluate safety and clinical course in pregnant idiopathic subglottic stenosis (iSGS) patients and to identify variables associated with operative dilation requirement during pregnancy. BACKGROUND: Pregnancy in patients with iSGS presents management challenges that may impact maternal and fetal health. Clinical studies and shared experiences are limited. METHODS: A retrospective chart review was conducted evaluating pregnant iSGS patients and an age-matched never pregnant iSGS control group. Pregnant patients were subcategorized based on whether they required surgery during pregnancy. The analyzed variables included demographics, inter-dilation intervals, time to first recurrence, intraoperative stenosis percent, and fetal and maternal safety. RESULTS: Thirty-three patients were included, 23 in the pregnancy group, and 10 in the control group. Thirteen patients required operative intervention during pregnancy. The mean age at iSGS diagnosis was 31.1 years. All pregnancies resulted in live births. No surgical or anesthesia-related complications were reported. Antinuclear antibody (ANA) positivity was more frequent in the surgical-intervention group compared to the nonintervention group (5/10 vs. 0, p < 0.05). The overall inter-dilation interval was longer in the pregnancy group compared to the control group (median: 70.9 vs. 39.6 weeks, p < 0.05) Average stenosis percentages in surgical dilations during and prior to pregnancy were comparable (60.4 ± 21.6 vs. 55.2 ± 27.8). CONCLUSION: Surgical management of iSGS patients is safe during pregnancy. Greater than 50% patients experienced exacerbation during pregnancy that required operative intervention. The only notable patient-specific factor associated with dilation during pregnancy was ANA positivity. There were no pregnancy-specific factors associated with the need for intervention.
Autologous Mastoid Cortex Bone Graft for Multilayer Repair of Lateral Skull Base Defects.
Wen CZ, Fong DC, Bzhilyanskaya V … +3 more , Kaufman AC, Hertzano R, Eisenman DJ
Laryngoscope · 2026 Jun · PMID 42265819 · Publisher ↗
Multilayer repair of lateral skull base cerebrospinal fluid leaks and encephaloceles can be reinforced with rigid autologous grafts. Harvesting a monocortical mastoid cortex bone graft is effective and easy to implement...
Multilayer repair of lateral skull base cerebrospinal fluid leaks and encephaloceles can be reinforced with rigid autologous grafts. Harvesting a monocortical mastoid cortex bone graft is effective and easy to implement without conferring additional morbidity.
Office-Based Blue Laser Therapy and Steroid Injection of Hemorrhagic and Nonhemorrhagic Vocal Fold Polyp.
Hamdan AL, Abou Raji Feghali P, Ghzayel L … +5 more , Lababidi G, Sarkis V, Hosri J, Alam E, Mourad M
Laryngoscope · 2026 Jun · PMID 42265571 · Publisher ↗
OBJECTIVE: To investigate the correlation between the morphology of vocal fold polyps, hemorrhagic versus nonhemorrhagic, and treatment outcome following office-based blue laser therapy with intralesional steroid injecti...
OBJECTIVE: To investigate the correlation between the morphology of vocal fold polyps, hemorrhagic versus nonhemorrhagic, and treatment outcome following office-based blue laser therapy with intralesional steroid injection. METHODS: All the medical records and video recordings of patients diagnosed with vocal fold polyps who underwent office-based blue laser therapy with intralesional steroid injection at a tertiary referral center between June 2023 and August 2025 were reviewed. Vocal fold polyps were classified as hemorrhagic versus nonhemorrhagic. The treatment outcome measures included the Voice Handicap Index-10 (VHI-10) score, acoustic parameters, maximum phonation time (MPT), and disease regression. The mean follow-up period was 12.79 ± 12.31 weeks. RESULTS: A total of 29 patients with vocal fold polyps were included in the study. Twenty-one patients had hemorrhagic polyps, while the remaining had nonhemorrhagic polyps. No significant differences in the demographic variables were noted between the two subgroups. The mean VHI-10 score in the hemorrhagic polyp subgroup decreased by 10.2 ± 6.76 points, compared to 6.33 ± 7.14 points in the nonhemorrhagic subgroup (p = 0.208). There was a significant difference in complete disease regression between the hemorrhagic and nonhemorrhagic subgroups (95.2% vs. 62.5% p = 0.022). No significant differences were observed in any of the acoustic parameters between the two subgroups except for jitter (p = 0.017). CONCLUSION: The results of this investigation indicate that hemorrhagic vocal fold polyps respond better to office-based blue laser therapy with intralesional steroid injection than nonhemorrhagic polyps.
Validity and Responsiveness of Chronic Rhinosinusitis Control Test Subdomains.
Sedaghat AR, Phillips KM
Laryngoscope · 2026 Jun · PMID 42260631 · Publisher ↗
OBJECTIVE: The chronic rhinosinusitis control test (CRCT) is a patient-reported outcome measure that measures, quantifies, and classifies CRS control. The CRCT has a sinonasal subdomain and an impairment subdomain. The o...
OBJECTIVE: The chronic rhinosinusitis control test (CRCT) is a patient-reported outcome measure that measures, quantifies, and classifies CRS control. The CRCT has a sinonasal subdomain and an impairment subdomain. The objective of this study is to psychometrically validate the CRCT subdomains. METHODS: A cohort of 701 adult CRS patients was recruited and completed a CRCT, as well as overall symptom severity (OSS), SNOT-22, and EQ-5D quality of life (QOL) questionnaires. A subset of participants completed these questionnaires at a second time point to establish responsiveness to change (N = 283). Psychometric validation was performed by establishing criterion validity and responsiveness for the CRCT subdomain scores in these CRS patients. Minimal clinically important difference (MCID) values for improvement/worsening were determined for the CRCT subdomain scores using distribution-based and anchor-based methods. RESULTS: The CRCT sinonasal and impairment subdomain scores significantly correlate with and are responsive to measures of CRS symptom severity (OSS), CRS-specific QOL (SNOT-22), and general QOL (EQ-5D). The CRCT sinonasal subdomain is more reflective of sinonasal symptom burden and has an MCID for improvement/worsening of ≥ 3 points, while the impairment subdomain is more reflective of general QOL and has an MCID for improvement/worsening of ≥ 1 point. CONCLUSIONS: The CRCT sinonasal and impairment subdomain scores may serve as psychometrically validated outcome measures that provide additional insights into a patient's CRS disease state and overall CRS control in addition to the CRCT score. MCID values for the CRCT subdomain scores may serve as benchmarks for judging change in the subdomain scores. LEVEL OF EVIDENCE: N/A.
Presbylarynx and Laryngeal Asymmetry as Predictors of Dysphonia in Patients 65 and Over.
Crawley BK, Vegar I, Dehom S … +2 more , Smith A, Krishna PD
Laryngoscope · 2026 Jun · PMID 42260323 · Publisher ↗
OBJECTIVES: Presbyphonia and presbylarynx are common in aging people. Presbylarynx and laryngeal asymmetry increase with age and are visible on videostroboscopy. The purpose of this study was to determine if findings of...
OBJECTIVES: Presbyphonia and presbylarynx are common in aging people. Presbylarynx and laryngeal asymmetry increase with age and are visible on videostroboscopy. The purpose of this study was to determine if findings of presbylarynx or overall laryngeal asymmetry could be linked with patient-reported dysphonia. METHODS: Two hundred exams of patients over 64 were included: 100 with and 100 without voice complaints. Their videostroboscopic exams were evaluated for presbylarynx and laryngeal asymmetry. RESULTS: Median age was 72 (65-95) and 127 (63.5%) were female. No videostroboscopic exam features distinguished the dysphonia patients from those without. The dysphonia group had a significantly higher VHI-10 (13 vs. 2) and lower BMI (26.5 vs. 28.3) than the non-dysphonia group but did not differ in age, gender, nor height. Gender, age, and height were associated with findings of presbylarynx but not with dysphonia. 146 (73%) had 3 findings of presbylarynx (bowing, vocal process prominence, and vocal process contact preceding midfold contact at adduction). 171 (85.5%) patients had overall laryngeal asymmetry, 166 (83%) had phase asymmetry, and 131 (65.5%) had asymmetric speed or range of motion of the vocal folds. Only 24 (12 in each group) displayed the triad of increased ventricular show, contralateral false vocal fold contraction, and interarytenoid cleft tilt consistent with possible neurogenic paresis. CONCLUSION: Neither presbylarynx nor laryngeal asymmetry was associated with dysphonia in patients age 65 and over. Pathologic presbyphonia remains a complaint without a universal distinguishing group of predictive features, complicating patient care and treatment.
In Reference to Adjunctive Hyperbaric Oxygen Therapy or Intratympanic Steroids in Sudden Sensorineural Hearing Loss?
Ganga K, Niemczak C, Buckey J
Laryngoscope · 2026 Jun · PMID 42252517 · Publisher ↗
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Spatiotemporal Medicare Reimbursement Trends and Economic Clusters in Otologic/Neurotologic Surgery.
Warrier A, Iqbal S, Bu D … +2 more , Bartholomew R, Lee DJ
Laryngoscope · 2026 Jun · PMID 42248816 · Publisher ↗
OBJECTIVES: To characterize national trends in Medicare reimbursement for otologic/neurotologic procedures from 2012 to 2024, quantify the relative contributions of service volume, procedural mix, and within-code reimbur...
OBJECTIVES: To characterize national trends in Medicare reimbursement for otologic/neurotologic procedures from 2012 to 2024, quantify the relative contributions of service volume, procedural mix, and within-code reimbursement to aggregate spending, and identify clusters of procedures with similar economic behavior. METHODS: Medicare Part B claims data from 2012 to 2024 were utilized and financial data were inflation-adjusted to 2024 USD. National trends in volume, spending, and reimbursement per service were evaluated. A Shapley decomposition framework quantified the contributions of service volume, procedural mix, and within-code reimbursement to changes in aggregate spending. Unsupervised clustering with principal component analysis, hierarchical clustering, and k-means classified CPT codes by reimbursement growth, variability, and service volume. Geographic and rural-urban reimbursement variation were also assessed. RESULTS: Annual otologic/neurotologic procedural volume increased from 1.85 million to 2.15 million services, while inflation-adjusted mean reimbursement per service declined from $80.47 to $57.07. Total inflation-adjusted spending fell from $147.1 million in 2012 to $121.9 million in 2024. Decomposition showed that rising service volume increased spending by $20.0 million, but this was offset by adverse shifts in procedural mix (-$7.7 million) and declining within-code reimbursement (-$37.5 million). Clustering identified three economic phenotypes: low-volume stable codes, high-volume moderate-variability codes, and high-cost volatile codes. Geographic analysis demonstrated widening interstate and rural-urban reimbursement variation over time. CONCLUSION: Despite growing demand for otologic/neurotologic services, inflation-adjusted Medicare reimbursement has steadily declined. Aggregate spending reductions were driven primarily by reimbursement erosion rather than reduced utilization, highlighting structural vulnerabilities in current fee-schedule valuation for otologic/neurotologic care. LEVEL OF EVIDENCE: III.
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