Gandra N, Roberts KA, Nguyen SA
… +4 more, Peters P, Howser LA, Soler ZM, Schlosser RJ
Laryngoscope
· 2026 Jun · PMID 42248815
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OBJECTIVE: To elucidate the association between olfactory dysfunction (OD) and metabolic syndrome components. DATA SOURCES: PubMed (National Library of Medicine-National Institutes of Health), Scopus (Elsevier), CINAHL C...OBJECTIVE: To elucidate the association between olfactory dysfunction (OD) and metabolic syndrome components. DATA SOURCES: PubMed (National Library of Medicine-National Institutes of Health), Scopus (Elsevier), CINAHL Complete (EBSCOhost), and the Cochrane Library (Wiley) databases were searched from inception through March 23rd, 2026. REVIEW METHODS: Eligible studies were stratified by olfactory dysfunction or different metabolic parameters. Extracted variables included metabolic measures (BMI, waist circumference, cholesterol levels, blood pressure, fasting glucose, HbA1c), olfactory scores, and comorbidities. Data were summarized as means, proportions (%), and corresponding differences (Δ) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI) tool. RESULTS: A total of 4045 studies were screened using Covidence, with 47 studies included for data analysis. Participants with OD demonstrated greater odds of smoking (OR = 1.2, p = 0.002), antihypertensive medication use (OR = 1.2, p = 0.03), atrial fibrillation (OR = 1.7, p < 0.00001), heart failure (OR = 1.6, p = 0.008), and diabetes (OR = 1.2, p < 0.0001). Additionally, adults with OD had higher fasting glucose (MD +0.8 mg/dL; p < 0.00001), lower total cholesterol (MD -6.0 mg/dL; p = 0.04), and lower HDL levels (MD -1.8 mg/dL; p < 0.00001). Individuals with diabetes and elevated BMI had significantly lower TDI composite scores (MD -5.6; p < 0.00001 and MD -2.8; p < 0.00001, respectively). CONCLUSION: Patients with OD showed increased rates of conditions that comprise and contribute to metabolic syndrome. Conversely, individuals with metabolic disorders exhibited lower mean scores on olfactory testing, indicating a bidirectional relationship between olfactory impairment and metabolic dysregulation.
Laryngoscope
· 2026 Jun · PMID 42248804
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OBJECTIVES: The objective of this study was to assess the clinical efficacy and safety of topical nitroglycerin ointment in patients diagnosed with empty nose syndrome (ENS). METHODS: ENS was diagnosed based on clinical...OBJECTIVES: The objective of this study was to assess the clinical efficacy and safety of topical nitroglycerin ointment in patients diagnosed with empty nose syndrome (ENS). METHODS: ENS was diagnosed based on clinical history, nasal endoscopic findings, a positive cotton test, and an Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) score of ≥ 11. Patients who met the inclusion criteria were instructed to apply a topical nitroglycerin ointment (Rectogesic, glyceryl trinitrate 0.2%) three times daily. The mean age was 42.09 years, with a male-to-female ratio of 3:1. Pre- and posttreatment ENS6Q scores were compared, and subjective symptom improvement was analyzed. RESULTS: The total ENS6Q score showed a significant improvement, dropping from 17.32 ± 4.34 to 12.52 ± 5.21 (p < 0.001). All six ENS6Q items showed significant improvements, with the greatest reduction observed in nasal dryness (4.16 to 2.86, p < 0.001). Sixteen patients (36.4%) showed moderate improvement (ΔENS6Q = 3 to 6). Fifteen patients (34.1%) showed marked improvement (ΔENS6Q > 6), exceeding the minimal clinically important difference. Subjective symptom improvement was reported by 27 patients (61.4%), who demonstrated significantly greater ENS6Q improvement than those without symptom improvement (ΔENS6Q 7.22 ± 4.99 vs. 0.94 ± 2.41, p < 0.001). Eleven patients (25.0%) reported adverse effects; mild headache was the most common symptom (n = 6, 54.5% of adverse effects). The presence of adverse effects did not have a significant impact on treatment duration. CONCLUSIONS: Topical nitroglycerin showed promising preliminary results and may represent a potential conservative treatment option for ENS, an uncommon yet serious complication arising after turbinate volume reduction surgery.
Wajsberg B, Christ AM, Benyo SE
… +7 more, Keuchel CA, Duggal R, Wu R, Benninger MS, Nelson RC, Bryson PC, Tierney WS
Laryngoscope
· 2026 Jun · PMID 42248802
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OBJECTIVE: To evaluate the safety and efficacy of silk protein-hyaluronic acid (silk-HA) injection laryngoplasty for glottic insufficiency at an independent tertiary academic voice center and compare outcomes and complic...OBJECTIVE: To evaluate the safety and efficacy of silk protein-hyaluronic acid (silk-HA) injection laryngoplasty for glottic insufficiency at an independent tertiary academic voice center and compare outcomes and complication rates with those of HA injection augmentation. METHODS: We retrospectively reviewed patients undergoing SilkVoice augmentation between June 2022 and August 2025 at a single institution. Outcomes included patient-reported vocal improvement, emergency department visits, hospitalizations, and operative interventions. For patients with prior HA injection, silk-HA outcomes were compared using a within-patient design. RESULTS: Thirty-three patients underwent 44 silk-HA injections (mean age 73.4 years; 51.5% female). Outcome data were available for 29 patients (87.9%). Most procedures (95.5%) were office-based with a mean follow-up of 12.7 months. Overall, 86.2% of patients reported at least minimal vocal improvement and 79.3% reported partial to significant improvement. In a within-patient comparison of 20 patients who received both silk-HA and prior HA, median improvement scores were equivalent (p = 0.776). Compared with a historical HA cohort from the same institution (691 patients, 1146 injections), operative intervention was significantly higher in silk-HA (6.8% vs. 0.6%, p = 0.005); two cases were elective revisions for overaugmentation, and one occurred in the setting of lung cancer progression. CONCLUSION: Silk-HA injection laryngoplasty demonstrates safety and efficacy for glottic insufficiency with voice outcomes comparable to HA and no increase in serious adverse events despite higher operative revision rates. These findings from an independent academic voice center provide external validation supporting silk-HA as a viable office-based augmentation option.
Cecola CF, Settoon C, Buck LS
… +2 more, Evans AK, Dunham ME
Laryngoscope
· 2026 Jun · PMID 42248801
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OBJECTIVE: To retrospectively evaluate Eyes-On, a patient-personalized AI-assisted video analysis system for frame-level detection of tracheostomy tube status and visual distress in tracheostomy-dependent infants. METHOD...OBJECTIVE: To retrospectively evaluate Eyes-On, a patient-personalized AI-assisted video analysis system for frame-level detection of tracheostomy tube status and visual distress in tracheostomy-dependent infants. METHODS: In an IRB-approved study, 25 tracheostomy-dependent infants aged ≤ 2 years underwent video recording during routine tracheostomy care and tube changes. Data were partitioned at the patient level (22 infants for model development; 3 withheld for staged evaluation). From edited clips, 10,000 frames were extracted and annotated by two blinded pediatric otolaryngologists. A YOLOv11 detector was trained to detect cannulation status, and a facial distress classifier was built using facial features and action unit signals. Generalized pretrained models were tested on held-out infants and then reevaluated after patient-specific calibration. Individualized thresholds were selected using decision curve analysis. RESULTS: The pretrained cannulation detector achieved accuracy 0.736, sensitivity 0.806, specificity 0.667, mAP@50 0.645, and a 23.62% Not-Detected rate (n = 1200). After calibration, pooled evaluable-frame cannulation performance improved to accuracy 0.940, sensitivity 0.997, and specificity 0.874 (AUROC 0.962; AUPRC 0.918). The pretrained distress classifier achieved accuracy 0.825, sensitivity 0.877, specificity 0.770, and a 21.8% face-extraction failure rate. After calibration, evaluable-frame distress accuracy increased to 0.960 with sensitivity 0.974 and specificity 0.946 (AUROC 0.993; AUPRC 0.993). CONCLUSION: In this retrospective proof-of-concept study, patient-personalized video-based AI showed promising frame-level classification of tracheostomy-status and facial distress. These results reflect calibrated within-patient deployment and do not validate event-level outcomes, alarm thresholds, or standard monitoring modalities. Prospective real-world evaluation is needed before clinical adoption.
Ziltzer RS, Bulbul MG, Barry E
… +5 more, Chowdhury M, Orabi NA, Chung J, Turner M, Fancy T
Laryngoscope
· 2026 Jun · PMID 42244039
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OBJECTIVES: To investigate whether routine involvement of the medical hospitalist service (MHS) in postoperative medical management of head and neck cancer (HNC) patients undergoing major ablative head and neck surgery w...OBJECTIVES: To investigate whether routine involvement of the medical hospitalist service (MHS) in postoperative medical management of head and neck cancer (HNC) patients undergoing major ablative head and neck surgery with free tissue transfer (FTT) improves inpatient outcomes. METHODS: This is a retrospective cohort study. Patients undergoing FTT after head and neck oncologic surgery between 2014 and 2022 were identified. Starting September 2018, MHS were involved in the medical care of every FTT patient (post-intervention). Prior to that, MHS were consulted on an as-needed basis (pre-intervention). Outcomes studied included transfer to a higher level of care (LOC), length of hospital stay (LOHS), 30-day readmission, and 90-day mortality. Data were analyzed using linear regression and generalized linear models. RESULTS: A total of 362 patients were included in this study (mean age 62.3 ± 10.5 and 30.1% females), 32.9% of the cohort being in the pre-intervention group. When comparing the post-intervention to pre-intervention groups, the risk difference (RD) for: (1) transfer to higher LOC was -7.4% (95% CI = -13.7 to -1.02, p = 0.02); (2) 30-day readmission was -4.4% (95% CI = -14.0 to 5.3%, p = 0.36); and (3) 90-day mortality was 2.4% (95% CI = -4.1 to 8.8, p = 0.49). Post-intervention, the LOHS decreased by 1.2 days compared to pre-intervention (95% CI = -3.9 to 1.5, p = 0.39). CONCLUSION: Involvement of MHS in the care of patients undergoing FTT halved the relative risk of transfer to higher LOC. There was no significant effect on mortality, readmission, or hospital stay. Further studies are needed to confirm our findings.
Jeyakumar A, Lu Q, Johnson R
… +2 more, Mitchell R, Brickman T
Laryngoscope
· 2026 Jun · PMID 42242924
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OBJECTIVES: The use of monopolar cautery is regarded as a contraindication in cochlear implant (CI) recipients, despite a large amount of contradicting data. The objectives are as follows: (1) Evaluate the effects of hig...OBJECTIVES: The use of monopolar cautery is regarded as a contraindication in cochlear implant (CI) recipients, despite a large amount of contradicting data. The objectives are as follows: (1) Evaluate the effects of high-powered electrocautery on CI devices. (2) Record any high-powered electrocautery induced temperature changes. METHODS: After IACUC approval, 12 manufacturer-donated CIs were implanted in two anesthetized pigs. All devices underwent pre-study integrity checks; six had onsite impedance testing, while six received post-cautery analysis. Fifty watts coagulation was applied for 20 min at sites 1-15 cm from the CI. Bluetooth thermometers monitored three sites of temperatures. Devices were explanted for analysis. Stata 17.0 was used for statistical analysis. A p-value < 0.05 was considered statistically significant. Outcome measurements were as follows: (1) Changes in the temperature. (2) Changes to the implanted CIs during electrocautery. (3) CI integrity analysis following electrocautery. RESULTS: The mean temperatures at the three sites (a*, b*, c*) was 32.9°C-38.8°C. Maximum absolute temperature changes averaged 4.1°C (95% CI: 1.4-6.8) for scalp measurements and 2.9°C (95% CI: 1.0-4.9) for round window measurements. Neither time (p = 0.09) nor distance (p = 0.64) generated significant scalp temperature changes. Devices were stratified by proximity. Mean maximum temperature changes showed a gradient by distance. Differences in device proximity were not statistically significant. Postimplantation device analysis was performed on six devices, and all passed the manufacturer in-depth device analysis. CONCLUSIONS: This controlled experimental evidence, demonstrating 100% device integrity across all tested conditions, challenges current manufacturer contraindications and supports evidence-based guideline revision. LEVEL OF EVIDENCE: N/A.
Yumita K, Mikoshiba T, Kono T
… +4 more, Sekimizu M, Nagai R, Fujiwara H, Ozawa H
Laryngoscope
· 2026 Jun · PMID 42242920
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OBJECTIVE: Facial nerve palsy is a major complication of parotid surgery. Several reports have demonstrated that the intraparotid facial nerve can be directly visualized using MRI. This study aimed to evaluate the role o...OBJECTIVE: Facial nerve palsy is a major complication of parotid surgery. Several reports have demonstrated that the intraparotid facial nerve can be directly visualized using MRI. This study aimed to evaluate the role of fast imaging employing steady-state acquisition cycled phases (FIESTA-C) and multi-echo steady-state acquisition (MENSA) in facial nerve identification and tumor localization. METHODS: Thirty-six patients with parotid tumors were analyzed. We evaluated whether the facial nerve could be identified and assessed tumor localization. The diagnostic accuracies of FIESTA-C, MENSA, and their combinations were compared. RESULTS: The main trunk of the facial nerve was identified in all patients, and its bifurcation into the temporofacial and cervicofacial divisions was visualized in 81% using FIESTA-C, 81% using MENSA, and 94% using their combinations. Tumor localization was correctly identified in 75%, 67%, and 83% using FIESTA-C, MENSA, and their combinations, respectively. CONCLUSION: Combination of FIESTA-C and MENSA could improve the accuracy of facial nerve identification and tumor localization compared to either sequence alone.
Wu M, Elayah SA, Wang C
… +4 more, Yang J, Liu Y, Shi B, Li Y
Laryngoscope
· 2026 Jun · PMID 42242912
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OBJECTIVES: This study aims to evaluate the healing process and identify risk factors associated with delayed healing and outcomes. METHODS: 1355 consecutive participants with nonsyndromic cleft palate, treated with the...OBJECTIVES: This study aims to evaluate the healing process and identify risk factors associated with delayed healing and outcomes. METHODS: 1355 consecutive participants with nonsyndromic cleft palate, treated with the Sommerlad-Furlow modified palatoplasty. Sixteen variables were recorded including sex, age, cleft type (Veau class), surgeons' qualification, antibiotics, relaxing incision (RI), postoperative upper respiratory tract infection (PURI), preoperative leukocyte count, preoperative hemoglobin (HGB), the cleft width, inter maxillary tuberosity width, the cleft ratio, operation duration, the initial time of poor healing wound observed after surgery, depth and location of the poor healing wound. RESULTS: In total, 1148 patients demonstrated normal healing (84.7%, 1148/1355), while 207 patients exhibited delayed wound healing issues (15.3%, 207/1355), among whom 131 healed within 3 months (9.7%, 131/1355; 63.3%, 131/207), 15 healed after 3 months and within 6 months (1.1%, 15/1355; 7.2%, 15/207), and fistula remained after 6 months in 61 patients (4.5%, 61/1355; 29.5%, 61/207). A total of 1294 (95.5%, 1294/1355) of the participants had healed palatal wounds after 6 months postoperatively. Surgeons' qualifications, PURI, the cleft width, cleft ratio, and operation duration were significantly different in the delayed healing group. CONCLUSIONS: Preoperative measurement of the cleft ratio might help the cleft surgeons to predict the palate healing outcome. Surgeons' improved operation skills, shortened operation duration, and prevention of PURI were supposed to reduce the occurrence of poor wound healing. Moreover, focusing on delayed wound depth and location is critical for estimating the process and outcomes of delayed healing.
Hirsch B, Szymczak A, Young A
… +3 more, Lagoski M, de Regnier RA, Hazkani I
Laryngoscope
· 2026 Jun · PMID 42240106
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OBJECTIVES: Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity that often requires prolonged respiratory support, including intubation and tracheostomy. While these interventions are essential for...OBJECTIVES: Bronchopulmonary dysplasia (BPD) is a chronic lung disease of prematurity that often requires prolonged respiratory support, including intubation and tracheostomy. While these interventions are essential for stability, their impact on neurodevelopmental outcomes remains unclear. This study evaluates whether tracheostomy is independently associated with neurodevelopmental outcomes in patients with severe BPD. METHODS: This retrospective cohort study included infants who met the 2001 NIH criteria for severe BPD, with or without tracheostomy, treated at a quaternary-care children's hospital from 2011 to 2023. Demographics, clinical factors, intubation duration, and Bayley neurodevelopmental scores (12-24 months corrected age) were collected. Tracheostomy-dependent patients were case-matched 1:2 to non-tracheostomy-dependent BPD patients by gestational age and sex. Associations with Bayley scores were analyzed using univariate and multivariate linear regression with cluster-robust standard errors. RESULTS: Twenty-five tracheostomy-dependent BPD patients were matched to 50 non-tracheostomy-dependent BPD patients. Tracheostomy-dependent patients had significantly longer intubation durations (114 vs. 66 days, p = 0.0047). In adjusted models accounting for tracheostomy status and relevant neurologic comorbidities, patients intubated longer than 50 days had significantly lower Bayley cognitive (-8.49 points, p = 0.047) and motor scores (-11.03 points, p = 0.012), suggesting a notable developmental difference. Tracheostomy status was not independently associated with cognitive (p = 0.697) or motor (p = 0.715) outcomes. CONCLUSIONS: Our findings suggest that prolonged intubation is associated with worse neurocognitive and motor outcomes in infants with BPD, whereas tracheostomy placement was not an independent predictor of neurodevelopmental delays. Prospective studies are needed to determine whether early tracheostomy, aimed at reducing total days intubated, may improve long-term outcomes.
Moise AC, Li YJ, Chan Y
… +2 more, Graham ME, Hu A
Laryngoscope
· 2026 Jun · PMID 42231054
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OBJECTIVES: To assess the national prevalence and severity of imposter phenomenon (IP) among Canadian Otolaryngology-Head and Neck Surgery (OHNS) residents and to explore associations between IP and demographic factors....OBJECTIVES: To assess the national prevalence and severity of imposter phenomenon (IP) among Canadian Otolaryngology-Head and Neck Surgery (OHNS) residents and to explore associations between IP and demographic factors. METHODS: National cross-sectional anonymized online survey was distributed to residents in Canadian OHNS programs in English and French. It included two validated instruments: the Clance Impostor Phenomenon Scale (CIPS) and the General Self-Efficacy Scale (GSES). Dillman Tailored Design Method was used for survey distribution over an eight-week period with four waves of email contact. CIPS and GSES scores were analyzed using t-tests and ANOVA. RESULTS: Fifty-six OHNS residents participated (response rate: 34%), including 29 men and 27 women. Mean CIPS score was 61.43 (SD 15.52), with 44.64% within the "significant" impostorism range (CIPS score 61-80). Women reported significantly higher impostor scores than men (mean CIPS: 65.85 vs. 57.31; p = 0.038). Among those who experienced intense impostorism (CIPS > 80), 71.42% were women and 28.57% men. Year of residency was significantly associated with IP (p = 0.024), with PGY-2 residents exhibiting the highest CIPS scores (71.40) compared to PGY-5 (48.17). Mean GSES was 31.75 (SD 3.46), with no significant variation across demographic groups. However, self-efficacy was inversely correlated with IP (Pearson's r = -0.366, p = 0.005). CONCLUSION: IP is prevalent in OHNS residency, particularly among women, and appears associated with lower self-efficacy and earlier stages of training. These findings underscore the need for wellness initiatives and structured support. LEVEL OF EVIDENCE: N/A.
Alani A, Anisman EJ, Bitner BF
… +9 more, Klug T, D'Souza G, Barton B, Tam E, Wu M, Toskala E, Rabinowitz M, Rosen M, Nyquist GG
Laryngoscope
· 2026 May · PMID 42219905
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OBJECTIVES: Endoscopic sphenopalatine artery ligation (ESPAL) is standard for refractory posterior epistaxis, yet persistent bleeding and need for reintervention remain common. We evaluated a modified ESPAL technique inc...OBJECTIVES: Endoscopic sphenopalatine artery ligation (ESPAL) is standard for refractory posterior epistaxis, yet persistent bleeding and need for reintervention remain common. We evaluated a modified ESPAL technique incorporating posterior septal artery (PSA) cautery and assessed outcomes versus traditional ESPAL. METHODS: We performed a retrospective cohort study of adults undergoing ESPAL for posterior epistaxis at a tertiary referral center. Patients underwent either modified ESPAL (PSA cautery) or traditional ESPAL (SPAL only). The primary outcome was persistent epistaxis within 30 days requiring major intervention (repeat surgery, embolization, or hospital admission). Secondary outcomes included salvage strategies and rebleeding after unilateral versus bilateral modified procedures. Multivariable logistic regression evaluated predictors of persistent epistaxis (surgical technique, anticoagulation, alcohol use, and COPD). RESULTS: A total of 292 patients were included (modified, n = 257; traditional, n = 35). Persistent epistaxis occurred less frequently after modified ESPAL than traditional ESPAL (7.8% vs. 28.6%), yielding an absolute risk reduction of 20.8% and a number needed to treat of 4.8. Anticoagulation use was higher in the modified cohort (33% vs. 17%). On multivariable analysis, traditional ESPAL was associated with higher odds of persistent epistaxis compared with modified ESPAL (OR: 6.50, 95% CI: 2.45-17.3; p < 0.001), and anticoagulation was independently associated with persistent epistaxis (OR: 3.22, 95% CI: 1.41-7.62; p = 0.006). Among modified cases, rebleeding did not differ between bilateral and unilateral procedures (9.8% vs. 5.6%; p = 0.2). CONCLUSIONS: Modified ESPAL incorporating PSA cautery was associated with substantially lower 30-day persistent epistaxis compared with traditional ESPAL, including in anticoagulated patients. Bilateral intervention appears safe when the bleeding side is uncertain.
Lavin J, Billings K, Smith A
… +3 more, Patel K, Corboy J, Hazkani I
Laryngoscope
· 2026 May · PMID 42212485
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OBJECTIVES: Nebulized tranexamic acid (TXA) can be utilized for non-operative management in post-tonsillectomy hemorrhage (PTH). Rapid adoption of new treatments in hospital settings is challenging due to personnel turno...OBJECTIVES: Nebulized tranexamic acid (TXA) can be utilized for non-operative management in post-tonsillectomy hemorrhage (PTH). Rapid adoption of new treatments in hospital settings is challenging due to personnel turnover, formulary restrictions, and inconsistent awareness. We investigated the utility of clinical care guideline (CCG) implementation on adherence to a TXA protocol and its association with operative control of hemorrhage. METHODS: Model for Improvement methodology was utilized to develop CCG for TXA administration. An algorithm was created where patients presenting to the Emergency Department (ED) with active bleeding or blood clot received three nebulized TXA treatments. Exclusion criteria were severe bleeding, absence of active bleeding or clot, and inability to tolerate treatment or protect the airway. An order set was used to facilitate implementation. Data from 2 years pre- and post-initiation were compared. Measures included ED returns for PTH, TXA order set usage, TXA administration frequency, returns to the operating room, and secondary returns to the ED. RESULTS: There were 2805 and 5382 tonsillectomies pre- and post- implementation periods respectively. There was no difference in patient age in the two groups. ED returns for bleeding were 70 (2.5%) and 155 (2.9%) respectively (p > 0.05). Post-implementation, 126 patients met inclusion criteria for TXA (81.3%). Order set utilization of patients receiving TXA in the ED was 95.7%. Operative PTH management pre- and post-intervention was 35/70 (50%) and 42/155 (27.1%) respectively (p = 0.001, ARR 0.320, 95% CI 0.116-0.500). CONCLUSIONS: Implementation of a PTH clinical care guideline was associated with rapid adoption of TXA adherence. This was associated with reduced rates of OR returns.
Micuda A, Rioux K, Helpard L
… +9 more, Bajin MD, Kassam Z, Pandey S, Hwang J, Romero-Sanchez GT, Sharma M, Parnes LS, Ladak HM, Agrawal SK
Laryngoscope
· 2026 May · PMID 42212468
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Publisher ↗
OBJECTIVE: To develop and externally validate a deep learning segmentation network capable of automatically segmenting the inner ear in preoperative clinical computed tomography (CT) scans across various resolutions and...OBJECTIVE: To develop and externally validate a deep learning segmentation network capable of automatically segmenting the inner ear in preoperative clinical computed tomography (CT) scans across various resolutions and protocols. METHODS: A deep learning-based segmentation network was developed using 100 cadaveric specimens that were scanned with synchrotron-radiation phase contrast imaging (SR-PCI) and various clinical CT scanners. Different acquisitions, protocols, and augmentations were used to create a total of 4,784 paired SR-PCI and clinical three-dimensional datasets used for deep learning training and model development. Performance and accuracy of the network were assessed on a separate unseen dataset and externally validated against manual segmentations from seven individual domain experts (otologists and radiologists), the mean expert performance, and a simultaneous truth and performance level (STAPLE) consensus segmentation. RESULTS: The network pipeline significantly outperformed each individual expert segmentation, the average of the expert segmentations, and the STAPLE consensus segmentation. Compared to the SR-PCI ground truth data, the network achieved a Dice similarity coefficient of 0.922, a maximum absolute Hausdorff distance of 0.329 mm, and an average Hausdorff distance of 0.006 mm on cone-beam CT and helical CT with resolutions as low as 625 μm. CONCLUSION: This is the first automated segmentation algorithm for the inner ear that has been shown to outperform segmentations from domain experts, establishing a new clinical gold standard. LEVEL OF EVIDENCE: N/A.
Kirtsreesakul V, Thongsuksai P, Sanghan N
… +1 more, Promsopa C
Laryngoscope
· 2026 May · PMID 42212465
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Publisher ↗
OBJECTIVE: Recurrence of chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS) is common; however, biomarkers for long-term risk stratification remain limited. We examined associations between complete blood...OBJECTIVE: Recurrence of chronic rhinosinusitis (CRS) after endoscopic sinus surgery (ESS) is common; however, biomarkers for long-term risk stratification remain limited. We examined associations between complete blood count (CBC)-derived biomarkers and long-term CRS recurrence after ESS. METHODS: A retrospective cohort of 543 CRS patients undergoing ESS was analyzed using time-to-event methods. Prespecified variables comprised CBC-derived biomarkers: absolute eosinophil count (AEC); eosinophil-to-lymphocyte, -monocyte, and -neutrophil ratios; monocyte-, neutrophil-, basophil-, and platelet-to-lymphocyte ratios; systemic immune-inflammation index (SII); systemic inflammation response index; and red cell distribution width, together with prespecified clinical covariates. Variable selection was performed using LASSO-penalized Cox regression with multicollinearity screening, followed by multivariable Cox modeling to estimate adjusted hazard ratios (HRs). Incremental prognostic value and longitudinal patterns were assessed. RESULTS: A total of 254 patients (46.8%) developed recurrence. In the multivariable model, higher AEC (HR: 2.868) and SII (HR: 1.320) were associated with recurrence, along with shorter symptom duration, asthma, NSAID hypersensitivity, nasal polyps, and higher Lund-Mackay scores. Addition of AEC improved model discrimination (C-index 0.778-0.797; ΔC = 0.019; p < 0.001), whereas SII provided minimal additional value (C-index 0.797-0.798; ΔC = 0.001; p = 0.513). In longitudinal analyses, baseline AEC and SII were associated with recurrence, but their changes over time did not differ between groups, with no significant temporal trends. CONCLUSION: Higher AEC and SII were independently associated with long-term CRS recurrence after ESS, with AEC providing greater incremental prognostic value than SII. These markers may reflect underlying host predisposition rather than dynamic disease activity.
Lin A, Kutler RB, Schulmeyer L
… +3 more, Zhang L, Han CY, Cai Y
Laryngoscope
· 2026 May · PMID 42210598
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OBJECTIVES: Hypoxia-related measures are valuable predictors of cardiovascular outcomes in obstructive sleep apnea. This scoping review evaluates existing literature on changes in hypoxia-related measures with hypoglossa...OBJECTIVES: Hypoxia-related measures are valuable predictors of cardiovascular outcomes in obstructive sleep apnea. This scoping review evaluates existing literature on changes in hypoxia-related measures with hypoglossal nerve stimulation (HGNS). DATA SOURCES: A systematic search was performed across PubMed, Embase, Web of Science, and Scopus databases. REVIEW METHODS: Population search terms included HGNS and upper airway stimulation. Measures of interest included hypoxic burden, oxygen desaturation index (ODI), and time below 90% or 88% oxygen saturation (T90/T88). Title, abstract, and full-text screenings were conducted by two reviewers. Studies that only reported O nadir or mean were excluded. When multiple studies were based on the same cohort of HGNS patients, the manuscript with the most comprehensive oxygenation measures was included; if these did not differ, the one with the longest period of follow-up was used. Postoperative sleep studies were labeled as titration polysomnography (PSG), full-night PSG at a single voltage, unspecified PSG type, or home sleep test. RESULTS: In total, 581 articles were identified, 86 underwent full-text review, and 22 studies corresponding to n = 2092 patients met inclusion criteria. There was heterogeneity in sleep testing types across studies. ODI was included in 20 studies (90.9%) and T90/T88 in 13 (59.1%). The majority of studies (15 of 17) demonstrated significant improvement in ODI from pre- to post-HGNS, but not in T90/T88. No studies meeting inclusion criteria reported hypoxic burden. CONCLUSION: The available literature suggests improvements in hypoxia-related measures with HGNS, though most report frequency-based measures and there is a dearth of literature examining HGNS and hypoxic burden.