Pinhas S, Schuman AD, Pinhas I
… +1 more, Friedman AD
Laryngoscope
· 2026 May · PMID 42121342
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Two new vocal fold microflap models using products found in any grocery store have been developed along with publicly available 3D-printable parts for simulating multiple laryngoscopes commonly used during laryngeal phon...Two new vocal fold microflap models using products found in any grocery store have been developed along with publicly available 3D-printable parts for simulating multiple laryngoscopes commonly used during laryngeal phonomicrosurgery. This represents a low cost, easily reproducible model for basic laryngeal phonomicrosurgery training.
Laryngoscope
· 2026 May · PMID 42121303
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OBJECTIVE: Circumferential reconstruction is required for total hypopharyngeal defects to restore swallowing. Reconstructive options differ in conduit biology and anastomotic configuration, particularly the presence of a...OBJECTIVE: Circumferential reconstruction is required for total hypopharyngeal defects to restore swallowing. Reconstructive options differ in conduit biology and anastomotic configuration, particularly the presence of a distal alimentary anastomosis. This study compared postoperative complications, dietary recovery, and survival among three reconstructive strategies. METHODS: This retrospective cohort study included 102 patients who underwent total hypopharyngeal reconstruction between 2015 and 2025 using a free anterolateral thigh (ALT) fasciocutaneous flap (n = 57), gastric pull-up (n = 24), or free ileocolonic flap (n = 21). Postoperative complications, long-term dietary outcomes, and 5-year survival were evaluated. Time to regular diet was analyzed using multivariable Cox proportional hazards models adjusting for age, body mass index, length of hospitalization, and endocrine comorbidities. RESULTS: Baseline characteristics were similar across groups. Early pharyngocutaneous fistulas were most common in the ileocolonic flap group (23.8%), whereas late fistulas occurred mainly after gastric pull-up reconstruction (12.5%). At 3 years, regular diet was achieved by 63.2% of ALT flap patients, compared with 100% of gastric pull-up and 90.5% of ileocolonic flap patients. After adjustment, gastric pull-up (adjusted HR 1.79; 95% CI, 1.05-3.07) and ileocolonic flap reconstruction (adjusted HR 2.00; 95% CI, 1.06-3.79) were independently associated with faster dietary recovery compared with ALT flaps. Five-year survival did not differ significantly among groups. CONCLUSION: Visceral reconstructions yield superior dietary recovery compared with fasciocutaneous flaps for total hypopharyngeal defects. The absence of a distal anastomosis alone did not confer a clear functional benefit, underscoring the importance of conduit biology over anastomotic number.
Solhan M, Cömertoğlu S, Zorlu ME
… +4 more, Yılmaz M, Cebeci S, Aydil U, Düzlü M
Laryngoscope
· 2026 May · PMID 42117898
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OBJECTIVE: The aim of this study was to evaluate the prognostic significance of lymph node yield, lymph node positivity ratio, and metastatic lymph node count in patients with laryngeal cancer undergoing laryngectomy wit...OBJECTIVE: The aim of this study was to evaluate the prognostic significance of lymph node yield, lymph node positivity ratio, and metastatic lymph node count in patients with laryngeal cancer undergoing laryngectomy with neck dissection, and to identify optimal cutoff values for these parameters using receiver operating characteristic (ROC) curve analysis. METHODS: This retrospective study included 48 patients who underwent partial or total laryngectomy with bilateral neck dissection at a tertiary referral center between January 2015 and December 2019. Demographic characteristics, TNM stage, lymph node parameters, pathological risk factors, recurrence, and mortality were analyzed. Neck dissection primarily bilateral involved cervical levels II-IV, with additional levels dissected when clinically or radiologically indicated. RESULTS: Metastatic lymph node count was significantly associated with overall survival in both univariate and multivariable Cox analyses (HR: 1.344, p < 0.001; HR: 1.348, p = 0.007, respectively). An optimal lymph node ratio (LNR) cutoff of 0.045 was identified. LNR ≥ 0.045 was associated with poorer survival (log-rank p = 0.006) and increased mortality in univariate analysis (HR: 4.815; p = 0.013), but not in multivariable analysis (p = 0.325). CONCLUSIONS: In conclusion, the findings of this study demonstrate that lymph node-based parameters are important prognostic indicators in laryngeal cancer. Among these, the absolute number of metastatic lymph nodes emerged as the most robust and biologically meaningful predictor of overall survival.
Zhang LL, Kristunas C, Robinson CM
… +16 more, Brooks JM, Sitch AJ, Winter SC, Weir J, Matthews P, Jones TM, Hunter K, Golusinski P, Shah KA, Thavaraj S, West CM, Haider S, Odell E, Nankivell P, von Zeidler SV, Mehanna H
Laryngoscope
· 2026 May · PMID 42117394
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OBJECTIVES: The PREDICTR-OPC model is the only prognostic classifier for oropharyngeal squamous cell carcinoma (OPSCC) also predictive of surgical outcomes. Of the four biomarkers included, survivin contributes minimally...OBJECTIVES: The PREDICTR-OPC model is the only prognostic classifier for oropharyngeal squamous cell carcinoma (OPSCC) also predictive of surgical outcomes. Of the four biomarkers included, survivin contributes minimally and presents practical limitations. This study aimed to refine and simplify the model by removing survivin, then re-assess its prognostic predictive performance compared to the original. METHODS: This retrospective cohort study analyzed a multi-center training cohort (n = 600) and an external validation cohort (n = 385) of OPSCC patients. Tumor biopsies were stained for p16, high-risk human papillomavirus (HR-HPV) DNA, tumor-infiltrating lymphocytes (TILs), and survivin and independently scored by at least three certified pathologists. Cox proportional hazards models assessed overall survival (OS), comparing three-biomarker (p16, HR-HPV, TILs) and four-biomarker models. Hazard ratios (HRs) for OS were estimated in the validation cohort, adjusting for covariates. Discrimination, calibration, and decision curve analysis (DCA) evaluated performance and clinical utility. RESULTS: Among 985 patients (median age: 57 years), median OS = 8.8 years (95% CI: 6.9-10.5). The three-biomarker model yielded HR = 4.10 (95% CI: 2.41-6.98, p < 0.001) for high- vs. low-risk groups in the validation cohort, comparable to the four-biomarker model (HR = 4.24, p < 0.001). Surgery was associated with improved OS in high-risk (HR = 0.45, p = 0.001) but not low-risk (HR = 0.83, p = 0.72) patients, consistent with the original model. The models performed similarly across all metrics (e.g., Concordance Index: 0.71 vs. 0.72; Brier Score: 0.22 for both) as was model fit (Likelihood Ratio Test: p = 0.066). DCA revealed comparable clinical benefit. CONCLUSION: Removing survivin preserves PREDICTR-OPC's predictive performance, offering a more cost-effective, easier-to-implement tool for OPSCC treatment recommendations.
Laryngoscope
· 2026 May · PMID 42116713
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This case report describes the use of targeted intracordal bevacizumab therapy for recurrent vocal fold hemorrhage refractory to conventional treatment. The intervention was associated with resolution of hemorrhagic epis...This case report describes the use of targeted intracordal bevacizumab therapy for recurrent vocal fold hemorrhage refractory to conventional treatment. The intervention was associated with resolution of hemorrhagic episodes and sustained clinical improvement over follow-up. These findings suggest a potential role for antiangiogenic therapy in selected cases.
Laryngoscope
· 2026 May · PMID 42103557
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OBJECTIVE: To evaluate the use of three-dimensional (3D) printed temporal bone models combined with final product analysis as an objective structured assessment of technical skills tool to assess mastoidectomy performanc...OBJECTIVE: To evaluate the use of three-dimensional (3D) printed temporal bone models combined with final product analysis as an objective structured assessment of technical skills tool to assess mastoidectomy performance across levels of otolaryngology residency training. METHODS: In this prospective observational study conducted at a single academic otolaryngology residency program, 32 residents performed 64 mastoidectomies on 3D-printed temporal bone models over a three-year period. Three expert faculty independently and anonymously evaluated each performance using a validated 14-item final product analysis checklist. Statistical analyses included linear regression, ANOVA, Mann-Whitney U, Wilcoxon signed-rank tests, and intraclass correlation coefficient (ICC) for inter-rater reliability. RESULTS: Median scores improved steadily with training level, from 35.0 in postgraduate year (PGY) 1 to 53.7 in PGY 5 out of 70. Linear regression demonstrated a significant positive association between both training level and duration in residency with performance. Senior residents (PGY 4-5, median score 54.0) significantly outperformed junior residents (PGY 1-3, median score 38.0; p = 0.012). Across all training levels, median scores improved from 43.2 on the first attempt to 52.5 on the third, though this difference was not statistically significant. Inter-rater reliability was excellent (ICC = 0.9210, p < 0.0001). A proficiency cutoff score of 45/70 was established using the contrasting groups method. CONCLUSION: The consistency of 3D-printed temporal bones judged by final product analysis allows for fair, objective, and reliable assessment for formative and summative evaluations. By longitudinally tracking skill improvement and differentiating performance across training levels, it supports the transition to competency-based surgical education. LEVEL OF EVIDENCE: N/A.
Tong JY, Amin N, Cruess C
… +8 more, Ludeman E, Moyer K, Wolf J, Taylor R, Molitoris JK, Ferris MJ, Mehra R, Hatten KM
Laryngoscope
· 2026 May · PMID 42103481
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OBJECTIVE: While smoking has been implicated as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell cancer (OPSCC) treated with definitive chemoradiation, its prognostic impact on surgically treate...OBJECTIVE: While smoking has been implicated as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell cancer (OPSCC) treated with definitive chemoradiation, its prognostic impact on surgically treated OPSCC is less clear. DATA SOURCES: MEDLINE, Embase, CENTRAL, and Scopus. REVIEW METHODS: Articles describing patients with HPV-associated OPSCC treated with transoral robotic surgery (TORS), which reported oncologic outcomes by smoking history, were included. RESULTS: 2079 patients were included across 12 studies. Median age was 58.5 years, and 1808 (87.0%) were male. HPV-associated disease was reported in 1681 (80.9%) patients. T stage was most commonly T2 in 831 (40.0%) and T1 in 764 (36.7%). N stage was N2 in 854 (41.1%), N1 in 544 (26.2%), and N0 in 307 (14.8%). 931 (44.8%) were considered individuals with a smoking history, while 1045 (50.3%) were considered without a smoking history. Median follow up was 33.7 months. Meta-analysis using a fixed effects model demonstrated an overall hazard ratio of 1.4 (95% confidence interval 1.0-2.0) for disease recurrence, 2.7 (95% confidence interval 1.5-4.8) for overall survival, and 1.4 (95% confidence interval 0.4-4.6) for disease specific survival. CONCLUSIONS: In this population of predominantly HPV-associated OPSCC treated with TORS, meta-analysis demonstrated no significant difference in recurrence-free survival or disease-specific survival between individuals with and without a smoking history. Individuals with a smoking history appeared to have worse overall survival, although only five studies reported on this outcome. Further research is required to clarify the prognostic influence of smoking on OPSCC treated with TORS.
Laryngoscope
· 2026 May · PMID 42093077
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OBJECTIVE: To develop a subject-specific, three-dimensional finite element (FE) model of the human upper airway and evaluate how ansa cervicalis stimulation (ACS), a novel neurostimulation for obstructive sleep apnea (OS...OBJECTIVE: To develop a subject-specific, three-dimensional finite element (FE) model of the human upper airway and evaluate how ansa cervicalis stimulation (ACS), a novel neurostimulation for obstructive sleep apnea (OSA), alters upper airway anatomy under physiologic loading. METHODS: Upper airway anatomy was reconstructed from a head-and-neck CT of an adult female using a semi-automated pipeline, including segmentation, smoothing, tetrahedral meshing, and registration. Linear elastic material properties were assigned from the literature. ACS was simulated as a caudal load on the anterior thyroid cartilage, and inspiratory collapse tendency was mimicked with a -70 Pa luminal negative pressure. Structural displacement and cross-sectional area (CSA) changes were quantified at the soft palate, lateral pharyngeal wall, tongue base, and epiglottis. RESULTS: ACS produced caudal displacement of the thyroid cartilage by approximately 10 mm with coordinated motion of the hyolaryngeal complex and longitudinal pharyngeal wall strain. It also tilted the epiglottis antero-inferiorly and increased its curvature, reducing posterior-inferior motion under negative pressure by more than 50% (5.0 to 2.2 mm). Retro-epiglottic CSA increased by 68.8% without negative pressure (42.43 to 71.63 mm) and by 2980.3% with negative pressure (0.79 to 24.19 mm). Retropalatal CSA improved by 34.4% without negative pressure (65.04 to 87.42 mm) and by 20.3% with negative pressure (16.98 to 20.43 mm). CONCLUSION: This proof-of-concept, subject-specific FE model shows that ACS imparts caudal traction through the hyolaryngeal complex, producing multilevel anatomic stabilization under physiologic loading. The findings establish a quantitative, hypothesis-generating framework for interrogating ACS-mediated airway stabilization mechanisms and support further investigation across broader OSA populations and collapse phenotypes. LEVEL OF EVIDENCE: N/A.
Kayekjian D, Chun WB, Nguyen SA
… +2 more, O'Rourke AK, Meenan KD
Laryngoscope
· 2026 May · PMID 42092344
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OBJECTIVES: The aim of this study was to elucidate the risk of developing voice disorders among peri- and post-menopausal female hormone replacement therapy (HRT) users. METHODS: A retrospective cohort study was conducte...OBJECTIVES: The aim of this study was to elucidate the risk of developing voice disorders among peri- and post-menopausal female hormone replacement therapy (HRT) users. METHODS: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Females aged 40-60 years old were included and stratified into two cohorts: HRT users (n = 16,586) and HRT non-users (n = 248,725) while excluding for head and neck radiation/neoplasms, smoking, benign laryngeal lesions, thyroid disorders, gender dysphoria, and any other systemic hormone use. Voice and resonance disorders (VRD) and dysphonia were separately assessed at 3-month intervals post-HRT initiation after propensity score-matching for age, sex, race, and ethnicity. Odds ratios (ORs) with 95% confidence intervals (CIs) and risk differences (RD) were generated to compare outcomes. RESULTS: HRT users had significantly higher odds of dysphonia, but not VRD, within 0-9 months (OR 1.72; 95% CI (1.01-2.95), OR 1.66; 95% CI (0.99-2.79), respectively). For HRT users with elevated BMI, the 1-year VRD incidence was not significantly different than non-HRT users (RD 0.19%, p = 0.069). Overall, the incidence of VRD and dysphonia within 1 year in both groups was < 0.5% and showed no significant difference at most times between groups. CONCLUSIONS: HRT may not have any significant clinical impact on the peri- and post-menopausal voice. Although higher odds were noted earlier after treatment, HRT users did not have higher odds of voice issues after 1 year. This study highlights the lack of consensus in literature and urges future research to fully understand the impact of HRT on peri- and post-menopausal voice.
Stinnett S, Liu SX, Carlson KM
… +4 more, Helou L, Smith L, Maria CS, Mazul AL
Laryngoscope
· 2026 May · PMID 42092329
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OBJECTIVE: The voice handicap index-10 (VHI-10) and reflux symptoms index (RSI) are validated, patient-reported outcome measures (PROMs) commonly used in laryngology to assess the subjective impact of voice disorders and...OBJECTIVE: The voice handicap index-10 (VHI-10) and reflux symptoms index (RSI) are validated, patient-reported outcome measures (PROMs) commonly used in laryngology to assess the subjective impact of voice disorders and severity of symptoms associated with laryngopharyngeal reflux, respectively. This study aims to evaluate the relationship between neighborhood-level socioeconomic disadvantage, as measured by the area deprivation index (ADI), and patient-reported laryngeal outcomes. METHODS: An analysis of 1310 adult patients who were referred to a tertiary care laryngology clinic between January and December 2024 was conducted. Patient addresses were geocoded and matched to corresponding ADI national percentile scores, and internally derived ADI quartiles were formed. Median VHI-10 and RSI scores by ADI quartile were compared using the Kruskal-Wallis test. Multivariable linear regression was performed to investigate the association between ADI and VHI-10 or RSI scores, adjusting for sociodemographic (race, sex, and age) and clinical (comorbidities, depression/anxiety, insurance status, BMI, and primary diagnosis) factors. RESULTS: Patients living in the least deprived ADI quartile had significantly lower median VHI-10 and RSI Scores, compared to patients in the most deprived ADI quartile (10 vs. 14, and 15 vs. 20, respectively). In adjusted analysis, living in a higher ADI area was significantly associated with a higher VHI-10 (β = 0.04, 95% confidence interval [CI]: 0.008-0.06) or RSI (β = 0.04, 95% CI: 0.01-0.07) score. CONCLUSIONS: Higher neighborhood socioeconomic deprivation is significantly associated with higher VHI-10 and RSI scores. Patients living in more deprived areas may face barriers to accessing care, including low health literacy and limited resources.
Weng ML, Vitkovska T, Hwang SH
… +5 more, Evans LK, Yang HH, Dann C, Sajed D, St John MA
Laryngoscope
· 2026 May · PMID 42087463
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OBJECTIVES: To characterize the survival and morbidity associated with immunocompromised status in patients with surgically resected Human Papillomavirus positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). METH...OBJECTIVES: To characterize the survival and morbidity associated with immunocompromised status in patients with surgically resected Human Papillomavirus positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). METHODS: We reviewed patients with surgically resected HPV + OPSCC at a tertiary institution between 2000 and 2023. The survival and morbidity associated with an immunocompromised status were assessed with multivariable Cox proportional hazards models controlling for patient, tumor, and treatment characteristics. RESULTS: Among 278 patients with HPV+ OPSCC that met inclusion criteria, 14 patients were immunocompromised. Causes of immunocompromise: 4, leukemia or lymphoma; 3, organ transplantation; 3, medically immunosuppressed; 2, HIV; 2, myelodysplastic syndrome and pancytopenia. Adjusting for covariates, the immunocompromised patient group had significantly worse overall survival (64.3% vs. 91.7%; HR 4.12, 95% CI: 1.14-14.90, p < 0.005) compared to the non-compromised group. The immunocompromised patient group did not have a significantly different postoperative length of stay (3.96 vs. 3.5 days; aβ 0.66, 95% CI: -1.30 to 2.64). CONCLUSIONS: In this small, heterogeneous cohort of surgically resected HPV + OPSCC, immunocompromised status was associated with significantly worse overall survival; however, these exploratory findings should be interpreted cautiously.
Laryngoscope
· 2026 May · PMID 42086505
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OBJECTIVES: High-frequency recurrence of peripheral facial palsy suggests an underlying structural predisposition. We aimed to identify the anatomical phenotype associated with ≥ 3 recurrences using high-resolution CT (H...OBJECTIVES: High-frequency recurrence of peripheral facial palsy suggests an underlying structural predisposition. We aimed to identify the anatomical phenotype associated with ≥ 3 recurrences using high-resolution CT (HRCT). METHODS: We retrospectively analyzed 63 patients with high-frequency recurrence (mean 3.5 episodes) and 62 normal controls. Four HRCT parameters were quantified: geniculate ganglion (GG) enlargement, labyrinthine segment (LS) constriction, intracanalicular bony exostosis, and greater superficial petrosal nerve (GSPN) thickening. Inter-parameter correlations were also evaluated. RESULTS: The mean age at the first attack was young (22.1 years). Intracanalicular bony exostosis was identified as the most potent predictor of recurrence (39.7% vs. 9.7%; OR: 7.39, p < 0.001). GG enlargement and GSPN thickening were significantly more prevalent in the recurrent group (p < 0.01) and showed a strong positive correlation (ρ = 0.58, p < 0.001), supporting a retrograde inflammatory spread mechanism. Overall, 63.5% of the recurrent group exhibited at least one structural or secondary finding (p < 0.001). CONCLUSION: High-frequency recurrent facial palsy is associated with a structural phenotype, where fixed bony constraints like exostosis exacerbate chronic secondary inflammatory changes in the GG and GSPN. Recognizing these features on HRCT may help predict individuals at risk for recurrence and assist in planning targeted surgical decompression.
Giombi F, Pace GM, Cerasuolo M
… +2 more, Spriano G, Malvezzi L
Laryngoscope
· 2026 May · PMID 42086497
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We present a modification of the traditional Epiglottis Stiffening Operation technique for the management of primary epiglottic collapse in OSA, introducing carbon dioxide (CO) laser application to promote anterior repos...We present a modification of the traditional Epiglottis Stiffening Operation technique for the management of primary epiglottic collapse in OSA, introducing carbon dioxide (CO) laser application to promote anterior repositioning of the epiglottis. The use of laser yielded promising improvements in polysomnographic parameters compared to baseline and allowed for modulable thermal effects on target tissues by adjusting power, spot size, and exposure time, thereby reducing the risk of cartilage injury from excessive collateral heat.
Laryngoscope
· 2026 May · PMID 42084120
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OBJECTIVE: To identify imaging predictors for successful sialendoscopy-assisted removal of proximal/hilar submandibular stones. METHODS: Retrospective cohort study of patients with sialolithiasis near the hilum of the su...OBJECTIVE: To identify imaging predictors for successful sialendoscopy-assisted removal of proximal/hilar submandibular stones. METHODS: Retrospective cohort study of patients with sialolithiasis near the hilum of the submandibular gland (SMG). Two independent reviewers measured CT images for stone size, number, location relative to the mylohyoid, and distance from the inferior mandible. RESULTS: Seventy-six patients were evaluated. Stones were located at the mylohyoid plane in 52 patients (68.4%), superior to the mylohyoid in 9 (11.8%), and inferior to the mylohyoid in 15 (19.7%). A combined transoral approach was required in 65 (85.5%) patients. Proximal/hilar SMG stones were successfully removed in 82.9% (n = 63), with higher removal rates in patients with stones located superior to the mylohyoid line (100.0%) compared to at (84.6%) or inferior (60.0%, p = 0.038). Shorter average distance between the inferior border of the mandible and the stone was associated with successful removal (p < 0.001). Maximum stone diameter was significantly larger in successful cases compared to unsuccessful cases (8.0 vs. 5.4 mm; p = 0.043). Stones visible with sialendoscopy (n = 55, 72.4%) were associated with higher successful removal rates than for stones not seen with sialendoscopy. CONCLUSIONS: Gland preservation techniques for proximal/hilar submandibular sialolithiasis required proximal transoral incision in 85.5% of cases. Imaging characteristics, including stone position superior to or at the mylohyoid plane and larger stone size, were predictors of successful sialendoscopy-assisted transoral removal. Imaging findings can assist with surgical planning for proximal/hilar submandibular stones.
Espahbodi M, Syed A, Tu A
… +25 more, Seidman MD, Danner CJ, Allen KP, Bartels LJ, Ahsan SF, Voelker CCJ, Deep NL, Hunter JB, Chiffer RC, Michaelides EM, Elrakhawy M, Miller MW, Lin HW, Djalilian HR, Vivas EX, Angeli SI, Hoa M, Kim HJ, Widick MH, Stidham KR, Patel NS, Gurgel RK, Doerfer KW, Koka K, Harris MS
Laryngoscope
· 2026 May · PMID 42084107
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OBJECTIVE: To evaluate intracochlear electrocochleography (ECochG) amplitude parameters during cochlear implantation (CI) using a novel multi-frequency ECochG algorithm. METHODS: A multi-institutional, prospective cohort...OBJECTIVE: To evaluate intracochlear electrocochleography (ECochG) amplitude parameters during cochlear implantation (CI) using a novel multi-frequency ECochG algorithm. METHODS: A multi-institutional, prospective cohort study was performed at 18 high-volume CI centers. The inclusion criteria were adults with sensorineural hearing loss and audiometric thresholds of ≤ 90 dB hearing level at 500 Hz undergoing CI with Advanced Bionics (Valencia, CA) Ultra 3D devices between 2024 and 2025. ECochG recordings were performed with simultaneous multi-frequency stimulation of four frequencies between 125 and 4000 Hz during cochlear implant insertion. Concurrent multi-frequency recording allowed extraction of amplitude and phase of each frequency individually. Post hoc analysis was performed to determine the difference in the number of drop alarms between single- and multi-frequency ECochG. An ECochG amplitude drop of 6 dB was defined as a drop alarm. Insertion track patterns were compared between single- and multi-frequency ECochG. RESULTS: One hundred ninety-five ears were included. Mean number of drop alarms for the single-frequency algorithm was 1.72 (95% CI: 1.52, 1.92; median 1) compared to 0.42 (95% CI: 0.31, 0.53; median 0) for multi-frequency; p < 0.001. The number of Type C patterns (rise in amplitude during insertion followed by a drop) decreased with the multi-frequency ECochG algorithm compared to the single-frequency ECochG algorithm. The number of Type D patterns (no-response) decreased, indicating that multi-frequency ECochG generated more responses across the cochlea than single-frequency ECochG. CONCLUSIONS: A novel multi-frequency ECochG algorithm during CI is associated with fewer drop alarms and altered insertion track patterns, which may provide a more accurate assessment of the cochlear microenvironment.