Laryngoscope [JOURNAL]
Sun
200 papers
Insomnia as a Clinical Predictor of Hypoglossal Nerve Stimulation Settings and Treatment Success.
Doan P, Durr ML, Chang JL
Laryngoscope · 2026 Apr · PMID 42063279 · Publisher ↗
OBJECTIVES: To examine the impact of comorbid insomnia and obstructive sleep apnea (COMISA) on hypoglossal nerve stimulation (HNS) stimulation levels and rates of therapeutic success. METHODS: A retrospective chart revie...
OBJECTIVES: To examine the impact of comorbid insomnia and obstructive sleep apnea (COMISA) on hypoglossal nerve stimulation (HNS) stimulation levels and rates of therapeutic success. METHODS: A retrospective chart review included adult OSA patients who received HNS surgery. Demographic information, baseline Insomnia Severity Index (ISI), pre and post implant sleep studies, and HNS stimulation data were collected. HNS therapy success was evaluated as ≥ 50% AHI reduction and AHI ≤ 15 (Sher15 criteria) and based on HNS treatment pathways using AHI symptoms and adherence. RESULTS: The cohort included 80 OSA patients treated with HNS therapy including 35.5% (n = 30) with pre-surgery COMISA based on ISI score ≥ 15. COMISA patients had lower therapeutic HNS stimulation levels (1.5 V (COMISA) vs. 1.9 V, p < 0.01) and lower mean HNS stimulation level change from baseline (0.8 V (COMISA) vs. 1.01 V, p < 0.05) compared to non-COMISA patients. Fewer COMISA patients met Sher15 criteria (33.3% (n = 10) (COMISA) vs. 62.0% (n = 31), p = 0.02). When classifying COMISA and non-COMISA patients by post-operative HNS pathways, 60.0% (n = 18) of COMISA patients were within the Yellow Pathway Type 2 (adequate adherence, Sher15 nonresponse) compared to 32.0% (n = 16) of non-COMISA (p = 0.02), with no significant differences in rates within the other pathways. CONCLUSION: COMISA patients have lower therapeutic HNS stimulation levels, fewer stimulation level changes, and reduced rates of achieving Sher15 success criteria compared to those without COMISA. Managing expectations during stimulation uptitration and balancing implant stimulation tolerance and effectivness are required to optimize HNS outcomes.
Effect of Preoperative Systemic Steroids on Tissue Eosinophils in CRSwNP: Meta-Analysis.
Chitsuthipakorn W, Pooldum V, Hoang MP … +3 more , Kanjanawasee D, Seresirikachorn K, Snidvongs K
Laryngoscope · 2026 Apr · PMID 42062802 · Publisher ↗
OBJECTIVE: Preoperative systemic corticosteroids are frequently used in chronic rhinosinusitis with nasal polyps (CRSwNP). This meta-analysis aimed to evaluate the effect of preoperative systemic steroids on tissue eosin...
OBJECTIVE: Preoperative systemic corticosteroids are frequently used in chronic rhinosinusitis with nasal polyps (CRSwNP). This meta-analysis aimed to evaluate the effect of preoperative systemic steroids on tissue eosinophil count (TEC) in CRSwNP. DATA SOURCES: PubMed, EMBASE, and Cochrane Library. REVIEW METHODS: Systematic searches were conducted through March 2026 for studies assessing TEC following preoperative systemic steroids in adult CRSwNP patients. Eligible designs included randomized controlled trials, cohort studies, and pre-post studies. TEC was reported as cells per high-power field (TEC/HPF) or as a percentage of eosinophils among inflammatory cells (%TEC). Pooled mean differences (MD) were calculated using random-effects models. RESULTS: Seventeen studies (930 participants) were included, of which 13 were eligible for quantitative synthesis. Systemic steroids significantly reduced TEC/HPF (MD -36.57; 95% CI: -43.94 to -29.20) and %TEC (MD -18.14; 95% CI: -24.88 to -11.39). Reductions were consistent across steroid dose, duration, and concomitant intranasal steroid use. However, low dose (4.2-18.6 mg/day) given in ≤ 7-day regimens showed a non-significant reduction (MD -17.78; 95% CI: -62.62 to 27.05). Adverse events were not statistically different between the steroid and control groups (5.60% vs. 1.12%, odds ratio = 5.22, p = 0.12). No adverse events were reported in studies using low-dose or tapering regimens. CONCLUSION: Preoperative systemic corticosteroids significantly reduce TEC in CRSwNP, regardless of the quantifying method. This effect may interfere with histologic assessment when biopsy is taken intraoperatively. To avoid misinterpretation, clinicians may consider either withholding preoperative systemic corticosteroids, using a less suppressive regimen, or obtaining a biopsy prior to steroid initiation. LEVEL OF EVIDENCE: N/A.
Primary Language Spoken at Home and Speech Outcomes Among Children With Cleft Palate.
Du AE, Lopes O, Mastacouris N … +2 more , Hanna CW, Scott AR
Laryngoscope · 2026 Apr · PMID 42062788 · Publisher ↗
OBJECTIVES: Following cleft palate repair, early detection of maladaptive compensatory mechanisms and hypernasality may determine the need for additional intervention. Our goal is to understand if primary language influe...
OBJECTIVES: Following cleft palate repair, early detection of maladaptive compensatory mechanisms and hypernasality may determine the need for additional intervention. Our goal is to understand if primary language influences rates of subsequent intervention among children with cleft palate in the United States. METHODS: Within a single urban cleft team, patients with a history of palate repair evaluated at least 2 years postoperatively were analyzed using Fisher's exact test. RESULTS: There were 124 patients representing 6 languages: 101 English, 9 Spanish, and 14 other (Vietnamese, Haitian Creole, Portuguese, and Tamil). Some patients were repaired elsewhere and presented to our clinic secondarily for evaluation. Among English and non-English speaking children, similar rates of symptomatic and asymptomatic postoperative fistula (17.8% vs. 17.4%, p = 1.00), hypernasality and/or audible nasal emissions (ANEs) (44.6% vs. 30.4%, p = 0.25), persistent hypernasality/ANE after speech therapy (ST) (22.8% vs. 13.0%, p = 0.40), and revision surgery (33.7% vs. 17.4%, p = 0.14) were observed. However, higher rates of hypernasality/ANE (45.5% vs. 14.3%, p = 0.04), persistent hypernasality/ANE after ST (23.6% vs. 0.0%, p = 0.04), and revision surgery (33.6% vs. 7.1%, p = 0.06) were noted among English and Spanish speakers. [Correction added on 08 May 2026, after first online publication: The preceding sentence has been revised in this version.] CONCLUSION: Within a single urban practice in the United States, lower rates of hypernasality and revision surgery were observed among non-English and non-Spanish speaking patients. Such findings may suggest disparities in resources available for detecting speech abnormalities in this population.
Laryngeal Dysfunction Following COVID-19: A TriNetX Retrospective Cohort Study.
Loblundo C, Chun WB, Nguyen SA … +2 more , Meenan K, O'Rourke AK
Laryngoscope · 2026 Apr · PMID 42059350 · Publisher ↗
OBJECTIVE(S): Long COVID affects multiple organ systems, yet the incidence and risk factors for post-COVID-19 laryngeal dysfunction remain underexplored. This study evaluated the incidence of laryngeal dysfunction follow...
OBJECTIVE(S): Long COVID affects multiple organ systems, yet the incidence and risk factors for post-COVID-19 laryngeal dysfunction remain underexplored. This study evaluated the incidence of laryngeal dysfunction following COVID-19. METHODS: A retrospective cohort study was performed using the TriNetX Global Collaborative EHR Network (> 180 million records). Adults without prior laryngeal dysfunction or major comorbidities were stratified by COVID-19 exposure and compared with uninfected controls. Outcomes included chronic cough, dysphagia, voice disorders, vocal fold paralysis, and laryngeal spasm, assessed up to 5 years post-infection. After propensity score matching, odds ratios (OR) and risk differences (RD) with 95% confidence intervals (CI) were calculated. RESULTS: COVID-19 was associated with significantly increased odds of chronic cough (peak OR 7.12; RD 0.33%, p < 0.0001), dysphagia (peak OR 2.71; RD 0.36%, p < 0.0001), voice disorders (peak OR 3.25; RD 0.12%, p < 0.0001), vocal fold paralysis (peak OR 2.17; RD 0.01%, p < 0.0001), and laryngeal spasm (peak OR 2.79; RD 0.003%, p < 0.0001). Incidence peaked at 1-2 years for most outcomes and at 2-3 years for laryngeal spasm. Hospitalization and mechanical ventilation were associated with increased rates of dysphagia (HR 2.63; HR 5.26), voice disorders (HR 1.15; HR 4.45), and vocal cord paralysis (HR 2.09; HR 9.35), but reduced rates of chronic cough (HR 0.68; HR 0.45). Vaccinated patients showed higher rates of chronic cough (HR 1.36) and voice disorders (HR 1.22). CONCLUSION: COVID-19 is associated with increased incidence of new-onset laryngeal dysfunction, most commonly peaking 1-2 years after infection and influenced by hospitalization, mechanical ventilation, and vaccination status.
The Statistical Fragility of Saline Nasal Irrigation for Rhinosinusitis: A Systematic Review.
Sethi R, Oral K, Guda R … +6 more , Sharma S, Ratna S, First O, Deshmukh S, Choi C, Khan MN
Laryngoscope · 2026 Apr · PMID 42053165 · Publisher ↗
OBJECTIVE: To assess the statistical fragility of randomized controlled trials (RCTs) evaluating high-volume saline nasal irrigation (SNI) for rhinosinusitis using fragility analysis. DATA SOURCES: PubMed, MEDLINE, and E...
OBJECTIVE: To assess the statistical fragility of randomized controlled trials (RCTs) evaluating high-volume saline nasal irrigation (SNI) for rhinosinusitis using fragility analysis. DATA SOURCES: PubMed, MEDLINE, and Embase were searched for RCTs published between May 1976 and January 2026. REVIEW METHODS: This study was reported as per PRISMA guidelines. RCTs that compared high-volume SNI to non-irrigation standard care for acute, recurrent, or chronic rhinosinusitis, and reported ≥ 1 dichotomous outcome, were included. Fragility index (FI), the minimum number of event reversals needed to alter statistical significance, and fragility quotient (FQ), FI normalized to sample size, were calculated for statistically significant dichotomous outcomes. Reverse FI (rFI) and reverse FQ (rFQ) were calculated for non-significant outcomes. RESULTS: Eight RCTs were included, yielding 38 dichotomous outcomes. Eight outcomes (21.1%) were statistically significant. The overall combined median FI was 5 (FQ 0.062), with similar FI values between significant and non-significant outcomes. In over one-fifth of outcomes, loss to follow-up exceeded FI. Analysis of principal dichotomous outcomes from studies demonstrated a median FI of 6 (FQ 0.092), with five of eight (62.5%) outcomes non-significant. CONCLUSION: RCTs evaluating SNI for rhinosinusitis exhibit moderate-to-high statistical fragility, with small outcome changes capable of reversing study conclusions. Because fragility analysis was limited to dichotomous outcomes while many primary endpoints were continuous, our findings should be interpreted as complementary rather than comprehensive appraisals of RCTs. Future RCTs with larger sample sizes, reduced bias, and pre-specified fragility considerations are needed to better define the clinical role of SNI.
Ménière's Disease: A Tri-Decade Scoping Review of Treatment Trends and Evidence Quality.
Zavdy O, Piyajarawong T, Boyle S … +2 more , O'Shea R, Rutka J
Laryngoscope · 2026 Apr · PMID 42053150 · Publisher ↗
INTRODUCTION: Ménière's disease (MD) is a complex inner ear disorder defined by endolymphatic hydrops and a triad of episodic vertigo, fluctuating hearing loss, and tinnitus. Despite AAO-HNS diagnostic guidelines, diseas...
INTRODUCTION: Ménière's disease (MD) is a complex inner ear disorder defined by endolymphatic hydrops and a triad of episodic vertigo, fluctuating hearing loss, and tinnitus. Despite AAO-HNS diagnostic guidelines, disease heterogeneity and lack of treatment consensus persist. OBJECTIVE: This study conducts a tri-decade scoping review (1994-2024) to evaluate the MD evidence base, shifts in management, and methodological rigor regarding AAO-HNS and CONSORT compliance. MATERIALS AND METHODS: A systematic search of PubMed, CINAHL, and Cochrane (2014-2024) identified English-language RCTs and prospective cohorts involving adults. Studies were graded via the Oxford CEBM system, with guideline compliance analyzed using IBM SPSS v29.0. A scoping review framework was adopted to map the "Quality Paradox" between evidence hierarchy and reporting standards. RESULTS: From 1344 publications, 257 studies met inclusion criteria. While research volume surged-with Level 2 studies quadrupling (p < 0.01) and Level 3 studies tripling (p < 0.05)-reporting standards significantly declined. Adherence to AAO-HNS diagnostic and treatment-outcome criteria dropped to 73% and 34%, respectively. Clinically, management shifted toward preservation-focused interventions, including hydrops-visualizing MRI, intratympanic steroids over gentamicin, and increased cochlear implantation, alongside a decline in positive-pressure device use. CONCLUSION: The MD evidence base increasingly favors non-ablative, patient-centered interventions. However, the validity of these advancements is threatened by a significant decline in reporting compliance. To safeguard the evidence base, journals must enforce standardized reporting as a nonnegotiable prerequisite for publication. LEVEL OF EVIDENCE: N/A.
Long-Term Outcomes of Patients Undergoing Cricothyrotomy at a Tertiary Care Level One Trauma Center.
Raizada S, Shapiro Y, Modi R … +4 more , Balouch B, Zhang K, Chovanes J, Solomon D
Laryngoscope · 2026 Apr · PMID 42053124 · Publisher ↗
OBJECTIVE(S): To identify short-term and long-term outcomes and complications for patients who underwent cricothyrotomy. METHODS: A retrospective review was conducted for all patients who underwent cricothyrotomy between...
OBJECTIVE(S): To identify short-term and long-term outcomes and complications for patients who underwent cricothyrotomy. METHODS: A retrospective review was conducted for all patients who underwent cricothyrotomy between 2014 and 2025. Data included demographics, procedural details such as time to tracheostomy conversion and success rates, hospital course, short-term complications (e.g., dysphagia, pneumonia, vocal cord paralysis), and long-term complications (e.g., subglottic stenosis, vocal fold injury). RESULTS: Forty-eight patients underwent emergent cricothyrotomy. 72.9% were male and the mean age was 57.7 years. Common short-term complications included dysphagia (35.4%), pneumonia (31.3%), and dysphonia (27.1%). Planned conversion to tracheostomy occurred in 83.3% of patients, on average 2.3 days post-cricothyrotomy. Time to tracheostomy was significantly longer in patients who developed pneumonia (3.9 vs. 1.4 days, p = 0.005). In-hospital mortality was 20.8% and 90-day mortality was 29.2%. The mean post-cricothyrotomy hospital length of stay was 19.4 days. Long-term complications included persistent dysphagia (18.8%), subglottic stenosis (12.5%), and vocal fold injury (10.4%). Thirty-day return to the ED visits occurred in 20.8% of patients, with both airway and comorbidity-related presentations. Twenty patients (41.7%) ultimately had their tracheostomy tube removed with a mean time to decannulation of 83.7 days. CONCLUSION: Cricothyrotomy remains a vital, life-saving intervention in the difficult airway algorithm but carries a risk of significant post-procedural complications, including dysphagia, pneumonia, dysphonia, subglottic stenosis, and vocal fold injury. These findings highlight the importance of meticulous postoperative care, particularly respiratory management, to reduce delays in conversion to tracheostomy and optimize long-term outcomes.
Diagnosis and Treatment of Refractory Chronic Cough: An American Broncho-Esophagological Association Expert Consensus Statement.
Malka RE, Saraswathula A, Lilly G … +11 more , Ryan MA, Bowen A, Altman KW, Amin M, Matrka L, O'Rourke AK, Simpson CB, Bock J, Bryson PC, Carroll TL, Akst LM
Laryngoscope · 2026 Apr · PMID 42049642 · Publisher ↗
OBJECTIVE: To develop an expert consensus statement (ECS) on the diagnosis and treatment of refractory chronic cough (RCC) in adults. RCC was defined as cough lasting longer than 8 weeks and refractory to standard manage...
OBJECTIVE: To develop an expert consensus statement (ECS) on the diagnosis and treatment of refractory chronic cough (RCC) in adults. RCC was defined as cough lasting longer than 8 weeks and refractory to standard management of pulmonary, gastrointestinal, sinonasal, and medication-induced etiologies. METHODS: An expert panel of otolaryngologists used published consensus statement methodology to develop statements guiding the diagnosis and management of RCC from an otolaryngologic perspective. A modified Delphi method was used to iteratively select, eliminate, and refine statements based upon accepted methodology until consensus was achieved. RESULTS: Three iterative Delphi surveys were performed with discussion rounds between each of the voting sessions. Twenty-seven statements met consensus while six statements did not. The clinical statements were grouped into 9 categories: operational definition, pathophysiology, assessment of prior work-up, phenomenology and symptomatology, four treatment categories (neuromodulators, superior laryngeal nerve blocks, behavioral cough suppression, and emerging treatments), and overall treatment approaches. CONCLUSION: The panel reached consensus for 27 statements related to the diagnosis and treatment of adults with RCC from an otolaryngologic perspective. These statements may be used to standardize evaluation and improve quality of care, while also identifying areas for future investigation in the management of RCC.
The Hidden Hazards of Vaping.
Usman AF, Khaja SF
Laryngoscope · 2026 Apr · PMID 42049509 · Publisher ↗
A 31 year old male presented with a penetrating oropharyngeal injury following a motor vehicle collision and was found to have a retained metallic foreign body suspected to be part of a vape pen. The foreign body was abu...
A 31 year old male presented with a penetrating oropharyngeal injury following a motor vehicle collision and was found to have a retained metallic foreign body suspected to be part of a vape pen. The foreign body was abutting the carotid artery and was removed via a combined transoral and transcervical approach. This case highlights a novel mechanism of head and neck trauma and emphasizes the importance of understanding a wide spectrum of unique injuries.
Electrode Contacts in the Functional Hearing Region for Pediatric Cochlear Implant Recipients.
Quinonez Del Cid E, Dillon MT, Park LR … +2 more , Brown KD, Thompson NJ
Laryngoscope · 2026 Apr · PMID 42049500 · Publisher ↗
OBJECTIVES: Examine the incidence of one or more electrode contacts placed within the region of functional acoustic hearing and the potential influence of electrode positioning on speech recognition for pediatric cochlea...
OBJECTIVES: Examine the incidence of one or more electrode contacts placed within the region of functional acoustic hearing and the potential influence of electrode positioning on speech recognition for pediatric cochlear implant (CI) recipients. METHODS: A retrospective review for pediatric CI recipients of straight electrode arrays with preserved low-frequency hearing (an unaided threshold of ≤ 80 dB HL at 250 Hz) was conducted at a tertiary referral center. Intraoperative X-rays were used to determine the angular insertion depth (AID) of each electrode. Proximity of contacts to the functional acoustic hearing region was calculated using AID and postoperative unaided thresholds. For electric-acoustic stimulation (EAS) users, the association between proximity values and CNC word recognition in quiet was reviewed at 3-, 6-, and 12-months post-activation. RESULTS: Among 69 ears, 90% had at least one electrode contact within the functional acoustic hearing region. Proximity values ranged from -131° to 450° (mean: 100°, SD: 120°). For EAS users with speech recognition data (n = 29), proximity values were not significantly associated with post-activation CNC scores (p ≥ 0.212). CONCLUSIONS: Most pediatric CI recipients with hearing preservation had at least one electrode contact in the region of functional acoustic hearing. Proximity was not significantly associated with word recognition in quiet for EAS users, though this subgroup was limited in sample size. Further studies in pediatric EAS users are needed to understand the potential relationship with speech recognition in noise and to determine the benefits of individualizing array selection and/or EAS mapping.
Disparities in Hearing Screening Practices in Minnesota Elementary Schools.
Sajjadi A, Kim E, Marcus KS … +10 more , Todatry S, Hable N, Roby B, Meyer AC, Redmann A, Herd H, Maher R, Chinnadurai S, Nickel A, Jayawardena A
Laryngoscope · 2026 Apr · PMID 42049482 · Publisher ↗
OBJECTIVE: Identifying and addressing pediatric hearing loss is critical to supporting a child's development. School-based hearing screening is a mainstay of timely identification of hearing loss. The objectives of this...
OBJECTIVE: Identifying and addressing pediatric hearing loss is critical to supporting a child's development. School-based hearing screening is a mainstay of timely identification of hearing loss. The objectives of this study were to characterize the current hearing screening practices in public, charter, and private elementary schools in Minnesota. METHODS: This was a cross-sectional survey with data collected between March and June 2023. Surveys assessed the presence of standardized hearing screening processes and compliance with American Academy of Audiology (AAA) or Minnesota Department of Health (MDH) guidelines. RESULTS: About 146 public schools, 43 charter schools, and 60 private schools met inclusion criteria and responded to the survey. There was a statistically significant difference in the rate of standardized screening between school types (χ = 18.06; p < 0.001). Only 10.44% (n = 26) of schools completed hearing screenings per AAA guidelines, and even fewer, 4.82% (n = 12), completed hearing screenings according to MDH guidelines. The odds of screening per AAA or MDH guidelines were 3.50 times higher in charter schools compared to public schools (95% CI: 1.14, 10.73) and 4.61 times higher in private schools compared to public schools (95% CI: 1.73, 12.26). CONCLUSION: There is a lack of standardization in hearing screening processes in Minnesota elementary schools. Adherence to screening per AAA or MDH recommendations is low in all types of elementary schools. Charter and private schools were more likely than public schools to screen per AAA or MDH guidelines. Overall, our data demonstrate an opportunity for improvement in school-based hearing screening. LEVEL OF EVIDENCE: N/A.
The Impact of Etiology on Time to Vocal Fold Motion Recovery in Unilateral Vocal Fold Paralysis.
Suresh R, Mau T
Laryngoscope · 2026 Apr · PMID 42049480 · Publisher ↗
OBJECTIVES: Spontaneous recovery of vocal fold (VF) motion in unilateral vocal fold paralysis (UVFP) has been shown to follow a bimodal time distribution for peripheral, nonidiopathic etiologies, but recovery time depend...
OBJECTIVES: Spontaneous recovery of vocal fold (VF) motion in unilateral vocal fold paralysis (UVFP) has been shown to follow a bimodal time distribution for peripheral, nonidiopathic etiologies, but recovery time dependencies on UVFP etiology are incompletely characterized. This study aimed to (1) determine recovery time differences between surgically induced, idiopathic, and intubation-related UVFP, and (2) investigate the impact of distance of injury from larynx on recovery time in surgically induced UVFP. METHODS: Retrospective study of 1425 UVFP patients over a 16-year period identified 736 patients with recovery of VF motion. The time to the first laryngoscopic sign of VF motion recovery in surgically induced, idiopathic, or intubation-related UVFP was fit to a bimodal or unimodal mathematical model. Time course of VF motion recovery was also compared using Kaplan-Meier estimates. RESULTS: Surgically induced UVFP demonstrated a bimodal time-to-recovery distribution, consistent with a previously described two-phase model of recovery. Both idiopathic and intubation-related UVFP followed unimodal recovery patterns. Among surgically induced cases, Kaplan-Meier recovery curves for thyroid/parathyroid and cardiothoracic surgeries were nearly identical despite differing injury locations along the recurrent laryngeal nerve. CONCLUSION: Differences in the time course of VF motion recovery in UVFP reflect the underlying etiologies. Among surgically induced UVFP, the recovery time did not correlate with the distance between the injury site and the larynx, challenging a long-held assumption. The findings support a model in which the severity of neural injury, not the location of injury, is the principal determinant of time to recovery.
Multi-Task Assessment of Context-Specific Gait Changes to Virtual Reality-Based Visual Perturbations.
Gbekie C, Bhardwaj S, Ro H … +2 more , Lalwani AK, Agrawal SK
Laryngoscope · 2026 Apr · PMID 42049473 · Publisher ↗
OBJECTIVE: Conventional gait assessments often fail to detect early, subclinical balance abnormalities that may become apparent under sensory conflict, such as visual perturbations. We investigated whether instrumented g...
OBJECTIVE: Conventional gait assessments often fail to detect early, subclinical balance abnormalities that may become apparent under sensory conflict, such as visual perturbations. We investigated whether instrumented gait analysis combined with virtual reality (VR)-delivered visual perturbations can reveal task-dependent gait adaptations in healthy adults exposed to discordant sensory information. METHODS: Ten healthy adults completed a purpose-designed battery of 10 walking tasks spanning steady-state and balance-challenging conditions (e.g., tandem gait, obstacle negotiation, Timed Up and Go) on an instrumented walkway under four visual conditions: no virtual reality, unperturbed VR, optic flow-perturbed VR, and flickering light-perturbed VR. Spatiotemporal gait parameters were quantified to assess task- and condition-specific changes in dynamic gait control. RESULTS: Visual perturbations elicited task-dependent gait adaptations rather than uniform effects across the battery. Compared to unperturbed walking, optic flow was associated with selective increases in stride width during tasks involving rapid reorientation and rotational head movements, including pivot turning (0.10 vs. 0.06, p = 0.045) and horizontal head turns (0.12 vs. 0.08, p = 0.027). Temporal and spatial gait variability increased during tandem gait under optic flow (step time variability: 32.23 vs. 12.75, p = 0.036; stride length variability: 27.96 vs. 8.08, p = 0.041), reflecting impaired cycle-to-cycle consistency under heightened precision demands. CONCLUSION: VR-delivered visual perturbations revealed task-specific alterations in mediolateral stability, temporal consistency, and spatial gait scaling that were absent during unperturbed walking. A multi-task, perturbation-based assessment framework may therefore enhance sensitivity to subtle gait instability by exposing context-dependent limits of balance control.
Should Superior Laryngeal Nerve Block Be Performed for Neurogenic Cough?
Tracy LF, Noordzij JP
Laryngoscope · 2026 Apr · PMID 42049468 · Publisher ↗
SLN block may be offered as a treatment for neurogenic cough after guideline-directed evaluation and treatment for other causes have been attempted. There is an ~80% success rate which may require multiple injections. Ri...
SLN block may be offered as a treatment for neurogenic cough after guideline-directed evaluation and treatment for other causes have been attempted. There is an ~80% success rate which may require multiple injections. Risks appear limited; however, long-term benefit is not yet determined.
National Trends and Risk Factors for Dysphagia After Anterior Cervical Discectomy and Fusion.
Ha CJ, Anne SG, Morgan S … +2 more , Otite FO, Yan K
Laryngoscope · 2026 Apr · PMID 42045981 · Publisher ↗
BACKGROUND: Dysphagia remains one of the most common complications following anterior cervical discectomy and fusion (ACDF), yet recent national trends and risk factors across surgical indications have not been fully cha...
BACKGROUND: Dysphagia remains one of the most common complications following anterior cervical discectomy and fusion (ACDF), yet recent national trends and risk factors across surgical indications have not been fully characterized. OBJECTIVE: To evaluate national trends in ACDF and dysphagia rates and to identify patient, surgical, and indication-specific risk factors for postoperative dysphagia. METHODS: A retrospective analysis of the Nationwide Inpatient Sample identified adult patients undergoing elective ACDF from 2016 to 2022. Multivariable logistic regression was used to determine independent risk factors for dysphagia and develop a predictive nomogram. Separate models were also constructed for single- and multilevel ACDF. RESULTS: Among 496,425 hospitalizations, dysphagia occurred in 7.7% of patients. Despite a 57.3% decline in ACDF, the odds of dysphagia increased at an estimated 11.4% annually (OR: 1.11, 95% CI: 1.09-1.13; p < 0.001). Cervical diffuse idiopathic skeletal hyperostosis (OR: 5.41; 95% CI: 3.81-7.67), cervical spine fracture (OR: 1.73; 95% CI: 1.31-2.30), and pseudoarthrosis (OR: 1.36; 95% CI: 1.15-1.61) were strong independent predictors of dysphagia. Additional risk factors included racial minority status, higher comorbidity burden, and care at urban teaching hospitals. Risk factors differed between single- and multilevel ACDF. Dysphagia was associated with higher rates of complications, including aspiration pneumonia, percutaneous endoscopic gastrostomy placement, and tracheostomy (all p < 0.001). CONCLUSIONS: These findings represent the first national analysis to demonstrate a decline in inpatient ACDF volumes yet rising postoperative dysphagia rates. Selective surgical indications emerged as key predictors, informing the development of a nomogram for risk stratification and preoperative optimization in ACDF patients.
Virtual Reality Mastoidectomy as Precadaver Training for Novices: A Randomized Crossover Study.
Nijim H, Cho WS, Marsh E … +3 more , Evans J, Sahota RB, Judd O
Laryngoscope · 2026 Apr · PMID 42045093 · Publisher ↗
OBJECTIVES: To compare cognitive load during virtual reality (VR) simulation and cadaveric dissection (CD) mastoidectomy training in novice learners. To determine whether training order influences cognitive load, charact...
OBJECTIVES: To compare cognitive load during virtual reality (VR) simulation and cadaveric dissection (CD) mastoidectomy training in novice learners. To determine whether training order influences cognitive load, characterize cognitive load progression during the procedure, and assess whether VR training improves subsequent cadaveric performance. METHODS: In this randomized crossover study, 24 core surgical trainees with no prior mastoidectomy experience performed a cortical mastoidectomy in both VR and CD settings. Participants were randomized to either VR-first or CD-first training sequences. Cognitive load was measured using a bespoke auditory reaction-time device at baseline and 10, 30, and 50 min. Relative reaction time (RRT) served as an objective index of cognitive load. Cadaveric performance was assessed using the Modified Welling Scale by two blinded otologists. RESULTS: Cognitive load was significantly lower during VR than CD, with mean RRT rising 26% from baseline in VR versus 60% in CD (p < 0.001). Training order did not affect cognitive load in either modality, and RRT increased progressively throughout mastoidectomy in both VR and CD. Participants who began with VR achieved significantly higher cadaveric performance scores than those who began with CD (mean 9.50 vs. 4.96; p < 0.001), and inter-rater reliability for performance scoring was high. CONCLUSION: VR mastoidectomy reduces cognitive load and enhances subsequent cadaveric performance in novice trainees, supporting its role as a cognitively optimized precadaver training modality that complements, rather than replaces, cadaveric dissection. These findings suggest VR enhances early learning efficiency and resource utilization in novice otolaryngology training. LEVEL OF EVIDENCE: N/A.
Integrating Augmented Reality Into Otologic Cadaveric Surgical Training.
Mizrakli Y, Hadida Barzilai D, Nagar N … +6 more , Cohen N, Vazhgovsky O, Bourla R, Tejman-Yarden S, Gavriel H, Garti Y
Laryngoscope · 2026 Apr · PMID 42045076 · Publisher ↗
OBJECTIVE: Temporal bone dissection poses a significant challenge due to its intricate three-dimensional (3D) anatomy. Traditional learning methods involving cadaver dissections are limited by practical constraints. Augm...
OBJECTIVE: Temporal bone dissection poses a significant challenge due to its intricate three-dimensional (3D) anatomy. Traditional learning methods involving cadaver dissections are limited by practical constraints. Augmented reality (AR) offers a potential solution by providing 3D anatomical visualization of key anatomical landmarks based on computed tomography (CT) scans, superimposed directly onto the cadaver specimen. This pilot study evaluated the feasibility of integrating AR to support temporal bone dissection of cadavers and enhance otolaryngology residents' grasp of anatomy. METHODS: Four otolaryngology residents performed a total of seven temporal bone dissections during a dedicated dissection course. AR models were developed using specimen-specific CT data and overlaid onto cadaveric specimens using the Microsoft HoloLens 2 headset. Participants' dissection accuracy and efficiency were evaluated using predefined metrics, and their feedback was collected through questionnaires to assess the system's contribution to learning. RESULTS: In this pilot feasibility study, the AR system was successfully integrated into the dissection workflow, with participants reporting improved understanding of these complex anatomical structures as well as enhanced spatial orientation. Dissection quality was high, and the participants expressed overall satisfaction with the course. CONCLUSION: AR technology shows significant potential as an adjunct to traditional temporal bone dissection training by providing enhanced visualization that leads to greater anatomical understanding. LEVEL OF EVIDENCE: N/A.
Bacterial Lysates Add-On Therapy to Reduce Postoperative Recurrence in Nasal Polyps.
Deng H, Qiu H, Yuan T … +2 more , Wu S, Yang Q
Laryngoscope · 2026 Apr · PMID 42037614 · Publisher ↗
OBJECTIVE: This study aimed to investigate the potential role of OM-85 in reducing polyp recurrence (PR). METHODS: A single-center randomized, prospective study was performed to compare the inter-group PR rate, patient-r...
OBJECTIVE: This study aimed to investigate the potential role of OM-85 in reducing polyp recurrence (PR). METHODS: A single-center randomized, prospective study was performed to compare the inter-group PR rate, patient-reported outcome measures (PROMs), CT and endoscopic scores. Hundred patients were randomized to receive either add-on OM-85 (34/50) or control group (43/50); 77 participants completed the 12-month follow-up. The OM-85 group received oral treatment for 10 days, followed by a 20-day washout (Months 1-3 and 7-9). Primary outcome was the PR rate. Secondary outcomes included PROMs, Lund-Kennedy (L-K) scores, Lund-Mackay (L-M) scores, and complete blood count (CBC) parameters. RESULTS: The PR rate was significantly lower in the OM-85 group (8.82%) than in the control group (27.91%, χ = 4.408, p = 0.036). Univariable analysis identified pre-operative Lund-Mackay (L-M) score (p = 0.008) and hyposmia VAS score (p = 0.031) as significant predictors of PR. In multivariable analysis, the L-M score remained an independent predictor (OR = 1.15, p = 0.012), with an optimal cutoff of 10. The OM-85 group showed significant improvements in nasal obstruction, olfactory dysfunction, and mucopurulent discharge at 6 and 12 months (p < 0.05). Lund-Kennedy (L-K) score and 22-item Sinonasal Outcome Test (SNOT-22) score were also significantly improved (p < 0.05). Furthermore, the OM-85 group exhibited elevated white blood cell counts and lymphocyte percentages from 6 months onward (p < 0.05). CONCLUSION: Adjuvant OM-85 may reduce postoperative PR, with improved endoscopic and symptom scores, potentially mediated by enhanced systemic immune function.
Validation of the TruBlue Light Laser for Laryngeal Somatosensory and Perturbation Testing.
Shembel AC, Mau T, Maryn Y … +4 more , Young E, Smeltzer J, Childs L, Dhar S
Laryngoscope · 2026 Apr · PMID 42035249 · Publisher ↗
OBJECTIVES: Clinical assessment of laryngeal somatosensation is limited by the lack of precise tools to directly stimulate the larynx and quantify sensorimotor responses. This study validated a blue light laser method fo...
OBJECTIVES: Clinical assessment of laryngeal somatosensation is limited by the lack of precise tools to directly stimulate the larynx and quantify sensorimotor responses. This study validated a blue light laser method for laryngeal somatosensory testing in vocally healthy adults and developed acoustic measures to quantify vocal responses to controlled laryngeal perturbations. METHODS: In this prospective validation study, a 445-nm diode blue light laser was delivered through a channeled flexible laryngoscope to the arytenoid mucosa. Single subablative pulses (1-10 W, 30 ms) were applied during quiet breathing or sustained phonation to determine perceptual and reflexive sensory thresholds, discrimination acuity, and laryngeal perturbation responses. Acoustic recordings during perturbations were analyzed in Praat using custom software to extract continuous fundamental frequency variability and quantify perturbation magnitude and recovery. RESULTS: Participants demonstrated reliable perceptual detection and laryngeal reflexive responses to laser stimulation. Mean perceptual sensory threshold was 1.46 W (SD = 1.17) and mean laryngeal response threshold was 4.62 W (SD = 2.04). Sensory ratings were higher during stimulation than foil trials (p < 0.001). Sensory perception increased with stimulation intensity (~0.3 points per 1 W; p < 0.001), and higher wattage increased odds of eliciting a laryngeal response (OR = 1.38; p < 0.001). Discrimination accuracy averaged 78.5% (OR = 1.45; p = 0.002). Laser stimulation during phonation produced measurable acoustic perturbations (peak SD(f) = 19.35 Hz; recovery = 0.48 s). CONCLUSION: Blue light laser stimulation is a feasible and precise method for evaluating laryngeal somatosensation and vocal sensorimotor responses.
Educational Benefit of Hospitalist Consult Experience During Otolaryngology Training.
Bourdillon AT, Civantos AM, Wang RA … +6 more , Willingham E, Kadin NE, Allen PG, Schlocker C, Crosby TW, Pletcher SD
Laryngoscope · 2026 Apr · PMID 42031663 · Publisher ↗
OBJECTIVE(S): To evaluate the consult and emergency care experience of Otolaryngology-Head and Neck Surgery (OHNS) trainees with a hospitalist faculty model. METHODS: An anonymous survey was distributed to OHNS residents...
OBJECTIVE(S): To evaluate the consult and emergency care experience of Otolaryngology-Head and Neck Surgery (OHNS) trainees with a hospitalist faculty model. METHODS: An anonymous survey was distributed to OHNS residents across institutions with hospitalist models. Each respondent reported trainee and institutional details and completed a 12-item five-point Likert-scale questionnaire rating resident experiences working with (1) faculty hospitalist and (2) rotating on-call coverage models across three domains: educational features, workflow efficiency, and global experience. Subgroup analyses were conducted stratifying by training level (junior vs. senior) and degree of hospitalist experience (≥ 60% vs. < 60%). RESULTS: Among 50 respondents (response rate 39.7%), the hospitalist model demonstrated superior performance across all domains. More respondents reported favorable education-to-service ratios with hospitalist supervision (58.0%) versus rotating coverage (14.0%, p < 0.001). The hospitalist model had higher ratings for quality of clinical instruction (mean difference = 0.58, p < 0.001), surgical instruction (0.37, p = 0.035), and managing emergencies (0.45, p < 0.001). Notably, 64.0% of residents reported rarely or never feeling rushed in the OR with hospitalist supervision, compared to 36.0% with rotating coverage (p < 0.001). Workflow advantages of the hospitalist model included improved procedural timeliness (p = 0.022), handoff efficiency (p = 0.002), and treatment plan clarity (p < 0.001). Training level did not significantly modulate responses. Residents with more hospitalist experience (≥ 60%) reported significantly greater advantages in clinical instruction (p = 0.026) and surgical teaching (p = 0.008) compared to those with less experience. CONCLUSION: The hospitalist model provides educational advantages and operational efficiency. These findings support the curricular and systemic value of a hospitalist role in enhancing overall satisfaction and potentially mitigating trainee burnout. LEVEL OF EVIDENCE: N/A.
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