We describe a technique for probe-based near-infrared autofluorescence (NIRAF)-guided parathyroid identification during TOETVA. The probe is mounted on a suction cannula and introduced via the central port, allowing real...We describe a technique for probe-based near-infrared autofluorescence (NIRAF)-guided parathyroid identification during TOETVA. The probe is mounted on a suction cannula and introduced via the central port, allowing real-time confirmation of parathyroid tissue without device modification. This approach enables integration of NIRAF into remote-access thyroid surgery.
OBJECTIVE: To define the bacteriological characteristics of otitis media with effusion (OME) in nasopharyngeal carcinoma (NPC) patients following radiotherapy and determine whether bacterial colonization in the middle ea...OBJECTIVE: To define the bacteriological characteristics of otitis media with effusion (OME) in nasopharyngeal carcinoma (NPC) patients following radiotherapy and determine whether bacterial colonization in the middle ear was associated with a higher risk of early recurrence of radiation-induced OME (RI-OME). METHODS: This prospective multicenter cohort enrolled patients with OME (with or without a history of radiotherapy for NPC) undergoing tympanocentesis. Middle ear effusion (MEE) samples were cultured and patients with RI-OME were followed up for 24 weeks. Data on demographics, radiotherapy history, treatment, comorbidities, and effusion characteristics were collected. Recurrence patterns were characterized descriptively throughout the 24-week post-tympanocentesis follow-up. RESULTS: A total of 93 RI-OME patients and 115 non-radiation-induced (NRI)-OME patients were included. RI-OME patients had a 4.843-fold higher risk of MEE bacterial culture positivity compared to NRI-OME patients (OR = 4.843, p = 0.006). MEE cultures in RI-OME patients showed higher proportions of opportunistic pathogens and drug-resistant bacteria. Mucoid effusion was a significant risk factor for bacterial positivity in RI-OME (OR = 8.553, p = 0.002). Male sex (OR = 12.120, p = 0.002) and bacterial colonization (OR = 10.239, p = 0.035) were associated with early recurrence (≤ 4 weeks post-tympanocentesis) in RI-OME patients; however, neither factor remained an independent predictor over the full 24-week period. CONCLUSION: RI-OME patients demonstrated significantly higher MEE bacterial culture positivity rates than NRI-OME patients. Although MEE bacterial colonization significantly impacted early recurrence, it lacked independent prognostic value for overall 24-week recurrence. Thus, whether targeted antibacterial therapy can reduce recurrence rates warrants further investigation.
This case series describes four obstructive sleep apnea patients who underwent hypoglossal nerve stimulation implant surgery. After a period of OSA resolution with therapy, these patients presented with symptoms of incre...This case series describes four obstructive sleep apnea patients who underwent hypoglossal nerve stimulation implant surgery. After a period of OSA resolution with therapy, these patients presented with symptoms of increased snoring and reduced tongue sensation with implant activation. Impedance testing showed abnormally elevated values on bipolar electrode settings, and electrode reprogramming led to restored therapeutic benefit.
Bhatt K, Ren Y, Chan C
… +3 more, Rara M, Djalilian HR, Abouzari M
Laryngoscope
· 2026 Apr · PMID 42018740
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OBJECTIVES: To observe the incidence of Meniere's disease (MD) and MD-related symptoms (i.e., aural fullness, tinnitus, hearing loss, and vertigo) between (a) non-migraine and migraine patients and (b) migraine untreated...OBJECTIVES: To observe the incidence of Meniere's disease (MD) and MD-related symptoms (i.e., aural fullness, tinnitus, hearing loss, and vertigo) between (a) non-migraine and migraine patients and (b) migraine untreated and migraine treated patients within the TriNetX database. METHODS: We conducted a retrospective cohort study of (a) non-migraine and migraine patients and (b) migraine treated and untreated patients within the TriNetX database from 2013 till 2025. Patients underwent propensity score matching for sex, age, race, and known lifestyle/disease confounders for MD. Incidence of MD and MD-related symptoms were evaluated 5 years post index date and beyond 5 years post index date. RESULTS: Migraine patients demonstrated a greater incidence of MD and MD-related symptoms 5 years and more than 5 years post index date. Amongst migraine patients, those not receiving treatment demonstrated a lesser predilection (risk ratio [RR] = 0.43, 95% CI: 0.28-0.66) of developing MD than patients receiving treatment. There was no significant difference in the incidence of hearing loss or aural fullness between migraine untreated and treated subgroups. Migraine patients not receiving treatment had an increased risk of experiencing tinnitus (RR = 1.11, 95% CI: 1.03-1.19). CONCLUSIONS: There exists a connection between migraine and MD. Migraine patients receiving migraine treatment are statistically significantly more likely to develop MD compared to non-migraine patients. These results support the findings of preceding studies that have demonstrated a pathophysiological link between migraine and vestibulocochlear dysfunction.
In cases where an expanded cholesteatoma has extensively eroded the petroclival bones, marsupialization of the cholesteatoma cavity without matrix removal through an endoscopic transsphenoidal approach is a feasible and...In cases where an expanded cholesteatoma has extensively eroded the petroclival bones, marsupialization of the cholesteatoma cavity without matrix removal through an endoscopic transsphenoidal approach is a feasible and safe option. This approach avoids CSF rhinorrhea and injury to critical structures which may be underlying and adherent to the cholesteatoma matrix, and periodic debridements address the disease satisfactorily.
We present a technique utilizing internal traction-assisted mobilization to effectively retrieve objects, such as pen caps, that lack an external grasping surface and resist conventional rigid bronchoscopy. In this case,...We present a technique utilizing internal traction-assisted mobilization to effectively retrieve objects, such as pen caps, that lack an external grasping surface and resist conventional rigid bronchoscopy. In this case, tracheotomy served as an alternative extraction route for impacted foreign bodies that failed to pass across the glottis or subglottic region. Concurrently, ECMO maintains oxygenation during complex airway manipulation and reduces the risk of hypoxia.
OBJECTIVE: This study aimed to optimize electrical stimulation modalities for the suprahyoid muscles to improve swallowing function. We hypothesized that novel stimulus patterns (amplitude-modulated, mid-frequency sinuso...OBJECTIVE: This study aimed to optimize electrical stimulation modalities for the suprahyoid muscles to improve swallowing function. We hypothesized that novel stimulus patterns (amplitude-modulated, mid-frequency sinusoidal, exponentially amplified, and short-pulse waveforms) would enhance contraction efficiency. METHODS: We delivered 80-Hz rectangular pulse, 2-kHz alternating current (AC) with nth-power sinusoidal modulation (n = 1, 5, 7, 9, 11), and 4- and 8-kHz sine waves. We also tested 2-kHz AC with nth-power sinusoidal modulation combined with short-pulsed currents. These were applied via subcutaneously embedded Ag-AgCl ball electrodes targeting the suprahyoid muscles in anesthetized mice. Threshold intensities were determined using isometric contraction measurements. Discomfort levels for each stimulus were then assessed in awake conditions. RESULTS: Increasing the power of sinusoidal modulation in AC significantly reduced muscle contraction thresholds. Waveforms combining amplitude-modulated sinusoids and short pulse trains (20 μs duration) further lowered thresholds over non-pulsed stimuli. Discomfort thresholds did not differ significantly across AC and composite stimulation. CONCLUSION: Our findings reveal an exponential relationship between amplitude-modulated AC and suprahyoid muscle contraction efficiency, and show that integrating pulsed current with sinusoidal stimulation synergistically optimizes activation. These results provide a foundation for advanced neuromuscular electrical stimulation strategies for swallowing rehabilitation. LEVEL OF EVIDENCE: N/A.
OBJECTIVES: To compare complication and removal rates between cartilage and lobule ear piercings in a large adult population. METHODS: An anonymous electronic survey was distributed to all individuals with a University o...OBJECTIVES: To compare complication and removal rates between cartilage and lobule ear piercings in a large adult population. METHODS: An anonymous electronic survey was distributed to all individuals with a University of Iowa email address. Respondents reported demographic characteristics, piercing site, age at piercing, technique, personnel, and specific complications. Multivariate logistic regression evaluated complication and removal rates between cartilage and lobule sites. RESULTS: Data were analyzed on 9016 ear piercings from 3270 respondents, including 6275 (69.6%) lobule piercings and 2741 (30.4%) auricular cartilage piercings. Complications were reported in 40.2% of cartilage piercings versus 25.4% of lobule piercings (odds ratio [OR] 1.98, p < 0.0001). Infection occurred in 30.3% of cartilage piercings versus 23.8% of lobule piercings (OR 1.39, p < 0.0001). Additionally, cartilage site and presence of any complication each independently predicted piercing removal (OR 1.62, p < 0.0001; OR 12.82, p < 0.0001). CONCLUSION: Cartilage piercings carried significantly greater odds of complication and removal compared to lobule piercings. These findings underscore the importance of thorough counseling and informed consent, especially when piercing through auricular cartilage.
We describe an endoscopic-assisted transcervical technique for excision of second branchial cleft anomalies in young children. In three cases (ages 2-8), this approach allowed safe identification and ligation of the trac...We describe an endoscopic-assisted transcervical technique for excision of second branchial cleft anomalies in young children. In three cases (ages 2-8), this approach allowed safe identification and ligation of the tracts while providing improved visualization and allowing smaller incisions. Endoscopic assistance may be an effective alternative to traditional wide transcervical excision.
OBJECTIVE(S): Current preoperative risk stratification for uvulopalatopharyngoplasty (UPPP) primarily relies on anatomic and disease-severity measures, which do not capture physiologic reserve or vulnerability to postope...OBJECTIVE(S): Current preoperative risk stratification for uvulopalatopharyngoplasty (UPPP) primarily relies on anatomic and disease-severity measures, which do not capture physiologic reserve or vulnerability to postoperative complications. This study aimed to compare the predictive performance of the risk analysis index (RAI) and the modified frailty index-5 (mFI-5) in stratifying postoperative risk among patients undergoing UPPP. METHODS: Adult patients who underwent UPPP between 2005 and 2020 were identified. Frailty was assessed, and associations with postoperative complications, length of stay, discharge disposition, and mortality were evaluated. Multivariable regression and receiver operating characteristic analysis were conducted. RESULTS: A total of 2129 patients were included and severe frailty (RAI > 31) was strongly associated with adverse postoperative outcomes, including Clavien-Dindo (CD) II complications (OR 21.3, 95% CI 3.7-123.8), CD IV (OR 4.6, 95% CI 2.0-10.6), extended length of stay (eLOS) (OR 29.4, 95% CI 5.4-160), non-home discharge (NHD) (OR 6.1, 95% CI 3.0-12.6), and deep surgical site infection (DSSI) (OR 17.5, 95% CI 1.7-176.3) (all p < 0.05). The mFI-5 predicted CD II, eLOS, and NHD but not CD IV or DSSI among severely frail patients (mFI-5 > 3). RAI consistently outperformed mFI-5 across outcomes, including mortality (AUC 0.813 vs. 0.580), CD II (0.784 vs. 0.652), CD IV (0.704 vs. 0.654), eLOS (0.767 vs. 0.669), and NHD (0.767 vs. 0.618). CONCLUSION: Although both RAI and mFI-5 are associated with postoperative outcomes following UPPP, RAI provides superior discrimination for mortality and major morbidity. These findings support the incorporation of RAI into preoperative risk stratification for sleep surgery to better inform perioperative planning and resource allocation.
OBJECTIVE: Vascularization remains a major barrier to the clinical translation of airway replacement. We previously demonstrated that engineered tracheal scaffolds support neovascularization, although restoration of micr...OBJECTIVE: Vascularization remains a major barrier to the clinical translation of airway replacement. We previously demonstrated that engineered tracheal scaffolds support neovascularization, although restoration of microvascular perfusion is delayed in part due to a reduction in capillary branching. Endothelial hydrogels (EH) have demonstrated the potential to enhance vascular regeneration in several domains of tissue engineering, yet their application in airway replacement has not been fully evaluated. In this study, we assessed the impact of EH on microvascular regeneration and perfusion in tracheal scaffolds. METHODS: Tracheal scaffolds were fabricated from C57BL/6J mice. EH were formulated with endothelial cells (EC) from human or mouse lineages and collagen, then applied to tracheal scaffolds. EH-scaffolds were cultured ex vivo for 7 days and stained with CD31, DAPI, lectin-FITC, and vascular endothelial growth factor (VEGF). The optimal EH composition was evaluated in vivo using orthotopic tracheal transplantation. At 1-month, microvascular regeneration was quantified, patterning was assessed via Sholl analysis, and perfusion was quantified using lectin-FITC. RESULTS: EH supported EC attachment on tracheal scaffolds. The ideal EH composition for maximal EC coverage was 3.6 × 10 cells/cm and 1.25 mg/mL collagen. EC expressed VEGF and formed microvascular networks on tracheal scaffold ex vivo. EH-scaffolds were successfully implanted without signs of respiratory distress or obstruction. Compared to control, EH-scaffolds improved graft perfusion and microvascular patterning in tissue engineered trachea. CONCLUSION: EH enhances microvascular regeneration and perfusion of engineered tracheal scaffolds in vivo, thus supporting the potential of EH as a strategy to accelerate vascular regeneration in airway reconstruction. LEVEL OF EVIDENCE: N/A.
OBJECTIVE: Bell's palsy impairs social functioning. Conventional prognostic assessment relies on clinical grading and electroneurography (ENoG), but predictive accuracy remains limited. This study introduces a time-conti...OBJECTIVE: Bell's palsy impairs social functioning. Conventional prognostic assessment relies on clinical grading and electroneurography (ENoG), but predictive accuracy remains limited. This study introduces a time-continuous probabilistic approach that integrates longitudinal Yanagihara scores and ENoG to enable dynamic, individualized prognostic estimation. METHODS: We conducted a retrospective longitudinal study of patients with Bell's palsy treated between April 2013 and March 2024. Eligible patients were aged ≥ 15 years, hospitalized within 1 week of onset, and received high-dose corticosteroids. Exclusion criteria included other etiologies, prior facial palsy, facial nerve decompression, treatment discontinuation, or incomplete data. Recovery was defined as a Yanagihara score ≥ 36, and nonrecovery as failure to achieve this within ≥ 6 months. ENoG values obtained within 4 weeks of onset were stratified into five groups. Multivariable logistic regression was performed using ENoG, sex, age, diabetes, hypertension, dyslipidemia, body mass index, and HbA1C as covariates. Logistic curves were fitted to longitudinal scores, and Monte Carlo/Bayesian procedures were applied to generate recovery probability maps. RESULTS: Among 128 eligible patients, ENoG emerged as the only significant predictor of recovery. The probability maps provided a novel visualization of individualized prognosis at any time point. This method estimated recovery likelihood even in patients with follow-up intervals, addressing irregular limitations of prior fixed-timepoint models. Conditional mutual information plateaued around 50 days, indicating stabilization of predictive discrimination beyond that period. CONCLUSION: Incorporating longitudinal Yanagihara scores obtained during outpatient follow-up enhances recovery prediction accuracy. This practical, dynamic approach facilitates intuitive risk visualization and supports improved prognostic counseling in clinical practice.
OBJECTIVES: To assess whether pre-existing tracheostomy location influences outcomes of open airway surgery for pediatric laryngotracheal stenosis (LTS) and to propose a pragmatic framework for tracheostomy placement. ME...OBJECTIVES: To assess whether pre-existing tracheostomy location influences outcomes of open airway surgery for pediatric laryngotracheal stenosis (LTS) and to propose a pragmatic framework for tracheostomy placement. METHODS: A retrospective review included 104 tracheostomized children who underwent open airway surgery for LTS between 1978 and 2022. Collected variables included stenosis characteristics, comorbidities, tracheostomy location, surgical technique, decannulation outcomes, complications, and revision surgery. Tracheostomy location was independently reviewed by two experienced pediatric airway surgeons and categorized as optimal, suboptimal, or nonoptimal based on stenosis characteristics and patient comorbidities. Surgical outcomes were compared across groups. RESULTS: Most suboptimal tracheostomies were in a classic position (60/62, 97%). In cricotracheal resection, the suboptimal group required a greater extent of resection (median 5 rings [IQR 4-5]) compared with the optimal (4 rings [3-4], p = 0.027) and nonoptimal groups (3 rings [2.5-4], p = 0.004). Among double-stage procedures, time to decannulation was longest in nonoptimal patients (median 11.7 months [IQR 4.6-19.8]) compared with suboptimal (4 months [2.5-8.6], p = 0.032) and optimal groups (3.8 months [2-4.9], p = 0.027). Tracheostomy relocation was less frequent in the optimal group (29% vs. 57%-67% in the other groups). Tracheostomy-related complications and revision procedures were more frequent in the suboptimal group. CONCLUSIONS: Preoperative tracheostomy location influences surgical complexity (single-stage vs. double-stage procedure), resection length, need for tracheostomy relocation, complication rates, and time to decannulation in pediatric LTS surgery. Planning tracheostomy location with the anticipated reconstructive pathway in mind may reduce morbidity and improve outcomes.
OBJECTIVES: Survival after trans-oral laser microsurgery (TLM) for glottic carcinoma is excellent. However, the voice quality after TLM remains unclear. This study examines voice outcomes following different surgical pro...OBJECTIVES: Survival after trans-oral laser microsurgery (TLM) for glottic carcinoma is excellent. However, the voice quality after TLM remains unclear. This study examines voice outcomes following different surgical procedures. STUDY DESIGN: A retrospective study of voice outcomes (GRBAS, VHI-10, CSID scores) after TLM. MATERIAL AND METHODS: Patients undergoing TLM were studied. We collected the Voice Handicap Index (VHI-10), acoustic analysis (Cepstral Spectral Peak Prominence, CSPP score), and GRBAS rating score. These data were correlated with cancer stage and ELS (surgery type). RESULTS: We studied 102 patients (86 males, 16 females; median age 74). There were 51 type I and 27 type Va resections. The rest underwent types II, III, IV, Vb, VI, and open vertical hemilaryngectomy surgery. The median follow-up time was 5.2 years. The median VHI-10 score was 7.5 (normal < 10). The median CSID score was 27.5 (mild = 20-40). The Average GRBAS score was G1.5, R1, B1, A0, S1.5 (mild = 1, moderate = 2). There was a correlation between the CSID score and the type of cordectomy and surgical stage. There was a statistical difference in Type I ELR resection outcomes compared with all other types in voice outcome (Cohen's d-value > 0.5). CONCLUSIONS: Patients often rate their VHI as normal, while objective and perceptual raters rate voices after TLM as showing mild to moderate dysphonia. This low VHI score may be due to cancer survivorship. Understanding the patient experience after TLM surgery and knowing the extent of surgery on voice outcomes can help better counsel patients undergoing TLM.
OBJECTIVE: To evaluate the surgical accuracy and intracochlear positioning of robot-assisted insertion of slim modiolar cochlear implant electrode arrays (CI632) using the RobOtol system in human cadaveric temporal bones...OBJECTIVE: To evaluate the surgical accuracy and intracochlear positioning of robot-assisted insertion of slim modiolar cochlear implant electrode arrays (CI632) using the RobOtol system in human cadaveric temporal bones. METHODS: A total of 14 fresh-frozen adult cadaveric temporal bones underwent cochlear implantation using RobOtol robot-assistance. Standard mastoidectomy, posterior tympanotomy, and round window exposure were performed. CI632 electrode arrays were robotically inserted at a speed of 0.1 mm/s. Postoperative micro-computed tomography (micro-CT) was performed to assess electrode scalar position, angular insertion depth, modiolar proximity (intracochlear position index), and frequency-to-place mismatch. RESULTS: Robot-assisted insertion of all 22 electrodes was successfully achieved in 14 specimens. Micro-CT analysis confirmed scala tympani placement without evidence of translocation. A total of 13 arrays demonstrated correct perimodiolar positioning, while one was misplaced along the lateral wall. Mean insertion angle of the 13 correctly placed arrays was 406° ± 25° (351°-441°), and mean intracochlear position index was 0.5 ± 0.05. One array (7%) was mispositioned with lateral wall placement, which occurred in a cochlea with a large cochlear duct length (36.4 mm) and a wide basal turn at 90° (4.6 mm). Frequency-to-place mismatch varied across specimens, with a mismatch of 2637 ± 663 Hz (1973-4077 Hz) for the 8th electrode, and 1246 ± 317 Hz (899-1948 Hz) for the 16th electrode, corresponding to approximately one octave. CONCLUSION: Robot-assisted insertion of slim modiolar electrode arrays was feasible and reproducible in human cadaveric temporal bones. One case of mispositioned array occurred in a cochlea with large dimensions, underscoring the importance of preoperative anatomical assessment. LEVEL OF EVIDENCE: N/A.
OBJECTIVE: To examine the effectiveness of tympanic membrane regeneration therapy (TMRT) for chronic otitis media (COM). METHODS: Of 154 patients (166 ears) with COM and tympanic membrane perforation (TMP), 53 (54 ears)...OBJECTIVE: To examine the effectiveness of tympanic membrane regeneration therapy (TMRT) for chronic otitis media (COM). METHODS: Of 154 patients (166 ears) with COM and tympanic membrane perforation (TMP), 53 (54 ears) underwent conventional tympanoplasty (CTP), and 101 (112 ears) underwent TMRT. TMRT was performed using an endoscope to create a fresh wound around the TMP edge and remove most of the remaining TM. After high-pressure saline irrigation of the tympanic cavity and removal of the lesion, a basic fibroblast growth factor-infiltrated gelatin sponge was placed and covered with fibrin glue. After 4 ± 1 weeks, the eschar was removed and closure assessed. CTP was performed by tympanomeatal flap elevation with/without a postauricular skin incision using a microscope/endoscope. After cleaning the tympanic cavity, autologous tissue was collected and transplanted for TM reconstruction. TMP closure rate, hearing improvement, operative time, patient satisfaction, adverse events, and reperforation rate were compared between groups. RESULTS: The main outcomes of TMRT versus CTP were: TMP closure rate 95.5% (107/112 ears) versus 88.9% (48/54 ears), average air conduction hearing (at 0.5/1.0/2.0 kHz) improvement 11.8 versus 7.7 dB, operative time 35.0 versus 112.0 min, patient satisfaction rate 94.1% (95/101 patients) versus 73.6% (39/53 patients), adverse event rate 9.8% (11/112 ears) versus 18.5% (11/54 ears), and reperforation rate 1.9% (2/105 ears) versus 8.3% (4/48 ears). CONCLUSION: TMRT has many advantages over CTP as a surgical treatment for COM. In particular, significant differences were observed in operative time, hearing improvement, and patient satisfaction between the procedures.