Laryngoscope [JOURNAL]
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200 papers
Vocal Tract Fat Distribution and Patient Tolerance to Transnasal Office-Based Laryngeal Surgery.
Nasr A, Hourani R, Ghzayel L … +7 more , Lababidi G, Achkar D, Sarkis V, Abou Raji Feghali P, Ghadieh J, Al Irani M, Hamdan AL
Laryngoscope · 2026 Apr · PMID 41968836 · Publisher ↗
OBJECTIVE: To analyze the correlation between vocal tract fat volume and patient tolerance to office-based laryngeal surgery using the transnasal approach. METHODS: The medical records and video recordings of all patient...
OBJECTIVE: To analyze the correlation between vocal tract fat volume and patient tolerance to office-based laryngeal surgery using the transnasal approach. METHODS: The medical records and video recordings of all patients who underwent office-based laryngeal surgery (OBLS) between April 2024 and January 2026 were reviewed. Demographic data included age, gender, body mass index (BMI), history of smoking, history of reflux disease, allergy, voice diagnosis, and type of OBLS. Three fat compartments were analyzed: (1) parapharyngeal fat volume at the palatal level, (2) parapharyngeal fat at the glossal level, and (3) the pre-epiglottic adipose tissue. Patient tolerance was evaluated using the IOWA Satisfaction with Anesthesia Scale and a Visual Analog Scale (VAS). RESULTS: Forty patients were included in the study. The mean IOWA score of the total group was 2.55 ± 0.68, and the mean VAS tolerance score was 8.70 ± 1.65. Linear regression analysis accounting for potential confounding factors showed a moderate, negative, statistically significant correlation between the volume of parapharyngeal fat at the level of the palate and IOWA scale score (adjusted coefficient β = -0.567, p = 0.049). There was also a mild, negative, non-significant correlation between the volume of parapharyngeal fat at the level of the palate and VAS scores (adjusted coefficient β = -0.251, p = 0.211). CONCLUSION: An increase in parapharyngeal fat volume at the level of the palate was associated with a decrease in IOWA scale score, suggesting reduced tolerance to OBLS. A study with a larger sample size is needed to draw stronger conclusions.
National Trends in Thyroidectomy and Molecular Diagnostic Utilization: A Medicare Analysis (2016-2023).
Allen DZ, Rosenthal JW, Harris ML … +3 more , Kligerman MP, Lilly MA, Sebelik ME
Laryngoscope · 2026 Apr · PMID 41968429 · Publisher ↗
OBJECTIVE: As healthcare expenditures rise, characterizing the national utilization and economic footprint of genomic sequencing classifiers (GSCs) for indeterminate thyroid nodules is essential. We evaluated adoption tr...
OBJECTIVE: As healthcare expenditures rise, characterizing the national utilization and economic footprint of genomic sequencing classifiers (GSCs) for indeterminate thyroid nodules is essential. We evaluated adoption trends and Medicare spending for primary GSC platforms (Afirma, ThyroSeq, and ThyGeNEXT/ThyraMIR) over 8 years. METHODS: We conducted a retrospective analysis of Medicare Part B Provider Utilization and Payment data (2016-2023). GSC and surgical services were identified via CPT codes. Medicare payments were adjusted to 2016 U.S. dollars using the Medical Care Consumer Price Index. Trends were evaluated using linear regression. RESULTS: Total GSC utilization increased from 4478 services in 2016 to 13,456 in 2023 (200.5% increase). GSC adoption as percentage of fine-needle aspirations increased from 2.11% to 7.71% (p < 0.001). Afirma was the primary driver, increasing from 4478 to 9273 services (p < 0.001). Following the introduction of Proprietary Laboratory Analyses codes, ThyroSeq and ThyGeNEXT/ThyraMIR demonstrated rapid uptake, reaching 509 and 3674 annual services by 2023, respectively. Concurrent with increased GSC adoption, total thyroidectomy procedures declined 42.1% (p < 0.001), while lobectomy procedures decreased 20.7% (p = 0.006), indicating surgical de-escalation. Inflation-adjusted Medicare expenditures for GSCs rose significantly from $14.0 million to $35.3 million (p = 0.002), but average adjusted payment per Afirma test remained stable ($2963-$3366, p = 0.218). CONCLUSION: This Medicare-based national analysis demonstrates GSC utilization tripled from 2016 to 2023, temporally associated with substantial surgical de-escalation. This population-level correlation may reflect the clinical impact of molecular diagnostics in reducing potentially unnecessary thyroid surgery. Expenditure growth was driven by adoption rather than price inflation. LEVEL OF EVIDENCE: N/A.
Bronchial Mucosal Abnormalities in Idiopathic Subglottic Stenosis.
Ring S, Bowen AJ, Griffin T … +2 more , Ferguson JS, Dailey SH
Laryngoscope · 2026 Apr · PMID 41966683 · Publisher ↗
OBJECTIVES: Investigate synchronous lower airway findings during bronchoscopy in idiopathic subglottic stenosis (iSGS). METHODS: Retrospective analysis of bronchoscopic images from adult iSGS patients (January 2018-June...
OBJECTIVES: Investigate synchronous lower airway findings during bronchoscopy in idiopathic subglottic stenosis (iSGS). METHODS: Retrospective analysis of bronchoscopic images from adult iSGS patients (January 2018-June 2021). Images were reviewed for pits, depressions, nodules, and striations distal to the cricotracheal junction. RESULTS: Forty-eight female patients; mean age 56 years. Comorbidities: gastroesophageal reflux 34%, hypertension 34%, diabetes mellitus 25%. All patients had pits and depressions; striations in 48/48, with both longitudinal and transverse in 32/48 (66.7%), transverse only in 13/48 (27.1%), and longitudinal only in 3/48 (6.3%). Spirometry available in 32; 60% showed normal or mild-moderate fixed obstruction. Four patients had FEV/FVC < 0.7; two had asthma, one COPD, and one no obstructive diagnosis; none were smokers. CONCLUSION: Bronchial mucosal abnormalities are prevalent in iSGS and may indicate distal airway involvement. Routine flexible bronchoscopy should be considered during evaluation and surveillance.
Chondrolaryngoplasty: Vocal Considerations, Outcomes, and Effects on Acoustic Measures of Voice.
Dwyer CD, Fein M, Kridgen S … +1 more , Winston J
Laryngoscope · 2026 Apr · PMID 41963097 · Publisher ↗
OBJECTIVES: Chondrolaryngoplasty reduces the laryngeal prominence creating a smoother, more feminine neck contour. Although voice change is a feared complication, validated voice outcomes remain limited and lack objectiv...
OBJECTIVES: Chondrolaryngoplasty reduces the laryngeal prominence creating a smoother, more feminine neck contour. Although voice change is a feared complication, validated voice outcomes remain limited and lack objective acoustic data. This study documents peri-operative voice metrics, including patient-reported outcomes, expert perceptual ratings, and quantitative acoustic measures. METHODS: A retrospective review was conducted of patients undergoing chondrolaryngoplasty between June 2021 and August 2025 through a tertiary care interdisciplinary laryngology practice. Pre-/post-operative voice data were collected, including stroboscopic findings, Voice Handicap Index-10 (VHI-10), Trans-Women Voice Questionnaire (TWVQ), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and objective acoustic analyses encompassing 11 parameters of pitch/frequency and cepstral parameters. Student's t-tests and Wilcoxon signed-rank tests assessed changes across measures. RESULTS: Thirty-five surgeries were analyzed. Postoperatively, 18 patients (51.4%) reported no perceived voice change, 17 (48.6%) described transient alterations with return to baseline. Mean change in VHI-10 was 0.08 ± 6.02 (p = 0.96), TWVQ was 8.67 ± 12.2 (p = 0.12). CAPE-V ratings showed no significant differences in overall severity (-2.6, p = 0.35), roughness (-2.9, p = 0.12), breathiness (0.5, p = 0.70), or strain (-0.7, p = 0.79). No statistically significant changes were observed across all 11 acoustic parameters (all p > 0.25). CSID, CPP, and pitch-related measures remained stable. CONCLUSIONS: Chondrolaryngoplasty provides aesthetic neck contour improvement without producing measurable changes in voice quality. Subjective patient reports, validated voice outcome measures, CAPE-V ratings, and acoustic analyses collectively support that the procedure does not adversely affect voice, pitch, or acoustic stability.
Quantifying Soft-Surgery in Cochlear Implantation: Multimodal Data From 30 International Specialists.
Aebischer P, Mantokoudis G, Caversaccio M … +1 more , Weder S
Laryngoscope · 2026 Apr · PMID 41958105 · Publisher ↗
OBJECTIVE: To quantify how surgical behavior influences intracochlear mechanical stress during cochlear implantation using objective multi-sensor data from a large cohort of specialist cochlear implant (CI) surgeons. MET...
OBJECTIVE: To quantify how surgical behavior influences intracochlear mechanical stress during cochlear implantation using objective multi-sensor data from a large cohort of specialist cochlear implant (CI) surgeons. METHODS: Thirty internationally recognized surgeons each performed bilateral insertions in mechanically representative artificial temporal bone models. Insertion force, pressure, and electrode kinematics were captured, and six trauma-related metrics were combined into a composite soft-surgery score. Associations with surgical experience, self-assessment, and handling behaviors were analysed using nonparametric statistics. RESULTS: Marked variability was observed across all metrics. Surgeons with < 50 lifetime insertions performed significantly worse than experienced colleagues. Self-assessment showed no correlation with objective outcomes. Excessively slow insertions and frequent electrode regrasping were associated with higher pressure exposure, greater force variation, and increased intracochlear implant motion. Post-insertion handling contributed substantially to intracochlear stress. CONCLUSION: Surgical behavior decisively influences intracochlear mechanical stress in CI. Steady, uninterrupted advancement at slow to moderate speed, avoidance of array regrasping, and careful post-insertion handling reduce mechanical load. Because self-assessment proved unreliable even among specialist CI surgeons, structured training with quantitative feedback and intraoperative monitoring is essential to refine soft-surgery technique, preserve residual hearing, and optimize hearing outcomes. LEVEL OF EVIDENCE: N/A.
Conductive Hearing Loss is Associated With Dementia in the All of Us Research Program.
Weinstein HNW, Tucker LH, Denham MW … +2 more , Gurgel RK, Golub JS
Laryngoscope · 2026 Apr · PMID 41957530 · Publisher ↗
OBJECTIVES: Sensorineural hearing loss (SNHL) has been associated with cognitive impairment and dementia. However, because SNHL contains a neural component, it is difficult to completely exclude reverse causation whereby...
OBJECTIVES: Sensorineural hearing loss (SNHL) has been associated with cognitive impairment and dementia. However, because SNHL contains a neural component, it is difficult to completely exclude reverse causation whereby dementia causes worse SNHL. Conductive hearing loss (CHL), a purely peripheral phenomenon, would not have this mechanistic connection. We investigate the association between CHL and dementia in a large national cohort. METHODS: Cross-sectional study of ≥ 18-year-old (n = 338,048) voluntary participants from the NIH All of Us Research Program. The exposure was bilateral CHL defined by ICD-10 code (H90.0). The outcome was dementia defined by ICD-10 codes (F03, G30-32). The odds of dementia in subjects with and without CHL were assessed with multivariable regression, controlling for potentially confounding variables (age, sex, ethnicity, race, education, and smoking history), as well as surgical and medical interventions for CHL. RESULTS: The mean (SD, range) age was 54 years (±17). 62.9% (n = 212,623) of participants identified as female. The cohort included 393 (0.1%) individuals with CHL. 1.9% (n = 6597) had dementia. After controlling for covariates, the odds of dementia were 2.05 times (95% CI 1.18-3.32; p = 0.006) higher for those with CHL compared to those without CHL. The odds were variably reduced when surgical interventions (stapedectomy, tympanoplasty, mastoidectomy, myringoplasty) (OR = 2.03, CI 1.17-3.29; p = 0.007) or hearing devices (hearing aids, implants) (OR = 1.98, CI 1.13-3.21; p = 0.010) were added to the fully adjusted multivariable model. CONCLUSION: In the All of Us Research Program, CHL was strongly associated with dementia and treatment of CHL, both surgically and non-surgically, minimally reduced the odds of dementia.
Endoscopic Transnasal Apicoectomy for Odontogenic Maxillary Sinusitis.
Fukui K, Hatakeyama H, Ando R … +5 more , Ichikawa A, Oki Y, Matsumoto Y, Takasu H, Oridate N
Laryngoscope · 2026 Apr · PMID 41952246 · Publisher ↗
Endoscopic transnasal apicoectomy (ETA) is a novel multidisciplinary technique that combines endoscopic sinus surgery with apicoectomy via a transnasal approach. ETA enables direct access to periapical lesions while pres...
Endoscopic transnasal apicoectomy (ETA) is a novel multidisciplinary technique that combines endoscopic sinus surgery with apicoectomy via a transnasal approach. ETA enables direct access to periapical lesions while preserving the causative tooth. Our initial experience suggests that this minimally invasive approach is safe, feasible, and effective for selected cases of odontogenic maxillary sinusitis.
Greater Cochlear Damage in Otogenic Versus Meningogenic Meningitis: Hearing Rehabilitation Implications.
Tavares MP, Pauna HF, Monsanto RDC … +3 more , Keskin-Yilmaz N, Almeida BL, Penido NO
Laryngoscope · 2026 Apr · PMID 41949031 · Publisher ↗
OBJECTIVE: To quantify cochlear and vestibular cellular losses between cases of meningogenic and otogenic meningitis. METHODS: From the archival human temporal bone collection at the University of Minnesota, we selected...
OBJECTIVE: To quantify cochlear and vestibular cellular losses between cases of meningogenic and otogenic meningitis. METHODS: From the archival human temporal bone collection at the University of Minnesota, we selected specimens with meningitis history and histopathological evidence of labyrinthitis. We grouped specimens into two categories (otogenic and meningogenic) based on infection route and included age-matched controls without ear or central nervous system disease. From 36 temporal bones, we quantitatively assessed outer hair cell (OHC) and inner hair cell (IHC) loss, as well as spiral ganglion neuron (SGN) and Scarpa's ganglion neuron (ScGN) counts, then compared results among groups. RESULTS: Both case groups demonstrated OHC loss compared with controls (p < 0.05), with more severe loss in the otogenic group versus the meningogenic group (p = 0.01). IHC loss occurred only in the otogenic group compared with both meningogenic and control groups (p = 0.019 and < 0.001, respectively). No statistically significant difference was found between IHC loss in meningogenic and control groups (p = 0.382). Both otogenic and meningogenic groups showed significant reduction of SGN and ScGN counts compared with controls (p < 0.05), with no statistically significant differences between the two meningitis groups for either measure (p = 0.993 and 0.762, respectively). CONCLUSION: Meningitis is associated with loss of cochlear hair cells, SGN and ScGN. The otogenic route demonstrated a greater loss of both IHC and OHC in comparison with the meningogenic route. LEVEL OF EVIDENCE: N/A.
Cochlear Implantation in Autoimmune Inner-Ear Disease: Outcome and Patient-Reported Benefit.
Hartmann M, Oestreicher D, Hüser MA … +2 more , Beutner D, Wrobel C
Laryngoscope · 2026 Apr · PMID 41947311 · Publisher ↗
OBJECTIVE: To investigate cochlear implant (CI) outcomes in patients with hearing loss related to secondary autoimmune inner ear disease (AIED) compared to a matched control cohort. PATIENTS AND METHODS: In this retrospe...
OBJECTIVE: To investigate cochlear implant (CI) outcomes in patients with hearing loss related to secondary autoimmune inner ear disease (AIED) compared to a matched control cohort. PATIENTS AND METHODS: In this retrospective cohort study, we included seven patients with profound sensorineural hearing loss (SNHL) related to secondary AIED treated with a CI. Data on pre- and postoperative pure-tone audiometry, speech perception in quiet and noise (German Freiburg mono- and multisyllable test, Oldenburg sentence test), and patient-reported outcome measures (Speech, Spatial, and Qualities of Hearing Scale, SSQ12) were assessed and compared to a matched control cohort. RESULTS: Postoperative recognition of monosyllables (65 dB) in AIED patients and controls showed significant improvement (p < 0.0001) after 12 months with gains of 54 and 58 percentage points, respectively. However, AIED patients required a substantially higher signal to achieve 50%-word recognition in sentence testing in noise compared to controls. Notably, subjective hearing abilities tested in the SSQ12 in both groups improved substantially, reaching 4.4 [2.4-6.5] in the AIED group and 5.1 [4.5-5.8] in controls at 12 months, showing a convergence of scores compared to the preoperative group difference. CONCLUSION: AIED patients substantially benefit from cochlear implantation despite potentially ongoing chronic inner-ear inflammation. In contrast to poorer performance in classical audiological test settings such as monosyllable presentation and word recognition in noise, self-perceived hearing was reported nearly as favorable as in the control cohort. Timely diagnosis, tailored preoperative imaging, and individualized rehabilitation are key to improved CI performance in AIED patients.
Transoral Robotic Resection of Pediatric Tongue Base Mucoepidermoid Carcinoma.
Somogyvári K, Jakab-Péter K, Tornóczki T … +2 more , Molnár K, Szanyi I
Laryngoscope · 2026 Apr · PMID 41947279 · Publisher ↗
OBJECTIVE: Mucoepidermoid carcinoma (MEC) of the base of the tongue is exceedingly rare in the pediatric population. While transoral robotic surgery (TORS) has expanded minimally invasive options for oropharyngeal malign...
OBJECTIVE: Mucoepidermoid carcinoma (MEC) of the base of the tongue is exceedingly rare in the pediatric population. While transoral robotic surgery (TORS) has expanded minimally invasive options for oropharyngeal malignancies in adults, its application in pediatric tongue base tumors remains limited. This report aims to highlight the feasibility and oncologic adequacy of TORS in a carefully selected pediatric patient. METHODS: We report the case of a 13-year-old girl with low-grade MEC of the base of the tongue treated with TORS using the da Vinci Xi surgical system (Intuitive Surgical Inc.). Surgical duration, intraoperative findings, histopathologic features, and postoperative course were analyzed. Relevant literature regarding pediatric applications of TORS and alternative surgical approaches was reviewed. RESULTS: Complete en bloc resection with negative margins (R0) was achieved in 37 min without measurable blood loss. A branch of the right lingual artery was safely clipped under robotic visualization. The postoperative course was uneventful, and nasogastric feeding was maintained until postoperative Day 7. Histopathologic analysis confirmed low-grade MEC with negative margins and demonstrated MAML2 rearrangement in more than 50% of tumor cells by fluorescence in situ hybridization. No adjuvant therapy was indicated. CONCLUSION: Transoral robotic surgery may represent a safe, minimally invasive, and oncologically appropriate surgical option for carefully selected pediatric patients with tongue base mucoepidermoid carcinoma. Further multicenter studies are warranted to better define long-term oncologic and functional outcomes in this population. LEVEL OF EVIDENCE: N/A.
SNORES Classification: Multicenter Prospective Validation for Obstructive Sleep Apnea.
Arshad E, Iqbal J, Shafique A
Laryngoscope · 2026 Apr · PMID 41947273 · Publisher ↗
OBJECTIVES: To validate a clinically feasible, multidimensional classification system-SNORES (Severity of apnea-hypopnea index, Nasal airflow limitation, Oxygen desaturation burden, Respiratory effort, Awake Endoscopic a...
OBJECTIVES: To validate a clinically feasible, multidimensional classification system-SNORES (Severity of apnea-hypopnea index, Nasal airflow limitation, Oxygen desaturation burden, Respiratory effort, Awake Endoscopic anatomy, and Sleep position dependency)-for obstructive sleep apnea (OSA), and to evaluate its ability to predict therapy escalation, CPAP adherence, and surgical intervention beyond the apnea-hypopnea index (AHI) alone. METHODS: In this prospective multicenter cohort study, 1560 adults with newly diagnosed OSA confirmed by in-laboratory polysomnography were enrolled. Each SNORES domain was scored from 0 to 3 using predefined objective criteria derived from routine diagnostic testing. Primary outcomes were therapy escalation, CPAP adherence, and surgical intervention. Predictive performance was compared with AHI alone. RESULTS: Higher SNORES scores were independently associated with therapy escalation (hazard ratio [HR] 3.10, 95% CI 2.62-3.67; p < 0.001) and surgical intervention (HR 2.71, 95% CI 2.21-3.33; p < 0.001). The SNORES framework demonstrated superior discrimination for therapy escalation (area under the curve [AUC] 0.82, 95% CI 0.78-0.86) compared with AHI alone (AUC 0.52, 95% CI 0.46-0.57; ΔAUC +0.30, p < 0.001). Removal of individual domains-particularly oxygen desaturation or respiratory effort-meaningfully attenuated predictive performance (ΔAUC -0.09 to -0.11). CONCLUSION: SNORES is a feasible, reproducible, multidimensional framework that captures clinically relevant heterogeneity in OSA and guides individualized therapy more effectively than traditional AHI-only models.
Extranodal Natural Killer/T-Cell Lymphoma Mimicking Chronic Mucormycosis.
Yun J, Lin ME, Madrigal J … +4 more , Tyagi R, Ni G, Chia JJ, Kang R
Laryngoscope · 2026 Apr · PMID 41947215 · Publisher ↗
We describe a rare case of a 34-year-old woman who presented with progressive, destructive midline facial lesions initially concerning for chronic rhinofacial mucormycosis. However, subsequent tissue biopsy and pathologi...
We describe a rare case of a 34-year-old woman who presented with progressive, destructive midline facial lesions initially concerning for chronic rhinofacial mucormycosis. However, subsequent tissue biopsy and pathologic evaluation established the diagnosis of extranodal NK/T-cell lymphoma. The patient demonstrated rapid disease progression despite prompt initiation of asparaginase-based chemotherapy, highlighting the diagnostic challenges and aggressive course of this malignancy that may resemble invasive fungal infection.
A Health Systems Analysis of Global Head and Neck Cancer Outcomes.
Dee EC, Go AE, Feliciano EJG … +16 more , Wu JF, Willmann J, Lapen K, Treechairusame T, Patel MS, Ranganathan S, Hammond A, Wu Y, Singh A, Wong AM, Jacomina LE, Ma J, Iyengar P, Estilo CL, Kingham TP, Lee NY
Laryngoscope · 2026 Apr · PMID 41943212 · Publisher ↗
OBJECTIVES: Head and neck cancer (HNC) remains a major global cause of cancer morbidity and mortality, with disproportionately poor outcomes in low- and middle-income countries. Substantial cross-national disparities sug...
OBJECTIVES: Head and neck cancer (HNC) remains a major global cause of cancer morbidity and mortality, with disproportionately poor outcomes in low- and middle-income countries. Substantial cross-national disparities suggest an important role for health system strengthening. We evaluated associations between national health system characteristics and global HNC outcomes. METHODS: We conducted a cross-sectional ecological analysis of 185 countries using sex-stratified, age-standardized incidence and mortality estimates from the International Agency for Research on Cancer (IARC) GLOBOCAN 2022 database. The primary outcome was the composite mortality-to-incidence ratio (MIR) for aggregated HNCs, including cancers of the lip and oral cavity, oropharynx, larynx, nasopharynx, hypopharynx, and salivary gland. Eleven national health system indicators capturing health financing, workforce density, service availability, socioeconomic development, and gender equity were evaluated. Univariable linear regressions identified candidate variables using Bonferroni correction (p < 0.0045), followed by multivariable modeling with assessment for multicollinearity using variance inflation factors. RESULTS: All 11 health system indicators were significantly associated with HNC MIR on univariable analysis (p < 0.001 for all). In multivariable analysis of 123 countries with complete data, higher Universal Health Coverage (UHC) service coverage index and higher gross domestic product (GDP) per capita were independently associated with lower (improved) HNC MIR (model R = 0.70). Findings were consistent in sex-stratified analyses. CONCLUSIONS: Across countries, progress toward universal health coverage and greater national economic capacity was independently associated with improved HNC outcomes. These findings may help to inform efforts at the level of health systems to improve HNC outcomes worldwide. LEVEL OF EVIDENCE: N/A.
Tumor Surface Necrosis on Laryngoscopy Predicts Prognosis in Hypopharyngeal Carcinoma.
Li F, Huang H, Gong H … +4 more , Tao L, Zhou L, Hsueh CY, Zhang M
Laryngoscope · 2026 Apr · PMID 41943142 · Publisher ↗
OBJECTIVE: The objective is to evaluate the prognostic significance of tumor surface necrosis (TSN) in hypopharyngeal squamous cell carcinoma (HPSCC), a feature commonly observed during laryngoscopic examination. METHODS...
OBJECTIVE: The objective is to evaluate the prognostic significance of tumor surface necrosis (TSN) in hypopharyngeal squamous cell carcinoma (HPSCC), a feature commonly observed during laryngoscopic examination. METHODS: We retrospectively analyzed 346 HPSCC patients who underwent laryngoscopy at our institution between January 2004 and December 2023. Following univariable and multivariable analyses and model diagnostics, a prognostic nomogram was constructed. The model's performance was assessed using discrimination and calibration measures. Comparative evaluation against the previous model was performed using integrated discrimination improvement (IDI) and net reclassification improvement (NRI). RESULTS: The presence of TSN was significantly associated with reduced overall survival (p = 0.0002), disease-free survival (p < 0.0001), local recurrence-free survival (p = 0.004), and regional recurrence-free survival (p < 0.0001). The final nomogram incorporated TSN (p < 0.001), tumor invasion depth (p = 0.001), lymphovascular invasion (p = 0.023), R_classification (p < 0.001), and pT_classification (p < 0.001). The area under the curve (AUC) values for 12-, 36-, and 60-month survival were 0.789, 0.791, and 0.759, respectively. Calibration curves demonstrated good concordance between predicted and observed outcomes. The new model showed significantly improved performance over the previous version (p < 0.001), with NRIs of 0.080, 0.123, and 0.129, and IDIs of 0.040, 0.049, and 0.051 at 12, 36, and 60 months, respectively. CONCLUSION: TSN identified via laryngoscopy was established as an independent risk factor for poor prognosis in HPSCC. The enhanced nomogram integrating TSN with key clinicopathological variables offers improved predictive accuracy, supporting better risk stratification and identification of high-risk patients.
Should Antithrombotic Therapy Be Withheld Perioperatively for Cutaneous Facial Reconstructions?
Roy CF, Magro IL, Tollefson TT … +1 more , Shaye DA
Laryngoscope · 2026 Apr · PMID 41943122 · Publisher ↗
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Limitations of Raised Thyroglobulin: Two Cases of Benign Lymphadenopathy Mimicking Thyroid Carcinoma.
Gohari SS, Wasserman I, Philteos J … +1 more , Richmon JD
Laryngoscope · 2026 Apr · PMID 41943071 · Publisher ↗
Markedly elevated thyroglobulin (Tg) washout is often considered highly suggestive of metastatic differentiated thyroid cancer. We present two cases of false-positive Tg washout in cervical lymph nodes with benign pathol...
Markedly elevated thyroglobulin (Tg) washout is often considered highly suggestive of metastatic differentiated thyroid cancer. We present two cases of false-positive Tg washout in cervical lymph nodes with benign pathology, notably in patients who were carriers of iron-handling disorders. These findings highlight the limitations of Tg washout as a standalone marker and the need for multimodal interpretation.
Implementation of a Novel VTE Risk Assessment and Prophylaxis Strategy for Otolaryngology Surgery.
Lu RJ, Berman H, Boonpongmanee I … +3 more , Persons B, Kim AH, Sclafani A
Laryngoscope · 2026 Apr · PMID 41937454 · Publisher ↗
OBJECTIVE: To evaluate the feasibility, process adherence, and clinical outcomes associated with department-wide implementation of simplified venous thromboembolism (VTE) risk assessment models (RAM) for inpatient and am...
OBJECTIVE: To evaluate the feasibility, process adherence, and clinical outcomes associated with department-wide implementation of simplified venous thromboembolism (VTE) risk assessment models (RAM) for inpatient and ambulatory otolaryngology surgical patients. METHODS: A mixed prospective and retrospective quality improvement initiative was conducted across two tertiary academic medical centers, including all scheduled adult otolaryngology surgical procedures from January 3, 2025, to November 20, 2025. Inpatient admissions were risk stratified using the COBRA score and ambulatory procedures using the Pannucci-NSQIP score; inpatient risk stratifications were shared with surgeons. High VTE risk was defined as COBRA ≥ 4 for inpatients and Pannucci-NSQIP ≥ 4 for ambulatory cases. Pharmacologic prophylaxis beginning on postoperative Day 1 was recommended for high-risk inpatients. Process measures included adherence to prophylaxis guidance and documented rationales for deviation. Outcome measures included 30-day VTE and hemorrhage events. RESULTS: A total of 3854 consecutive adult procedures were included (608 inpatient, 3246 ambulatory). 65% of inpatients and 14% of ambulatory cases were classified as high risk. Among high-risk inpatients with length of stay ≥ 2 days, VTE occurred in 2.5% of patients receiving chemoprophylaxis on POD1 compared with 4.7% of those not receiving POD1 prophylaxis. No VTE events occurred in low-risk inpatients, high-risk inpatients discharged on POD1, or high-risk ambulatory patients. Hemorrhage rates were similar across prophylaxis groups (3.2%-4.1%). Overall VTE rates were 1.8% for inpatients and 0.1% for ambulatory procedures. CONCLUSION: The simplified COBRA and Pannucci-NSQIP RAMs provide a feasible and potentially scalable framework for integrating VTE risk stratification into routine otolaryngology practice.
Incidence and Risks of Chronic Rhinosinusitis in Head and Neck Cancer: A Meta-Analysis.
Dewey J, Majeethia H, Modi K … +2 more , Ramadan HH, Makary CA
Laryngoscope · 2026 Apr · PMID 41934348 · Publisher ↗
OBJECTIVE: Several studies have described the occurrence of chronic rhinosinusitis (CRS) in adult patients with head and neck cancers (HNC). The goal of this review is to identify the incidence and risk factors for CRS i...
OBJECTIVE: Several studies have described the occurrence of chronic rhinosinusitis (CRS) in adult patients with head and neck cancers (HNC). The goal of this review is to identify the incidence and risk factors for CRS in adult patients with HNC. DATA SOURCES: PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials. REVIEW METHODS: A systematic search was performed from inception to July 2025 and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies that looked at the development of CRS following treatment of HNC were included. RESULTS: Seventeen studies representing a total of 3685 patients were pooled. There was significant heterogeneity in how CRS was diagnosed. The overall pooled incidence of CRS in all HNC patients was 0.37 (95% CI, 0.27-0.47). The incidence was significantly higher in patients with nasopharyngeal cancer (NPC) (0.45 vs. 0.18, p < 0.001). The maxillary sinuses were the most common sinuses involved with an incidence of 0.60 followed by the ethmoid sinuses at 0.45. Radiation therapy was associated with a higher risk of CRS (log OR = 1.46, 95% CI of 0.76, 2.16), especially in patients with NPC (log OR of 1.82 vs. log OR of 0.52, p = 0.01). Qualitative review showed that concurrent chemotherapy and advanced disease stage also increased the risk of CRS. CONCLUSIONS: The presence of NPC, radiation therapy, advanced stage, and concurrent chemotherapy significantly increases the risk of CRS in patients with head and neck cancers. Clinicians should be aware of the risk when treating these patients.
Unique Features of Nasal Airway and Airflow Improvement Post-Dupilumab: A Computational Cohort Study.
Odeh A, Wu Z, Jha N … +10 more , Schneller AR, Mihalich J, Root ZT, Brooks C, Curtis C, Kraft M, Wada K, Otto BA, Kelly KM, Zhao K
Laryngoscope · 2026 Apr · PMID 41933438 · Full text
OBJECTIVE: Dupilumab is a monoclonal antibody approved for treatment of chronic rhinosinusitis (CRS) with nasal polyps, yet literature is sparse regarding its precise effect on nasal airway patency and airflow patterns....
OBJECTIVE: Dupilumab is a monoclonal antibody approved for treatment of chronic rhinosinusitis (CRS) with nasal polyps, yet literature is sparse regarding its precise effect on nasal airway patency and airflow patterns. This study applied Computational Fluid Dynamics (CFD) modeling to examine the relationship between the changes in nasal structures and aerodynamics and the changes in symptoms after dupilumab treatment. METHODS: Twelve patients enrolled, completed the Sinonasal Outcomes Score (SNOT-22), as well as CT scans pre and 3 or more months post-dupilumab treatment. Patient-specific CFD models were constructed, and Lund-Mackay (LM) scores were calculated. RESULTS: Nasal airway cross-sectional area (CSA) and airflow rate (AFR) in the middle and superior but not inferior meatuses significantly increased posttreatment (all p < 0.05). These increases correlated with SNOT-22 scores (CSA: r = 0.49, AFR: r = 0.41, p < 0.05), as well as with one question in SNOT-22, decreased sense of smell/taste (CSA: r = 0.32-0.54, AFR: r = 0.29-0.53, p < 0.05), which may explain previously reported rapid improvement in olfaction post-dupilumab. Surprisingly, nasal resistance did not significantly decrease posttreatment (p = 0.12) nor significantly correlate with symptom scores. LM scores significantly improved post-dupilumab (14.4 ± 6.3 to 9.8 ± 4.6; p < 0.05), with moderate residual inflammation. LM significantly correlated with SNOT-22 scores (r = 0.46, p < 0.05), but not with smell/taste complaints. CONCLUSION: The impact of dupilumab on nasal airway patency and airflow is not uniform. It is more pronounced in the middle and superior, but not inferior meatus. These unique regional changes significantly correlate with and potentially drive the improvement in patient symptoms.
Assessing the Area Deprivation Index in Relation to Orbital Floor Fractures.
Islam AM, Dyer BJ, Baldwin RB … +3 more , Dallas AE, Hudnall R, Toman J
Laryngoscope · 2026 Apr · PMID 41933430 · Publisher ↗
OBJECTIVES: Social determinants of health are acknowledged as significant factors affecting trauma occurrence, severity, and outcomes. The area deprivation index (ADI) is a validated tool that combines social determinant...
OBJECTIVES: Social determinants of health are acknowledged as significant factors affecting trauma occurrence, severity, and outcomes. The area deprivation index (ADI) is a validated tool that combines social determinants into a single measure of "neighborhood disadvantage." We aimed to investigate whether ADI was linked to injury severity and other clinical benchmarks in orbital floor fracture patients. METHODS: Patients presenting to a single Level 1 Emergency Department with acute orbital floor fracture were reviewed. Data on additional trauma, length of stay (LOS), and follow-up attendance were collected. Patients were classified into a stable, urgent, or critical condition based on initial clinical presentation. Neighborhood socioeconomic disadvantage was evaluated using national percentile and state decile ADI. Analyses were conducted using chi-squared tests, Mann-Whitney U, Spearman rank correlations, and Kruskal-Wallis tests. RESULTS: A total of 1255 patients with acute orbital floor fractures were analyzed. ADI was significantly higher in patients with additional facial trauma (national ADI: 55 vs. 51, p = 0.0240; state ADI: 7 vs. 6, p = 0.0119). However, ADI was not significantly associated with the incidence of bodily polytrauma, initial clinical acuity, or LOS. Follow-up attendance rates did not differ by ADI. CONCLUSION: Social disadvantage was significantly associated with differences in injury characteristics and indirectly with care utilization among orbital floor fracture patients. This may reflect different mechanisms of injury in high ADI areas and indicate that ADI may be useful as a contextual marker of injury severity. Future studies should investigate these mechanisms and other risk factors unique to high ADI areas.
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