The Annals Of Otology, Rhinology, And Laryngology[JOURNAL]
Sun
200 papers
Patient Selection for Efficacious Mandibular Advancement Device Therapy in Obstructive Sleep Apnea: An Institutional Outcomes Analysis.
Nanda N, Robertson A, Upton DC
Ann Otol Rhinol Laryngol · 2025 Aug · PMID 40285532 · Publisher ↗
INTRODUCTION: Mandibular advancement devices (MADs) are a treatment option for obstructive sleep apnea/hypopnea syndrome (OSAHS); however, the ideal patient selection criteria continue to be refined. OBJECTIVES: To deter...
INTRODUCTION: Mandibular advancement devices (MADs) are a treatment option for obstructive sleep apnea/hypopnea syndrome (OSAHS); however, the ideal patient selection criteria continue to be refined. OBJECTIVES: To determine the overall efficacy of a custom titratable MAD in treating a subset of OSAHS patients. A secondary objective was to determine predictive factors affecting treatment outcome for MAD therapy. METHODS: Retrospective analysis of a single otolaryngologist's (DCU) experience in 86 patients with Friedman Stages 2 to 4 treated with a MAD (Thornton Adjustable Positioner) at an academic medical center. RESULTS: Therapeutic success as measured by type 3 home apnea test (HSAT) before and after proper MAD titration was defined as a 50% reduction in initial AHI or reduction of AHI to a mild severity below 15 events/hour. The 50% AHI reduction rate after MAD titration was 64% and the overall success rate inclusive of patients with reduction below 15 events/hour was 72.1%. MAD therapy significantly reduced the mean AHI (-10.4 ± 12.6), < .001) and improved the minimum oxygen saturation (1.88 ± 5.79, = .003). Significant reduction of OSAHS severity was seen across all treatment groups regardless of initial OSAHS severity: mild (55.9%), moderate (85%), severe (75%; < .001 for all 3 groups). High BMI, advanced age, concentric velopharyngeal collapse pattern, prior pharyngeal surgery, and male sex were not statistically significant predictors of ineffectiveness. CONCLUSIONS: MAD therapy for OSAHS in patients with Friedman Stages 2 to 4 is an effective treatment in 72% of cases and should be considered as an initial treatment option within this subset of patients, inclusive of those with initially severe, moderate, and mild OSAHS.
Development of a Computed Tomography Imaging Grading Scale for Pneumolabyrinth.
Liu SX, McCall AA, Anderson J … +6 more , Perez P, Hirsch B, Hughes M, Arani K, Traylor K, Branstetter BF
Ann Otol Rhinol Laryngol · 2025 Aug · PMID 40219758 · Publisher ↗
OBJECTIVE: To develop a reliable prognostic grading scale for pneumolabyrinth detected on CT. DESIGN: Retrospective case series. SETTING: Tertiary care institution. PARTICIPANTS: A total of 39 patients with pneumolabyrin...
OBJECTIVE: To develop a reliable prognostic grading scale for pneumolabyrinth detected on CT. DESIGN: Retrospective case series. SETTING: Tertiary care institution. PARTICIPANTS: A total of 39 patients with pneumolabyrinth identified through CT imaging from 2010 to 2019 were included. The main outcome measures involved reviewing clinical outcomes and radiographic features. The extent of pneumolabyrinth was assessed and graded as low, intermediate, or high risk for permanent hearing loss, by expert radiologists. MAIN OUTCOMES AND MEASURES: The primary outcome of the study was the association between the extent of pneumolabyrinth, as graded by a novel prognostic scale (low, intermediate, or high risk), and the likelihood of permanent hearing loss. Hearing outcomes and vestibular symptoms were assessed through retrospective chart review, while the grading of pneumolabyrinth extent was based on expert radiologic evaluations of CT imaging. The hypothesis regarding the predictive utility of the grading scale was formulated after data collection. Reliability of the grading scale was measured using Cohen's kappa and Fleiss' kappa. RESULTS: The patient cohort had a median age of 30 years (range = 8-84 years), 33% of whom were female. Trauma, predominantly temporal bone fractures (87.5%), was the most common cause. The grading scale demonstrated excellent intra-rater reliability (Cohen's kappa = .95) and substantial inter-rater reliability (Fleiss' kappa = .729). High risk pneumolabyrinth cases had a higher rate of profound hearing loss (90.9%) compared low or intermediate risk cases (46.2%, = .0136). Dizziness was not associated with pneumolabyrinth grade, but correlated with involvement of semicircular canals (72.7%) compared to patients with pneumolabyrinth limited to vestibule and/or cochlea (31.3%, = .008). Presence of pneumolabyrinth isolated to the vestibular labyrinth was significantly associated with dizziness symptoms ( = .047). CONCLUSION: Our novel grading scale reliably predicted clinical outcomes, providing prognostic utility in hearing status and potential guidance in surgical approach.
The Novel "Hot Dog" Technique for Reconstruction of Incudostapedial Discontinuity: A Randomized Controlled Trial.
Kaya İ, Şahin FF, Hasan TO … +1 more , Kirazlı T
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40219661 · Publisher ↗
OBJECTIVES: Chronic otitis media can cause ossicular chain discontinuity (OCD), especially erosion of long process of incus. This study introduces a novel "Hot Dog" technique for OCD reconstruction that combines glass io...
OBJECTIVES: Chronic otitis media can cause ossicular chain discontinuity (OCD), especially erosion of long process of incus. This study introduces a novel "Hot Dog" technique for OCD reconstruction that combines glass ionomer cement (GIC) with autogenous cartilage dust and platelet-rich fibrin (PRF) to address these limitations. The aim is to evaluate the auditory and anatomical outcomes of the "Hot Dog" technique compared to GIC alone, and to describe the "Hot Dog" reconstruction method in detail. METHODS: This prospective, randomized controlled trial compared the "Hot Dog" technique to GIC alone for incudostapedial rebridging. Thirty-eight adult patients were included and randomized (18 patients in both study and control groups). Preoperative and postoperative pure-tone audiometry were performed. Air-bone gap (ABG) and ABG gain were measured at least 12 months postoperatively. Postoperative complications were assessed. RESULTS: Both groups achieved significant postoperative ABG closure (mean gain: 22.8 dB in "Hot Dog" vs 19 dB in GIC), with no statistically significant difference. A success rate of 100% (postoperative ABG ≤ 20 dB) was observed in both groups at a minimum 12-month follow-up. No complications were observed in the "Hot Dog" group, while 1 patient in the GIC group developed a postoperative tympanic membrane perforation. CONCLUSION: The "Hot Dog" technique demonstrated promise for incudostapedial rebridging, achieving significant hearing improvement and a favorable complication profile compared to GIC alone. While a trend toward better hearing was observed, larger studies with longer follow-up are needed to confirm these findings and definitively compare its efficacy to established techniques. LEVEL OF EVIDENCE: Level 1b.
Acute Kidney Injury (AKI) After Pediatric Tonsillectomy: An Opportunity for Quality Improvement.
Wang AJ, Vasireddy A, Cheng J
Ann Otol Rhinol Laryngol · 2025 Aug · PMID 40143790 · Publisher ↗
PURPOSE: There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing ton...
PURPOSE: There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively. METHODS: A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined. RESULTS: Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI. CONCLUSION: Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.
Risk Factors Associated With Pediatric Post-Tonsillectomy Complications: A Focus on Racial, Ethnic and Socioeconomic Factors.
Wikner E, Nguyen C, Vazifedan T … +4 more , Almirante J, Chilampath B, Mason L, Derkay C
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40125920 · Publisher ↗
OBJECTIVES: Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydration. There has been some research investigating racial/ethnic and socioeconomic d...
OBJECTIVES: Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydration. There has been some research investigating racial/ethnic and socioeconomic disparities in other pediatric otolaryngic issues such as otitis media and sleep disordered breathing. However, there is a paucity of research regarding disparities in children undergoing tonsillectomy. METHODS: A retrospective case control study was performed on all pediatric patients who underwent tonsillectomy with or without adenoidectomy from January 1, 2019 to December 31, 2020 at a tertiary care center. Patient records were documented including demographics, race, ethnicity, type of insurance, surgical technique, and post-operative complications. A major post-operative complication was defined as post-surgical hemorrhage, uncontrolled pain, or dehydration requiring medical attention. RESULTS: There were 1751 patients included in the study with an average age of 6.7 years old with 55.3% patients white, 41.6% black and 3% identified as another race and 8% patients Hispanic or Latino. A complication occurred in 7% of patients including 2.3% who experienced a post-operative hemorrhage and 4.6% with dehydration or poor pain control. Among the entire cohort, 64.2% were publicly insured while 35.8% had private insurance and 1.2% were self-pay.There was no statistically significant difference in terms of probability of complication among patients with different races ( = .85), ethnicities ( = .18) or insurance type ( = .48). Those with bleeding complications were found to be significantly older ( = .011). There was a statistically significant lower likelihood of complication in patients who underwent intracapsular tonsillectomy compared to total electrocautery tonsillectomy ( < .001). DISCUSSION: We found no racial/ethnic or socioeconomic disparities in the risk of post-operative complications in children who underwent tonsillectomy. Despite the frequency of tonsillectomy in children, there are few studies addressing inequalities. Further investigation of disparities in other regions of the United States should be performed.
Pitfalls and Strategies for Implementing and Sustaining an Otolaryngology Perioperative Registry in Mekelle, Ethiopia.
Useche M, Eyassu DG, Rincon AS … +4 more , Hable N, Yehala ZM, Asgedom BH, Wiedermann JP
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40087917 · Publisher ↗
BACKGROUND: Surgical registries have been widely adopted in high-income countries to improve patient outcomes. However, similar data-driven initiatives are still scarce in low- and middle-income countries (LMICs). AIMS:...
BACKGROUND: Surgical registries have been widely adopted in high-income countries to improve patient outcomes. However, similar data-driven initiatives are still scarce in low- and middle-income countries (LMICs). AIMS: This study aimed to address the challenges of implementing a perioperative registry for otolaryngology-head and neck surgery (OHNS) in Mekelle, Ethiopia, and to assess strategies for ensuring its long-term sustainability. METHODS: The registry was developed using REDCap, through a collaborative effort between otolaryngologists in the United States and Ethiopia, ensuring its relevance to the local context. On-site training sessions were conducted for 13 OHNS residents and four senior surgeons to facilitate their use of the registry. A Wi-Fi router was installed in the operating room to enable real-time data entry. Continuous support was provided through remote communication between the local team and the U.S. research team. Sustainability strategies focused on fostering local ownership, integrating the registry into existing workflows, and maintaining continuous data monitoring. RESULTS: Despite facing challenges like intermittent internet connectivity and issues with workflow integration, the local team successfully integrated the registry into routine clinical and surgical practices. Key strategies included providing dedicated Wi-Fi routers, modifying registry fields for improved efficiency, and emphasizing the registry's value to the institution. Ongoing collaboration between the local team and the U.S. team enabled continuous optimization and data collection. CONCLUSION: The successful implementation of this perioperative registry underscores the importance of engaging local stakeholders and integrating sustainable workflows. This initiative serves as a model for other LMICs seeking to establish surgical registries that enhance data-driven decision-making at both the patient and institutional levels.
Device Survival After Pediatric Cochlear Implant Surgery: A 15-Year Single-Center Retrospective Analysis.
Xu B, Fu Y, Bi J … +2 more , Chen W, Yu L
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40071740 · Publisher ↗
OBJECTIVE: To evaluate device survival and identify risk factors for failure in pediatric cochlear implant (CI) surgery to guide strategies for minimizing failure rates and improving survival outcomes. METHODS: A retrosp...
OBJECTIVE: To evaluate device survival and identify risk factors for failure in pediatric cochlear implant (CI) surgery to guide strategies for minimizing failure rates and improving survival outcomes. METHODS: A retrospective analysis was conducted on pediatric patients who underwent CI surgery at the Children's Hospital, Zhejiang University School of Medicine, from September 2008 to September 2023. Device survival was assessed using the Kaplan-Meier method while independent factors influencing device survival were analyzed using the log-rank test and Cox regression model. RESULTS: Among 602 children, the mean age at first CI surgery was 50.3 months (range = 8-155 months). The cohort included 353 males (58.6%) and 249 females (41.4%). Revision surgery was required in 28 cases (4.7%), primarily due to device failure (17/28, 60.7%), including 14 hard and 3 soft failures. Kaplan-Meier analysis showed CI survival rates of 99.1%, 98.1%, 96.7%, 96.4%, and 96.4% at 1, 2, 3, 5, and 10 years post-surgery, respectively. The log-rank test identified sex, age, and history of head trauma as significant factors affecting device survival ( < .05). Multivariate Cox regression confirmed that male sex, first implantation ≤3 years of years, and postoperative head trauma were independent risk factors for device failure. CONCLUSIONS: Pediatric cochlear implantation is generally safe and effective, though device failure remains a concern, necessitating revision surgery remains. Male children who undergo cochlear implantation at ≤3 years of age or have a history of postoperative head trauma require enhanced postoperative care. This includes avoiding vigorous head impacts and increasing follow-up visits to monitor device function and speech recovery. Manufacturers should prioritize developing more durable, impact-resistant cochlear implants to reduce failure rates and improve long-term device survival.
Validation of an In Situ Self-Administered Hearing Test with a Self-Fitting Device for Mild to Moderately Severe Hearing Loss in Various Acoustic Environments.
Lo TS, Chang HY
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40071674 · Publisher ↗
OBJECTIVES: This study compared a simplified in situ self-administered hearing screening test, conducted with a neckband-type self-fitting device, with conventional pure-tone audiometry. It evaluated the maximum speech-s...
OBJECTIVES: This study compared a simplified in situ self-administered hearing screening test, conducted with a neckband-type self-fitting device, with conventional pure-tone audiometry. It evaluated the maximum speech-shaped noise level for screening (MSNLS), crucial for evaluating the feasibility of this in situ screening test in quiet environments. METHODS: This study included 30 adults with normal hearing and 30 adults with mild to moderately severe hearing impairment. A binaural neckband-type self-fitting device was developed. The results of an in situ hearing screening test conducted using the self-fitting device were compared with those obtained using traditional pure-tone audiometry conducted using TDH-50 earphones. Subsequently, MSNLS was determined by assessing noise-masking effects on screening outcomes. All tests were conducted in an audiometric booth, with the hearing screening test conducted in the booth with the door open. RESULTS: Strong positive correlations were observed between the results of pure-tone audiometry and those of hearing screening tests across all test frequencies, with the strongest correlation observed at 2000 Hz ( = 0.793, < .001) and the weakest correlation observed at 500 Hz ( = 0.625, < .001). Comparisons of screening tests results with pure-tone thresholds across all test frequencies revealed differences of approximately 10 dB HL for 80% of all ears. The sensitivity and specificity of the hearing screening test in detecting candidates with hearing loss (>30 dB HL) who are suitable for this device were 93% and 90%, respectively. The hearing-impaired group exhibited MSNLSs, such as 57 dB SPL at 500 Hz, exceeding ambient noise levels in an empty classroom. CONCLUSION: The in situ hearing screening test, conducted using a self-fitting device, exhibited reasonable accuracy for self-fitting scenarios in general quiet environments. This test can be used for monitoring mild to moderate hearing loss or fluctuating hearing loss, such as that associated with Ménière's disease.
Composite Outcomes of Sleep Surgery Using the Modified Sleep Apnea Severity Index (mSASI).
Kaki PC, Shah SN, Rodin J … +3 more , Kaffenberger TM, Boon M, Huntley C
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40071646 · Publisher ↗
OBJECTIVE: The apnea-hypopnea index (AHI) defines obstructive sleep apnea (OSA) severity but fails to describe nuances in disease burden. The modified sleep apnea severity index (mSASI) combines patient anatomy, weight,...
OBJECTIVE: The apnea-hypopnea index (AHI) defines obstructive sleep apnea (OSA) severity but fails to describe nuances in disease burden. The modified sleep apnea severity index (mSASI) combines patient anatomy, weight, sleep study metrics, and symptoms to provide a composite OSA index ranging from 1 to 3. While prior studies have associated mSASI with quality of life and hypertension, its utility in continuous positive pressure intolerant (CPAPi) surgical patients remains unexplored. METHODS: A retrospective cohort study of surgically treated CPAPi patients who underwent upper airway stimulation (UAS), maxillomandibular advancement (MMA), or expansion sphincter pharyngoplasty (ESP) at our Tertiary Care Academic Center from 2014 to 2021. Five hundred twenty-eight patients were identified and 260 had available data to calculate mSASI pre- and postoperatively using the published method. Wilcoxon rank-sum tests were used during the analysis. RESULTS: Out of 260 patients, 167 underwent UAS (64%), 73 ESP (28%), and 20 MMA (8%). Fifty-five percent had a preoperative mSASI = 1 (average = 1.56, standard deviation = 0.68). The average overall change in mSASI postoperatively was -0.32 ( < .01). mSASI change in UAS, ESP, and MMA groups was -0.21, -0.51, and -0.50, respectively. Of note, 64% of UAS patients had a preoperative mSASI = 1, compared to 40% and 37% for MMA and ESP, respectively. The change in mSASI score was not significantly associated with treatment efficacy per Sher's Criteria ( = .6)Conclusion:The mSASI is a valuable alternative index to measure preoperative OSA severity and characterize surgical outcomes. Further prospective studies are needed to confirm these findings and to determine its ability to detect risk reduction post-treatment. LEVEL OF EVIDENCE: 4.
Comparison of Technetium-99m Tilmanocept to Technetium-99 Sulfur Colloid Radiotracer for Sentinel Lymph Node Biopsy in Head and Neck Melanoma.
Maddineni S, Tosoni SM, Sunwoo JB … +1 more , Baik FM
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 40008522 · Publisher ↗
BACKGROUND: Sentinel lymph node biopsy (SLNB) is integral to management of head and neck melanomas (HNM). Here, we evaluate how radiotracer selection (Tc-99m tilmanocept or Tc-99m sulfur colloid) and imaging modality (pl...
BACKGROUND: Sentinel lymph node biopsy (SLNB) is integral to management of head and neck melanomas (HNM). Here, we evaluate how radiotracer selection (Tc-99m tilmanocept or Tc-99m sulfur colloid) and imaging modality (planar imaging or single positron emission computed tomography (SPECT)) may influence SLNB and its outcomes. METHODS: We performed a retrospective chart review of patients who received SLNB for HNM at our institution between January 2000 and July 2022. RESULTS: A total of 211 patients received Tc-99m tilmanocept (Tc-tilmanocept) and 113 received Tc-99m sulfur colloid (Tc-SC). There was no difference between Tc-tilmanocept and Tc-SC in terms of number of nodal levels to which the radiotracers localized (1.48 ± 0.93 SD vs 1.38 ± 0.93, respectively). Tc-tilmanocept had a lower rate of failed sentinel node identification as reported on radiology reports compared to Tc-SC (1.9% vs 11.5%, < .001). There was a lower 5-year recurrence rate with Tc-tilmanocept versus Tc-SC (20.9% vs 28.3%, respectively = .07), but this difference was not significant. When analyzing only cases in which SPECT was obtained, this there was no observed difference in 5-year recurrence rate. With SPECT, fewer patients had non-specific description of their node localization as "cervical" without further detailing of nodal basin (0% SPECT vs 9.7% non-SPECT, < .001). Multivariable linear regression analysis for predictors of HNM 5-year recurrence found the odds ratio for SPECT imaging was 0.43, but not statistically significant ( = .06). CONCLUSIONS: Tc-tilmanocept may be associated with greater rate of successful radiotracer migration along lymphatics compared to Tc-SC. SPECT imaging may confer more precision of the nodal basin to which radiotracer localizes as fewer patients receiving SPECT had radiology findings showing nonspecific localization of nodes to "cervical" basins without further specification. More patients are necessary to determine if Tc-tilmanocept and SPECT imaging are associated with lower melanoma recurrence rate.
Preventive Effect of Controlled-Release Dexamethasone on Cochlear Ossification in Meningitis Model.
Eravcı FC, Kaplan Ö, Kılınç F … +3 more , Doğan M, Arbağ H, Orhan M
Ann Otol Rhinol Laryngol · 2025 Jul · PMID 39991894 · Full text
OBJECTIVE: Despite vaccination and early antibiotic treatment, pneumococcal meningitis remains a disease with significant mortality and morbidity. The resulting inflammatory response can lead to cochlear fibrosis, ossifi...
OBJECTIVE: Despite vaccination and early antibiotic treatment, pneumococcal meningitis remains a disease with significant mortality and morbidity. The resulting inflammatory response can lead to cochlear fibrosis, ossification where cochlear implant surgeries are far challenging. Our study aimed to investigate the preventive effect of controlled-release dexamethasone implant in such cases in terms of structural integrity. METHODS: Twenty-four rats were induced with pneumococcal meningitis and randomized into study (n = 16) and control (n = 8) groups. Controlled-release dexamethasone implants were placed transbullarly into the right round window of the study group. Bilateral cochleas underwent histological examination 3 months post-infection. RESULTS: In the study, cochlear effects of pneumococcal meningitis were evaluated. The basal turn was significantly more affected by fibrosis and ossification ( = .013 and .010, respectively). Compared with control ears, the dexamethasone implant group showed less fibrosis in all turns and less ossification in the basal turn ( = .014, .003, .044, and .035, respectively). CONCLUSION: In pneumococcal meningitis, fibrosis and ossification occur more intensively in the basal turn of the cochlea. Controlled-release dexamethasone implants are effective in preventing cochlear ossification and fibrosis. The prevention from the structural damage indicates the potential role of these dexamethasone implants in post-meningitic hearing loss and easing cochlear implant surgeries.
A Multi-Center Randomized Study Assessing If Validated Short Videos Improve Sinus Education.
Bailey CE, Cabrera-Muffly C, Chen PG … +6 more , Farrell N, Rangarajan SV, Yim M, Irish J, Le CH, Chang EH
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39985413 · Publisher ↗
OBJECTIVE: To determine if a short 10-minute video of either CT images (Video1: V1) or CT and endoscopic surgical videos (Video 2: V2) could be used to improve sinonasal anatomy knowledge in medical students (Med) and ot...
OBJECTIVE: To determine if a short 10-minute video of either CT images (Video1: V1) or CT and endoscopic surgical videos (Video 2: V2) could be used to improve sinonasal anatomy knowledge in medical students (Med) and otolaryngology residents (OtoR). BACKGROUND: YouTube is a widely used platform for surgical training, yet many educational videos are of poor quality. We developed and validated two 10-minute narrated videos of sinus anatomy, the first (V1) incorporated CT images of critical structures while the second (V2) combined CT images and surgical endoscopic video. In tandem, we developed a sinonasal assessment used to test sinonasal anatomy, surgical landmarks, and situational awareness. METHODS: We performed a multicenter, randomized IRB-approved educational study evaluating the efficacy of the V1 and V2 videos by comparing pre-test (PrT) and post-test (PoT) scores in Med and OtoR subject groups. Subjects then watched the alternate video and preferences were assessed. RESULTS: A total of 30 Med and 37 OtoR successfully completed the study at 6 different institutions. There were significant differences in pre-test knowledge with OtoR scoring higher than Med in all 3 pre-test subdomains [(S1: 4.3 v s2.9, < .0001, S2: 4.4 vs 3.1, < .0001, and S3: 4.6 vs 3.2, < .0001)]. In the Med group, both V1 and V2 educational videos significantly improved post-test scores compared to pre-test scores (V1: 10.06 vs 12.59, = .0005; V2: 8.23 vs 11.08, = .0008). In the OtoR group, only the V2 educational video showed significant improvement (13.24 vs 14.76, < .0001). Both groups thought the videos were helpful and improved their spatial awareness of sinus anatomy. CONCLUSIONS: Short, validated videos significantly improve sinonasal education and should be incorporated in modern training programs.
Exploring Completion Rates of the SNOT-22 Questionnaire.
Amin L, Davis J, Thapa M … +4 more , Khalil SL, Wu AW, Higgins TS, Tang DM
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39968847 · Publisher ↗
BACKGROUND: The 22-item Sinonasal Outcome Test (SNOT-22) is a widely used patient-reported outcome measure (PROM) for assessing chronic rhinosinusitis (CRS). However, incomplete surveys may impact its predictive utility....
BACKGROUND: The 22-item Sinonasal Outcome Test (SNOT-22) is a widely used patient-reported outcome measure (PROM) for assessing chronic rhinosinusitis (CRS). However, incomplete surveys may impact its predictive utility. AIMS: This study explores SNOT-22 completion rates, response trends, and potential factors influencing survey omissions aiming to optimize its predictive utility and practical application. METHODS: SNOT-22 surveys were retrospectively collected from patients at various time points throughout their CRS treatment. Surveys with at least one question unanswered were included in the study. Completely unanswered surveys were excluded. Survey response dynamics and trends were analyzed and reported. RESULTS: 1,034 SNOT-22 surveys were collected, 18% of the surveys were incomplete. Questions on "Ear fullness" and "Embarrassed" were most unanswered, while "Need to blow nose" and "Nasal blockage" were least unanswered. Questions later in the survey showed a moderate positive correlation with missing responses. Mean scores per question were higher in incomplete than in complete surveys, though differences in SNOT-22 scores between partially and fully completed surveys weren't significant. CONCLUSION: Our study found that a large number of SNOT-22 surveys were incomplete, higher than rates reported in similar PROMs. Mean scores did not differ significantly between partial and complete surveys, suggesting interpretation should prioritize individual responses over total scores. Potential barriers to survey completion include question wording, symptom relevance, and survey length. Future research should further investigate survey completion through qualitative methods and randomized question ordering to refine survey design.
Thyroid-Stimulating Hormone Testing and Outcomes in Total Laryngectomy Patients.
Warren JD, Oglesby KR, Homan CR … +4 more , Howe E, Paul O, Tassone P, Kane AC
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39957050 · Publisher ↗
OBJECTIVE: Assess timing and prevalence of thyroid-stimulating hormone (TSH) testing after total laryngectomy (TL). Identify prevalence of postoperative hypothyroidism and determine associations between thyroidectomy, po...
OBJECTIVE: Assess timing and prevalence of thyroid-stimulating hormone (TSH) testing after total laryngectomy (TL). Identify prevalence of postoperative hypothyroidism and determine associations between thyroidectomy, postoperative hypothyroidism, and wound complications, including pharyngocutaneous fistula (PCF). METHODS: Retrospective chart review performed at 2 tertiary care centers of adult patients undergoing TL between 2013 and 2021. Demographic data, perioperative labs and post-operative outcomes were collected. Analysis was performed. RESULTS: Of 237 patients identified, thyroid removal was performed in 156 (65.8%), including 23 (9.7%) total thyroidectomies and 133 (56.1%) hemi-thyroidectomies. Of the 191 (80.6%) receiving postoperative TSH testing, 98 (41.4%) had TSH testing within 90 days, and 112 (58.6%) developed hypothyroidism. Mean postoperative TSH testing interval was 222.0 days (SSD 400.2), with variations associated with age ( = .026), gender ( = .009), PCF formation ( < .001), history of radiation therapy (RT, = .011), and preoperative levothyroxine use ( = .031). Partial or total thyroid removal significantly increased the likelihood of high postoperative TSH (OR = 2.631, = .002, 95% CI [1.410, 4.911]). PCF occurred in 62 (26.2%) patients, and there were no significant associations between pre/postoperative TSH or thyroid removal and PCF development or wound complications. CONCLUSION: Thyroidectomy was associated with elevated postoperative TSH levels, adding support to prior literature for consideration of avoiding thyroid removal during TL when appropriate. The wide range of TSH testing intervals and prevalence of postoperative hypothyroidism in our cohort highlights the importance of monitoring thyroid function in TL patients during the perioperative period.
Assessing Patient-Reported Outcomes: A Mixed Methods Qualitative Comparison Between Obturator and Surgically Reconstructed Maxillectomy Patients.
Almanaseer A, Dong C, Paczkowski F … +7 more , Laxague F, Macneil SD, Nichols AC, Yoo J, Fung K, Aragon C, Mendez A
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39949108 · Full text
OBJECTIVES: Cancers of the maxillary region are often treated surgically with a maxillectomy followed by rehabilitation involving surgical reconstruction or obturator insertion to improve functional outcomes. However, th...
OBJECTIVES: Cancers of the maxillary region are often treated surgically with a maxillectomy followed by rehabilitation involving surgical reconstruction or obturator insertion to improve functional outcomes. However, there is a lack of consensus regarding the specific indications for either rehabilitation method. The objective of this study was to identify unique functional domains for maxillectomy patients who underwent surgical reconstruction or obturator insertion post-op to provide standardized data that can inform selection of either method. METHODS: This mixed-methods qualitative research was conducted from January 2020 to June 2022 at London Health Sciences Centre, a tertiary care center in London, Ontario, Canada. Phase I included open-ended patient interviews through grounded theory, while phase II incorporated focus groups through the Delphi technique. Phase I identified functional domains of interest, which were further refined based on importance to patients in phase II. Inclusion criteria consisted of adults, 18 years or older who underwent maxillectomy surgery for head and neck cancer. RESULTS: A total of 22 patients were included in phase I and 8 patients were included in phase II. The top 4 functional domains that affected patients regardless of rehabilitation method were eating difficulties, speaking difficulties, social discomfort with public eating, and numbness. The top 4 unique functional domains identified for the surgical group were dry mouth, trismus, chewing difficulties, and eye-related symptoms. The top 4 unique functional domains for the obturator group were obturator discomfort, nasal regurgitation, weight loss, and voice changes. CONCLUSIONS: This study identified functional domains affecting maxillectomy patients, which can be used to inform decisions regarding selection of rehabilitation method in clinical practice. This data can also in the future to create the first patient-reported outcomes instrument for this patient population.
Impact of Otologic Surgery on Medical and Social Outcomes in Adults With Hearing Loss.
Perlov NM, Li M, Patel J … +4 more , Kumar AT, Urdang ZD, Willcox TO, Chiffer RC
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39949079 · Publisher ↗
OBJECTIVES: To test the hypothesis that surgical otologic intervention for any type of adult hearing loss decreases the odds for incident adverse life events (ALEs) and medical comorbidities (MCBs). STUDY DESIGN: Retrosp...
OBJECTIVES: To test the hypothesis that surgical otologic intervention for any type of adult hearing loss decreases the odds for incident adverse life events (ALEs) and medical comorbidities (MCBs). STUDY DESIGN: Retrospective cohort database study. METHODS: Electronic medical record data from the TriNetX Research Network were queried for adults (age ≥18 years) with congenital, sensorineural, conductive, and mixed hearing loss (HL). Patients were further stratified into 3 groups by presence or absence (HL-surgery) of surgical intervention at any point following diagnosis, including (1) stapes surgery (HL + stapes); (2) cochlear implantation and bone-anchored hearing aid (HL + CI); and (3) mastoidectomy alone and tympanoplasty with or without mastoidectomy (HL + TM). Primary outcomes were defined as odds for new ALEs or MCBs at any point given HL treatment status [Odds ratio with 95% confidence interval, (OR; 95% CI, -value)]. Cohorts were balanced using propensity-score matching (PSM) based on US census-defined demographics and congenital comorbidities. RESULTS: There were 2 577 153 patients included in this study. Matched analysis demonstrated that HL + stapes adults (n = 7985) had 0.37-lower odds (95% CI = 0.30-0.47, < .0001) of experiencing any incident ALE versus HL-surgery adults (n = 2 518 409). Adults in the HL + CI cohort (n = 17 129) had 0.58-lower odds (0.52-0.66, < .0001) of experiencing any incident MCB versus HL-surgery adults. CONCLUSIONS: This study highlights the benefit of surgical intervention for adult hearing loss on social and medical phenomes. These findings represent the largest cohort study to date demonstrating this association and further support that hearing restoration improves patient socioeconomic and medical outcomes.
Reliability and Validity of a Pediatric Drug-Induced Sleep Endoscopy Grading System (PedDISE-8).
Jaffal H, Coutras SW, Dewey J … +2 more , McArdle E, Cui R
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39924960 · Publisher ↗
OBJECTIVES: Drug-induced sleep endoscopy (DISE) is increasingly being used in children with obstructive sleep apnea (OSA) to identify specific sites of upper airway obstruction and plan surgical interventions. This study...
OBJECTIVES: Drug-induced sleep endoscopy (DISE) is increasingly being used in children with obstructive sleep apnea (OSA) to identify specific sites of upper airway obstruction and plan surgical interventions. This study aims to test the reliability and validity of a new grading system for pediatric DISE procedures (PedDISE-8). METHODS: We conducted a retrospective chart review of children 0 to 18 years old with OSA who underwent DISE. Four independent raters reviewed and graded each video recording twice using the PedDISE-8. Eight upper airway sites were evaluated: inferior turbinates, adenoid, velum, tonsils/lateral pharyngeal walls, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. Intraclass correlation coefficients were calculated to determine inter-rater and intra-rater rating reliability for each site. External validity was assessed by analyzing the correlation between the number of sites with severe obstruction and polysomnographic data. RESULTS: DISE recordings were reviewed for 86 pediatric patients, 59.5% of whom were male and 26.7% were obese. The median age was 3.5 (IQR 2.4-5.3) years, and the median obstructive apnea-hypopnea index (oAHI) was 5.5 (IQR 3.1-10.4). Moderate to good inter-rater and intra-rater reliability were found for all eight sites (intraclass correlation coefficient 0.67 to 0.88 and 0.71 to 0.87, respectively). The number of sites with severe obstruction correlated positively with the oAHI (τ = 0.119, = .004). CONCLUSIONS: The PedDISE-8 grading system demonstrated good inter-rater and intra-rater reliability and external validity. It can be used in children undergoing DISE for OSA.
Patient Experience of Awake Laryngoscopy Procedures.
Hsu AR, Johns HL, Arguelles I … +4 more , O'Byrne J, Ekbom D, Orbelo D, Bayan S
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39910839 · Publisher ↗
OBJECTIVE(S): To quantify and compare pre-procedure worry versus the experience of pain, gagging, and dyspnea during in-office laryngoscopy procedures in patients who did or did not receive pre-procedure anxiolytics, and...
OBJECTIVE(S): To quantify and compare pre-procedure worry versus the experience of pain, gagging, and dyspnea during in-office laryngoscopy procedures in patients who did or did not receive pre-procedure anxiolytics, and to explore patient perception of intra-procedure interventions. METHODS: Patients undergoing awake laryngology procedures at a quaternary care center were enrolled. The State-Trait Anxiety Inventory (STAI) Y1 and Y2 questionnaires were administered to establish baseline levels of state anxiety and trait anxiety, respectively. Pre-procedure and post-procedure surveys assessed patient perception of select interventions. RESULTS: 34 patients were enrolled (35.3% female, 91.2% white, mean age 60 years). Pre-procedure, 51.5% of patients reported some degree of worry about pain, 61.8% about gagging, 52.9% about dyspnea, and 55.9% about having something in their nose/throat. Post-procedure, 54.5% reported experiencing pain to some degree, 63.6% had gagging, 39.4% had dyspnea, and 78.7% were bothered by having something in their nose/throat. Patients who received a pre-procedure anxiolytic were significantly more likely to report more pain compared to those who did not. The highest rated interventions were pre-procedural education (97.0% "Very helpful"), verbal reassurance (96.9%), provider communicating steps of the procedure (96.9%), and reminders to breathe (87.5%). CONCLUSION: For patients undergoing awake laryngology procedures, the anticipation of gagging, pain, trouble breathing, and scope-related discomfort are worrisome factors. Of these, scope-related discomfort and gagging are the most often-reported sources of intraprocedural discomfort. The interventions patients found most helpful were based on preprocedural education and clear intraprocedural communication, which suggests that purposeful communication has a role in relieving anxiety. LEVEL OF EVIDENCE: Level 4.
Hearing Loss Secondary to Gene Mutations.
González-Aguado R, Onecha E, Gallo-Terán J … +1 more , Morales-Angulo C
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39905815 · Publisher ↗
OBJECTIVES: To assess the prevalence and clinical characterization of variants in the gene among individuals with bilateral sensorineural hearing loss of unknown etiology in northern Spain. METHODS: A 6-year (2018-2024)...
OBJECTIVES: To assess the prevalence and clinical characterization of variants in the gene among individuals with bilateral sensorineural hearing loss of unknown etiology in northern Spain. METHODS: A 6-year (2018-2024) observational, prospective, and descriptive study was conducted on patients with bilateral sensorineural hearing loss at a tertiary hospital. Next generation sequencing using a gene panel for sensorineural hearing loss was performed to detect pathogenic, likely pathogenic, or variants of unknown significance in the gene. RESULTS: Among 326 patients, pathogenic or likely pathogenic variants were found in 7 patients (2.14%), including c.3107G>A (n = 6) and c.5383+6T>A (n = 1). Variants of unknown significance were found in 8 patients (2.45%). About 14 of 15 probands had a family history of hearing loss with autosomal dominant inheritance. Eight relatives with confirmed pathogenic variants were also included, totalling 23 cases. Six patients with pathogenic variants and 3 with variants of unknown significance had moderate mid-frequency hearing loss, while others had severe high-frequency loss. Hearing loss was typically progressive, ranging from congenital onset to the fifth decade. Most were treated with hearing aids; none required cochlear implants. CONCLUSIONS: gene variants are relatively common in this population, with c.3107G>A being the most frequent. The typical phenotype is slowly progressive, mid-to-high frequency sensorineural hearing loss, often starting in childhood and usually requiring hearing aids fitting with good results in improving speech intelligibility.
Mask Anesthesia, Straight Laryngoscope, and Alligator Forceps for Cervical Esophageal Coin Removal: A Comparison with Traditional Methods.
Shah HP, Brawley CC, Gabra L … +3 more , Maddalozzo J, Maurrasse S, Johnston D
Ann Otol Rhinol Laryngol · 2025 Jun · PMID 39905790 · Publisher ↗
OBJECTIVE(S): Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We ai...
OBJECTIVE(S): Coins are the most frequently ingested foreign bodies by children. While rigid esophagoscopy with concomitant intubation is frequently used for removal, it has the potential for serious complications. We aimed to assess and compare the safety, efficacy, and efficiency of two different techniques for pediatric cervical esophageal coin removal. METHODS: Retrospective chart review identified patients who underwent esophageal coin removal from January 2017-August 2023 at one of two tertiary academic centers: Ann & Robert H. Lurie Children's Hospital and Yale-New Haven Hospital. Patients with foreign bodies other than coins were excluded. Patients underwent one of two approaches for cervical esophageal coin removal depending on surgeon preference: (1) induction of general anesthesia, intubation, rigid esophagoscopy, and coin extraction with optical forceps (esophagoscope group) or (2) mask ventilation, insertion of a straight laryngoscope blade into the esophagus orifice, and coin extraction with alligator forceps (straight laryngoscope group). Primary outcomes were successful removal of the esophageal coin, regarded a marker of efficacy, as well as operative and anesthesia times, which were regarded as measures of efficiency. Secondary outcomes were postoperative complications, regarded as markers of safety. RESULTS: Of the 108 patients meeting inclusion criteria, 23 (21.3%) were in the straight laryngoscope group and 85 (78.7%) in the esophagoscope group. Mean operative time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (2.8 ± 1.5 minutes vs 13.8 ± 17.2 minutes, respectively, < .0001). Mean anesthesia time was significantly shorter for the straight laryngoscope group compared to the esophagoscope group (24.2 ± 6.4 minutes vs 44.7 ±1 6.2 minutes, respectively, < .0001). There were no intra- or post-operative complications in the straight laryngoscope group and two minor complications in the esophagoscope group. CONCLUSIONS: Esophagoscopy using a straight laryngoscope blade under mask anesthesia can represent a safe and efficient alternative for impacted esophageal coin removal.
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