The Annals Of Otology, Rhinology, And Laryngology[JOURNAL]
Sun
200 papers
Assessment of Surgical Salvage Outcomes for Exposed Cranial Neuromodulating Devices.
Molotkova E, Isaac H, Greenlee JD … +3 more , Hansen MR, Claussen A, Andrews BT
Ann Otol Rhinol Laryngol · 2026 May · PMID 42089563 · Publisher ↗
OBJECTIVES: Implanted neuromodulating devices (NMDs) such as cochlear implants (CIs) and deep brain stimulators (DBSs) are commonly used in modern medicine. Rarely, complications arise post-operatively, including hardwar...
OBJECTIVES: Implanted neuromodulating devices (NMDs) such as cochlear implants (CIs) and deep brain stimulators (DBSs) are commonly used in modern medicine. Rarely, complications arise post-operatively, including hardware exposure. Traditional teaching suggests that these devices require removal if exposed; however, surgical salvage is a high risk, high reward alternative. We review our single institution experience managing NMD exposure with surgical salvage. METHODS: Retrospective chart review was performed on individuals who had a NMD implanted and underwent an attempt at surgical salvage for exposure during the study period (January 01, 2021 through December 31, 2023). Study outcome success was defined as maintaining a functional NMD 1 year after salvage was attempted. Surgical techniques associated with successful salvage were compared. RESULTS: Nine of 729 patients (1.2%) implanted with NMDs experienced hardware exposure during this 2-year study period. Nine subjects were referred for NMD salvage; however, only 6 of 9 subjects (66.7%, CI = 3; DBS = 3) underwent NMD salvage attempts. Four of the subjects had successful salvage demonstrated successful salvage with a functioning NMD and without wound healing concerns 1 year after their salvage procedure. CONCLUSIONS: Classic teaching states that exposed NMDs require explantation. However, this approach necessarily imposes time without benefit from the NMD between explantation and reimplantation. Our experience demonstrates that surgical salvage can be a successful alternative for the majority (66.7%) of individuals.
Tinnitus Trends in Young Adults: Prevalence and Duration from 2008 to 2023.
Bartholomew RA, Kersbergen CJ, Bhattacharyya N
Ann Otol Rhinol Laryngol · 2026 May · PMID 42089210 · Publisher ↗
PURPOSE: To assess for longitudinal changes in the prevalence, duration, and self-perceived impact of persistent tinnitus amongst young adults (ages 18-24) in the United States. METHODS: The adult National Health Intervi...
PURPOSE: To assess for longitudinal changes in the prevalence, duration, and self-perceived impact of persistent tinnitus amongst young adults (ages 18-24) in the United States. METHODS: The adult National Health Interview Surveys (NHIS) for calendar years 2008 and 2023 were investigated for specific tinnitus related symptoms among young adults (ages 18-24). The prevalence of tinnitus in the past 12 months and the overall duration of tinnitus symptoms were determined and compared between the 2 survey years. RESULTS: In 2023, an estimated 2.30 million young adults reported tinnitus in the prior 12 months, risk for which was increased with very loud sound exposure (odds ratio [95% confidence interval], 2.6 [1.7-3.9]). Tinnitus was reported to be a moderate or big problem in 8.7% and 3.1% of respondents, respectively, and only 10.1% saw a medical specialist for their tinnitus. The prevalence of tinnitus increased from 5.8% in 2008 to 7.8% in 2023 ( = .030). From 2008 to 2023 there was also an increase in duration of tinnitus ( < .001). CONCLUSION: Nationally representative data indicate a concerning increasing prevalence and duration of tinnitus among young adults with a significant self-perceived impact. This increasing prevalence of tinnitus may reflect underlying issues of noise exposure and merits further ongoing surveillance. LEVEL OF EVIDENCE: IV.
Identifying and Mitigating Risk Factors for Last Minute Otolaryngology Surgical Cancelations.
Linquest L, Shires CB, Young N … +4 more , Kaskas A, Fontenot A, Jasper K, Dewan K
Ann Otol Rhinol Laryngol · 2026 May · PMID 42076855 · Publisher ↗
OBJECTIVE: The primary objective is to identify patient-based risk factors influencing otolaryngologic surgical no-shows. Secondarily we compare surgical no-show rates of patients undergoing otolaryngology surgery in the...
OBJECTIVE: The primary objective is to identify patient-based risk factors influencing otolaryngologic surgical no-shows. Secondarily we compare surgical no-show rates of patients undergoing otolaryngology surgery in the pre-COVID-19 pandemic versus the post-COVID-19 pandemic. METHODS: Retrospective chart review performed on all patients with surgical appointments at Ochsner-LSU Health with any Otolaryngology physician over a 3-months pre- and post-pandemic. Participants were separated as having the surgical procedure completed, canceled greater than 48 hours before the procedure, or a cancelation within 48 hours of the procedure. Distance from the hospital, procedure type, diagnosis related to surgery, cancelation reasons, subspecialty clinic, date of clinic appointment, need for medical clearances, and any pre-operative test results were recorded. RESULTS: Elective cases were significantly more likely to no-show than non-elective cases (24% vs 16.3%, = .02). Additionally, patients who did not show up to the pre-operative testing appointments were significantly more likely to cancel within 48 hours of surgery than those with normal or abnormal pre-operative testing ( < .001). A difference in no-show rates was found between subspecialties ( = .01) with rhinology having the most no-shows (30.4%). No statistically significant difference was found between the pre- and post-pandemic groups who canceled within 48 hours of surgery. CONCLUSION: Risks for no-show included failure to attend pre-op appointment, elective surgery, and rhinology surgery. There was no change in no-show risk factors from pre-COVID-19 pandemic to post COVID-19 pandemic.
Intraoperative and Postoperative Advantages of two Absorbable Materials for Supporting Graft in Endoscopic Tympanoplasty: Oxidized Regenerated Cellulose (Surgicel) Over Gelatin Sponge (Spongostan).
Karatas E, Ibas M, Elgormus MN
Ann Otol Rhinol Laryngol · 2026 May · PMID 42068162 · Publisher ↗
OBJECTIVE: To compare the intraoperative and postoperative outcomes of using oxidized regenerated cellulose (Surgicel) versus absorbable gelatin sponge (Spongostan) for supporting graft material in endoscopic tympanoplas...
OBJECTIVE: To compare the intraoperative and postoperative outcomes of using oxidized regenerated cellulose (Surgicel) versus absorbable gelatin sponge (Spongostan) for supporting graft material in endoscopic tympanoplasty. METHODS: We retrospectively analyzed 92 patients who underwent endoscopic type 1 tympanoplasty between 2020 and 2024. Patients were divided into 2 groups based on the supporting graft material used: 47 received Surgicel and 45 received Spongostan. Primary outcome measures included intraoperative hemostasis quality, duration of graft placement, postoperative graft success, graft lateralization, and hearing outcomes at 6 and 12 months. RESULTS: Hemostasis during graft placement was better in the Surgicel group ( = .017), and shorter graft placement duration was observed ( = .047). At ≥ 6 months, graft success rates were comparable between the groups (89.4% for Surgicel vs 82.2% for Spongostan; = .380). However, graft lateralization was significantly less frequent in the Surgicel group (2.1%) compared to the Spongostan group (15.6%; = .029). While the Spongostan group showed significantly better hearing results at 6 months (mean ABG 16.9 dB vs 28.6 dB; < .001), hearing outcomes were similar by 12 months. CONCLUSION: Both Spongostan and Surgicel are effective supporting graft materials in endoscopic tympanoplasty. However, Surgicel was associated with certain intraoperative advantages, including superior hemostasis and shorter operative time, along with a significantly lower risk of postoperative graft lateralization. These benefits suggest Surgicel may be a preferable option for enhancing surgical efficiency and optimizing outcomes in endoscopic ear surgery.
Medicare Reimbursement Trends in Sleep Surgery: A 2 Decade Analysis of the Most Billed Codes.
Fuleihan AA, Kaki P, Allcroft TJ … +3 more , Sideris A, Boon M, Huntley C
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 42046370 · Publisher ↗
OBJECTIVES: The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic via...
OBJECTIVES: The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement. METHODS: The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed. RESULTS: Among the analyzed CPT codes, a consistent decline in inflation-adjusted facility prices was observed, with an average aggregate decrease of 39.8%. The most pronounced decline was in CPT 42975 (Drug-Induced Sleep Endoscopy), which decreased by 72.1% ( = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction. CONCLUSION: The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system. LEVEL OF EVIDENCE: 4.
Surgery-Induced Stress Promotes SOX9 Nuclear Localization and Increases COL2A1 in Tracheal Cartilage.
Pong S, Liu L, Calyeca J … +3 more , Sher AC, Sussman S, Chiang T
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 42026755 · Publisher ↗
OBJECTIVE: Airway reconstruction triggers a surgery-induced stress (SIS) response, but its effect on cartilage regeneration remains elusive. SOX9 regulates cartilage regeneration by promoting type II collagen production...
OBJECTIVE: Airway reconstruction triggers a surgery-induced stress (SIS) response, but its effect on cartilage regeneration remains elusive. SOX9 regulates cartilage regeneration by promoting type II collagen production and may aid in repair; however, the role of SOX9 in response to SIS is unclear. We utilized a mouse model to validate SOX9 nuclear expression in tracheal chondrocytes and assess its localization after segmental tracheal replacement. METHODS: Tracheas from C57BL/6J mice were digested using Dispase-Collagenase-Trypsin, then collagenase II to isolate chondrocytes for primary culture. Syngeneic tracheal grafts were harvested from donor animals, and a 3 to 4 mm tracheal graft was implanted orthotopically to assess chondrocyte function in vivo. At 1 month, graft, anastomosis, and adjacent host tissues were harvested. Samples were stained for SOX9 and COL2A1, and their localization was analyzed with ImageJ. RESULTS: Primary tracheal chondrocytes showed strong nuclear SOX9 and cytoplasmic COL2A1 expression. One month after orthotopic tracheal replacement, SOX9 nuclear colocalization increased in the host and anastomosis regions ( = .0269 and = .0262, respectively), but not in the graft ( = .5958). COL2A1 intensity in the cartilage matrix was significantly higher in graft, host, and anastomosis compared to native cartilage (all < .01), with no morphological differences. CONCLUSION: After tracheal reconstruction, increased SOX9 and COL2A1 intensities indicate a potential chondrocyte response to SIS. SOX9 nuclear localization may be involved in regulating COL2A1 in tracheal chondrocytes during cartilage injury and repair. This supports a possible role for SOX9 in maintaining cartilage function and its potential as a therapeutic target to improve graft integration and airway stability.
Frailty and Steroid Treatment Outcomes in Patients with Sudden Sensorineural Hearing Loss.
Adwer LM, Higgins RC, Lyden ER … +1 more , Maxwell AK
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 42001299 · Publisher ↗
OBJECTIVE: To investigate the relationship between frailty and steroid treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Retrospective cohort studySetting:Tertiary-care institut...
OBJECTIVE: To investigate the relationship between frailty and steroid treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Retrospective cohort studySetting:Tertiary-care institution. PATIENTS: 185 adult patients (≥19 years) with unilateral SSNHL presenting January 1, 2017 to May 24, 2023, stratified by 5-Factor Modified Frailty Index (mFI5). INTERVENTIONS: Oral prednisone and/or intratympanic dexamethasone. MAIN OUTCOME MEASURES: Post-treatment changes in pure-tone average (PTA), speech reception threshold (SRT), and word recognition scores (WRS). RESULTS: Female and younger patients were significantly less frail than male and older patients ( = .004, < .001 respectively). Patients with higher frailty scores (≥2) were less likely to receive oral steroids (59.6% vs 82.8%, = .004), though equally likely to receive intratympanic steroids ( = 1.000). However, patients classified as frail (≥1) were not more likely to receive intratympanic steroids alone compared to combination therapy ( = .220). Higher frailty scores were significantly associated with metabolic syndrome ( = .002), but specific treatment patterns in diabetic patients could not be delineated as treatment was individualized. Dizziness ( = .650) and vertigo ( = .200) did not correlate with frailty or treatment outcomes. The number of comorbidities increased with higher frailty scores ( < .001) but did not directly correlate with SSNHL outcomes. No significant differences were observed in audiometric outcomes (PTA/SRT/WRS) based on patient frailty scores across all comparisons ('s > .05). CONCLUSIONS: While we found an association between frailty scores and treatment selection for SSNHL, we did not find a significant association between frailty scores and treatment outcomes. Therefore, treatment may be individualized in frail patients without compromising audiometric outcomes.
Recurrent Acute Tonsillitis: Re-evaluating Surgical Indications Through Long-Term Outcome Assessment.
Houborg HI, Klug TE
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41986245 · Publisher ↗
OBJECTIVES: To investigate whether current tonsillectomy (TE) guidelines for adults with recurrent acute tonsillitis (RT) are too restrictive, potentially excluding patients who would benefit from surgery, and to explore...
OBJECTIVES: To investigate whether current tonsillectomy (TE) guidelines for adults with recurrent acute tonsillitis (RT) are too restrictive, potentially excluding patients who would benefit from surgery, and to explore predictive factors of improved postoperative Throat-Related Quality of Life (TR-QoL). METHODS: In this prospective cohort study, patients undergoing TE were stratified into 3 groups based on increasingly stringent criteria: G1 (not meeting the Danish National Guidelines (DNG) or the Scottish Intercollegiate Guidelines Network [SIGN]/Paradise criteria), G2 (meeting only DNG), and G3 (meeting both DNG and SIGN/Paradise criteria). The effects of TE were assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) and the Glasgow Benefit Inventory (GBI). TOI-14 scores, GBI scores, patient satisfaction and postoperative sore throat episodes were evaluated after 12, 24 and 36 months. Predictive factors of improved TR-QOL were identified using multiple linear regression. RESULTS: At baseline, 65 patients (G1: n = 21, G2: n = 33, G3: n = 11) were analyzed. Response rates ranged from 65% to 86% at follow-ups. All groups demonstrated significant, sustained improvements in TOI-14 and GBI scores. TOI-14 total scores improved from 45.0 at baseline to 8.1-10.2 at follow-ups, GBI total scores ranged from 34.9-40.1, satisfaction rates were high (96%-98%), and sore throat episodes were infrequent postoperatively. Group differences were minimal. The preoperative TOI-14 score was the strongest predictor of improved TR-QOL (adjusted = 0.723). CONCLUSIONS: TE provided sustained benefits and significantly improved TR-QoL across a broad range of RT patients, including those who did not meet current guideline criteria, suggesting that guidelines may be too restrictive. The preoperative TOI-14 score was the strongest predictor of TR-QoL improvement. Integrating such a patient-centered tool to select patients for TE may enhance RT patient management.
A Novel 3D-Printed Simulator for Patient-Directed Home Drain Removal in Head and Neck Surgery.
Kannan V, Freeman T, Marquardt M … +3 more , Herster R, Vankoevering K, Seim N
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41968534 · Publisher ↗
OBJECTIVES: The purpose of this study was to develop and implement a novel 3D printed simulator to be used to educate patients about home drain removal prior to discharge and to highlight its benefits to the patient and...
OBJECTIVES: The purpose of this study was to develop and implement a novel 3D printed simulator to be used to educate patients about home drain removal prior to discharge and to highlight its benefits to the patient and healthcare systems. METHODS: A deidentified CT scan was used to create an anatomically accurate 3D printed mold of a neck. Additional conduits and inserts were added to the simulator during the silicone molding process. Simulators were produced and utilized on inpatient floors of a head and neck service at one comprehensive cancer center to assist with patient education for an existing home drain removal program. RESULTS/DISCUSSION: Three novel simulators were produced and used in the patient discharge training program for patient-directed home drain removal. 3D anatomic models have been shown to improve patient understanding and assist with acquisition of procedural skills, so the incorporation of a drain removal simulator into a home drain removal program sought to improve patient comfort with drain removal and expand the number of eligible patients for this program. Home drain removal is associated with reduced unnecessary clinic visits, lower healthcare costs, and optimized resource utilization. CONCLUSION: A 3D printed drain removal simulator has the potential to enhance patient education for home-based surgical neck drain removal and expand enrollment in self-directed drain removal. Greater enrollment in home drain removal has the potential to benefit patients and healthcare systems through improved time efficiency and financial savings.
Current Utilizations and Limitations of Augmented Reality in Otolaryngology-Head and Neck Surgery: A Scoping Review.
Tang A, Daniels KE, Adida S … +5 more , Kass N, Canton S, Biehl JT, Andrews E, Jabbour N
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41964140 · Publisher ↗
OBJECTIVE: Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physic...
OBJECTIVE: Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physical world, and mixed reality (MR), which builds upon AR with the inclusion of interactions between the digital display and the physical world. Previous reviews of AR and MR in OHNS have been limited in their scope and do not address underlying technological shortcomings. METHODS: A scoping review of relevant literature was conducted using PRISMA methodology. Electronic databases were screened using keywords including "augmented reality," "mixed reality," "ENT, "OHNS," and "otolaryngology." Editorials, reviews, meta-analyses, unpublished, and -only articles were all excluded. Studies were individually assessed for quality using technological usability heuristics. RESULTS: A total of 107 studies were reviewed with 46 studies meeting our inclusion criteria. Of the included studies, there were 4 (8.7%) studies on preoperative surgical planning, 37 (80.4%) on intraoperative surgical guidance, and 5 (10.9%) on surgical education. The majority of studies on AR or MR in OHNS were in subspecialty Otology/Neurotology with 19 studies, while 10 were in Rhinology, and 7 were in Head and Neck Surgery. The majority have been on intraoperative usage. However, almost all of these were preclinical studies (84.8%). Commonly cited challenges limiting the transition of intraoperative guidance from models to the OR include accuracy of registration and ease-of-use. CONCLUSION: Current studies in this field have focused on intraoperative guidance and were predominantly in the preclinical phase. The limitations in current AR/MR technology have prevented a greater level of evidence in studies and advancements in AR/MR implementation.
Factors Influencing Post-Operative Oral Intake Following Tonsillectomy in Children with OSA.
Nicolette M, Shapiro Y, Zhang K … +7 more , Diaz Garcia L, Kolia NR, Hunter K, Roth H, Rosen B, Balouch B, Solomon D
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41956547 · Publisher ↗
OBJECTIVE: To investigate the factors that influence oral intake in the first 24 hours following tonsillectomy in children performed for Obstructive Sleep Apnea (OSA) and their impact on dehydration in the 30-day post-op...
OBJECTIVE: To investigate the factors that influence oral intake in the first 24 hours following tonsillectomy in children performed for Obstructive Sleep Apnea (OSA) and their impact on dehydration in the 30-day post-operative period. METHODS: A retrospective cohort study was conducted reviewing the records of 1200 patients who underwent tonsillectomy. Patients were excluded if they were 19 years or older, did not have a diagnosis of SDB (sleep disordered breathing) or OSA (obstructive sleep apnea), or their oral intake was not recorded for 24 hours post-operatively. Primary outcomes were 24-hour post-operative oral intake controlled for body weight and post-operative dehydration determined by ED visits or phone calls for dehydration within 30 days post-operatively. RESULTS: 357 patients were included. Higher BMI (body mass index; = -.261) older age ( = -.393), longer operative time ( = -.125), longer time under anesthesia ( = -.186), higher apnea-hypopnea index (AHI; = -.171), higher pain scores ( = -.239), and the presence of a resident ( = .028) were all significantly associated with lower oral intake. Post-operative oral intake did not have a significant effect on post-operative dehydration events (OR = 0.995, 95% CI [0.975-1.015]). CONCLUSION: Our findings suggest that age, BMI, operative time, time under anesthesia, AHI, pain, and the presence of a resident were significantly associated with post-operative oral intake following tonsillectomy. Post-operative oral intake was not associated with dehydration in the 30-day surgical recovery period.
Functional Outcomes of Tympanoplasty Based on Graft Position: Medial Versus Lateral to the Malleus Handle.
Maqbool T, Showkat SA, Ali I … +2 more , Hamid WU, Andrabi D
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41956528 · Publisher ↗
OBJECTIVES: This study compared the functional and anatomical outcomes of medial versus lateral graft placement techniques in type I tympanoplasty, focusing on hearing improvement and residual perforation rates. Tympanop...
OBJECTIVES: This study compared the functional and anatomical outcomes of medial versus lateral graft placement techniques in type I tympanoplasty, focusing on hearing improvement and residual perforation rates. Tympanoplasty is a common surgical intervention for tympanic membrane (TM) perforations aimed at improving hearing and achieving tympanic closure. Debate continues regarding the optimal graft placement-medial or lateral to the handle of the malleus-for superior postoperative outcomes. METHODS: A retrospective comparative study was conducted on 48 patients aged 15 to 50 years with central TM perforations and preoperative air-bone gap (ABG) > 25 dB. Group 1 (n = 23) underwent medial graft placement, and Group 2 (n = 25) underwent lateral placement. ABG changes at 3 months post-surgery were assessed using audiometry. Statistical analysis included independent and paired t-tests, Fisher's Exact Test, 2-way ANOVAs, and Cohen's d for effect size estimation. Ethical approval was obtained from the Institutional Ethical Committee (ECR/467/Inst/AP/2013/RR-19). RESULTS: Both groups exhibited significant postoperative hearing improvement. Mean ABG gain was 21.6 dB in Group 1 and 20.1 dB in Group 2 ( = .567). No statistically significant difference was found in pre- or postoperative ABG values or residual perforation rates ( = 1.0). Effect sizes for all comparisons were negligible (Cohen's < 0.2). Demographics, including age and gender, showed no interaction effects on outcomes. CONCLUSION: Medial and lateral graft placements in tympanoplasty yield comparable functional and anatomical results. Given the negligible differences, graft positioning should be tailored to intraoperative findings and individual anatomical considerations. Larger, multicenter studies with varied graft materials and longer follow-up are warranted for definitive guidance.
A Novel Cost-Effective 3D-Printed Model for Flexible Nasolaryngoscopy Training Provides Trajectory Information and Distinguishes Early Learners From Experts.
Clements AC, Bindschadler M, Le H … +4 more , Friedman SD, Fernández-Penny F, Meyer TK, Sardesai MG
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41943270 · Publisher ↗
OBJECTIVES: Flexible fiberoptic nasolaryngoscopy is among the most common procedures performed by otolaryngologists worldwide. Despite this, there is no standard training method. High-fidelity approaches typically requir...
OBJECTIVES: Flexible fiberoptic nasolaryngoscopy is among the most common procedures performed by otolaryngologists worldwide. Despite this, there is no standard training method. High-fidelity approaches typically require trainees to learn on live patients and provide general qualitative information about the scope's path. However, trainees lack objective quantitative procedural feedback to optimize their technique, and patients may be subjected to pain and epistaxis. A trainer that provides a safe, reusable interface and quantitative report would transform this learning experience. METHODS: Our team developed a cost-effective 3D-printed task trainer for flexible fiberoptic nasolaryngoscopy and coupled this with a calibrated electromagnetic tracker to evaluate scope trajectory across users. Thirty-one subjects ranging from secondary school student to practicing otolaryngologist used the trainer. Participant confidence and perceived model realism were assessed with surveys. Scope trajectory was assessed using the electronic tracker. RESULTS: Mean score on the realism of endoscopic appearance was 7.5 on a 10-point visual analog scale. All subjects reported stable or increased confidence in flexible nasolaryngoscopy after using the model, with novices demonstrating the most significant change ( = .005). Trajectory data from the fine-wire tracker demonstrated that less experienced trainees paused and backtracked more than more experienced trainees ( = .004). CONCLUSIONS: This novel 3D-printed model offers a feasible task trainer for flexible nasolaryngoscopy and yields trajectory information that distinguishes between novices and experts. This model can provide an accessible training method that does not compromise patient experience, while simultaneously offering objective feedback to trainees as they grow their skills.
Association of Menopause and Hormone Replacement Therapy with Hearing Loss.
Hsu JZ, Gu K, Nguyen B … +1 more , Choi JS
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41943268 · Publisher ↗
OBJECTIVE: Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its ag...
OBJECTIVE: Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US. METHODS: Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss. RESULTS: After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: -1.02 to 2.86]). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: -4.60 dB, [95% CI: -8.42 to -0.79]) and longer reproductive lifespan was significantly associated with better hearing (β: -0.16 dB per year, [95% CI: -0.32 to -0.002]). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: -4.86 dB, [95% CI: -8.28 to -1.44]). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, [95% CI: -1.69 to 2.58]). CONCLUSION: While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships. LEVEL OF EVIDENCE: 2b.
Challenges with Neural Anomalies in Hypoglossal Nerve Stimulator Implantation.
Gulati J, Knops A, White S … +3 more , Ideker H, Huyett P, Huntley C
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41940468 · Publisher ↗
Hypoglossal nerve stimulation (HGNS) is an FDA-cleared therapy for obstructive sleep apnea (OSA) in patients who cannot or are unable to tolerate contentious positive airway pressure (CPAP) therapy. However, underlying n...
Hypoglossal nerve stimulation (HGNS) is an FDA-cleared therapy for obstructive sleep apnea (OSA) in patients who cannot or are unable to tolerate contentious positive airway pressure (CPAP) therapy. However, underlying neural anomalies may impair surgical efficacy and require intraoperative adaptability. We present 2 cases of HGNS in patients with preexisting neurologic conditions affecting nerve morphology. Case 1 involves a 66-year-old woman with OSA (REI 52.5) and neurofibromatosis (NF). Despite normal tongue motion and favorable drug-induced sleep endoscopy (DISE), intraoperative findings revealed diffuse enlargement of the hypoglossal nerve. The nerve exhibited weak and inconsistent stimulation responses, and the cuff could not be placed effectively. The procedure was aborted. Postoperative MRI confirmed diffuse left-sided hypoglossal nerve thickening consistent with a plexiform neurofibroma. Case 2 features a 64-year-old man with OSA (AHI 41.3) and chronic inflammatory demyelinating polyneuropathy (CIDP). Intraoperatively, the hypoglossal nerve was enlarged, firm, and lacked identifiable branches. Mixed stimulation patterns prevented functional cuff placement. A contralateral approach was pursued with successful implantation and device activation. These cases highlight challenges in HGNS when neural anomalies-such as those from NF or CIDP-alter nerve structure or function. Neurofibromas can diffusely infiltrate cranial nerves, complicating stimulation, while CIDP causes patchy demyelination and conduction variability. Preoperative imaging, including high-resolution T2-weighted MRI, is essential to assess nerve morphology and plan surgical approaches. Surgeons must be prepared for intraoperative variability, including the potential need for contralateral dissection. Anomalies of the hypoglossal nerve can compromise HGNS success. Preoperative identification of underlying neuropathies and adaptable intraoperative planning are critical for optimizing outcomes in complex patients.
Exploring the Predictive Value of National Residency Matching Program (NRMP) Rank in Residency Outcomes.
Kwon E, Pei M, Xu A … +3 more , Bahethi RR, Kalyoussef E, Hsueh WD
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41937745 · Publisher ↗
PURPOSE: To examine the relationship between the National Residency Matching Program (NRMP) rank list position and otolaryngology residency performance. METHODS: Five consecutive graduating classes at a single institutio...
PURPOSE: To examine the relationship between the National Residency Matching Program (NRMP) rank list position and otolaryngology residency performance. METHODS: Five consecutive graduating classes at a single institution's otolaryngology residency training program (2021-2025) were evaluated (n = 18) using their complete 5-year data. Correlation coefficients were calculated to assess the relationship between NRMP rank and in-service exam scores, research productivity, total case logs, milestone evaluations, selection as Administrative Chief Resident, receipt of teaching awards, and post residency position. Milestone evaluations were based on faculty ratings across all 7 core competencies on a 1- to 7-point scale, with an average score calculated for each resident. Spearman's rho was used to evaluate correlations between NRMP rank and both in-service scores and milestone evaluations. Chi-square tests were conducted to assess associations between NRMP rank and categorical outcomes, including selection as Administrative Chief Resident, receipt of the teaching award, and post residency position. RESULTS: The average NRMP rank of the residents was 8.778 (range: 1-26). There was a significant correlation between higher NRMP rank and higher milestone evaluations (ρ = -.544, = .020). However, no significant correlations between NRMP rank and in-service exam scores, research productivity, total case logs, selection as Administrative Chief Resident, receipt of the teaching award, or post residency position were found. CONCLUSION: Our results suggest that better-ranked residents receive higher milestone evaluation scores. However, NRMP rank alone may not reliably predict performance on in-service exam scores, chief resident selection, receipt of teaching awards, or position after residency training.
Adjunctive Serum Drops to Paper Patch for Tympanic Membrane Perforation.
Yazdani Y, Lee EJ, Tawk K … +2 more , Abouzari M, Djalilian HR
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41937679 · Full text
OBJECTIVE: To evaluate the effectiveness of autologous serum drops combined with paper patch myringoplasty in enhancing tympanic membrane (TM) perforation closure among patients with prior patch failure. METHODS: This re...
OBJECTIVE: To evaluate the effectiveness of autologous serum drops combined with paper patch myringoplasty in enhancing tympanic membrane (TM) perforation closure among patients with prior patch failure. METHODS: This retrospective chart review included 81 patients with chronic TM perforations unresponsive to initial paper patching. Patients were divided into 2 groups: the experimental group received autologous serum drops alongside secondary paper patching, while the control group received patching alone. The primary outcome was TM closure at 8 weeks. Kaplan-Meier survival analysis and Cox regression were used to evaluate time-to-closure and the effect of patient variables. RESULTS: Closure rates were significantly higher in the experimental group (54.5%) compared to the control group (21.6%; = .002). The addition of serum drops was associated with improved healing outcomes, even in cases unresponsive to initial patching. Perforation size and location influenced closure, with smaller and posterior TM perforations showing higher success. No significant associations were found between healing and age, sex, race, comorbidities, or perforation etiology. No adverse effects from serum drops were reported. CONCLUSION: Autologous serum drops significantly improve TM closure rates when added to paper patch myringoplasty, offering a safe, cost-effective, and non-surgical option for managing chronic perforations. Further studies with larger sample sizes and long-term follow-ups are warranted.
Efficacy of Topical Anesthesia Before Fine Needle Aspiration of Thyroid Nodule: A Randomized Clinical Trial.
Charoonwattanalaoha P, Marpukdee VR, Binsirawanich P … +1 more , Muenkaew Y
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41937677 · Publisher ↗
OBJECTIVE: This study aimed to assess the effectiveness of local anesthesia in reducing pain associated with fine needle aspiration (FNA) of thyroid nodules, examine the side effects of local anesthesia, and identify fac...
OBJECTIVE: This study aimed to assess the effectiveness of local anesthesia in reducing pain associated with fine needle aspiration (FNA) of thyroid nodules, examine the side effects of local anesthesia, and identify factors that influence pain during FNA of thyroid nodules. METHOD: We conducted a randomized clinical trial in the Department of Otolaryngology at Ramathibodi Hospital. Patients scheduled to undergo FNA of thyroid nodules were divided into four groups and subsequently administered four types of local anesthesia: Group A (Placebo cream), Group B (Cold placebo cream), Group C (Topical anesthetic cream), and Group D (Cold topical anesthetic cream). The primary outcome was the mean difference in pain levels (measured using a visual analog scale [VAS] and a numeric rating scale [NRS]) between the treatment and control groups. RESULTS: Initially, 72 participants were enrolled in this study, and data from 62 participants were analyzed. The VAS scores were measured at 0, 10, and 30 minutes post-procedure, with mean scores of 25.85 ± 4.65 (Group A), 21.26 ± 4.81 (Group B), 18.05 ± 4.51 (Group C), and 16 ± 4.97 (Group D). Although Group D showed the lowest pain scores, statistical analysis revealed no significant differences between groups (all > .05). CONCLUSION: Local anesthesia and cooling can decrease the level of pain. However, in this study, topical anesthetic did not significantly reduce pain compared to non-anesthetic treatments. LEVEL OF EVIDENCE: 2.
Control Status of Chronic Rhinosinusitis in Severe Asthma Patients Receiving Biologics: A Real-World Cross-Sectional Study.
Çolak S, Çelebi Sözener Z, Aydin Ö … +5 more , Çolak M, Bavbek S, Sin BA, Demirel YS, Mungan D
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41925107 · Publisher ↗
OBJECTIVE: This study aimed to determine the prevalence, subtypes, and control status of chronic rhinosinusitis (CRS) among patients with severe asthma receiving biologic therapy in a tertiary allergy clinic. METHODS: A...
OBJECTIVE: This study aimed to determine the prevalence, subtypes, and control status of chronic rhinosinusitis (CRS) among patients with severe asthma receiving biologic therapy in a tertiary allergy clinic. METHODS: A single-center, cross-sectional observational study was conducted in adult patients with severe asthma receiving biologics for at least 6 months. CRS diagnosis and control were assessed based on European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria. The Sinonasal Outcome Test-22 (SNOT-22) was also administered. Statistical analyses were performed using appropriate univariate and multivariate methods. RESULTS: Among 148 patients with severe asthma receiving biologic therapy, 97 (65.5%) were diagnosed with comorbid CRS. Of these, 68 (45.9%) had CRS with nasal polyps (CRSwNP) and 29 (19.5%) had CRS without nasal polyps (CRSsNP). A total of 54 patients (55.6%) were treated with omalizumab and 43 (44.3%) with mepolizumab. Overall, 32.9% of patients had controlled CRS, 36.0% were partly controlled, and 30.9% were uncontrolled. In multivariable ordinal regression analysis, the presence of N-ERD and higher BMI were associated with poorer CRS control, whereas early-onset asthma and prior maintenance systemic corticosteroid use were associated with better control, suggesting that these factors may be related to CRS control status in this population. CONCLUSIONS: CRS is highly prevalent among patients with severe asthma receiving biologics, and approximately one-third remain uncontrolled despite treatment. These findings emphasize the importance of regular upper airway assessment and may inform future strategies for optimizing biologic selection and treatment outcomes in this population.
Limitations of PET/CT in Detecting Cervical Lymph Node Metastases in Betel Nut Induced Oral Cancer.
Young K, Ghias AF, Fancher N … +7 more , Ahn HJ, Khalid T, Nunez A, Koshi EJ, Anderson KG, Marcelo KR, Wirtz ED
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41913574 · Publisher ↗
OBJECTIVE: Limited research has been done previously in examining the utility of PET/CT in the preoperative staging of betel nut associated OSCC (BNOSCC). This study was conducted to evaluate the relationship between the...
OBJECTIVE: Limited research has been done previously in examining the utility of PET/CT in the preoperative staging of betel nut associated OSCC (BNOSCC). This study was conducted to evaluate the relationship between the standardized uptake values (SUV) of lymph nodes via FDG-PET/CT and their corresponding pathological specimens in betel nut chewers. STUDY DESIGN: Retrospective review. SETTING: Single-institution academic center. METHODS: A retrospective review of patients with BNOSCC seen at the Tipler Army Medical Center (TAMC) Head and Neck Surgery clinic from October 2004 to October 2019 was conducted. Preoperative FDG-PET/CT images were analyzed for the SUVmax of regional lymph nodes, with a node positive for malignancy defined as >3. The extent of disease spread predicted by FDG-PET/CT was then compared to the postoperative histopathological results. RESULTS: Among patients with BNOSCC, FDG-PET/CT was found to significantly overpredict the extent of lymph node involvement identified on pathological analysis. Metabolic activity of lymph nodes was significantly overestimated on preoperative imaging. These findings highlight a clear discrepancy between the sensitivity and specificity of FDG-PET/CT found in BNOSCC and that in non-betel nut related disease. CONCLUSION: Elevated false-positive rates for LN positivity on FDG-PET/CT have been observed in BNOSCC patients. This finding could potentially lead to upstaging, and lead to excessive, more invasive treatment courses and interventions. This is a phenomenon that Head and Neck surgeons should be cautious about when working with BNOSCC patients. LEVEL OF EVIDENCE: 3.
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