The Annals Of Otology, Rhinology, And Laryngology[JOURNAL]
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200 papers
Risk Factors for the Initial Misdiagnosis of Spontaneous Cerebrospinal Fluid Rhinorrhea.
Liu MY, Lopez EM, Weitzel EK … +3 more , Lally J, Tantiwongkosi B, Chen PG
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41277111 · Full text
OBJECTIVE: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is commonly misdiagnosed due to overlapping symptomatology with other sinonasal diseases, thus leading to delay in diagnosis and increased risk of meningitis. T...
OBJECTIVE: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is commonly misdiagnosed due to overlapping symptomatology with other sinonasal diseases, thus leading to delay in diagnosis and increased risk of meningitis. The objective of this study was to examine the risk factors for the initial misdiagnosis of spontaneous CSF rhinorrhea. METHODS: A single-institutional retrospective chart review of patients with spontaneous CSF rhinorrhea was performed. Patient characteristics, initial diagnosing provider specialty, and accuracy of radiology reports were compared between subjects initially diagnosed correctly versus those that were not. RESULTS: Fifty-seven patients with spontaneous CSF rhinorrhea were included with 61% being initially misdiagnosed with rhinitis, sinusitis, or migraines. Being initially seen by a non-otolaryngology provider was significantly associated with being misdiagnosed (misdiagnosis rate 83%, < .001, Cramer's = 0.49). Otolaryngologists had a misdiagnosis rate of 36%. Only 32% of radiology reports correctly identified the skull base defect prior to a positive beta-2 transferrin. However, once the diagnosis of a CSF leak was established, subsequent reads by radiologists were more likely to identify the skull base defect ( < .001). Multivariable logistic regression revealed that initial visit to a non-otolaryngology provider increased the odds of misdiagnosis after adjusting for relevant confounders ( = .035). CONCLUSIONS: Spontaneous CSF rhinorrhea is commonly initially misdiagnosed by both non-otolaryngology and otolaryngology providers. Moreover, the skull base defect on radiographic imaging is frequently missed by radiologists when the official diagnosis is not established. Further education for all providers on the proper differential diagnosis of sinonasal symptomatology is warranted to expedite the diagnosis of spontaneous CSF rhinorrhea.
Comparing Transoral Robotic Surgery and Hypoglossal Nerve Stimulation Using Mean Disease Alleviation in OSA.
Mandloi S, DeKloe J, Kaki P … +5 more , Shah R, Estephan LE, Naimi B, Boon MS, Huntley CT
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41235609 · Publisher ↗
BACKGROUND: The majority of the current literature assessing OSA utilizes change in AHI as the outcome measure. Clinical effectiveness of therapy is influenced by treatment adherence. Mean disease alleviation (MDA) was d...
BACKGROUND: The majority of the current literature assessing OSA utilizes change in AHI as the outcome measure. Clinical effectiveness of therapy is influenced by treatment adherence. Mean disease alleviation (MDA) was designed to determine the effectiveness of treatment as a function of both treatment efficacy and adherence. Our study compares outcomes in OSA patients treated with transoral robotic surgery (TORS) with lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) using MDA. METHODS: A retrospective study of CPAP-intolerant OSA patients that underwent HGNS or TORS from 2015 to 2022 was conducted. Comparisons of MDA and treatment efficacy were performed using a Wilcoxon sum rank tests after 3:1 matching for race, age, sex, body mass index, and baseline AHI. Statistical significance was defined as < .05. RESULTS: One hundred fifty-nine patients (127 HGNS and 32 TORS) were included. Mean AHI decreased postoperatively in both TORS and HGNS patients ( < .001). There was no difference in AHI reduction between TORS and HGNS patients (22.95 ± 21.99 vs 23.27 ± 15.28; = .50). This relationship persisted when examining MDA between TORS and HGNS patients (41.56 ± 58.24 vs 51.46 ± 29.05; = .40). CONCLUSION: Mean disease alleviation is a useful metric combining both adherence and efficacy to determine the effectiveness of OSA treatments expanding beyond AHI. Our data suggests that the clinical effectiveness of TORS and HGNS is comparable, and both are promising treatment options for well-selected OSA patient's refractory to CPAP.
Early Outcomes of Cochlear Implantation for Pediatric COVID-19 Related Single Sided Deafness: Case Series and Literature Review.
Arya P, Brooks KA, Cross A … +2 more , Alfonso KP, Govil N
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41235593 · Publisher ↗
OBJECTIVE: Sudden sensorineural hearing loss (SSNHL) is a rare manifestation of COVID-19. Cochlear implantation (CI) has been reported for definitive management of COVID-19 related single sided deafness (SSD) in adults....
OBJECTIVE: Sudden sensorineural hearing loss (SSNHL) is a rare manifestation of COVID-19. Cochlear implantation (CI) has been reported for definitive management of COVID-19 related single sided deafness (SSD) in adults. We present the first cases of pediatric CI for presumed COVID-19 related SSD. METHODS: Patients under 18 years were included who underwent CI following SSNHL after COVID-19 infection via retrospective review. Literature review was performed on PubMed for "cochlear implant" and "COVID" and "deafness or hearing loss." RESULTS: A 13-year-old boy (patient A) and 6-year-old girl (patient B) met inclusion criteria; both patients underwent round window insertion of a perimodiolar electrode. For patient A, audiogram showed SNHL in the left ear; pre-operative word recognition score (WRS) and speech awareness threshold (SAT) were 20% at 100 dB HL and 90 dB HL, respectively. The patient underwent CI 9 months post-infection; SAT for patient A improved to 25 dB HL at 2.5 months after surgery. Patient B's pre-operative WRS and SAT in the affected ear were 0% at 100 dB HL and non-responsive, respectively. She underwent right CI 10 months post-infection; her SAT improved post-operatively to 20 dB HL at 2 post-operative months. Neither patient suffered from intra- or post-operative complication. Both patients and their caregivers reported subjective benefit from CI. CONCLUSION: Single-sided deafness is a rare neurological complication from COVID-19. CI is a valuable tool for restoring hearing localization and awareness in this scenario. Early success with these cases demonstrates technical feasibility and benefit with this management of pediatric COVID-19 related SSD.
Comorbidities and Airway Prosthesis Dependence in Bilateral Vocal Fold Immobility.
McKenzie C, Mandybur I, Walker K … +3 more , Zhou A, Howell R, Friedman AD
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41216792 · Publisher ↗
OBJECTIVES: Bilateral vocal fold immobility (BVFI) results from posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP). In the context of prolonged intubation, PGS often presents with additional airway...
OBJECTIVES: Bilateral vocal fold immobility (BVFI) results from posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP). In the context of prolonged intubation, PGS often presents with additional airway stenosis (PGS). There is a paucity of literature comparing isolated PGS (iPGS), PGS, and isolated BVFP (iBVFP). The objective of this study is to analyze demographics, airway prosthesis (AP) dependence, and risk factors for failed decannulation within these cohorts. METHODS: Retrospective case series of patients with BVFI managed at a tertiary academic institution between 2011 and 2021. Univariate analysis determined factors associated with decannulation rates and AP dependence at last contact. RESULTS: 118 patients were identified: 39 iPGS, 54 PGS, 25 iBVFP. PGS patients were younger than iPGS or iBVFP ( = .009). iPGS, PGS, and iBVFP were less common in men than women ( = 0.838). The mean number of airway operations per year was higher in PGS versus iPGS or iBVFP patients ( = .001). Decannulation rate was similar in iPGS, PGS+, and iBVFP ( = 0.739). The AP dependence rate was 39% in the PGS cohort and 26% and 24% in patients with isolated glottic pathology (iPGS, iBVFP respectively, = 0.105). Active smoking was associated with a higher rate of AP dependence in the iPGS group only ( = .020). PGS and a history of head and neck radiation both had higher observed rates of AP dependence without achieving statistical significance ( = .092, = .073). CONCLUSIONS: 58% of PGS patients had additional stenosis beyond the glottis. These patients were younger and received more airway surgeries than iPGS or iBVFP patients, however there was no statistically significant difference in AP dependence or decannulation rate between the groups. Independent analysis of iPGS and PGS elucidates the relative complexity of treating PGS patients with additional airway stenosis.
Managing a Complex Foreign Body: A Case Report of a Fork in the Upper Esophagus.
Canick J, Connors J, April M
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41216789 · Publisher ↗
INTRODUCTION: Foreign bodies in the aerodigestive tract pose a clinical challenge that must be addressed both swiftly and judiciously. Characteristics specific to both individual patients and to individual types of forei...
INTRODUCTION: Foreign bodies in the aerodigestive tract pose a clinical challenge that must be addressed both swiftly and judiciously. Characteristics specific to both individual patients and to individual types of foreign bodies must be taken into consideration when planning for foreign body removal. OBJECTIVE: To discuss a scenario in which multidisciplinary decision-making was employed to remove a foreign body both quickly and safely. CASE SUMMARY: We present a case of an adolescent girl who presented with throat pain and inability to manage her secretions after unintentionally swallowing a fork, which became lodged in her proximal esophagus. The position of the tines of the fork made intubation impossible. The fork was removed using direct laryngoscopy while the patient maintained spontaneous respirations. DISCUSSION: Complex decision-making, involving clinicians with expertise in various specialties, is often necessary to ensure a safe outcome. Careful planning and consideration of various details, specific to both foreign body characteristics and to patients themselves, are necessary to provide safe and efficient care for patients with foreign body ingestion.
Otitis Media and Ventilation Tube Insertion and Quality of Life in a Rural Population in Denmark: Data From the LOFUS Cohort.
Søborg T, Kørvel-Hanquist A, Homøe P
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41204876 · Publisher ↗
BACKGROUND: Otitis media (OM) is among the most common infections in childhood. Approximately 60% of all children will experience 1 or more episodes of OM before the age of 7 years, and 26% of children in Denmark are tre...
BACKGROUND: Otitis media (OM) is among the most common infections in childhood. Approximately 60% of all children will experience 1 or more episodes of OM before the age of 7 years, and 26% of children in Denmark are treated with ventilation tube insertion (VTI) before the age of 7 years. Previous studies investigating the effects of VTI on quality of life (QoL) for children and caregivers from urban areas have yielded conflicting results. Here, we investigate how OM and VTI affect the QoL in children and their families in a rural area of Denmark. METHODS: We have performed a cross-sectional population-based questionnaire survey in the LOFUS cohort where caregivers of 1169 children aged 2 to 10 years, answered questions on how OM affects the child's and their family's general QoL. We used Visual Analog Scales from 0 (no effect) to 10 (worst possible effect) to score the impact on QoL. RESULTS: In total, 480 children (43%) reported no episodes of OM, 385 (35%) experienced 1 to 3 episodes, and 247 (22%) experienced more than 3 episodes. Twenty-six percent of the total childhood cohort and 47% of children who reported OM had had VTI procedure performed. We found an odds ratio (OR) of 1.54 (0.36-10.62) and 2.66 (0.62-18.41) for poorer QoL in the affected child and an OR of 1.13 (0.26-7.91) and 1.91 (0.43-13.34) for poorer QoL in the family, for 1 to 3 and >3 episodes, respectively. VTI yielded an OR of 2.13 (95% CI = 1.48-3.08, < .001) and 2.27 (95% CI = 1.54-3.37, < .001) for poorer QoL on children's and family's QoL, respectively. CONCLUSION: Our study shows a high frequency of reported OM and a high frequency of VTI procedures performed in a rural population in Denmark. Furthermore, the study shows an association between VTI and poorer QoL in the children and in their families.
Outcomes of Open Osteophytectomy in Dysphagia Related to Cervical Osteophytes: A Systematic Review.
Malhotra R, Khan H, Celidonio J … +3 more , Kumar K, Suresh R, Yan K
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41204874 · Publisher ↗
OBJECTIVE: This study investigates the efficacy of open osteophytectomy in patients with dysphagia associated with cervical osteophytes, stratified by C-spine level and presence of diffuse idiopathic skeletal hyperostosi...
OBJECTIVE: This study investigates the efficacy of open osteophytectomy in patients with dysphagia associated with cervical osteophytes, stratified by C-spine level and presence of diffuse idiopathic skeletal hyperostosis (DISH). DATA SOURCES: PubMed and ScienceDirect. REVIEW METHODS: We conducted a systematic review of published literature pertaining to osteophyte-related dysphagia. Patients with objective measurements of dysphagia severity who underwent an open surgical approach for osteophytectomy were included. Demographics, symptomatology, and patient outcomes were analyzed. RESULTS: A total of 44 articles with 214 cases (mean age = 67, 85% male) were included. Outcomes after osteophytectomy were analyzed in DISH vs non-DISH groups, as well as stratified by demographics and cervical levels affected. Patients with osteophytes at or above C4 were more likely to demonstrate pre-operative aspiration ( = .018). Short- and long-term outcomes among patients with DISH and non-DISH osteophytes were similar ( = .269 and .476). Outcomes among patients with osteophytes at or above C4, at or below C4, and diffuse presentations were also similar. Among all cases, 84% of patients experienced significant short-term initial improvement in their dysphagia. At long-term follow-up, 82% of patients had continued significant improvement in their dysphagia outcome. CONCLUSION: Open surgical approaches for osteophytectomy demonstrate good short- and long-term efficacy. Patients with osteophytes at or above C4 were more likely to aspirate pre-operatively, but osteophyte level, age, sex, and presence of DISH did not impact likelihood of operative success.
Evaluation of Electrophysiological and Histopathological Effects of Hydroxyapatite and Glass Ionomer Bone Cement on Facial Nerve: An Animal Study.
Yazir M, Imre A, Oncel S … +5 more , Tanyeri Toker G, Sarıkcıoglu L, Kurus M, Cakalagaoglu F, Erbas O
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41190485 · Publisher ↗
OBJECTIVE: To investigate whether otologic bone cements-hydroxyapatite (HAC) and glass ionomer cement (GIC)-cause facial nerve damage by evaluating their electrophysiological and histopathological effects in a rat model....
OBJECTIVE: To investigate whether otologic bone cements-hydroxyapatite (HAC) and glass ionomer cement (GIC)-cause facial nerve damage by evaluating their electrophysiological and histopathological effects in a rat model. MATERIALS AND METHODS: All rats, except those in the control group, underwent surgical exposure of the facial nerve. Bone cement was applied in the intervention groups. Rats were randomly assigned to 6 groups (n = 10 each): (1) control; (2) sham; (3) HAC; (4) HAC with soft tissue graft; (5) GIC; and (6) GIC with soft tissue graft. In Groups 3 and 5, bone cement was applied directly onto the facial nerve trunk near the stylomastoid foramen. In Groups 4 and 6, the nerve trunk was first covered with a soft tissue graft to prevent direct contact. Facial nerve function was assessed using evoked electromyography (EMG) and video-based whisker movement analysis. Tissue samples from the facial nerve and surrounding structures were collected for histopathological evaluation. RESULTS: The HAC and GIC groups showed significant histopathological changes compared to the control group in all parameters assessed-including foreign body reaction, granulation tissue, perineurium thinning, disorganized nerve fiber structure, axon-myelin swelling, and Schwann cell nuclear enlargement-except for necrosis. However, there were no statistically significant differences among groups in terms of EMG or whisker movement outcomes. CONCLUSION: This study underscores the need for caution when using bone cement near neural structures. Although HAC and GIC did not impair facial nerve function, their histopathological effects highlight the importance of avoiding direct neural contact. Future research should explore improved surgical techniques and neurotoxin-sparing alternatives.
The Effects of Sutured Scroll Reconstruction Versus Sutureless Scroll Reconstruction in Rhinoplasty on Aesthetic and Functional Outcomes: A Randomized Controlled Trial.
Goljanian Tabrizi A, Ghazizadeh M, Hooshmandnia S … +2 more , Faghih Habibi A, Aghsaghloo V
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41190484 · Publisher ↗
OBJECTIVES: With the growing popularity of rhinoplasty, techniques for enhancing functional and aesthetic outcomes are evolving. This study aims to compare 2 methods in rhinoplasty-sutured scroll reconstruction versus no...
OBJECTIVES: With the growing popularity of rhinoplasty, techniques for enhancing functional and aesthetic outcomes are evolving. This study aims to compare 2 methods in rhinoplasty-sutured scroll reconstruction versus no scroll repair-focusing on their effects on nasal breathing, aesthetic results, and patient satisfaction. METHODS: This randomized controlled study at Taleghani Hospital in Tehran involved female patients aged 18 to 50 years undergoing primary rhinoplasties. Participants were assigned to 2 groups, and only 1 received sutured horizontal scroll ligament repair. Outcomes were assessed using the FACE-Q rhinoplasty module for patient satisfaction and rhinomanometry for nasal function, with independent surgeons evaluating aesthetic results via a Visual Analog Scale. For statistical analyses SPSS version 22.0 was used, with significance set at < .05. RESULTS: The study involved 164 female patients, with 82 in the sutured scroll ligament group and 82 in the no scroll repair group. The mean age was 26.32 ± 6.86 years (range = 19-46). No significant baseline differences were found. After a mean follow-up of 11.6 months, no patients required revision surgery. Post-operative FACE-Q scores and VAS ratings were higher in the sutured group. The mean postoperative peak inspiratory nasal flow (PNIF) was 116.42 ± 13.78 ml/minute in the sutured group versus 111.08 ± 15.67 ml/minute in the other group ( = .034). CONCLUSION: This randomized clinical trial emphasizes on the positive effect of ensuring the scroll ligament repair using sutures on the facial aesthetics, quality of life, and functional capacity of patient after the surgery. Which is consistent with the prior studies indicating both cosmetic and functional benefits for scroll preservation/reconstruction.
Third Window Phenomenon in Advanced Otosclerosis: The Critical Role of Preoperative CT Imaging.
Hwang J, Shimunov D, Isildak H
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41190479 · Publisher ↗
OBJECTIVE: To describe a case of advanced otosclerosis complicated by third window phenomenon and emphasize the importance of preoperative CT imaging in advanced or revision otosclerosis, not only for assessing ossicular...
OBJECTIVE: To describe a case of advanced otosclerosis complicated by third window phenomenon and emphasize the importance of preoperative CT imaging in advanced or revision otosclerosis, not only for assessing ossicular status and superior semicircular canal dehiscence (SSCD) but also for detecting abnormal otic capsule demineralization that may contribute to third window pathology. PATIENTS: A 52-year-old male with bilateral otosclerosis, mixed hearing loss, and multiple prior ear surgeries, including a right-sided bone-anchored hearing aid (BAHA), presented for revision surgery. INTERVENTION(S): The patient underwent right-sided BAHA abutment removal with ossicular reconstruction using a Lippy bucket-handle prosthesis and left-sided revision stapedotomy with a new prosthesis and cartilage graft. MAIN OUTCOME MEASURE(S): Postoperative hearing outcomes were assessed via audiograms, with CT imaging used to evaluate persistent hearing loss in the left ear. RESULTS: Right ear revision surgery improved hearing by 50 dB at 250 to 500 Hz, closing air-bone gaps. Left ear surgery resulted in a 10-dB worsening in the 3 to 6 kHz range. CT imaging revealed fenestral and retrofenestral otospongiosis with cochlear-perilymphatic continuity, indicating a third window phenomenon contributing to persistent hearing loss. CONCLUSIONS: In cases of persistent conductive hearing loss, third window phenomenon due to otospongiosis should be considered despite proper prosthesis placement and absence of SSCD or perilymph fistula.
Inferior Turbinate Reduction Using Bipolar Cautery: Technique and Outcomes in Pediatric Patients.
Ali AH, Riley C, Digoy GP
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41190463 · Publisher ↗
OBJECTIVES: To evaluate extended outcomes up to 6 years following bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort. METHODS: Retrospective case series of 326 children (mean age 9.0 ± 4.1 yea...
OBJECTIVES: To evaluate extended outcomes up to 6 years following bipolar-cautery inferior turbinate reduction (ITR) in a large pediatric cohort. METHODS: Retrospective case series of 326 children (mean age 9.0 ± 4.1 years) who underwent 12-W bipolar-cautery ITR between December 2017 and May 2024 at a single-surgeon tertiary practice. Concurrent procedures were performed in 82% of patients; 59 underwent ITR alone. Parent-reported nasal breathing improvement was assessed at regular intervals up to 6 years. Statistical analyses included Cochran's Q tests and generalized estimating equations (GEE). RESULTS: In the full cohort, nasal breathing improvement rates were: 95.4% at 3 months, 91.7% at 6 months, 90.2% at 1 year, 88.1% at 2 years, and 78.7% at 3 years. Sample sizes decreased beyond 3 years due to follow-up attrition. Cochran's Q test showed significant changes over time through 3 years (Q = 60.101, < .001). The ITR-only subgroup showed more marked decline: 98% improvement at 3 months to 69.0% at 3 years ( = .002), compared to more stable rates with concurrent surgery. GEE analysis confirmed significant time effects ( < .001). Compared to ITR alone, concurrent septoplasty (OR 0.39, = .002) and sinus surgery (OR 0.34, = .020) were each associated with significantly lower odds of reporting persistent symptoms (i.e., a greater likelihood of improvement). Complications remained low: minor bleeding (4.6%), major bleeding requiring intervention (1.2%), MRSA infection (0.3%), and synechiae (1.5%). CONCLUSIONS: Bipolar-cautery ITR provides safe, effective symptom improvement with excellent short-term results (>90% at 1 year). However, efficacy declines over time, particularly in ITR-only patients (78.7% overall at 3 years). Concurrent airway procedures may provide more stable outcomes. These findings emphasize the need for long-term follow-up and appropriate patient selection.
Pediatric Benign Nasal Triton Tumor: Its Diagnosis and Treatment.
Berlucchi M, Comincini I, Redaelli de Zinis LO … +2 more , Ghini I, Bondioni MP
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41190458 · Publisher ↗
BACKGROUND: Benign triton tumor (BTT) is a rare, benign peripheral nerve tumor typically affecting young children. While most found in the brachial plexus or sciatic nerve, BTT can occur in other various locations, inclu...
BACKGROUND: Benign triton tumor (BTT) is a rare, benign peripheral nerve tumor typically affecting young children. While most found in the brachial plexus or sciatic nerve, BTT can occur in other various locations, including cranial nerves. METHODS: Case report and review of literature.Results/Case:This report describes an infant who showed a swelling localized at nasal pyramid. Patient underwent ultrasound and magnetic resonance imaging. Following, a surgical treatment was performed and histological examination supported the diagnosis of a BTT (neuromuscular choristoma). CONCLUSIONS: BTT is a very rare tumor at the head and neck area in pediatric age. Given the unusual presentation and rarity of this tumor, this case highlights the importance of considering BTT in the diagnosis of pediatric nasal masses. Imaging of this lesion is fundamental to plan the surgical therapy. To date, present patient is the first case in which this neoplasm is localized to the nasal pyramid.
Beyond the Maxillary Sinus: A Proposed Classification of Chronic Sinus Atelectasis.
Puri A, Straughan AJ, Klingele CK … +1 more , Godse NR
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41190455 · Publisher ↗
BACKGROUND: Chronic maxillary atelectasis (CMA) describes the loss of maxillary sinus volume and has been well-described in the literature under many different names, creating inconsistency in reporting. A recent proposa...
BACKGROUND: Chronic maxillary atelectasis (CMA) describes the loss of maxillary sinus volume and has been well-described in the literature under many different names, creating inconsistency in reporting. A recent proposal has standardized the nomenclature but does not include disease of other paranasal sinuses. OBJECTIVE: We describe a unique case of chronic ethmoid atelectasis, briefly review literature associated with CMA, and propose an expanded classification of chronic sinus atelectasis. RESULTS: A 70-year-old man presented to the emergency department with transient vision loss and was incidentally found to have sinus opacification on MRI. At his otolaryngology follow-up, he did not have any signs of sinonasal symptoms, hypoglobus, or enophthalmos. CT confirmed sinus opacification which was correlated with lateralized left middle turbinate and uncinate process. The patient underwent functional endoscopic sinus surgery to correct the anatomical changes. CONCLUSIONS: The spectrum of atelectasis affecting the ethmoids mirrors what has been described for CMA, potentially indicating a similar disease process affecting different areas. If this falls along the same spectrum of disease, the grading system applied to CMA may be applied to other paranasal sinuses.
Impact of Graft Material and Surgical Technique on Frequency-specific Audiometric Outcomes Following Tympanoplasty.
Hallak D, Macielak RJ, Zhang L … +4 more , Cueva RA, Dodson EE, Adunka OF, Ren Y
Ann Otol Rhinol Laryngol · 2026 Apr · PMID 41190452 · Publisher ↗
OBJECTIVE: Investigate frequency-specific audiometric outcomes following tympanoplasty without ossiculoplasty using different grafting materials and techniques. METHODS: A multi-institutional review of patients who under...
OBJECTIVE: Investigate frequency-specific audiometric outcomes following tympanoplasty without ossiculoplasty using different grafting materials and techniques. METHODS: A multi-institutional review of patients who underwent tympanoplasty via either medial or lateral graft techniques from May 2017 to August 2022 was performed. Frequency-specific audiometric outcomes were analyzed using multivariable logistic regression. RESULTS: A total of 88 patients (93 ears) met criteria (mean age 46 years). Median follow-up was 6.7 ± 6.1 months. Perforation closure was achieved in 87% cases and did not vary between graft materials. Loose areolar fascia (LAF) was used in 32% of tympanoplasties (N = 30) and temporalis fascia (TF) in 48% cases (N = 45). Compared to TF, LAF was associated with better low-frequency (500 and 1 kHz) pure-tone average (PTA) improvement (12.4 dB vs 1.6 dB, < .001) and air-bone gap (ABG) closure (11.4 dB vs 1.6 dB, = .003). PTA improvement and ABG closure were superior in medial technique cases compared to lateral technique ( < .001for both). When considering only medial underlay technique, ABG closure were comparable for both grafting materials (9.5 dB in LAF vs 10.5 dB in TF, = .7). Multivariable logistic regression accounting for graft material, identified surgical technique as a significant predictor of postoperative audiometric outcomes. CONCLUSION: Loose areolar fascia may be associated with better low-frequency hearing than TF following tympanoplasty. However, when using only medial underlay technique, both materials offered similar improvements, suggesting surgical technique may be more crucial than the choice of grafting material.
Long-Term Risk of Revision Surgery Following Balloon Sinuplasty Versus Endoscopic Sinus Surgery.
Parikh MJ, Franco A, Hur K
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41190449 · Publisher ↗
OBJECTIVE: We aimed to compare revision surgery risk and postoperative healthcare utilization between patients with chronic rhinosinusitis (CRS) who undergo balloon sinuplasty (BSP) versus endoscopic sinus surgery (ESS)....
OBJECTIVE: We aimed to compare revision surgery risk and postoperative healthcare utilization between patients with chronic rhinosinusitis (CRS) who undergo balloon sinuplasty (BSP) versus endoscopic sinus surgery (ESS). METHODS: Using the TriNetX US database, patients 18 years or older with CRS were retrospectively followed for five years, excluding those with a history of cystic fibrosis or sinonasal malignancy. The cohort was stratified into patients who underwent BSP versus ESS, and subsequently propensity score matched by age, sex, race, ethnicity, history of asthma, allergic rhinitis, nicotine dependence, and nasal polyposis. The primary outcome was revision ESS or BSP. Secondary outcomes included postoperative oral antibiotic and steroid utilization. RESULTS: Of the 4,632 patients included, 26.0% had nasal polyps. Within five years of initial surgery, 215 (9.70%) BSP patients underwent either revision BSP or ESS compared to 160 (7.22%) patients with initial ESS (p=0.0004). Initial BSP was associated with a greater risk of undergoing revision BSP at one year [OR 2.70; 95%CI (1.49,4.90)], three years [OR 2.41; 95%CI (1.49,3.90)], and five years [OR 3.02; 95%CI (1.87,4.86)] postoperatively. Notably, after one year of initial surgery, there was no difference in postoperative antibiotic or steroid utilization between patients who underwent ESS or BSP. DISCUSSION: Patients with CRS who undergo BSP are at a greater five-year-risk for revision ESS or BSP, as compared to patients who undergo ESS. However, long-term postoperative healthcare utilization does not vary significantly between patients who undergo either procedure.
Preliminary Analysis to Quantify Sinonasal Airspace Changes in Chronic Rhinosinusitis.
Hodges KZ, Wright J, Kim MH … +1 more , Frank-Ito DO
Ann Otol Rhinol Laryngol · 2026 Mar · PMID 41189317 · Publisher ↗
PURPOSE: Chronic rhinosinusitis (CRS), marked by nasal mucosal inflammation, is a common condition often assessed via computed tomography (CT). However, the extent of airway opacification due to CRS-related inflammation...
PURPOSE: Chronic rhinosinusitis (CRS), marked by nasal mucosal inflammation, is a common condition often assessed via computed tomography (CT). However, the extent of airway opacification due to CRS-related inflammation remains incompletely quantified relative to healthy sinonasal anatomy. This preliminary study aims to quantify nasal and paranasal sinus volumes in CRS subjects, offering insights into the impact of inflammation on sinonasal airspace volumes. METHODS: Anatomically accurate 3-dimensional sinonasal airspaces were reconstructed from CT images of 9 adult subjects with varying disease severity of CRS sans polyposis and 10 adult subjects with healthy normal sinonasal anatomy. Volumetric quantification of the sinonasal airspace volumes between subject groups were performed for comparison. RESULTS: Across all subjects, nasal cavity volume was 23% larger in the Normal group; although not statistically significant ( = .14), the effect size ( = -.28) indicated a small volumetric advantage. Similarly, maxillary and frontal sinuses were 12% and 61% larger in the Normal group, respectively, with effect sizes (maxillary: = -.16; frontal: = -.23) supporting this trend despite non-significant -values (maxillary: = .42; frontal: = .24). Notably, female subjects with CRS exhibited significantly reduced maxillary and frontal sinus airspace volumes. CONCLUSION: As a result of inflammation, preliminary findings suggest that patients with CRS exhibit notably reduced airspace volumes compared to those considered "normal." Additionally, differences in airspace volumes between sexes, as supported by existing literature, were also noted.
Multiple Drug-Induced Sleep Endoscopy in Pediatric Obstructive Sleep Apnea: Obstruction Patterns and Outcomes.
Habib DRS, Arida-Moody L, Patro A … +6 more , Wu J, Davis S, Zhao S, Patel K, Wootten CT, Whigham AS
Ann Otol Rhinol Laryngol · 2026 Feb · PMID 41126721 · Full text
OBJECTIVES: Residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT) is common in children with obesity. Drug-induced sleep endoscopy (DISE) identifies upper airway obstruction and guides surgery. A gap r...
OBJECTIVES: Residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT) is common in children with obesity. Drug-induced sleep endoscopy (DISE) identifies upper airway obstruction and guides surgery. A gap remains in evaluating multiple DISE-directed treatments. This study evaluates multiple DISE-directed procedure outcomes, obstruction patterns, and BMI in pediatric patients. METHODS: This single-institution retrospective cohort study included pediatric patients who underwent DISE-directed interventions from 2009 to 2020. Variables included patient characteristics, DISE timing, obstruction patterns, obstructive apnea-hypopnea index (OAHI), and OSA-18 quality-of-life (QOL). Chi-square tests compared patient demographics and comorbidities between single and multiple DISE groups. Unpaired -tests compared age, OAHI, and OSA-18 scores between single and multiple DISE groups as well as multiple-DISE outcomes for high versus normal BMI groups. RESULTS: Of 122 children who underwent DISE, 27 (22%) had multiple DISE-directed procedures. Average age at first DISE for single and multiple DISE patients was 7.25 (SD = 3.93) and 4.99 (SD = 3.63) years, respectively ( < .01). Common obstructions at second DISE involved the epiglottis (N = 20, 74%), adenoid (N = 18, 67%), and inferior turbinates (N = 15, 56%). Multilevel obstruction was identified in 96% (N = 26) of second and 80% (N = 4) of third DISEs. Children with high BMI (versus normal BMI) exhibited shorter intervals between DISEs. Patients who underwent single DISE exhibited significant OAHI improvement (mean 8.48 vs 3.91, < .05), but this was not significant for multiple DISEs. The OSA-18 score improved significantly in patients with single DISE (mean summed score 61.3 vs 44.6, < .05). CONCLUSIONS: Pediatric OSA involves persistent, multilevel obstruction, especially in younger patients with elevated BMI undergoing multiple DISE-directed procedures. These findings support anatomy-guided, patient-specific surgical planning for high-risk groups. While a single DISE-directed intervention can significantly improve OAHI and QOL, repeated procedures may yield diminishing returns, underscoring the need to consider their timing and utility. Early multidisciplinary evaluation and long-term follow-up are essential for managing persistent OSA.
Using Surgical Navigation to Capture Objective Metrics During Endoscopic Sinus Surgery: A Proof-of-Concept Study.
Fearington FW, Jabbour C, Pinheiro Neto CD … +1 more , Stokken JK
Ann Otol Rhinol Laryngol · 2026 Feb · PMID 41051162 · Publisher ↗
BACKGROUND: Evaluation of otolaryngology resident technical performance has historically relied on subjective perioperative feedback. Despite various assessment tools attempting to provide consistent surgical skill evalu...
BACKGROUND: Evaluation of otolaryngology resident technical performance has historically relied on subjective perioperative feedback. Despite various assessment tools attempting to provide consistent surgical skill evaluations, current methods remain inherently subjective. AIM: This proof-of-concept pilot study aimed to assess if a 3-dimensional surgical navigation system could capture objective surgical data during endoscopic sinus surgery (ESS). A secondary aim was to analyze if there were any differences between novice and practiced trainees. METHODS: Otolaryngology residents performed supervised ESS on patients while their instrument (microdebrider, suction) motion was recorded using a TruDi Navigation System. Prior to the surgery, surgical landmarks were defined with sensory beacons in the navigation system using the patient's preoperative computed tomography (CT) scan. Metrics included time to reach beacons, number of alerts at each beacon, and instrument speed. RESULTS: Fifteen otolaryngology residents performed 87 ESS. The navigation system successfully obtained "time to reach sinus X" data for 64% of sinuses/ case, velocity data in 93% of cases, and number of beacon "alerts" per minute in 93% of cases. We found a significant difference between PGY 3 residents and PGY 4/PGY5 residents in the number of sphenoid sinus alerts per minute ( = .01) and the percentage of cases in which the resident accessed the maxillary sinus via the natural os ( < .001). IMPACT: This study demonstrates the feasibility of collecting objective, navigation-based intraoperative metrics during live surgery and is a first step toward building a comprehensive objective assessment tool in ESS. We hope this report encourages further research into this technology's application in objective resident skill assessment and correlation with concurrent faculty assessments.
Elexacaftor/Tezacaftor/Ivacaftor Improves Sinonasal Disease in Young Patients With Cystic Fibrosis: A Prospective Study.
Pantazopoulos T, Zarkada I, Arvaniti A … +7 more , Chalkiadakis V, Pouliakis A, Moustaki M, Petrocheilou A, Troupi E, Papapetropoulos N, Loukou I
Ann Otol Rhinol Laryngol · 2026 Feb · PMID 41051141 · Publisher ↗
OBJECTIVES: Chronic rhinosinusitis is common among patients with cystic fibrosis (CF) and often significantly impacts their quality of life. The introduction of CFTR modulators, particularly the triple therapy of elexaca...
OBJECTIVES: Chronic rhinosinusitis is common among patients with cystic fibrosis (CF) and often significantly impacts their quality of life. The introduction of CFTR modulators, particularly the triple therapy of elexacaftor/tezacaftor/ivacaftor (ETI), appears to alleviate these symptoms. This study aims to evaluate the effect of this therapy on children and adolescents under 20 years of age with cystic fibrosis and concurrent chronic rhinosinusitis. METHODS: A prospective single-institution study was conducted. Patients were evaluated before starting treatment with ETI and after a median period of 3 months of therapy. Nasal endoscopy findings were recorded using the modified Lund-Kennedy score. Additionally, the Sinonasal Outcome Test-22 (SNOT-22), validated for Greek patients, was administered. RESULTS: A total of 15 patients participated in the study, with a median age of 18 years, ranging from 14 to 20 years. Seven patients (46.7%) were male, and 8 (53.3%) were female. Analysis of the SNOT-22 scores before and after treatment showed no statistically significant difference ( = .325). However, the analysis of the modified Lund-Kennedy scores revealed a statistically significant improvement after a median period of 3 months of treatment ( = .002). CONCLUSION: Patients with cystic fibrosis (CF) often suffer from chronic rhinosinusitis. The highly effective modulator therapy with ETI appears to result in a statistically significant improvement in sinonasal disease as assessed by nasal endoscopy. Conversely, this innovative therapy does not seem to improve the quality of life for CF patients experiencing rhinosinusitis symptoms, likely due to the few preexisting symptoms before initiation of the therapy.
Clinical Efficacy of Spray-Type Nasal Allergen Blocker as Adjuvant Treatment for Pediatric Allergic Rhinitis.
Zhou M, Wang X, Li J … +3 more , Ji W, Gao D, Zhang T
Ann Otol Rhinol Laryngol · 2026 Feb · PMID 41031654 · Publisher ↗
OBJECTIVE: To evaluate the clinical efficacy of Spray-Type Nasal Allergen Blocker as an adjuvant therapy for pediatric allergic rhinitis (AR). METHODS: Eighty-two pediatric AR patients aged 4 to 14 years were included in...
OBJECTIVE: To evaluate the clinical efficacy of Spray-Type Nasal Allergen Blocker as an adjuvant therapy for pediatric allergic rhinitis (AR). METHODS: Eighty-two pediatric AR patients aged 4 to 14 years were included in this retrospective study and divided into 2 groups based on the treatments documented in their medical records: one treated with Mometasone Furoate Aqueous Nasal Spray (n = 38) and the other with a combination of a Spray-Type Nasal Allergen Blocker and Mometasone Furoate Aqueous Nasal Spray (n = 44). RESULTS: After 4 weeks of treatment, the total effective rate, the serum levels of IFN-γ, TGF-β, nasal ventilation area, ciliary movement rate, and pediatric Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores were higher in the Combination group than in Mometasone group, while the Total Nasal Symptom Score (TNSS) and nasal resistance were lower in the Combination group ( < .05). CONCLUSION: Combination of Spray-Type Nasal Allergen Blocker and Mometasone Furoate Aqueous Nasal Spray exhibits promising results in the treatment of pediatric AR compared to Mometasone Furoate Aqueous Nasal Spray alone.
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