Otolaryngol Head Neck Surg [JOURNAL]
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200 papers
Otovent Versus Valsalva: Physiological Insights for Diagnostic and Therapeutic Autoinflation in Eustachian Tube Dysfunction.
Joshi K, Lim V, Ho V … +2 more , Tysome J, Smith M
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42398502 · Publisher ↗
OBJECTIVES: Autoinflation aids assessment of Eustachian tube function, or as a conservative treatment for obstructive Eustachian tube dysfunction. This study compares the physiological characteristics of 2 autoinflation...
OBJECTIVES: Autoinflation aids assessment of Eustachian tube function, or as a conservative treatment for obstructive Eustachian tube dysfunction. This study compares the physiological characteristics of 2 autoinflation techniques, the Otovent® device and the Valsalva manoeuvre, to inform clinical application for both diagnosis and therapy. STUDY DESIGN: Prospective physiological study. SETTING: Tertiary academic teaching hospital. METHODS: Twenty-one healthy adult volunteers performed 3 trials of both the Otovent and Valsalva manoeuvres. A linear mixed-effects model (LMM) was used as the primary analysis to compare the mean maximum and plateau nasopharyngeal pressures. Intra-subject repeatability was assessed using the intraclass correlation coefficient (ICC), while inter-subject consistency was evaluated by comparing standard deviations. Eustachian tube (ET) opening rates were measured via tubo-tympano-aerodynamic-graphy, otoscopy, and participant report. RESULTS: The Valsalva manoeuvre generated significantly higher nasopharyngeal pressures. Mean maximum NP pressure for Valsalva (597.5 daPa) was greater than for Otovent (482.3 daPa) (F(1, 104) = 18.82, P < .001). This difference was more pronounced for plateau pressures (Valsalva: 486.0 daPa vs Otovent: 278.0 daPa; F(1, 104) = 126.42, P < .001). Conversely, the Otovent demonstrated markedly superior consistency, showing higher intra-subject repeatability for plateau pressure (ICC = 0.872 vs 0.572) and substantially less intersubject variability (SD ± 39.8 daPa vs ±144 daPa). ET opening rates were comparable between the 2 techniques. CONCLUSIONS: Otovent facilitates autoinflation at lower but significantly more consistent pressures than Valsalva. Thus, Otovent may offer greater clinical value when a controlled, repeatable insufflation pressure is required for diagnostic or therapeutic purposes.
CSNK1A1 Mediates Inner Ear Inflammation and Endolymphatic Hydrops in a Lipopolysaccharide-Induced Mouse Model.
Deng W, Lai L, Li Z … +3 more , Ou Y, Zheng Y, Xiong H
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42398501 · Publisher ↗
OBJECTIVE: Our previous studies demonstrated that casein kinase 1α1 (CSNK1A1) was significantly upregulated in the endolymphatic sac of patients with Meniere's disease (MD). However, its specific role in the development...
OBJECTIVE: Our previous studies demonstrated that casein kinase 1α1 (CSNK1A1) was significantly upregulated in the endolymphatic sac of patients with Meniere's disease (MD). However, its specific role in the development of MD remains unclear. This study aims to investigate the effects of CSNK1A1 inhibition on alleviating hydrops, inflammation, and preserving audiovestibular function in a mouse model of endolymphatic hydrops (EH). STUDY DESIGN: Experimental animal study. SETTING: Translational research laboratory. METHODS: An EH model was induced in mice by postauricular lipopolysaccharide (LPS) injection. CSNK1A1 localization in hair cells was visualized via immunofluorescence. To functionally interrogate CSNK1A1, mice received intraperitoneal injections of the CSNK1A1 inhibitor CSNK1-IN-2. Evaluations encompassed three key parameters: cochlear morphology (EH severity), auditory brainstem response (ABR) and vestibular evoked myogenic potential (VEMP, audiovestibular function), and immunofluorescence for CD45 and F4/80 (macrophage infiltration). RESULTS: In LPS-induced EH mice, CSNK1A1 expression was significantly upregulated in cochlear and vestibular hair cells. Pharmacological inhibition of CSNK1A1 markedly improved audiovestibular function, reducing ABR thresholds (all frequencies, P < .01) and attenuating VEMP latency prolongations (P < .0001), CSNK1A1 inhibition also reduced EH, decreasing the membrane length increase rate (P < .01), and decreased the infiltration of CD45 and F4/80 inflammatory macrophages in the cochlea and vestibule (P < .05). CONCLUSION: CSNK1A1 plays a role in attenuating LPS-induced inner ear injury, suggesting that its inhibition may represent a potential strategy for attenuating inflammation-associated cochleovestibular damage.
Medial Flap Versus Coblation-Assisted Turbinoplasty For Turbinates Hypertrophy: A Prospective Randomized Controlled Trial.
Daoud A, Geva S, Dror A … +4 more , Ahmad B, Francis S, Sela E, Marshak T
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42398225 · Publisher ↗
OBJECTIVE: Inferior turbinate (IT) hypertrophy is a common cause of nasal obstruction. Surgical intervention may be required when medical treatment fails. This study compares the long-term efficacy of medial-flap turbino...
OBJECTIVE: Inferior turbinate (IT) hypertrophy is a common cause of nasal obstruction. Surgical intervention may be required when medical treatment fails. This study compares the long-term efficacy of medial-flap turbinoplasty (MFT) and coblation-assisted turbinoplasty (CAT) in patients with persistent nasal obstruction. STUDY DESIGN: A prospective, randomized controlled trial. SETTING: Otolaryngology department-hospital and ambulatory clinics. METHODS: Patients with IT hypertrophy who were surgical candidates were assigned to undergo either MFT or CAT. Symptom severity was assessed using the NOSE scale and VAS for nasal obstruction at baseline and at 1, 3, 6, and 12 months postoperatively. Secondary outcomes included endoscopic assessment of turbinate size, postoperative complications, and pain. Outcome examiners were blinded to the surgical technique. RESULTS: Forty-four patients completed the study (MFT: 21; CAT: 23). Both groups showed significant symptom improvement at all time points (P < .0001). While early outcomes were similar, the MFT group demonstrated significantly greater long-term symptom relief at 12 months (NOSE: 18.5 vs 34.5, P = .027; VAS: 2.2 vs 4.0, P = .043). MFT also showed greater turbinate size reduction (P < .001) and was associated with significantly less postoperative crusting. Pain scores and recovery times were comparable between groups. CONCLUSION: Both MFT and CAT are effective in improving nasal breathing in patients with IT hypertrophy. However, MFT demonstrated superior long-term outcomes and fewer complications, supporting this technique in appropriately selected patients.
Gender-Affirming Care in Otolaryngology: A State of the Art Review.
Alter IL, Rameau A, Flaherty AJ … +3 more , Faucett EA, Yoshikawa N, Nuyen B
Otolaryngol Head Neck Surg · 2026 Jul · PMID 42383571 · Publisher ↗
OBJECTIVE: Otolaryngologists have provided gender-affirming care to transgender and gender nonconforming (TGNC) individuals for many years, but demand for these services has recently increased substantially as visibility...
OBJECTIVE: Otolaryngologists have provided gender-affirming care to transgender and gender nonconforming (TGNC) individuals for many years, but demand for these services has recently increased substantially as visibility of TGNC communities grows. Furthermore, attention to gender-affirming care in general has sharpened as TGNC individuals' access to healthcare has entered the political sphere. We sought to compile evidence regarding gender-affirming care within otolaryngology, and to review novel surgical and nonsurgical advancements for the treatment of TGNC patients. DATA SOURCES: Data were sought from clinical peer-reviewed primary literature. REVIEW METHODS: Searches were conducted in PubMed, Cochrane, Embase, and Scopus. Clinical studies reporting outcomes of gender-affirming interventions, and studies investigating demand for and/or difficulty accessing gender-affirming otolaryngologic care were included. CONCLUSIONS: Eighty-three studies met inclusion criteria. TGNC individuals indicate strong desire for gender-affirming therapies for the face and voice, while access remains limited by cost, lack of insurance coverage, and few qualified providers. Surgical interventions for the face and voice have shown objective improvements (ie, vocal frequency and measurements of facial dimensions, respectively), and resulted in high patient-rated satisfaction as measured by validated patient-reported outcome measures and quality of life evaluations, especially for facial and vocal feminization. Non-surgical interventions for the voice have also demonstrated objective and subjective efficacy, alone or in combination with surgery. IMPLICATIONS FOR PRACTICE: Gender-affirming care in otolaryngology can make demonstrable improvements in the quality of life and social function of TGNC individuals. Given this evidence, otolaryngologists can and should continue to advance gender-affirming head and neck care.
Caffeine Consumption and Rhinologic Symptom Severity.
Green DGJ, Wang SX, DeBakey MS … +2 more , Kattar N, McCoul ED
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42377318 · Publisher ↗
Caffeine is the most widely consumed habit-forming drug in the world. A relationship has been proposed between caffeine consumption and rhinologic symptoms. To determine whether the potential deleterious effects of caffe...
Caffeine is the most widely consumed habit-forming drug in the world. A relationship has been proposed between caffeine consumption and rhinologic symptoms. To determine whether the potential deleterious effects of caffeine withdrawal are outweighed by the rhinologic symptom benefits, our group conducted a prospective study of patients presenting with rhinologic complaints at local clinics. Rhinologic symptom severity was assessed using the SNOT-22 and the frequency and quantity of daily caffeine consumption was assessed by questionnaire. A total of 226 participants completed the study. No correlation was found between caffeine consumption and total SNOT-22 (P > .05), rhinologic SNOT-22 subscale (P > .05), or tertiles of low, medium, and high caffeine consumers (P = .18). This suggests that caffeine consumption does not have an appreciable effect on rhinologic symptoms.
Ethical Considerations in Using the Pernkopf Atlas in Otolaryngology Education Ethics in Practice: Point-Counterpoint.
Kraus E, Solis LG, Holt GR
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42371670 · Publisher ↗
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Preoperative Neutrophil-to-Lymphocyte Ratio Predicts Recurrence in HPV-Associated Oropharyngeal Cancer After Transoral Robotic Surgery.
Harris MK, Daniels K, Helou V … +10 more , Carlson K, Patel SD, Sell E, Spector ME, Zevallos JP, Smith JD, Maxwell JH, Kim S, Sridharan SS, Contrera KJ
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42371658 · Publisher ↗
OBJECTIVE: Evaluate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) as a predictor of survival outcomes after transoral robotic surgery (TORS) for human papillomavirus-related (HPV+) oropharyngeal squamous...
OBJECTIVE: Evaluate the role of preoperative neutrophil-to-lymphocyte ratio (NLR) as a predictor of survival outcomes after transoral robotic surgery (TORS) for human papillomavirus-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN: Single-institution retrospective review of patients who underwent TORS for HPV + OPSCC from April 2014 to October 2021 and had a preoperative complete blood count test. SETTING: Tertiary academic center. METHODS: Preoperative NLR was calculated from complete blood counts drawn within 1 month prior to surgery. Receiver operating characteristic curves evaluated performance of prognostic markers. Kaplan-Meier estimator and Cox regression analyses were used to evaluate survival outcomes when controlling for confounding variables. RESULTS: A total of 117 patients were included (85.5% male, 94.0% Caucasian, 59.6 ± 9.1 years old), of which 13 patients (11.1%) recurred at a median of 23.5 ± 23 months, including 7 distant metastases. At the latest follow-up, 90.6% remained alive. On Kaplan-Meier analyses, a preoperative NLR of >2.2 was associated with worse recurrence-free survival (77.1% vs 95.5%, P = .02), whereas overall survival was similar between patients (P = .94). When controlling for demographics, tumor stage, pathologic risk criteria, and adjuvant therapy, NLR > 2.2 remained a significant independent predictor of recurrence on multivariate Cox regression analysis (HR 20.6, 95% CI 1.92-80.7, P = .012). CONCLUSION: While OS was similar across groups, a preoperative NLR of >2.2 predicted worse recurrence-free survival in a cohort of patients with HPV + OPSCC who underwent TORS. Future studies may consider integrating NLR into prospective trials as a complementary risk-stratification biomarker.
PEAK-II Trach: A Multi-Institutional Quality Improvement/Simulation Study Assessing Pediatric Emergency Readiness.
Dunne O, Shen A, Mosavian R … +33 more , Biel J, Tawfik MM, Schiff EB, Windsor AM, Weingarten-Arams J, Soshnick S, Mbbs MA, Lind M, Ernest E, Pian T, Maa T, Van Horn A, Harwayne-Gidansky I, Fortunov R, Nishisaki A, Ward L, Beal J, Abulebda K, Chang T, Hozumi T, Ghosh A, Nawathe P, Zurca AD, Van Genderen K, Koressel LR, Narsing B, Chiou DC, Sugarman A, Choudhury TA, Fazzari M, Lounsbury DW, Ahmed AS, Yang CJ
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42371646 · Publisher ↗
OBJECTIVE: Pediatric tracheostomy emergencies are high-acuity events requiring rapid, coordinated team-based care. This study assessed objective team performance and used in situ simulation to identify systems factors, i...
OBJECTIVE: Pediatric tracheostomy emergencies are high-acuity events requiring rapid, coordinated team-based care. This study assessed objective team performance and used in situ simulation to identify systems factors, including latent safety threats (LSTs) and resilience supports, that influence pediatric tracheostomy emergency readiness across diverse clinical settings. METHODS: In situ simulations of pediatric tracheostomy emergencies (obstructed or partially dislodged tubes) were conducted across inpatient floors, critical care units, and emergency departments at 11 pediatric hospitals. Time to completion of critical actions was recorded using the NeoCHART+™ for PEAK-II mobile application. Structured debriefs identified LSTs and resilience supports at unit and hospital levels. Multivariable Cox proportional hazards models assessed predictors of time-critical actions (tube replacement, suction, first effective ventilation) and the percentage of critical actions completed. RESULTS: Sixty-seven baseline simulations were conducted across 11 institutions. Seventy-seven percent of teams replaced an identical tracheostomy tube within 5 minutes (median 188.4 seconds, [IQR 165.3, 204.6]). Teams reported a median of 3.2 LSTs per simulation (IQR 3.0, 4.0). Common LSTs included attempted ventilation through occluded tracheostomy tubes, unclear leadership, ambiguous role definitions, and non-standardized equipment locations. Teams with a RT and at institutions with a dedicated tracheostomy team performed time-critical actions faster. DISCUSSION: In situ simulation revealed LSTs, resilience supports, and performance variability that may influence effective pediatric tracheostomy emergency response at the systems level. IMPLICATIONS FOR PRACTICE: Variability identified in systems factors and team performance can guide targeted interventions to improve pediatric tracheostomy emergency preparedness.
Clinical Features, Treatment, and Outcomes for Oropharyngeal Adenoid Cystic Carcinoma: A Systematic Review.
Hernandez-Herrera GA, Rourk KS, Peraza LR … +8 more , Moore EJ, Price DL, Tasche KK, Price KA, Lester SC, Routman DM, Van Abel KM, Yin LX
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42371638 · Publisher ↗
OBJECTIVE: To describe the presenting symptoms, treatment regimens, and outcomes associated with oropharyngeal adenoid cystic carcinoma. DATA SOURCES: Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Contr...
OBJECTIVE: To describe the presenting symptoms, treatment regimens, and outcomes associated with oropharyngeal adenoid cystic carcinoma. DATA SOURCES: Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Scopus via Elsevier. REVIEW METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses. A medical librarian conducted the literature search using controlled vocabulary and keywords, with investigator input. Eligible articles were clinical trials and observational studies reporting on clinical features, treatment, or outcomes for oropharyngeal adenoid cystic carcinoma. RESULTS: Our search identified 233 unique citations, with 44 articles included covering 195 patients. The female-to-male ratio was 1.7:1, and the base of the tongue was the most common subsite (73%). Presenting symptoms were mainly pain/discomfort (n = 31), followed by a palpable mass (n = 19) and dysphagia (n = 12). At diagnosis, 22.3% (29 patients) had positive lymph nodes. Treatment was primarily surgical (n = 102), with definitive radiation therapy used in 58 cases. Disease progression was noted in 86 patients, 36% (n = 31) of whom developed distant metastases-primarily to the lungs (n = 26). Long-term outcomes (n = 76) showed 3- and 5-year overall survival rates of 71.5% to 100% and 47.6% to 79.0%, and disease-free survival rates of 54.7% to 70.0% and 21.9% to 44.0%, respectively. CONCLUSION: Among patients with available data, oropharyngeal adenoid cystic carcinoma appeared more common in women and has a predilection for the base of the tongue. However, this finding should be interpreted with caution, given the high proportion of missing data. These tumors appear to carry a higher risk for nodal metastases and may lead to poor outcomes.
Extended Reality in Otolaryngology-Head & Neck Surgery: A State-of-the-Art Review.
Kutler RB, Gantwerker E, Jotwani R … +3 more , Sigaras A, Difede J, Rameau A
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42371620 · Publisher ↗
OBJECTIVE: To review the current literature on the applications of extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), in otolaryngology-head and neck surgery (OHNS). DA...
OBJECTIVE: To review the current literature on the applications of extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), in otolaryngology-head and neck surgery (OHNS). DATA SOURCES: MEDLINE, Embase, Web of Science, and Scopus databases. REVIEW METHODS: A comprehensive review of the literature on the applications of XR in OHNS was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Eligible studies were synthesized into a narrative review. CONCLUSIONS: In OHNS, XR technologies are increasingly being used across a wide range of clinical and educational contexts. The majority of studies focused on simulation for surgical education, particularly in otology, demonstrating improvements in learner engagement, anatomical understanding, and procedural skills. Other applications included preoperative planning, intraoperative guidance, distraction analgesia, vestibular and voice rehabilitation, and provider wellness. Despite these promising developments, the literature remains heavily concentrated in certain subspecialties, focused on education and surgical simulation, and largely limited to feasibility or proof-of-concept studies, with minimal integration into routine clinical practice. Unexplored XR applications in OHNS include at home self-monitoring, mental health conditions relevant to the specialty and telemedicine. IMPLICATIONS FOR PRACTICE: As XR technologies continue to evolve, they offer significant potential to enhance clinical care, improve patient education, and bridge gaps in surgical training. While early applications have focused largely on simulation, there is a growing interest in leveraging XR for perioperative and rehabilitative uses. Addressing current limitations, such as cost, access, standardization, and real-world validation, will be critical for broader adoption.
Scan for Success? Number Needed to Scan and Management Changes in Preoperative Otosclerosis: Quantitative Analysis.
Ungar OJ, Brenner A, Zikk D … +6 more , Abu-Eta R, Oron Y, Cavel O, Handzel O, Muhanna N, Maymon SL
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42334261 · Publisher ↗
OBJECTIVE: To quantify the cumulative number of images needed to scan (NNS) with preoperative high-resolution temporal bone computed tomography (HR-TBCT) to yield a change in management in patients undergoing primary sta...
OBJECTIVE: To quantify the cumulative number of images needed to scan (NNS) with preoperative high-resolution temporal bone computed tomography (HR-TBCT) to yield a change in management in patients undergoing primary stapes surgery for otosclerosis-related hearing loss. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary academic referral center. METHODS: Medical records of all patients referred for primary stapes surgery between 2010 and 2025 were reviewed. All patients suspected of otosclerosis routinely underwent preoperative HR-TBCT scan, and their CT findings were compared to the intraoperative findings of those who underwent surgery. All findings that altered informed consent, surgical candidacy, or surgical approach were recorded. The cumulative and temporal bone-specific condition NNS were calculated. RESULTS: A total of 892 patients were identified (male-to-female ratio 305:587). HR-TBCT revealed temporal bone pathology resulting in management change in 14% (1 ears). Prevalence of temporal bone conditions that alter management of stapes surgery included third window lesions (5.8%), lateral ossicular chain fixation (4.1%), overhanging facial nerve (1.3%), obliterative otosclerosis (1.0%), far-advanced otosclerosis (1.0%), and persistent stapedial artery (0.6%). The cumulative NNS for at least one management change, confirmed intraoperatively, was 38 (95% confidence interval 77-22). CONCLUSION: Routine preoperative HR-TBCT identifies clinically significant temporal bone pathology that alters management in approximately 14% of stapes surgery candidates. The NNS for intraoperatively confirmed findings was 38. HR-TBCT facilitates more accurate patient selection, improves informed consent, and reduces intraoperative complications. Incorporating HR-TBCT into the preoperative assessment enables comprehensive presurgical counseling and planning.
A Protocol for Reconstructing Complex Lateral Skull Base Defects: Two Decades of Tertiary Care Experience.
Farooq MU, Hirayama Y, Muzaffar J … +6 more , Kumar R, Huins C, Monksfield P, Baden J, Evriviades D, Irving R
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42334254 · Publisher ↗
OBJECTIVE: To describe a multidisciplinary protocol for the resection and reconstruction of complex lateral skull base pathology, based on over two decades of experience in a high-volume tertiary referral center in the U...
OBJECTIVE: To describe a multidisciplinary protocol for the resection and reconstruction of complex lateral skull base pathology, based on over two decades of experience in a high-volume tertiary referral center in the United Kingdom. STUDY DESIGN: Retrospective descriptive analysis of institutional practice. SETTING: A high-volume tertiary skull base unit in the United Kingdom. METHODS: This study presents a summary of clinical experience in managing lateral skull base pathologies-both benign and malignant-over a 20-year period. It outlines a multidisciplinary approach involving ENT, neurosurgery, plastic surgery, anesthesia, radiology, oncology, and specialist nursing teams. The institutional protocol for resection and reconstruction is described, including surgical planning, intraoperative decision-making, perioperative care, and long-term rehabilitation strategies. RESULTS: The integrated multidisciplinary protocol enabled safe and effective management of a broad range of lateral skull base lesions. The team achieved high rates of complete resection and functional reconstruction, with acceptable levels of morbidity. Complex anatomy, tumor extent, and reconstructive requirements were successfully navigated through coordinated team-based planning. The approach has been refined through iterative experience and now serves as a reference pathway for similarly structured centers. CONCLUSIONS: Effective management of lateral skull base pathology requires a highly coordinated multidisciplinary strategy. The described protocol, developed and implemented over two decades, offers a structured and reproducible approach that may serve as a valuable reference for other high-volume centers involved in skull base surgery.
Reconsidering Surgical Strategy in the Era of Neoadjuvant Immunotherapy for Head and Neck Cancer.
Migliorelli A, Sacchetto A, Patel S
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42319383 · Publisher ↗
Neoadjuvant immunotherapy is increasingly incorporated into the management of resectable locally advanced mucosal head and neck squamous cell carcinoma, raising questions about its impact on surgical decision-making. Des...
Neoadjuvant immunotherapy is increasingly incorporated into the management of resectable locally advanced mucosal head and neck squamous cell carcinoma, raising questions about its impact on surgical decision-making. Despite encouraging trial data, limitations in response assessment and evidence of heterogeneous tumor regression challenge the use of treatment response to guide surgical de-escalation. This commentary highlights current uncertainties and emphasizes the need for prospective evidence before response-adapted surgical strategies can be safely implemented.
Effect of Superior Laryngeal Nerve Block for Neurogenic Cough: A Single-Arm Meta-Analysis.
Cabral TDD, Knoll RM, Vendramini BDV … +3 more , Plane J, Conrado JEP, Naunheim MR
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42319377 · Publisher ↗
OBJECTIVE: We aimed to assess cough symptom improvement following superior laryngeal nerve block (SLNB) in patients with neurogenic cough (NC). DATA SOURCES: Studies were systematically searched on PubMed, Embase, Web of...
OBJECTIVE: We aimed to assess cough symptom improvement following superior laryngeal nerve block (SLNB) in patients with neurogenic cough (NC). DATA SOURCES: Studies were systematically searched on PubMed, Embase, Web of Science, and Cochrane Library. REVIEW METHODS: Articles reporting SLNB for the treatment of NC were included. Outcomes of interest included subjective reporting of improvement, patient-reported outcome measures, and adverse events. Mean difference (MD) was used for continuous outcomes and proportions for binary endpoints, with 95% confidence intervals (CI). RESULTS: Eight retrospective studies involving 552 patients met inclusion criteria. The pooled proportion of subjective improvement of cough following SLNB was 74.04% (95% CI 68.61-78.81, I² = 13.6%). Patients experienced a statistically significant reduction in Cough Severity Index scores (MD -7.37, 95% CI -13.42 to -1.32, P = .02, I² = 81.7%), with the greatest reduction in those who underwent 3 or more injections (MD -10.57, 95% CI -19.37 to -1.78, I² = 33.4%, P = .02). Adverse events were minimal and self-resolving, with 17.91% and 3.35% of patients experiencing local transient and systemic transient events, respectively. Injection-limiting/serious adverse events were rare, occurring in 1.97% of patients. CONCLUSION: Our findings suggest that SLNB may benefit a substantial number of patients, as evidenced by improvements in both subjective reports and cough-specific patient-reported outcomes, while maintaining a favorable safety profile with minimal adverse events. Additionally, patients who received multiple injections generally experienced greater reductions in cough severity. Further large-scale clinical trials are needed to confirm the efficacy and long-term effects of this treatment modality. LEVEL OF EVIDENCE: II.
Nonpharmacologic Therapy for Pediatric Posttonsillectomy Pain: A Systematic Review.
Sargios JT, Kayekjian D, Nguyen SA … +3 more , Peters P, Clemmens CS, Carroll WW
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42308000 · Publisher ↗
OBJECTIVE: To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and Scopus. REVIEW METHODS: Studies on nonpharmacologic interventions...
OBJECTIVE: To understand efficacies of nonpharmacologic therapy for pediatric posttonsillectomy pain. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and Scopus. REVIEW METHODS: Studies on nonpharmacologic interventions for pediatric posttonsillectomy pain were included in this systematic review. Extracted variables included demographics, pain scores, and postoperative bleeding. Pain scores on 0-10 scales (eg, Visual Analog Scale, Wong-Baker, FLACC, Oucher) were analyzed, and scales using different ranges, but comparable pain markers, were standardized to 0 to 10. Data were summarized as means, proportions (%), and differences (Δ) with 95% confidence intervals (CI). Risk of bias was evaluated using the Joanna Briggs Institute (JBI), ROBINS-I, or ROB-2 tools. RESULTS: Twenty-three studies (n = 3538) met inclusion criteria. Several nonpharmacologic intervention groups showed significant reductions in postoperative pain compared to control. At 6 hours postoperatively, acupuncture (∆ -0.8, 95% CI [-1.17, -0.43], P < .01), ice cream (∆ -1.4, 95% CI [-2.28, -0.52], P < .01), cartoon distraction (∆ -1.3, 95% CI [-1.83, -0.77], P < .01), and lavender essence inhalation (∆ -0.9, 95% CI [-1.76, -0.04], P = .04), were associated with lower pain scores. By postoperative Day 7 sugar-free gum was the only intervention associated with lower pain scores (∆ -2.2, 95% CI [-3.07, -1.33], P < .01). Salvia officinalis, cold diet, and food and effort restrictions were associated with less postoperative bleeding. Honey, intraoperative music, autologous serum, and liquid/soft diet (among other interventions) showed no changes in postoperative pain. CONCLUSIONS: Nonpharmacologic interventions including acupuncture, sugar-free gum, distraction, and select oil essence therapies are associated with less pain, with some interventions reducing postoperative bleeding risk. This supports incorporating non-pharmacologic adjuncts for pediatric posttonsillectomy pain, though further high-quality studies are needed.
The Utility of Large Language Models to Assist With Emergency Triage Decisions Within Otolaryngology.
Hack S, Attal R, Steckbeck RJ … +12 more , Boldes T, Ayeni T, Smith AJ, Sagiv D, Kellermeyer B, Garcia-Lliberos A, Rodriguez-Prado C, Biadsee A, Sebelik M, Roxbury CR, Purnell P, Zalzal HG
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42307998 · Publisher ↗
OBJECTIVE: To determine whether contemporary large language models can match clinician performance in evaluating the urgency of emergency otolaryngology referrals. STUDY DESIGN: Blinded cross-sectional diagnostic reasoni...
OBJECTIVE: To determine whether contemporary large language models can match clinician performance in evaluating the urgency of emergency otolaryngology referrals. STUDY DESIGN: Blinded cross-sectional diagnostic reasoning study. SETTING: Simulated emergency referral environment modeled on tertiary care otolaryngology practice. METHODS: Thirty emergency referral scenarios spanning the spectrum of otolaryngologic urgency were independently evaluated by 4 large language models (GPT-5, GPT-4, DeepSeek, and Grok) and 4 clinicians (otolaryngology attending and resident, emergency attending and resident). Outputs were anonymized and scored by 10 blinded otolaryngologists for appropriateness of urgency and quality of explanation using a three-point scale. Statistical analyses included nonparametric group comparisons, adjusted ordinary least squares modeling with case-level control, and correlation of each entity's case profile with that of the otolaryngology attending. RESULTS: Inter-rater reliability was excellent. The otolaryngology attending achieved the highest overall performance. GPT-5 demonstrated comparable mean performance, with no statistically significant difference in either domain. GPT-4 scored modestly lower but received higher mean ratings than both emergency clinicians. DeepSeek and the otolaryngology resident demonstrated intermediate performance, while Grok and the emergency clinicians performed lowest. Group-level analyses showed no significant difference between the large language model and otolaryngology cohorts; both were rated higher than emergency clinicians in this sample. CONCLUSION: GPT-5 demonstrated triage performance comparable to the otolaryngology attending in this controlled sample. Large language models may support emergency decision-making and education when specialist consultation is limited, but require supervision, transparency, and local calibration.
Trends in Otolaryngology Match Dynamics Before and After the USMLE Step 1 Pass/Fail Transition.
Allen DZ, May R, Duhon BH … +5 more , Rosenthal JW, Karni RJ, Jain K, Kain J, Sebelik M
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42307993 · Publisher ↗
OBJECTIVE: To evaluate otolaryngology (ENT) residency match trends before and after the USMLE Step 1 transition to pass/fail. STUDY DESIGN: Observational longitudinal analysis of annual, publicly available specialty-leve...
OBJECTIVE: To evaluate otolaryngology (ENT) residency match trends before and after the USMLE Step 1 transition to pass/fail. STUDY DESIGN: Observational longitudinal analysis of annual, publicly available specialty-level data (2010-2025). SETTING: National Resident Matching Program (NRMP). METHODS: Data from 2010 to 2025 were used to calculate applicants per PGY-1 position, fill rate, and nonmatch-in-specialty rate. ENT was compared with plastic surgery, orthopedic surgery, neurological surgery, and general surgery. We used ordinary least squares (OLS), segmented regression with a 2023 breakpoint, and difference-in-differences (DID) models. RESULTS: From 2010 to 2025, ENT programs increased from 105 to 139 and positions from 280 to 394. Applicants per position ranged from 1.06 to 1.60 (mean 1.38). OLS showed no significant long-term trend in applicants per position (+0.002/year, P = .86), fill rate (+0.03 percentage points/year, P = .68), or nonmatch-in-specialty rate (+0.04 percentage points/year, P = .94). Segmented regression showed no significant post-2023 changes in applicants per position (slope change +0.03/year, P = .78), and no significant changes in applicant counts (P = .7). ENT had the largest 2022 to 2023 decline in this cohort, in both applicants (-14.1%) and applicants per position (-16.9%). However, in two-way fixed-effects DID models, there was no ENT-specific post-transition change in applicants per position (P > .05 in primary and sensitivity analyses). CONCLUSION: ENT remained highly competitive but trend-stable from 2010 to 2025. Although 2023 showed a notable drop in applicants, we found no consistent evidence of a sustained ENT-specific competitiveness shift after the Step 1 pass/fail transition.
The Molecular Heterogeneity of NRAS Variants in Thyroid Nodules.
Ravin E, Alshalalfa M, Jiang R … +3 more , Hao Y, Klopper JP, Cottrill E
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42307992 · Publisher ↗
OBJECTIVE: NRAS variants are the most common mutations in thyroid nodules with (B)ethesda III/IV cytology. This study aims to characterize co-occurring variants, molecular signatures, and hallmarks of cancer pathways in...
OBJECTIVE: NRAS variants are the most common mutations in thyroid nodules with (B)ethesda III/IV cytology. This study aims to characterize co-occurring variants, molecular signatures, and hallmarks of cancer pathways in nodules with NRAS variants. STUDY DESIGN: Retrospective database analysis. METHODS: The database of nodules sent for Afirma GSC testing was analyzed for the most common NRAS hotspot mutations, co-occurring mutations, BRAF-RAS score (BRS), thyroid differentiation score (TDS), ERK expression, and activity levels of hallmarks of cancer pathways. RESULTS: Of 87,817 Afirma GSC-suspicious or BV/VI nodules, 12.6% had NRAS mutations. Of those, 79.7% were NRAS p.Q61R and 19.4% were NRAS p.Q61K. 421 nodules (3.8%) had co-occurring mutations, EIF1AX being the most common (1%, about twice the rate seen alone). Of 872 nodules with TERT promoter mutations (TERTp), 7.8% had concurrent NRAS + TERT mutations (more than twice the rate of TERT alone). The presence of NRAS (+/- co-mutations) was highly RAS-like on the BRS score. Hallmarks of cancer pathways analyzed across NRAS+ nodules, with TERTp profiling, revealed 2 distinct clusters: one with higher inflammatory pathway activity, and another with higher DNA repair, estrogen response, and MYC activity. The latter had a higher rate of BV/VI nodules. NRASp.Q61R was equally distributed across the 2 clusters. CONCLUSION: NRAS p.Q61R/K comprises 99% of reported NRAS variants. TERTp is the most frequent co-mutation. Among NRAS p.Q61R/K nodules, there are 2 different clusters of samples based on the activity of hallmarks of cancer pathways. Further studies correlating these clusters with clinical and pathological outcomes are necessary.
Is COVID-19 Infection A Risk Factor for Intubation-Related Acquired Airway Stenosis?
Taylor KM, Tang JA, Amadio G … +3 more , Ni G, Dass C, Soliman AMS
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42307991 · Publisher ↗
OBJECTIVE: To determine whether COVID-19 is a risk factor for developing airway stenosis in intubated patients. STUDY DESIGN: Retrospective case-control study with planned chart review. SETTING: Temple University Health...
OBJECTIVE: To determine whether COVID-19 is a risk factor for developing airway stenosis in intubated patients. STUDY DESIGN: Retrospective case-control study with planned chart review. SETTING: Temple University Health Systems hospitals in Philadelphia, PA. METHODS: Chart review of patients 18 to 90 years old diagnosed with COVID-19 who underwent endotracheal intubation and had a post-extubation CT scan at our institution between February 2020 and December 2022 was performed. Patients without COVID-19 matched for age, sex, and BMI who were intubated within one year served as a control group. Outcome variables included endoscopic and radiographic evidence of airway stenosis. Descriptive statistics were analyzed using Chi-squared and unpaired two-tailed T-test analyses for cohort comparison. RESULTS: One hundred five COVID-positive and 101 COVID-negative met inclusion criteria. The mean age was 58.6 years. Mean endotracheal tube size was 8.05 for COVID-positive and 7.72 for COVID-negative patients (P = .0075). Twenty-six (24.76%) COVID-positive and 45 (44.55%) COVID-negative patients had COPD (P = .0016). Length of intubation was 8.8 days in COVID-positive patients and 3.5 days for COVID-negative patients (P < .0001). Thirty-five (33.98%) COVID-positive and 1 (0.99%) COVID-negative patient were ventilated while prone (P = .0002). Seventy-eight (75%) COVID-positive and 38 (41.76%) COVID-negative patients received intravenous steroids (P = .0001). Mean length of stay was 38.81 days for COVID-positive and 17.16 days for COVID-negative patients (P < .0004). Six (5.77%) COVID-positive and 2 (1.3%) COVID-negative patients developed airway stenosis (P = .202). CONCLUSION: Patients with COVID-19 infection were not at an increased risk for intubation-related airway stenosis. LEVEL OF EVIDENCE: IV.
Complications of Cochlear Implant Surgery in Low- and Middle-Income Countries: A Systematic Review.
Srinivasan A, Prakash A, Chou WK … +2 more , Steiner K, Lakhoo K
Otolaryngol Head Neck Surg · 2026 Jun · PMID 42307989 · Publisher ↗
OBJECTIVE: Hearing loss disproportionately affects low- and middle-income countries (LMICs). Recent advances in cochlear implant surgery have benefitted patients globally, but the risk of complications in LMICs may be he...
OBJECTIVE: Hearing loss disproportionately affects low- and middle-income countries (LMICs). Recent advances in cochlear implant surgery have benefitted patients globally, but the risk of complications in LMICs may be heightened due to social and structural factors. This systematic review characterises the types and rates of complications reported in LMICs, while identifying the key barriers and facilitators to safe surgery. DATA SOURCES: Three databases (Ovid MEDLINE, Ovid Embase, and Global Index Medicus) and grey literature were searched from January 1, 2015 to May 30, 2025. REVIEW METHODS: Studies reporting quantitative data on cochlear implant surgery complications were independently reviewed by 2 authors, with conflicts resolved by a third reviewer. RESULTS: Thirty eligible studies from seventeen countries were identified. No studies were based in low-income countries, with 37% and 63% arising from lower-middle-income and upper-middle-income countries, respectively. Pooled average complication rates were higher in lower-middle-income (8.83%) than upper-middle-income countries (5.08%). Complication profiles also varied by income classification, with facial nerve injuries predominating in lower-middle-income countries compared to vertigo/dizziness and device failure in upper-middle-income countries. Thematic analysis identified systemic, procedural, technological, and capacity issues as barriers to safe surgery, whilst highlighting the importance of specialist expertise, perioperative planning, multidisciplinary teams, and widening access initiatives to mitigate these barriers. CONCLUSION: Overall complication rates of cochlear implant surgery in LMICs are comparable to high-income countries, although data may be underreported due to limited follow-up, and complication profiles differ by income classification. Further work is required to overcome the social and structural barriers to safe surgery.
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