The Annals Of Otology, Rhinology, And Laryngology[JOURNAL]
Sun
200 papers
Laryngeal Injuries Following General Endotracheal Anesthesia: A Case Series.
Zodl A, Weingarten TN, Ryll MJ … +4 more , Bayan SL, Ekbom DC, Sprung J, Harrison TE
Ann Otol Rhinol Laryngol · 2026 Jun · PMID 42307091 · Publisher ↗
OBJECTIVE: Endotracheal intubation can cause laryngeal injury, with clinical presentation ranging from transient hoarseness to persistent vocal cord immobility. This study examines the incidence, clinical features, and o...
OBJECTIVE: Endotracheal intubation can cause laryngeal injury, with clinical presentation ranging from transient hoarseness to persistent vocal cord immobility. This study examines the incidence, clinical features, and outcomes of post-intubation laryngeal injuries following procedures traditionally considered low risk for such complications. METHODS: We conducted a retrospective review of adult patients who underwent tracheal intubation for surgical procedures between May 1, 2018, and December 31, 2024, and subsequently presented with postoperative laryngeal injury-related symptoms. Patients who underwent cardiothoracic, thyroid, parathyroid, or anterior cervical spine procedures were excluded. We reviewed patient demographics, airway and intubation characteristics, treatments, and clinical outcomes. RESULTS: Among 267 824 patients undergoing 454 924 general anesthetics, 30 developed postoperative laryngeal injury (6.6/100 000; 95% CI 4.5-9.4) which did not resolve spontaneously and required laryngology evaluation. Of these 22 (67%) had well defined : unilateral (n = 15) and bilateral vocal cord immobility (n = 1), unilateral hypomobility (n = 4), bilateral hypomobility (n = 1), combined unilateral vocal cord immobility with contralateral hypomobility (n = 1), and 11 (33%) had . Twenty-one (64%) were intubated via video laryngoscopy. Follow-up was available for 21 patients (70%) with a median [IQR] duration of 12 [9-35] months; 15 (72%) showed partial improvement without complete resolution, while 6 showed no improvement. CONCLUSION: Laryngeal injury following general anesthesia with tracheal intubation is a uncommon complication. In our series, approximately two-thirds of patients had identifiable injuries, while one-third exhibited no structural abnormality. While 75% of patients demonstrated partial symptomatic improvement, however, complete resolution was not observed in any of the patients who received follow-up in our institution, underscoring the severity of this complication.
Clinical and Voice Outcome Differences in Vocal Cord Cysts with and Without Sulcus Vocalis: Insights From a Tertiary Center in Saudi Arabia.
Bukhari M
Ann Otol Rhinol Laryngol · 2026 May · PMID 42218614 · Publisher ↗
BACKGROUND: Vocal cord cysts are common benign lesions causing dysphonia, while sulcus vocalis, a groove on the vocal fold, can coexist with cysts and complicate treatment. This study compares clinical characteristics an...
BACKGROUND: Vocal cord cysts are common benign lesions causing dysphonia, while sulcus vocalis, a groove on the vocal fold, can coexist with cysts and complicate treatment. This study compares clinical characteristics and voice outcomes in patients with vocal cord cysts, with and without sulcus vocalis. METHODS: This retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, from 2012 to 2023. Patients with vocal cord cysts who underwent microlaryngeal surgery were included. Sulcus vocalis was suspected preoperatively using videostroboscopic examination and confirmed intraoperatively during microlaryngoscopy with visual inspection and palpation. They were divided into 2 groups: with and without coexisting sulcus vocalis. Voice outcomes were assessed using pre- and postoperative Voice Handicap Index-10 (VHI-10) scores. RESULTS: A total of 54 patients with vocal cord cysts were included, with 31 (57.4%) having coexisting sulcus vocalis and 23 (42.6%) without. Patients with sulcus vocalis were significantly older (median age 30 vs 22 years, = .008) and had lower smoking rates (6.45% vs 52.17%, < .001). They also exhibited worse voice outcomes, with higher preoperative (30 vs 22, = .002) and postoperative VHI-10 scores (20 vs 10, < .001) and smaller median VHI-10 improvements (8 vs 12 points, = .047). Mucosal bridges were more common in the sulcus group (19.35% vs 0%, = .032), but no significant differences in cyst type (epidermoid or mucus retention), recurrence rates, or follow-up duration were observed between the 2 groups. CONCLUSION: Sulcus vocalis worsens voice outcomes in patients with vocal cord cysts, highlighting the need for comprehensive preoperative evaluation. Future research should explore combined surgical treatments for both conditions.
Bioabsorbable Stenting in a Case of Severe Pediatric Posterior Glottic Stenosis.
Feminella S, Snyder AJ, Reichert L
Ann Otol Rhinol Laryngol · 2026 May · PMID 42210520 · Publisher ↗
INTRODUCTION: Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various...
INTRODUCTION: Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various surgical options, optimal management remains unclear, and restenosis is a common complication. Steroid-eluting stents, such as the Propel™, have shown promise in sinus applications but are underreported in airway stenosis and reconstruction. METHODS: We present a case of a 2-year-old female with transverse myelitis and neuromuscular respiratory failure with bilateral vocal cord paresis, which led to multiple intubations and subsequent PGS. She ultimately underwent tracheostomy due to recurrent respiratory failure with viral infections and associated failure to thrive. Once stable, preparations for decannulation began. The patient underwent endoscopic division of posterior glottic scar tissue, followed by placement of a Propel™ steroid-eluting stent to the interarytenoid and arytenoid mucosa. RESULTS: At 2-week follow-up, laryngoscopy revealed significant reduction in scar tissue without restenosis, with progressive resolution of granulation tissue and edema. Despite persistent vocal cord paresis, airway patency was maintained. At 3-month follow-up, there was marked improvement of stenosis sufficient to allow tracheostomy capping. CONCLUSION: This case highlights the off-label use of a steroid-eluting stent as adjunctive therapy in a pediatric patient with PGS. Outcomes demonstrated reduced scar tissue and improved airway patency, allowing progression toward decannulation. Further studies are needed to evaluate the role of steroid-eluting stents in the management of complex laryngeal disorders.
Efficacy and Safety of Finafloxacin Otic Suspension, 0.3% for the Treatment of Acute Otitis Externa: Results from two Phase III Randomized Clinical Studies.
Edmunds A, Bentley C, Lückermann M … +2 more , Voet B, Vente A
Ann Otol Rhinol Laryngol · 2026 May · PMID 42210509 · Publisher ↗
OBJECTIVE: Evaluation of the clinical efficacy and safety of finafloxacin otic suspension in 2 Phase III clinical trials, in patients 6 months or older, reflective of the populations at risk for acute otitis externa (AOE...
OBJECTIVE: Evaluation of the clinical efficacy and safety of finafloxacin otic suspension in 2 Phase III clinical trials, in patients 6 months or older, reflective of the populations at risk for acute otitis externa (AOE). METHODS: Two identical multicenter, randomized, double-masked, vehicle-controlled prospective Phase III studies in which 1234 patients (≥6 months) with AOE of presumed bacterial origin were randomized at 128 sites in the United States and Canada. Patients received finafloxacin otic suspension or vehicle twice daily for 7 days. The primary efficacy endpoint was the proportion of patients with clinical cure (resolution of tenderness, erythema and edema) on day 11 in the pathogen positive subset of the intention to treat (ITT) population. RESULTS: Patients of the pathogen positive subset of the ITT population treated with finafloxacin had a clinical cure rate of 70.2% on day 11 (test of cure visit, ToC) compared to 36.6% in the vehicle group ( < .0001). A comparable effect was observed in the ITT population (finafloxacin 71% cure vs vehicle 49.8%). Finafloxacin eradicated the most common AOE pathogens with high efficiency: 89% for and 85.3% for (39.2% and 26.8% in the vehicle group, respectively). Median time to cessation of ear pain was 3.5 days in the finafloxacin group versus 7.0 days in the vehicle group ( < .0001), and thus markedly shorter than durations reported for other otic therapies. Finafloxacin had a safety profile comparable to that of vehicle. Adverse events-primarily ear pruritus, ear discomfort, and dizziness-occurred at similar rates in both groups. CONCLUSIONS: Finafloxacin otic suspension was statistically superior to vehicle in clinical cures, pathogen eradication, and median time to ear pain resolution. It also demonstrated high efficacy against the primary AOE pathogens, and , including fluoroquinolone-resistant pathogens. Finafloxacin was well-tolerated with a safety profile equivalent to vehicle.Clinical trial registry name:ClinicalTrials.gov; https://clinicaltrials.gov/Identifier:NCT01535599 and NCT01535560.
Evaluation Of the Expression Levels Of SerpinB3/B4/B10, Interleukin-17 As Biomarkers For Chronic Rhinosinusitis With Nasal Polyps.
Hussein HA, Habieb MS, Hamdan AM
Ann Otol Rhinol Laryngol · 2026 May · PMID 42186918 · Publisher ↗
OBJECTIVE: To evaluate the serum expression of SerpinB3/B4/B10 and serum level of interleukin-17 as biomarkers for chronic rhinosinusitis with nasal polyps. METHODS: This was a cross-sectional study involving 70 patients...
OBJECTIVE: To evaluate the serum expression of SerpinB3/B4/B10 and serum level of interleukin-17 as biomarkers for chronic rhinosinusitis with nasal polyps. METHODS: This was a cross-sectional study involving 70 patients with CRSwNP and 70 age and gender matched healthy controls. The study patients were assessed using an Arabic version of the Sinonasal Outcome Test 22 score (SNOT-22), an otorhinolaryngology examination, and computed tomography of the nose and paranasal sinuses with grading of the findings using the Lund-Mackay staging system. The patients were divided into 2 subgroups: primary (n = 46) and recurrent (n = 24). Laboratory assessment included an assessment of the serum level of interleukin-17 (IL-17) and the expression of SerpinB3, SerpinB4, and SerpinB10. RESULTS: The values of IL-17, SerpinB3, SerpinB4, and SerpinB10 were higher in the patient group compared with the control group and in the recurrence subgroup compared with the primary subgroup, with statistically significant differences. All 3 serpins had significant potential as biomarkers for CRSwNP and for differentiating primary from recurrent subtypes, with a value < .001 for the sensitivity and specificity of all markers. There was a significant positive correlation between the serum expression of each of the serpin markers and the serum levels of IL-17, SNOT 22, and Lund-Mackay score ( < .001 for all). CONCLUSION: The biomarkers studied had significantly higher values in CRSwNP patients, especially the recurrent subgroup. SerpinB3/B4/B10 had significant sensitivity and specificity as biomarkers for CRSwNP, predicting the likelihood of postoperative polyp recurrence, and showing a positive correlation with disease severity.
Correlation of Patient-Reported Symptoms With Rhinogram Features Beyond Simple Airway Resistance.
Darbari Kaul R, Alvarado R, Choy C … +16 more , Sun H, Liu S, Hua E, Grouse L, Haghighi M, Liang K, Zou E, Desai A, Campion NJ, Thiel C, Azemi G, Sacks R, Campbell RG, Kalish L, Di Ieva A, Harvey RJ
Ann Otol Rhinol Laryngol · 2026 May · PMID 42178145 · Publisher ↗
INTRODUCTION: Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer inform...
INTRODUCTION: Rhinomanometry, a reference measure for the nasal airway, is often considered a research tool with only weak-to-moderate correlations with patient symptoms. However, like lung spirometry curves offer information beyond forced expiratory volume (FEV), rhinomanometry curves (rhinograms) have characteristics beyond simple nasal resistance at 150 Pascals. This study explored the correlation between rhinogram curve features and patient-reported outcomes (PROMs), when compared with nasal airway resistance. METHODS: A diagnostic cross-sectional study was conducted on patients from a rhinology clinic. PROMs collected included ordinal nasal obstruction and visual analogue scale (VAS) of the more obstructed side. Rhinomanometry curves underwent mathematical polynomial fitting to extract 835 features. The primary outcome was correlation using Spearman's rho (ρ) comparing curve-derived features with nasal airway resistance at 150 Pascals. Machine learning was applied to the top 8 correlated features to generate an AI predictive model. RESULTS: About 601 patients (mean age 45 ± 16 years, 45% female) were analysed. Curve-derived features (ρ = 0.305) correlated more than total NAR at 150 Pa (ρ = 0.222) with VAS. Similarly with ordinal nasal obstruction, curve-derived features correlated more (ρ = 0.230) than total NAR at 150 Pa (ρ = 0.112). The best performing AI prediction models achieved correlations of 0.133 (VAS) and 0.117 (nasal obstruction). CONCLUSION: This study offers a novel method for rhinogram analysis with curve-derived features for correlation and predictive modelling. Whilst correlation scores remain weak-moderate with PROMs, they outperform nasal airway resistance. Therefore, rhinograms produced from rhinomanometry may offer more clinical information than a simplistic numerical resistance testing.
Analysis of Long-Term and Short-Term Efficacy of Different Types of Tympanosclerosis Surgery Under Total Otoendoscopy.
Gui W, Yang Y, Du S … +2 more , Wu C, Wu X
Ann Otol Rhinol Laryngol · 2026 May · PMID 42175891 · Publisher ↗
OBJECTIVE: To explore the surgical effect for patients with different types of tympanosclerosis under total otoendoscopy. MATERIALS AND METHODS: A retrospective analysis was performed on the clinical data of 86 patients...
OBJECTIVE: To explore the surgical effect for patients with different types of tympanosclerosis under total otoendoscopy. MATERIALS AND METHODS: A retrospective analysis was performed on the clinical data of 86 patients who were diagnosed with tympanosclerosis and underwent total endoscopic ear surgery. According to the Wielinga classification, the patients were categorized into type II group (n = 34) and type IV group (n = 52). Hearing outcomes were recorded and analyzed at the preoperative, short-term postoperative (≤6 months), and long-term postoperative (≥1 year) periods. RESULTS: Significant differences in average air-bone gap (ABG) were observed among preoperative, short-term, and long-term postoperative periods in type II and IV tympanosclerosis. No difference was found between type II and IV in short-term ABG, whereas a significant difference appeared in long-term outcomes ( < .05). The duration of illness was strongly correlated with tympanosclerosis type and preoperative ABG. CONCLUSION: The short-term surgical benefits of type II and type IV are similar, while the long-term hearing recovery of type II is better. The bone conduction recovery of type IV is better. The longer the disease course, the more severe the hearing loss.
Safety and Efficacy of a Novel Radiofrequency Device for Submucosal Turbinate Reduction - A Prospective, Open-Label Pilot Trial.
Daoud A, Geva S, Hassidov E … +3 more , Gruber M, Sela E, Marshak T
Ann Otol Rhinol Laryngol · 2026 May · PMID 42175854 · Publisher ↗
OBJECTIVE: Inferior turbinate (IT) hypertrophy is a major cause of nasal obstruction. Although surgical intervention is effective, it can be associated with morbidity and prolonged recovery. This study evaluated the safe...
OBJECTIVE: Inferior turbinate (IT) hypertrophy is a major cause of nasal obstruction. Although surgical intervention is effective, it can be associated with morbidity and prolonged recovery. This study evaluated the safety, efficacy, and tolerability of a novel submucosal fractional radiofrequency (FRF) treatment. METHODS: A prospective, single-arm, open-label study was conducted from March to November 2024. Patients with nasal obstruction caused by IT hypertrophy unresponsive to at least 1 month of medical treatment were included in the study. The procedure was performed endoscopically under topical anesthesia using FRF. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) scale, Visual Analog Scale (VAS), and endoscopic turbinate grading at baseline, 1 month, and 3 months after the procedure. The safety outcomes included pain scale, adverse events, and complications. RESULTS: A total of 22 patients completed the protocol. The NOSE score improved from 71.2 to 30.0 at 1 month ( < .001). Sustained NOSE score improvement was observed at 3 months (37.1, < .001). The VAS scores for nasal obstruction decreased from 7.4 to 3.2 at 1 month and 3.9 at 3 months ( < .0001). Endoscopic grading of turbinate size demonstrated a reduction at both follow-up points ( < .05). The average VAS score for pain was 3.4, indicating good tolerability. No bleeding, synechiae, or other adverse events were reported. Crusting appeared in 50% of patients at 1 month, resolving in all but 1 patient by 3 months. A significant correlation was observed between the pulse count and symptom improvement ( = .02). CONCLUSION: Submucosal FRF treatment leads to significant and sustained improvement in nasal obstruction with minimal pain and no major adverse events. These results support the safety, efficacy, and tolerability of the procedure for IT hypertrophy in an outpatient setting. Larger cohorts and long-term follow-up studies are warranted to refine the treatment and further validate these findings. LEVEL OF EVIDENCE: 3.
Long-Term Survey to Assess Recurrence and Complications of Surgically Treated Pleomorphic Adenoma.
Rourk KS, Hidalgo CM, Shurtz AK … +5 more , Tasche KK, Price DL, Van Abel KM, Yin LX, Moore EJ
Ann Otol Rhinol Laryngol · 2026 May · PMID 42152554 · Publisher ↗
OBJECTIVE(S): To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomyMethods:Cross-sectional survey of all patients wit...
OBJECTIVE(S): To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomyMethods:Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve. RESULTS: Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n = 420). The clinical median follow-up length was 51 days, which extended to a median length of 6.2 years following the survey. The median change in follow-up length was 5.37 years ( < .001). The recurrence rate was 1% at 5 years, with a median time to first recurrence of 7.54 years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment. CONCLUSION: Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling. LEVEL OF EVIDENCE: 3.
Determining the Impact of Race and Ethnicity on Diagnosis and Management of Vestibular Schwannoma.
Patel AA, Levi JR, Weber PC
Ann Otol Rhinol Laryngol · 2026 May · PMID 42145214 · Publisher ↗
OBJECTIVE: While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity o...
OBJECTIVE: While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity on management of vestibular schwannoma (VS). The objective of this study was to determine whether race and ethnicity impacted treatment choice and postoperative management of VS. METHODS: Retrospective review of patients diagnosed with VS (ICD9 225.1, ICD10 D33.3, and ICD 10 H93.3) who presented to a tertiary care center between January 1, 2018 and October 31, 2023 was completed (IRB H-45412). Primary outcomes, including treatment choice, time to treatment, and postoperative management, were compared among different racial and ethnic groups. RESULTS: Of the 78 patients diagnosed with VS, 46 (59.0%) patients were observed with serial imaging, 12 (15.4%) underwent radiation, and 14 (18.0%) pursued surgery initially. Treatment choice ( = .3917), time to treatment ( = .3310), and loss to follow up ( = .0579) were not significantly different between different races/ethnicities. In patients who pursued surgery, the duration of admission ( = .9300), need for rehabilitation ( = .6271), postoperative facial nerve paresis ( = .8233), and hospital readmission ( = .5680) did not differ significantly. The proportion of patients who qualified for hearing rehabilitation did not differ significantly ( = .3545). However, a significantly higher proportion of White patients chose to pursue hearing rehabilitation compared to the other groups ( = .0096). CONCLUSION: Race and ethnicity did not significantly impact choice of treatment, management patterns, or postoperative course for patients with VS.
Comparison of Adult Tracheostomy Outcomes Before and After Implementation of a Dedicated Tracheostomy Team.
Palmer TT, Moore CM, Bounds-Wood KL … +5 more , Bryant W, Rose A, Paul O, Spankovich C, Jefferson GD
Ann Otol Rhinol Laryngol · 2026 May · PMID 42132473 · Publisher ↗
OBJECTIVE: (A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN: Mixed...
OBJECTIVE: (A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN: Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. PARTICIPANTS: Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. METHODS: Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. RESULTS: Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD = 28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS ([1,316] = 28.706, < .001]) and complication odds (OR = 2.92, = .015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (β = .253, (314) = 4.741, < .001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (β = .406, (184) = 6.321, < .001, 95% CI[.928, 1.771]); (β = .554, (129) = 7.625, < .001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days ( = .586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 ( = .344). CONCLUSIONS: Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. LEVEL OF EVIDENCE: 4.
Can ChatGPT Replace Human Clinical Coders? A Comparative Study in Otology Billing.
Derbarsegian A, Vesole AS, Sun DQ … +1 more , Gordon SA
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126183 · Publisher ↗
OBJECTIVE: Evaluate the utility of the large language model (LLM), ChatGPT, for the analysis of operative notes and the generation of Current Procedural Terminology (CPT) codes in comparison to human clinical coders. STU...
OBJECTIVE: Evaluate the utility of the large language model (LLM), ChatGPT, for the analysis of operative notes and the generation of Current Procedural Terminology (CPT) codes in comparison to human clinical coders. STUDY DESIGN: CPT billing codes assigned by ChatGPT were compared to existing billing data. Otology practice within a tertiary academic center. METHODS: About 191 operative notes from a single surgeon (9/2022-10/2023) were analyzed. ChatGPT-3.5 and 4 models were prompted for CPT codes based on operative notes. Assessment included determining exact and partial match rates, sensitivity and specificity for targeted procedures, and work Relative Value Units (wRVU) differences between ChatGPT-generated and human-assigned codes. RESULTS: ChatGPT-3.5 achieved exact matches in 22% of cases and partial matches in 32%, while ChatGPT-4 achieved 14% exact and 33% partial matches. When cochlear implantation (CI) was excluded, performance dropped significantly. For CI, ChatGPT-3.5 demonstrated a sensitivity of 94% and specificity of 90%, while ChatGPT-4 showed a sensitivity of 96% and specificity of 92%. In contrast, performance on cartilage grafting was poor, with sensitivities of 4.2% for ChatGPT-3.5 and 0% for ChatGPT-4. ChatGPT-3.5 and 4 showed moderate CPT code matching accuracy among themselves, with slight agreement to human coders. Both models tended to underbill for wRVUs compared to human coders, with significant differences in the values generated. CONCLUSION: This study assessed ChatGPT's effectiveness in automating CPT code assignment for otologic surgeries. While the models achieved high sensitivity values for assigning codes related to cochlear implantation, both models struggled with complex cases, failed to apply modifiers, and often assigned fewer wRVUs. The findings highlight ChatGPT's potential in medical billing but indicate a need for further refinement.
Effects of Crocin on Wound Healing and Fibrosis in Vocal Cord Injury: An Experimental Study.
Tonç S, Çağlar Çil Ö, Sofu MS … +2 more , Akarsu D, Güçlü O
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126174 · Publisher ↗
OBJECTIVE: This experimental study aimed to evaluate the effects of crocin on wound healing and fibrosis in vocal fold injury. MATERIALS AND METHODS: Thirty-six male Wistar Albino rats were randomly divided into 3 groups...
OBJECTIVE: This experimental study aimed to evaluate the effects of crocin on wound healing and fibrosis in vocal fold injury. MATERIALS AND METHODS: Thirty-six male Wistar Albino rats were randomly divided into 3 groups: a sham group, a local crocin treatment group, and a systemic crocin treatment group. In the study, all rats underwent injury to their right vocal folds. Six rats from each group were randomly sacrificed on the 5th and 30th days after surgery. Tissue samples were evaluated for lamina propria thickness, inflammation severity, epithelial regeneration, edema, hyaluronic acid, collagen, elastin, and the cytokines TGF-β1, FGF2, and HGF. RESULTS: In the early phase, less inflammation, more epithelial regeneration, and lamina propria were observed in the systemic treatment group compared to the sham group. In the late phase, Compared to the sham group, both the systemic and local treatment groups showed higher values in lamina propria thickness, elastin, and HGF measurements, while collagen levels were significantly decreased. Furthermore, in the systemic group, TGF-β1 decreased in the late period, while hyaluronic acid and FGF2 levels remained high. When the groups were evaluated within themselves, inflammation and edema were observed to decrease more significantly in the late period in all groups. Hyaluronic acid decreased significantly in the sham and local treatment groups, while this decrease was limited in the systemic treatment group. Lamina propria thickness increased significantly in the treatment groups on day 30 compared to day 5. CONCLUSION: Crocin treatment applied using different methods has shown positive effects on various parameters, wound healing, and fibrosis reduction in the early and late periods after vocal fold injury. However, more extensive preclinical and clinical studies are needed to determine the efficacy and applicability of this treatment.
Effect of Perioperative Sucralfate Administration on Pain Control After Tonsillectomy: A Systemic Review and Meta-Analysis.
Kim DH, Jang DW, Hwang SH
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126168 · Publisher ↗
OBJECTIVES: This study evaluated the efficacy of perioperative intraoral sucralfate in reducing postoperative pain following tonsillectomy through a systematic review and meta-analysis. METHODS: A comprehensive search of...
OBJECTIVES: This study evaluated the efficacy of perioperative intraoral sucralfate in reducing postoperative pain following tonsillectomy through a systematic review and meta-analysis. METHODS: A comprehensive search of PubMed, SCOPUS, Embase, Web of Science, and Cochrane up to September 2025 identified 13 studies comparing perioperative intraoral sucralfate with placebo or no treatment. Outcomes included throat pain, otalgia, swallowing pain, analgesic consumption, and perioperative morbidities. RESULTS: Sucralfate increased the proportion of patients reporting no or mild throat pain and otalgia, improved mucosal healing at 5 to 7 days, and reduced throat pain, swallowing pain, otalgia, analgesic use, and time to resume >50% of a regular diet. No significant differences were observed in postoperative bleeding or nausea/vomiting. CONCLUSION: Perioperative intraoral sucralfate may be an effective adjuvant therapy that improves postoperative pain control, enhances wound healing, reduces analgesic requirements, and facilitates earlier dietary resumption after tonsillectomy.
Implications of Glucagon-Like Peptide-1 Receptor Agonists in Otolaryngology - Head and Neck Surgery: A Review.
Anderson BJ, Van Daele DJ, Claussen AD … +2 more , Tanenbaum Z, Owen SR
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126155 · Publisher ↗
The number of patients taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) is increasing. Beyond diabetes and weight management, these medications have various effects within the head and neck with both beneficia...
The number of patients taking glucagon-like peptide-1 receptor agonists (GLP-1RAs) is increasing. Beyond diabetes and weight management, these medications have various effects within the head and neck with both beneficial and potentially adverse clinical implications. Delayed gastric emptying may contribute to reflux, chronic cough, and potential aspiration in the perioperative setting; as such, physicians should be aware of anesthetic guidelines (duration of pre-operative cessation, pre-operative fasting or liquid diet) to improve safety and avoid operative delay. GLP-1RAs have shown benefit in treating obstructive sleep apnea in those with obesity or overweight and may become increasingly relevant in multimodal treatment of sleep disorders. GLP-1 receptor signaling is involved in sinopulmonary inflammatory cascades and recent evidence suggests clinical implications for chronic sinusitis and olfactory disorders. Previously reported neuroprotective effects have led to investigation regarding potential benefit in neurotoxicity-associated hearing loss. Muscle atrophy with weight loss may contribute to a gaunt, aged appearance leading patients to seek facial rejuvenation, or to a patulous eustachian tube and changes in conductive hearing. Animal studies suggested an increased risk of thyroid cancer, but population studies have been inconclusive and will require long-term investigation to determine any causal relationship.
Mitomycin C in the Endoscopic Treatment of Airway Stenosis: A Systematic Review and a Meta-Analysis.
Russo E, Mangiameli G, Costantino A … +7 more , Cariboni U, Festa BM, Alloisio M, Spriano G, Marulli G, Ferraroli GM, De Virgilio A
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126099 · Publisher ↗
OBJECTIVE: To assess the efficacy of adjuvant MMC in the endoscopic treatment of airway stenoses. DATA SOURCES: PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar databases. REVIEW METHODS: A literature...
OBJECTIVE: To assess the efficacy of adjuvant MMC in the endoscopic treatment of airway stenoses. DATA SOURCES: PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar databases. REVIEW METHODS: A literature search was conducted following PRISMA guidelines. The PICOS tool was used to determine the eligibility criteria for this study. A single arm meta-analysis was performed for stenosis resolution, the rate of patients requiring multiple endoscopic procedures, and the rate of patients requiring other surgical treatments. RESULTS: A total number of 358 patients (median age: 48.0 years; 95% CI 44.8-50.8) were included. The median follow-up was 25.2 months (n = 244/358; 95% CI 15.4-38.3). Overall, the cumulative stenosis resolution rate was 76.37% (n = 187/254; 95% CI 59.72-89.64), the rate of patients requiring multiple endoscopic procedures was 52.33% (n = 131/260; 95% CI 32.03-72.25), and the rate of patients requiring other surgical treatments was 4.08% (n = 26/310; 95% CI 0.37-11.48). The median intervention-free interval was 366 days (n = 155/358; 95% CI 270-696). CONCLUSIONS: Current evidence does not allow definitive conclusions regarding the efficacy of adjuvant MMC in reducing recurrence or prolonging intervention-free intervals in airway stenosis. Further well-designed prospective studies are needed to clarify the role of MMC and to inform evidence-based guidelines for patient selection and treatment use. LEVEL OF EVIDENCE: NA.
Response to Pitak-Arnnop "Letter to the Editor".
Anderson BJ, Graham SM, Andrews BT … +2 more , Camargo JD, Kendrick DE
Ann Otol Rhinol Laryngol · 2026 May · PMID 42126079 · Publisher ↗
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The Effect of Radiofrequency Ablation of Posterior Nasal Nerves on Inflammatory Cytokines, Peak Nasal Inspiratory Flow, and Subjective Symptom Scores in Chronic Rhinitis: A Prospective Clinical Trial.
Allen DZ, Skaribas EE, Bandi A … +9 more , Siddiqui S, Kontoyiannis P, Jacob J, Hawes E, Hua S, Shetty K, Yao W, Citardi MJ, Luong AU
Ann Otol Rhinol Laryngol · 2026 May · PMID 42105251 · Publisher ↗
BACKGROUND: Chronic rhinitis (CR) is inflammation of the nasal mucosa, causing a multitude of symptoms. Temperature-controlled radiofrequency neurolysis (RFN) of the posterior nasal nerve (PNN) is a treatment for CR. In...
BACKGROUND: Chronic rhinitis (CR) is inflammation of the nasal mucosa, causing a multitude of symptoms. Temperature-controlled radiofrequency neurolysis (RFN) of the posterior nasal nerve (PNN) is a treatment for CR. In allergic rhinitis (AR), Type 2 cytokines are drivers of symptom severity. This study explores whether RFN's symptomatic improvements are linked to changes in nasal airflow and local cytokine levels. METHODS: This prospective, single-arm study was conducted at the Texas Sinus Institute at The University of Texas Health Science Center at Houston. Patients with ≥6 months of CR symptoms, a reflective total nasal symptom score (rTNSS) ≥6, and refractory to medical management were included. Follow-ups occurred at 4 and 12 weeks, with the primary endpoint at 12 weeks. Symptom improvement, peak nasal inspiratory flow (PNIF) and cytokine changes were assessed. RESULTS: Seventeen patients were enrolled with 15 patients undergoing the treatment. The procedure was well tolerated with no major adverse events. The rTNSS improved from a median of 7.5 to 4 at 12 weeks ( < .01). Median NOSE scores improved from 52.5 to 17.5 at week 12 ( < .05). Minimal clinically important differences (MCID) were achieved by 67% of patients for rTNSS and 50% for NOSE. There were no significant changes in PNIF. Patient-level change in IL-10 was significantly associated with improvement in NOSE score ( = -.70, = .011). CONCLUSIONS: RFN of the PNN is a safe, effective in-office treatment for CR. While PNIF and group-level cytokines were not consistent indicators of improvement, the correlation between IL-10 and symptom relief suggests a potential link between neural ablation and the local mucosal microenvironment. This investigation shows the feasibility of cytokine monitoring to further investigate the mechanisms of rhinitis treatment.
Vitamin D Supplementation for Preventing Recurrent Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study.
Tawfeeq HA, Zaidan MA, Ghanim AK
Ann Otol Rhinol Laryngol · 2026 May · PMID 42098930 · Publisher ↗
OBJECTIVE: To determine whether cholecalciferol supplementation reduces recurrence rates in patients with benign paroxysmal positional vertigo (BPPV) and concurrent vitamin D deficiency. STUDY DESIGN: Prospective, random...
OBJECTIVE: To determine whether cholecalciferol supplementation reduces recurrence rates in patients with benign paroxysmal positional vertigo (BPPV) and concurrent vitamin D deficiency. STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Two tertiary otolaryngology centers in Baghdad, Iraq (Al-Kafaat Hospital ENT outpatient clinic and Al-Dora Hospital ENT outpatient clinic). METHODS: One hundred sixty adults with confirmed idiopathic BPPV and serum 25-hydroxyvitamin D < 20 ng/mL were randomized 1:1 to receive cholecalciferol 10 000 IU weekly or matched placebo for 24 months. Primary outcome was BPPV recurrence (cumulative incidence, time-to-first recurrence) at 6, 12, 18, and 24 months. Secondary outcomes included vitamin D concentrations, DHI scores, per-participant recurrence frequency, and safety parameters. Full intention-to-treat analysis; missing data handled by multiple imputation. RESULTS: Baseline characteristics were balanced between groups (mean age 36.8 ± 7.2 years). Cholecalciferol significantly elevated serum 25-hydroxyvitamin D concentrations at all timepoints (24 months: 24.8 ± 3.2 vs 9.8 ± 3.6 ng/mL, < .001). BPPV recurrence was significantly reduced with cholecalciferol versus placebo at 6 months (15.0% vs 35.0%, = .004), 12 months (22.5% vs 48.8%, < .001), 18 months (25.0% vs 52.5%, < .001), and 24 months (27.5% vs 55.0%, < .001), representing a 50% relative risk reduction. Number needed to treat was 3.6. No hypercalcemic episodes occurred. Treatment adherence exceeded 94% in both groups. CONCLUSION: Cholecalciferol supplementation provides sustained, clinically meaningful reduction in BPPV recurrence among vitamin D-deficient patients over 24 months with excellent safety profile. Routine vitamin D assessment and targeted supplementation may be considered in vitamin D-deficient BPPV patients.
Letter to the Editor Regarding "The Maxillary Lid Approach to Intra-Antral Pathology".
Pitak-Arnnop P
Ann Otol Rhinol Laryngol · 2026 May · PMID 42095560 · Publisher ↗
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