Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Specialty
Otolaryngology
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Showing 80 of 1376 matching items (19450 indexed).
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
A Protocolled Implementation of Upfront Ultrasound, A Stepwise Pre-Operative Imaging Regimen in Primary Hyperparathyroidism.
OBJECTIVE: To evaluate the sensitivity of a stepwise preoperative imaging regimen for patients with primary hyperparathyroidism. STUDY DESIGN: Prospective cohort study. SETTING: A high-volume tertiary referral center for parathyroidectomy. METHODS: Patients with primary hyperparathyroidism referred for parathyroidectomy underwent surgeon-performed ultrasound as the primary preoperative imaging examination. The diagnostic confidence of the examiner on a scale from 0 to 3 determined whether additional imaging was acquired. If ultrasound identified an enlarged parathyroid gland with certainty (score 3), the patient was booked directly for surgery. If the confidence score was <3, the patient underwent either parathyroid scintigraphy or 18F-choline PET/CT. The gold standard was the intraoperative location of pathological parathyroid glands combined with biochemical cure ≥6 months after surgery. The primary endpoint was the sensitivity of the stepwise imaging regimen per patient, irrespective of the number of acquired imaging modalities. Secondary endpoints were the sensitivity per gland and the sensitivity of the imaging regimen if the cut-off for additional imaging had been a confidence score of 1 or 2. RESULTS: Upfront ultrasound spared 49 of 99 patients (49.5%) from additional imaging and correctly localized ≥1 pathological parathyroid gland in 98.0% of patients [95% CI 92.9-99.8]. The per-gland sensitivity was 92.5% [95% CI 84.8-1.0]. When changing the cut-off to a confidence score of 2, the per-patient sensitivity remained 98.0% [95% CI 92.9-99.8]. CONCLUSION: Our study demonstrates that a stepwise imaging regimen based on upfront ultrasound by an experienced examiner can substantially reduce the number of radiation-based supplemental scans, while maintaining a high sensitivity.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Contralateral Hearing Status as a Determinant of Cochlear Implant Device Engagement and Rehabilitation Trajectory.
OBJECTIVE: To compare device utilization, speech recognition trajectories, and predictive validity of early postactivation performance across 3 contralateral hearing status groups: single-sided deafness (SSD), asymmetric hearing loss (AHL), and bilateral nonserviceable hearing loss (BSHL). STUDY DESIGN: Retrospective longitudinal cohort study. SETTING: Tertiary academic medical center. METHODS: Retrospective review of 360 adult cochlear implant recipients implanted 2018 to 2024, classified by contralateral pure-tone average (PTA) into SSD (≤30 dB HL; n = 81), AHL (>30-50 dB HL; n = 41), and BSHL (>50 dB HL; n = 238). Measures included mean daily utilization via processor datalogging and Consonant-Nucleus-Consonant (CNC) word recognition at 1, 3, 6, and 12 months postactivation; distribution of utilization categories; multivariable predictors of limited use; and cross-temporal predictive validity. RESULTS: SSD showed lower utilization than BSHL through 6 months postactivation, with near-convergence by 12 months. Full-time utilization (≥8 h/day) was achieved by 50% of SSD patients compared to 82% of BSHL patients (P < .001). SSD was the sole independent predictor of limited use (OR = 4.38; 95% CI: 2.03-9.48; P < .001). CNC scores were persistently lower in SSD across the first postoperative year, failing to cross the 50% clinical responder threshold at 12 months. One-month postactivation performance strongly predicted 12-month outcomes in AHL and BSHL patients but not in SSD, indicating a fundamentally distinct early rehabilitation dynamic. CONCLUSION: Contralateral hearing status is an independent determinant of cochlear implant device engagement. SSD recipients demonstrate distinct utilization patterns, lower speech recognition trajectories, and unpredictable early rehabilitation dynamics, warranting configuration-specific counseling and heightened clinical surveillance beginning at the time of activation.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Evaluating Dysphonia Referrals to Otolaryngology Providers: Is There a Need For Improved Referral Guideline Implementation?
OBJECTIVE: Evaluate referring physicians' adherence to the 2018 Hoarseness/Dysphonia Clinical Practice Guideline when referring to an academic otolaryngology department. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary academic medical center. METHODS: Adult patients (≥ 18 years old) referred to the University of Missouri Department of Otolaryngology-Head and Neck Surgery for a primary complaint of dysphonia between January 2015 and December 2022 were included. Patients referred from otolaryngologists or primary complaints other than dysphonia were excluded. Demographics, diagnoses, referral reason, and prior management were assessed. Referral practices before and after the 2018 update were examined across recommendations relevant to referring physicians: timely referral, avoidance of pre-laryngoscopy imaging, avoidance of empiric antireflux therapy, corticosteroids, and antibiotics, and performance of laryngoscopy before prescribing voice therapy. Adherence to each recommendation and all recommendations combined was compared between pre- and post-guideline cohorts. RESULTS: In all, 528 patients were included: 141 (26.7%) were referred before and 387 (73.3%) after the 2018 update. Following guideline publication, adherence significantly decreased for timely referral (71.3% vs 80.9%; p = .027), avoidance of imaging (96.6% vs 100%; p = .028), and avoidance of antibiotics (89.7% vs 95.7%; p = .028). No significant changes were observed for antireflux therapy, corticosteroid use, or referral before prescribing voice therapy. Adherence to all analyzed guidelines did not improve (52.5% vs 61.7%; p = .059). CONCLUSION: Referral patterns to otolaryngology physicians for dysphonia do not reflect high fidelity to updated clinical practice guidelines. These findings underscore the limitations of passive dissemination and the need for targeted implementation strategies.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Experiences With Parental Leave Policies After Training in Otolaryngology-HNS: A Systematic Review.
OBJECTIVES: (1) Understand parental leave policies for North American otolaryngologists post-training. (2) Identify barriers to fully utilizing parental leave and the financial implications of doing so on women versus men. DATA SOURCES: Medline, Embase, and Web of Science. METHODS: Databases were queried for "pregnancy," "parental leave," and "compensation." Inclusion criteria specified otolaryngologists who took parental leave after training. Primary outcomes were to quantify the average length of leave and financial compensation, in addition to identifying common themes in experiences. RESULTS: In all, 1458 studies were screened, with six in the final analysis comprising 1889 otolaryngologists (69.3% female). Surveys were administered across the United States (n = 5) and Canada in 1998, 2018, 2020, 2021, and 2024. All studies reported that most respondents lacked knowledge regarding parental leave policies. Studies were focused on gender differences (n = 4) or family planning. Only three studies reported the average leave for female otolaryngologists, at 10.3, 11.5 weeks, and over 6 weeks. Those studies also reported increased impacts on female otolaryngologists' salaries compared to males due to parental leave. The 1998 study reported that female otolaryngologists earned $35,000 less than male colleagues due to factors such as significant differences in "childbearing experiences and" "increased family responsibilities." CONCLUSION: Otolaryngology parental leave policies negatively impact women's financial compensation, but are difficult to understand due to limited data. Further investigation is warranted to identify the various policies and compensation models across practice settings, the financial and professional consequences of parental leave on women versus men, and the comparison of parental leave to other forms of medical leave.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Five Year Recovery From COVID-19 Smell Loss: Preliminary Report from a Nationwide Survey.
This scientific briefing reports preliminary 5-year recovery outcomes from COVID-19-associated smell loss in a nationwide cohort. Adults with confirmed COVID-19 infection and self-reported smell loss since January 2020 were surveyed through a longitudinal web-based questionnaire, and a follow-up survey was distributed to participants who had completed a prior 2-year study. Among 419 respondents (mean age 45.7 ± 13.7 years; 79.0% female; 84.5% white), 44.2% reported complete smell recovery, 48.4% partial recovery, and 7.4% no recovery or worsening smell. Complete recovery was significantly higher in participants younger than 40 years (P < .001) but did not differ by gender (P = .51). Compared with 2-year outcomes, the rate of complete recovery increased from 38.4% to 44.3%. These findings indicate that while modest additional recovery occurs beyond 2 years, olfactory dysfunction persists in more than half of patients 5 years after COVID-19-associated smell loss. While a much larger analysis is currently in progress, this report represents the longest-term results published to date.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Hypoglossal Nerve Stimulation Treatment Outcomes in Patients With Supine-Dependent Obstructive Sleep Apnea.
OBJECTIVE: To evaluate hypoglossal nerve stimulation (HGNS) treatment response in patients with supine-dependent obstructive sleep apnea (sOSA) and non-supine-dependent obstructive sleep apnea (nOSA). STUDY DESIGN: Single-institution retrospective cohort study. SETTING: Academic tertiary care medical center. METHODS: A retrospective analysis of 45 unilateral HGNS patients was conducted. Supine, non-supine, and total apnea-hypopnea indices (AHIs) were collected from electronic medical records. Treatment response was assessed with postoperative AHI, change in AHI, and Sher15 and Sher20 criteria (≥50% AHI reduction to ≤15 or ≤20 events per hour, respectively). Mann-Whitney U, chi-squared, and paired t tests were performed in Python. RESULTS: sOSA patients experienced significantly less AHI change (P = .008), though HGNS efficacy was comparable between sOSA and nOSA groups when evaluating outcomes with postoperative AHI and Sher15 (P = 1.0) and Sher20 success (P = .87). HGNS treatment also had similar effects on supine and non-supine AHI. Mean change in supine AHI was -14.51 and mean change in non-supine AHI was -11.17. Mean difference in AHI changes (supine minus non-supine) was -3.34 and not statistically significant (P = .27). CONCLUSION: Unilateral HGNS is a treatment option for both sOSA and nOSA, demonstrating similar overall treatment efficacy with comparable postoperative AHI and surgical success rates in this limited cohort. Larger AHI reductions in nOSA patients may indicate greater therapeutic effect for non-positional obstructive sleep apnea (OSA). Combining HGNS with positional therapy or other strategies to minimize supine sleep time may help enhance outcomes in this subgroup. Further research is needed to explore factors influencing residual AHI in sOSA patients and refine treatment approaches for optimal results.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Laryngopharyngeal Reflux Disease: Microbial Signatures and Their Associations With Clinical and Digestive Enzyme Profiles.
OBJECTIVE: To characterize the salivary microbiome of patients with laryngopharyngeal reflux disease (LPRD) and investigate its associations with clinical presentation and salivary gastroduodenal enzymes. STUDY DESIGN: Prospective controlled study. SETTING: University Hospital. METHODS: Saliva samples from patients with LPRD at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing and asymptomatic individuals were consecutively collected for analyzing digestive enzyme/biomarker (pepsin, elastase, bile salts, cholesterol, trypsin) and microbiome features (16S rRNA IlluminaMiSeq). Pretreatment to posttreatment symptoms and findings were evaluated with reflux symptom score and reflux sign assessment. Association between microbiome abundance, enzyme concentration, and baseline and post-treatment clinical findings were assessed. RESULTS: Sixty-seven LPRD patients (40 females [59.7%]) and 44 controls (26 females [59.1%]) completed the evaluations. LPRD patients demonstrated significantly higher concentrations of elastase, higher salivary pH, and lower levels of cholesterol compared to controls. The comparative analysis of salivary microbiota between LPRD patients and controls demonstrated significant taxonomic-level alterations in alpha diversity (reduced Shannon index at family and genus levels in LPRD, P < .006) and beta diversity (distinct community composition by UniFrac metrics, PERMANOVA, P ≤ .005), with differential abundance of key taxa including a modulation of Streptococcus species, elevated Actinomyces and Abiotrophia, and depleted Oribacterium and Eubacterium nodatum group in LPRD patients compared to controls. Elastase, trypsin, and bile salts reported significant association with relative abundance of some bacteria. CONCLUSION: This preliminary study supports that LPRD patients exhibit distinct microbial signatures compared to asymptomatic subjects, characterized by reduced diversity at specific taxonomic levels, subtle shifts in community membership, and differential abundance of some key genera.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Predictors of Recurrent Croup: The Role of Social Determinants of Health and Otolaryngology Evaluation.
OBJECTIVE: To evaluate the influence of patient comorbidities, social determinants of health (SDOH), and otolaryngology (OTO) referral timing on disease course and healthcare utilization among pediatric patients with recurrent croup. STUDY DESIGN: Retrospective cohort study. SETTING: Large tertiary children's hospital. METHODS: Pediatric patients (0-18 years) evaluated by an OTO for recurrent croup between 2011 and 2024 were included (n = 70). Demographic, clinical, and referral data were obtained from medical records. SDOH were quantified using state-standardized Childhood Opportunity Index (COI) 3.0 scores across 3 domains and 14 subdomains. Associations between comorbidities, SDOH, and referral timing with disease duration, number of emergency department (ED) visits, corticosteroid prescriptions, and age at resolution were analyzed using t-tests and correlation coefficients (α = 0.05). RESULTS: Household tobacco exposure and gastroesophageal reflux disease were associated with earlier croup onset (P < .05). Higher Wealth, Health Resource, and Educational Resource scores correlated with shorter disease duration, fewer ED visits, and younger age at resolution (P < .05). Shorter intervals from first ED visit to OTO evaluation correlated with fewer ED visits (r = 0.28, P < .02), fewer corticosteroid prescriptions (r = 0.28, P < .02), and shorter disease duration (r = 0.51, P < .0001). CONCLUSION: Early otolaryngology involvement and favorable SDOH-particularly wealth, health, and educational resources-were associated with improved outcomes in recurrent croup. These findings highlight opportunities for targeted counseling, timely referral, and community-based interventions to reduce healthcare burden and enhance pediatric airway care. LEVEL OF EVIDENCE: III.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Intraoperative PTH Monitoring in Primary Hyperparathyroidism: A Risk-Stratified Approach.
OBJECTIVE: To evaluate whether routine intraoperative parathyroid hormone (ioPTH) monitoring is necessary in all cases of sporadic primary hyperparathyroidism (pHPT) in the era of advanced preoperative localization and to propose a conservative, risk-stratified operative framework. DATA SOURCES: PubMed, Scopus, and Embase were searched for English-language publications from January 2020 through January 2026, supplemented by key guidelines, consensus statements, and high-impact reviews. REVIEW METHODS: This narrative review synthesizes contemporary guidelines, imaging performance studies (ultrasound, sestamibi-based techniques, four-dimensional computed tomography [4D-CT], andF-fluorocholine positron emission tomography [FCH-PET]), observational cohorts comparing operative strategies, and decision-analytic and cost-effectiveness analyses. Evidence was prioritized by clinical relevance and methodological quality. CONCLUSIONS: Focused parathyroidectomy, ioPTH-guided surgery, and bilateral neck exploration all achieve high cure rates when appropriately applied. The incremental value of ioPTH is greatest in settings of elevated residual uncertainty, including discordant or nonlocalizing imaging, atypical biochemical profiles (including normocalcemic or discordant calcium-PTH presentations), familial or syndromic disease, reoperative necks, and unfavorable anatomy. In a narrowly defined subgroup with sporadic disease, favorable anatomy, and concordant high-fidelity localization-particularly high-quality, surgeon-reviewed or surgeon-performed ultrasound combined with 4D-CT-the likelihood that routine ioPTH alters management appears low. IMPLICATIONS FOR PRACTICE: Selective omission of ioPTH may be reasonable in carefully selected patients within a conservative, risk-stratified framework, with a low threshold for intraoperative escalation.
JAMAArticle
JAMA
Amoxicillin-Clavulanate vs Amoxicillin for Sinusitis-Reply.
JAMAArticle
JAMA
Amoxicillin-Clavulanate vs Amoxicillin for Sinusitis.
JAMAArticle
JAMA
Amoxicillin-Clavulanate vs Amoxicillin for Sinusitis.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Effects of Minority Status on Sensory Outcomes, Cognition, and Depression.
OBJECTIVE: To evaluate the association between minority status and sensory function, sleep quality, depressive symptoms, and cognitive performance in an aging population. STUDY DESIGN: Prospective, cross-sectional study. SETTING: Participants were recruited from the Department of Otolaryngology and the Center for Cognitive Neuroscience and Aging at a large academic medical center. METHODS: Adults aged 50 to 90 years underwent audiologic, visual, olfactory, and cognitive testing. Olfaction was assessed using the University of Pennsylvania Smell Identification Test. Depressive symptoms and sleep quality were measured using the Geriatric Depression Scale and Pittsburgh Sleep Quality Index, respectively. Cognitive function was evaluated using the Mini-Mental State Examination-2 (brief and standard versions). Participants were stratified by minority status. Group comparisons and multiple linear regression analyses were performed to identify independent predictors of cognitive performance. RESULTS: A total of 164 participants were included. Minority participants were younger but demonstrated poorer olfactory performance, memory recall, and Mini-Mental State Examination-2 scores. Minority individuals also reported more depressive symptoms and longer sleep latency. Hearing thresholds were also worse among non-minority participants. Multivariable regression identified minority status, olfactory function, and depressive symptoms as independent predictors of cognitive performance, although overall model explanatory power was modest. CONCLUSION: Minority status, depressive symptoms, and olfactory dysfunction were independently associated with lower cognitive performance despite younger age. These findings highlight potential disparities in sensory and cognitive health and support incorporation of olfactory and mood assessment in geriatric otolaryngologic evaluation.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Efficacy of Exhalation Delivery System With Fluticasone in Chronic Rhinosinusitis With Versus Without Polyps.
OBJECTIVE: To evaluate whether treatment responses to the exhalation delivery system with fluticasone (EDS-FLU; XHANCE®) differ between patients with CRS with nasal polyps (CRSwNP) and patients without nasal polyps (CRSsNP). STUDY DESIGN: Post hoc analysis of the ReOpen clinical trials conducted between November 2018 and November 2021 for a 24-week duration. SETTING: Multinational, multicenter, randomized, EDS-placebo-controlled studies. METHODS: Data were pooled from the randomized trials in which patients with CRSwNP (n = 206) or CRSsNP (n = 341) were randomly assigned (1:1:1) to EDS-FLU 186 μg, 372 μg, or EDS-placebo, 1 or 2 sprays twice daily per nostril for 24 weeks. Endpoints included composite symptom score, Smell Identification Test (SIT), sinus opacification on computed tomography (CT) scan, frequency of acute exacerbations of CRS, 22-Item Sino-Nasal Outcome Test (SNOT-22), and Patient Global Impression of Change (PGIC). RESULTS: Patients with CRSwNP and CRSsNP reported substantially greater benefits with EDS-FLU versus EDS-placebo on symptoms, SIT, sinus opacification on CT scan, incidence of acute exacerbations of CRS, and quality-of-life outcomes (SNOT-22 and PGIC). Composite symptom score and SNOT-22 improvements were consistent in the subgroup of patients entering the trial reporting symptoms despite recent standard-delivery nasal steroid spray use. Treatment-by-subgroup interaction effects indicated similar magnitude EDS-FLU treatment effect for patients with CRSwNP and patients with CRSsNP. CONCLUSION: EDS-FLU improved subjective and objective measures of CRS irrespective of nasal polyp status. TRIAL REGISTRATION: Title: Study Evaluating the Efficacy and Safety of Intranasal Administration of OPN-375 in Subjects With Chronic Rhinosinusitis With or Without the Presence of Nasal Polyps; ID: NCT03781804 and NCT03960580, Clinicaltrials.gov.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Evaluation and Management of Laryngopharyngeal Reflux Disease: An Updated State of the Art Review.
OBJECTIVE: To review the updated literature about epidemiology, clinical presentation, diagnosis, and treatment of laryngopharyngeal reflux disease (LPRD) and to provide a practical management for clinical practice. DATA SOURCES: PubMED, Cochrane Library, and Scopus. REVIEW METHOD: Four authors conducted the literature review on LPRD epidemiology, clinical presentation, diagnosis, and treatment according to the PRISMA statement. A critical analysis of the literature and a related management algorithm for clinical practice were provided. CONCLUSIONS: Studies from the last 5 years provided increased evidence about the gaseous and alkaline profile of LPRD at 24-hour hypopharyngeal-esophageal impedance-pH monitoring, and the presence of alkaline-activated enzymes in the upper aerodigestive tract mucosa. Three consensuses emerged, emphasizing the importance of objective testing to demonstrate LPRD in patients with laryngopharyngeal symptoms. The recent literature suggested that LPRD may be associated with atypical presentations, including posterior nasal inflammation, dry eyes, and middle ear disorders. The predominantly alkaline nature of LPRD has prompted clinical studies supporting alginate and magaldrate over proton pump inhibitors (PPIs), which only target gastric acidity, for managing acid, weakly acid, and alkaline pharyngeal reflux events. Despite a growing literature, there was no randomized controlled trial comparing alginate, magaldrate, diet, and PPIs conducted in the last 5 years. IMPLICATIONS FOR PRACTICE: The increased evidence about alkalinity of pharyngeal reflux events and the detection of alkaline-activated enzymes in saliva may shift the current PPI-based therapy to alginate therapy. Multicenter international randomized controlled studies with standardized protocols could improve the scientific knowledge about LPRD.
CochraneSystematic review
The Cochrane database of systematic reviews · Cochrane
Hearing aids for mild to moderate hearing loss in adults.
RATIONALE: This is an update of an existing review. The main clinical intervention for mild to moderate hearing loss is the provision of hearing aids, which amplify speech in addition to environmental sounds. Hearing aids are routinely offered and fitted to those who seek help for hearing difficulties. Since the previous 2017 review, further randomised-controlled trials (RCTs) have been published. This review updates the certainty of the evidence and assesses two additional outcomes: mental health and cognition. OBJECTIVES: To evaluate the benefits and harms of hearing aids in adults with mild to moderate hearing loss. SEARCH METHODS: Cochrane Information Specialists searched CENTRAL, Cochrane ENT registry, MEDLINE, Embase, Web of Science, ClinicalTrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the final search was 2 August 2024. We have also included published existing and ongoing studies up to 18 May 2026. ELIGIBILITY CRITERIA: We included RCTs and cross-over trials that investigated the effect of acoustic hearing aids on adults with mild to moderate hearing loss. We did not include cluster-RCTs. We included studies where the control comparison was passive (waiting list, no intervention) or active (e.g. placebo hearing aids, education programmes, assistive listening devices, auditory training). We excluded studies with interventions delivered in a group setting. OUTCOMES: The critical outcomes were hearing-specific health-related quality of life (participation as the key domain) and the adverse effect, pain. Important outcomes were health-related quality of life, listening ability, mental health (loneliness as the prioritised subdomain; other subdomains were depression, anxiety, and social isolation), cognition (working memory as the prioritised subdomain; other subdomains were memory, immediate attention span, set shifting, inhibition, language, processing speed, visuospatial function, and brief measures of global cognitive performance), and the adverse effect, noise-induced hearing loss. We show only prioritised outcomes in the synthesis of results section below and in the summary of findings. RISK OF BIAS: We used the Cochrane tool for assessing risk of bias (RoB 1), and assigned a judgement about the risk of bias for each included study. SYNTHESIS METHODS: We synthesised results for each outcome using random-effects meta-analyses of the standardised mean differences (SMDs). Where this was not possible, we synthesised results using a narrative approach. We used GRADE to assess the certainty of evidence. INCLUDED STUDIES: We included 16 RCTs involving 2261 participants; we added 11 new studies to this update. The studies were conducted in the USA, Europe, Brazil, Hong Kong, and Australia, and were published between 1987 and 2025. Participants had mild to moderate hearing loss. The average age ranged from 58 to 83 years. Study duration was 4 weeks to 3 years. SYNTHESIS OF RESULTS: All studies except one had high or unclear risk for performance and detection bias because blinding was inadequate or absent. Most studies had low risk for selection, attrition, and reporting bias. For hearing-specific health-related quality of life (participation), there is likely to be a large difference favouring those wearing hearing aids over the control comparison (SMD -1.25, 95% confidence interval (CI) -1.63 to -0.87; 8 studies, 1683 participants; moderate-certainty evidence, downgraded for risk of bias). The evidence for pain is very uncertain. Six studies (1186 participants) monitored adverse effects. Of these, one study reported two instances of pain or discomfort (one participant stopped using hearing aids due to pain while wearing them; one stopped using hearing aids due to ear dryness requiring treatment). Certainty of evidence was very low, downgraded for risk of bias and extreme imprecision. For health-related quality of life, there may be a small difference favouring those wearing hearing aids over the control comparison (SMD -0.27, 95% CI -0.46 to -0.09; 4 studies, 1558 participants; low-certainty evidence, downgraded for risk of bias and indirectness). For listening ability, there is likely to be a large difference favouring those wearing hearing aids over the control comparison (SMD -1.28, 95% CI -2.41 to -0.15; 5 studies, 622 participants; moderate-certainty evidence, downgraded for risk of bias). For loneliness, there may be little to no difference between those wearing hearing aids and the control comparison (SMD -0.12, 95% CI -0.25 to 0.01; 2 studies, 907 participants; low-certainty evidence, downgraded for risk of bias and indirectness). For working memory, the evidence is very uncertain about the effect of hearing aids compared to the control (SMD 0.51, 95% CI -0.21 to 1.23; 3 studies, 910 participants; very low-certainty evidence, downgraded for risk of bias, indirectness and inconsistency). Of the six studies that monitored for adverse effects, none reported noise-induced hearing loss (1186 participants; evidence certainty not graded). AUTHORS' CONCLUSIONS: The available evidence suggests that hearing aids likely improve hearing-specific health-related quality of life and listening ability in adults with mild to moderate hearing loss, with a large beneficial effect. Hearing aids may also improve general health-related quality of life. This evidence is compatible with the widespread provision of hearing aids as first-line clinical management in those who seek help for hearing difficulties. The review did not provide evidence that hearing aids were effective at improving loneliness or working memory, nor that hearing aids resulted in adverse effects. To improve the certainty of evidence and ascertain whether the effects of hearing aids vary according to demographics (e.g. age, sex, degree of hearing loss, socioeconomic environment, race and ethnicity), greater consistency is needed in outcome measures used. Longer-term, placebo-controlled studies may be more sensitive to potential effects on mental health and cognition, but it may not be ethically justifiable to withhold hearing aids long term. FUNDING: The review had no dedicated funding. REGISTRATION: Registration (2015) PROSPERO: CRD42016043834 Protocol (2015) DOI: 10.1002/14651858.CD012023 Original review (2017) DOI: 10.1002/14651858.CD012023.pub2.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Incidence and Risk Factors for Free Flap Compromise in Head and Neck Reconstruction: A Meta-Analysis.
OBJECTIVE: Microvascular free flap reconstruction is the gold standard for head and neck defects, but flap compromise remains a primary cause of reconstructive failure. This study aims to evaluate the pooled incidence of flap compromise and total flap failure, and to identify risk factors to optimize perioperative management. DATA SOURCES: A systematic search was conducted across PubMed, MEDLINE, Embase, the Cochrane Library, and Web of Science for studies published up to September 1, 2025. REVIEW METHODS: This meta-analysis followed the PRISMA guidelines. Two independent reviewers screened the literature, extracted data, and assessed study quality using the Newcastle-Ottawa Scale (NOS). Random-effects models were used to calculate pooled incidences and odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Forty-seven studies involving 30,002 free flaps were included. The pooled incidence of flap compromise was 8.2% (95% CI: 6.6%-9.9%), with a complete failure rate of 3.9% (95% CI: 3.2%-4.7%). Flap compromise was significantly associated with prior radiotherapy (OR = 3.98). Other significant non-modifiable factors included diabetes (OR = 2.20), advanced age (OR = 1.35), and high comorbidity scores (OR = 1.68). Importantly, several modifiable factors were identified as critical drivers, including fluid overload (OR = 2.57), prolonged operative time (OR = 2.14), low serum albumin (OR = 2.06), low BMI (OR = 1.75), and low hemoglobin (OR = 1.34). CONCLUSION: Free flap compromise remains a clinically significant complication. These findings support integrating modifiable physiological markers into preoperative risk stratification and implementing targeted, multidisciplinary optimization strategies to improve flap outcomes.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Letter to the Editor Regarding "Therapeutic Effects and Mechanisms of Olfactory Training in a Murine Model of Olfactory Dysfunction".
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Preoperative Visualization of the Intraparotid Facial Nerve-Tumor Relationship in Parotidectomy.
Preoperative visualization of the intraparotid facial nerve remains challenging with conventional imaging. This retrospective case series evaluated the feasibility of three-dimensional double-echo steady-state with water excitation magnetic resonance imaging for identifying the intraparotid facial nerve and its relationship to parotid tumors. Fifteen lesions in 14 patients who underwent parotidectomy with preoperative imaging using this sequence were analyzed. The main trunk and major divisions were identified in 14 of 15 lesions (93%). Three-dimensional reconstructions demonstrated the tumor-main trunk relationship, and findings were concordant with intraoperative observations in all evaluable cases, including in the setting of distorted anatomy. Visualization of distal branches was limited. These findings suggest that this imaging technique enables preoperative assessment of the intraparotid facial nerve and may support surgical planning in anatomically complex cases.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Topical Intranasal Treatments for Epistaxis in Hereditary Hemorrhagic Telangiectasia: A Systematic Review.
OBJECTIVE: To characterize the landscape of topical intranasal therapies in hereditary hemorrhagic telangiectasia (HHT) associated epistaxis, evaluate comparative effectiveness versus placebo, and define their potential adjunctive role within evolving treatment paradigms. DATA SOURCES: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and the WHO-ICTRP were searched through May 2025. REVIEW METHODS: English-language studies of adults with HHT treated with topical agents for epistaxis were included. Study selection and data extraction were performed using Covidence in accordance with PRISMA guidelines. Risk of bias was assessed using Joanna Briggs Institute (JBI) checklists. Due to study heterogeneity, results were synthesized narratively. RESULTS: Of 310 records, 20 studies met inclusion (n = 590). Within-group reductions in Epistaxis Severity Score (ESS) were frequently observed; however, no topical class demonstrated consistent superiority over placebo in randomized controlled trials. Bevacizumab showed the largest reduction in ESS among case series (mean -3.3, n = 26). Across all agents, adverse events were uncommon and primarily limited to mild localized irritation. CONCLUSIONS: Current evidence does not support durable or clinically meaningful efficacy of topical intranasal monotherapy beyond placebo for HHT-related epistaxis. However, this absence of definitive efficacy reflects a structural evidence gap rather than a lack of biologic plausibility or patient-centered benefit. Given the phenotypic heterogeneity of HHT and the biologic variability in treatment response, topical agents remain clinically relevant as frontline adjunctive options for otolaryngologists managing this condition before systemic therapies become necessary. This review provides a framework for evidence-informed agent selection in the context of multimodal HHT care.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Treatment Strategies and Outcome in Minimally Invasive, Gland-Preserving Treatment for Multiple Sialolithiasis.
OBJECTIVE(S): Minimally invasive procedures are well established for patients with sialolithiasis involving single stones. For patients with multiple sialolithiasis, few data are available regarding the treatment approaches and outcomes with gland-preserving therapies. The aim of this study was to review current treatment concepts and postinterventional outcomes in these patients and to propose a treatment algorithm. STUDY DESIGN: Retrospective study. SETTING: University hospital and tertiary referral center. METHODS: The study was conducted to evaluate therapeutic effectiveness and outcome in patients who presented with multiple sialolithiasis in the major salivary glands between January 2016 and October 2022. All patients received minimally invasive treatment following established treatment algorithms. RESULTS: In 177 patients with multiple sialolithiasis, 556 stones were treated using a minimally invasive treatment regimen, with a mean of 2.55 interventions per patient. Monomodal therapy was carried out in 54.8% of the patients and multimodal therapy in 45.2%. Stone-free and/or symptom-free status was achieved for all patients with stones in the submandibular glands and for 97.6% of those with stones in the parotid glands. Gland preservation was possible in 97.2% of the patients, with no significant differences between the submandibular glands (97.8%) and parotid glands (95.2%; P = .371). CONCLUSION: Multiple sialolithiasis can be treated with high success rates. In nearly half of the patients, a multimodal minimally invasive treatment regimen is needed in order to achieve stone-free and/or symptom-free status and preservation of the gland-both possible in over 97% of cases.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Drug-Induced Sleep Endoscopy Findings in Obese Adolescents With Sleep Apnea.
OBJECTIVE: Data regarding drug-induced sleep endoscopy (DISE) findings in obese adolescents with obstructive sleep apnea (OSA) are lacking; such information could be used to direct and improve management as there is controversy whether adenotonsillectomy (AT) or positive airway pressure is standard therapy for this population. Our primary objective is to describe DISE findings in obese adolescents. STUDY DESIGN: Case-control. SETTING: Tertiary care children's hospital. METHODS: A 10-year retrospective review was conducted of obese adolescents 12 to 21 years old with OSA (apnea-hypopnea index [AHI] ≥ 1) that underwent DISE prior to AT. All DISE procedures were scored utilizing a modified VOTE classification. RESULTS: Forty surgically naïve obese adolescents underwent DISE. Median age of the adolescents was 16 (interquartile range [IQR] 3.0) years. The majority of patients had severe disease with a median AHI of 44 (IQR 46). The most common site of collapse noted on DISE was the oropharynx/lateral oropharyngeal walls, occurring in 93.3% (n = 36) of obese adolescents. Complete tongue base obstruction was infrequent, occurring in only 12.8% (n = 5) of obese patients. While the majority (n = 31, 80%) of obese patients had multilevel obstruction, median AHI was not associated with multilevel collapse (diff 19.2, 95% CI [-44.1, 5.7], P = .13). CONCLUSION: The most common site of collapse found on DISE in surgically naïve obese adolescents is the oropharynx. Multilevel upper airway obstruction is common among obese adolescents with OSA. Future research is needed to assess if DISE-directed multilevel sleep surgery improves outcomes in this challenging-to-treat population.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Examining Practice and Payment Gaps in Otolaryngology: Evidence from US Medicare Data.
OBJECTIVE: To assess longitudinal differences in Medicare reimbursement, billing patterns, and service composition among US otolaryngologists. STUDY DESIGN: Retrospective cohort study. SETTING: Centers for Medicare & Medicaid Services (CMS) Medicare fee-for-service database. METHODS: Medicare claims data from 2013 to 2022 were analyzed for US-practicing otolaryngologists. Outcomes included total and per-service charges and reimbursements, service volume, billing diversity, and practice characteristics. Multivariable regression models adjusted for years in practice, geographic region, and clinical volume. Sensitivity analyses assessed inflation-adjusted and log-transformed payment trends over time. RESULTS: Among 11,010 otolaryngologists, female physicians had fewer years in practice, treated fewer Medicare beneficiaries annually, and billed fewer unique CPT codes than male physicians. In 2022, females received an average of $56,401 (95% CI [$40,805-$71,998]) in Medicare reimbursement compared with $89,880 (95% CI [$82,941-$97,270]) for males. Across top codes, females had lower mean submitted charges (females $63,755 [$59,501-$68,009] vs males $97,834 [$95,489-$100,179]) and reimbursements per service (females $28,894 [$22,692-$23,097] vs males $29,061 [$28,920-$29,202]). Adjusted regression models showed that female physicians were reimbursed 5.3% less per service on average across all services (95% CI [2.7%-8.2%]). A sensitivity analysis of log-transformed payments demonstrated a 1% annual decline in Medicare reimbursement regardless of gender, with a significant gender-year interaction (P = .002). CONCLUSIONS: Despite increasing representation and gross reimbursement, female otolaryngologists consistently received lower Medicare reimbursement than male peers. These findings suggest systemic differences in billing patterns, coding practices, and institutional support. Interventions to address billing education, infrastructure, and equitable compensation models should be explored to mitigate reimbursement differences in otolaryngology.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Glucagon-Like Peptide-1 Receptor Agonists for Obstructive Sleep Apnea With and Without Continuous Positive Airway Pressure.
OBJECTIVE: To evaluate glucagon-like peptide 1 receptor agonists for obstructive sleep apnea compared with controls. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and Scopus. REVIEW METHODS: A PRISMA-compliant search was conducted from database inception through October 2025. Randomized controlled trials evaluating glucagon-like peptide 1 receptor agonist use (liraglutide and tirzepatide) for obstructive sleep apnea were included. The primary outcome was the change in apnea-hypopnea index. Data on apnea-hypopnea index, body weight, waist circumference, blood pressure, inflammatory markers, and adverse events were extracted and stratified by continuous positive airway pressure use. Outcomes were summarized as mean differences (Δ) with 95% confidence intervals (CI). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. RESULTS: Of 3,836 articles screened, five studies met the inclusion criteria, comprising 948 patients (479 GLP-1; 469 control). Glucagon-like peptide 1 receptor agonists reduced apnea-hypopnea index by 12.4 events/hour more than controls (95% CI: -17.2 to -7.7; P < .00001), independent of continuous positive airway pressure use. Glucagon-like peptide 1 receptor agonists produced greater weight loss (Δ: -12.5%; 95% CI: -22.0% to -3.0%; P = .01) and reduced waist circumference (Δ: -3.3 cm; 95% CI: -4.4 to -3.2; P < .00001). Systolic and diastolic blood pressure decreased by 4.5 mmHg (95% CI: -6.4 to -2.7) and 1.30 mmHg (95% CI: -2.59 to -0.01), respectively. Gastrointestinal adverse events were more common with glucagon-like peptide 1 receptor agonists. CONCLUSION: Glucagon-like peptide 1 receptor agonists produced clinically meaningful improvements in obstructive sleep apnea severity, independent of continuous positive airway pressure use.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Minimal Clinically Important Difference of Reflux Symptom Score, Reflux Symptom Score-12, and Reflux Symptom Index.
OBJECTIVE: To establish the minimal clinically important difference (MCID) of reflux symptom score (RSS), reflux symptom score-12 (RSS-12), and Reflux Symptom Index (RSI). DESIGN: Prospective study. SETTING: University hospital. METHOD: Patients with laryngopharyngeal reflux disease (LPRD) at 24-hour hypopharyngeal-esophageal impedance pH monitoring were prospectively recruited from the European Reflux Clinic. Pretreatment to posttreatment symptoms and findings were assessed with RSS, RSS-12, RSI, and reflux sign assessment (RSA). Baseline LPRD severity (mild, moderate, severe) was determined using the RSS-Quality-of-Life (RSS-QoL). Therapeutic response was defined as improvement by at least one severity category regarding the IFOS classification based on post-treatment RSS-QoL. MCID was evaluated using receiver operating characteristic (ROC) curve analysis and Youden-index. RESULTS: Evaluation was completed by 351 consecutive patients (208 females), including 127 responders to treatment (36.2%) and 224 (63.8%) partial or nonresponders. RSS-QoL demonstrated strong correlations with RSS (ρ = 0.697), RSS-12 (ρ = 0.783), and RSI (ρ = 0.776; all P < .001), validating its use as anchor. Responders showed significantly greater score improvements than non-responders for all patient-reported outcome measures (P < .001). ROC analysis revealed excellent discriminative ability for RSS (AUC = 0.822; 95% CI: 0.78-0.87), RSS-12 (AUC = 0.827; 0.78-0.87), and RSI (AUC = 0.867; 0.76-0.97). MCID values were 35 points for RSS, (sensitivity 81.1%, specificity 69.6%), 20 points for RSS-12 (sensitivity 85.3%, specificity 68.2%), and 8 points for RSI (sensitivity 77.3%, specificity 88.6%). CONCLUSION: The MCID for improvement in RSS, RSS-12, and RSI in LPRD patients is a decrease of 35, 20, and 8 points, respectively. This information improves the understanding of therapeutic response, allowing for drug class discontinuation and weaning.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Plateau in Growth or Losing Influence? Costs and Shifting National Trends of Ankyloglossia Treatment 2010-2022.
OBJECTIVE: The primary objective of this study was to evaluate demographic trends and financial impacts of ankyloglossia treatments across privately insured pediatric patients in inpatient and outpatient settings. STUDY DESIGN: Retrospective database analysis. SETTING: The Merative™ MarketScan® Commercial Claims and Encounters Database 2010 to 2022. METHODS: Within the MarketScan database, we identified infants (age <1 year) who had diagnoses of ankyloglossia and received surgical treatment for ankyloglossia. Sociodemographic variables included sex and geographic location. Financial variables included copays, deductibles, net payments, and billing provider type. RESULTS: A total of 10,353,534 unique infants were captured within the database. From 2010 to 2022, the annual rate of ankyloglossia diagnosis increased from 0.77% to 4.03%, and the annual rate of surgical treatment of ankyloglossia increased from 0.47% to 1.78%, plateauing after 2018. The percentage of medical claims from dental specialists and nurse practitioners increased from 1.7% to 13.1% and from 0.08% to 5.33%, respectively. A total of $45.8 million was billed for surgical procedures in infants. The cost per infant increased 33% from $350.79 to $467.08. Out-of-pocket costs per infant increased 109% from $56.26 to $117.85. CONCLUSION: We demonstrate increases in the number of claims and associated costs for procedures in the treatment of ankyloglossia. The true medical costs of this condition are likely higher, as we do not capture procedures uncovered by insurance. Despite increased diagnosis of ankyloglossia, there is a surprising plateau in the frequency of frenotomy in recent years, suggesting either market saturation or shifts in treatment away from medical specialties.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Symptom Burden and Sexual Quality of Life in Women With Idiopathic Subglottic Stenosis.
OBJECTIVE: To evaluate the connection between symptom burden and sexual quality of life in women with idiopathic subglottic stenosis (iSGS). iSGS is a rare fibroinflammatory disorder involving progressive airway narrowing and respiratory distress. While the impact on physical functioning is well-established, the influence of iSGS on sexual health, a key component of quality of life, remains unexplored. STUDY DESIGN: Anonymized cross-sectional survey using validated questionnaires. SETTING: Online international iSGS support group (Living with Idiopathic Subglottic Stenosis). METHODS: The Dyspnea Index (DI), the Female Sexual Quality of Life (SQOL-F) questionnaire, and the Medical Outcomes Health Survey (SF-36) were distributed to an iSGS support group. Only complete responses were analyzed. Associations between DI and sexual quality of life were evaluated using correlation and linear regression. Median-based symptom burden groupings were used for secondary descriptive comparisons. RESULTS: 682 completed all items in the assigned questionnaires and met inclusion criteria. DI scores were inversely correlated with SQOL-F (Rho = -0.305, P < .001). SQOL-F was consistently lower among those with high symptom burden across nearly all items; only partner communication showed no difference. Each one-point increase in DI predicted a 0.61-point decrease in SQOL-F (B = -0.609, P < .001). High-burden patients also reported significantly lower SF-36 Physical (PCS) and Mental (MCS) Component Scores. CONCLUSIONS: Greater airway symptom burden in iSGS is associated with significantly diminished sexual and general health-related quality of life. These findings reinforce a need for patient-centered care that considers both physical and psychosocial well-being.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Awake Blue Laser Excision and Balloon Dilation of Oropharyngeal Stenosis in High-Risk Patients.
Oropharyngeal stenosis is a rare condition that can develop following head and neck cancer treatment, leading to progressive dyspnea, dysphagia, and dysphonia. Patients with symptomatic dyspnea may benefit from endoscopic surgery. However, head and neck cancer survivors can have severe trismus, limited neck extension, and altered laryngeal landmarks, which make rigid endoscopic surgery under general anesthesia high-risk or potentially not feasible without a tracheostomy tube. We describe an awake approach for the management of oropharyngeal stenosis for 2 head and neck cancer survivors with high-risk airways. Briefly, under monitored anesthesia care in the operating room, a flexible channeled nasolaryngoscope was utilized to perform awake blue light laser excision of stenosis followed by balloon dilation. Postoperatively, both patients reported symptomatic improvement, and objective increases in airway patency were noted at clinic follow-up. This operative technique represents a feasible, well-tolerated approach for high-risk airway patients with oropharyngeal stenosis.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Bell's Palsy in 11,255 Cases: Cardiometabolic Associations in a Population-Based Healthcare Database.
OBJECTIVE: To estimate Bell's palsy incidence and evaluate the prevalence and associations with diabetes and other cardiometabolic conditions. STUDY DESIGN: Population-based cohort study. SETTING: Clalit Health Services, the largest healthcare provider organization in Israel (2005-2022). METHODS: Bell's palsy cases were identified by ICD-10 code G51.0 (n = 11,255). To optimize specificity, individuals with secondary facial palsy codes or competing acute etiologies within ±30 days were excluded. Members without Bell's palsy served as controls. Annual incidence per 100,000 person-years. Multivariable logistic regression adjusted for age, gender, socioeconomic status, and ethnicity; Bonferroni correction applied. Age-stratified and ≥40-year sensitivity analyses were performed. Systemic corticosteroid dispensing was evaluated in peri-index and extended capture windows. RESULTS: Among 5,489,298 members, 11,255 were diagnosed with Bell's palsy (median age, 51 years); about one-third occurred at ages 50 to 69 years. Incidence was ~18 per 100,000 person-years. Diabetes was more prevalent among cases than controls (21% vs 6%; standardized mean difference [SMD] = 0.45) and independently associated with Bell's palsy (adjusted odds ratio [aOR], 1.63), persisting across age groups and in the ≥40-year sensitivity analysis. Diabetic retinopathy and nephropathy were also associated (aOR 1.97 and 1.41). Stroke, smoking and obesity were also independently associated with Bell's palsy. Hypertension was more prevalent among cases but was not independently associated after Bonferroni correction and age-restricted analyses. CONCLUSION: Bell's palsy incidence remained stable throughout the 18-year study period and was associated with diabetes and diabetes-related complications. While current guidelines do not recommend routine HbA1c testing in patients with Bell's palsy, our findings support considering targeted diabetes screening and assessment of glycemic status and diabetes-related complications.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Clinic-Based Transnasal Marsupialization for the Treatment of Congenital Dacryocystocele.
OBJECTIVE: To evaluate the feasibility and outcomes of endoscopic intranasal marsupialization as treatment for congenital dacryocystocele, performed under topical anesthesia in a clinical setting. STUDY DESIGN: A retrospective review was conducted at a tertiary pediatric care hospital spanning from 2014 to 2024. SETTING: 23 infants under 1 year of age who underwent marsupialization under topical anesthesia for the treatment of a dacryocystocele were identified and their medical records were analyzed. No control group was used for this study. METHODS: Through a review of patient's medical files, the surgical technique used for cases of marsupialization under topical anesthesia in our medical center was documented and described. RESULTS: The primary outcome was the success rate of marsupialization procedures under topical anesthesia, defined as nonrecurrence. Secondary outcomes comprised periprocedural and postprocedure complications. The age of the patients at diagnosis ranged from 7.1 to 16.4 days. Among the 23 patients, 19 (83%) had previously failed conservative treatment before undergoing surgical intervention. Two patients (9%) experienced recurrent dacryocystocele. There were no perioperative or postoperative complications observed. Following the procedure, the most prevalent persistent symptom was nasal congestion, observed in 4 patients (17%). The mean time to treatment was 4.4 days and the overall hospital duration post-procedure was 0.4 days. CONCLUSION: This study underscores the efficacy and safety of clinic-based endoscopic intranasal marsupialization for treating dacryocystocele. This approach expedites surgical care, eliminates the requirement for general anesthesia and allows a reduced hospital stay, making it a favorable treatment option in clinical practice.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Frailty Severity and Voice Outcomes After Type 1 Thyroplasty.
OBJECTIVE: Frailty is associated with high mortality and morbidity, even for low-risk procedures. The role of frailty in postoperative quality of life is not well characterized. We studied the relationship between frailty and voice outcomes after type 1 thyroplasty. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care voice center. METHODS: Data were collected for type 1 thyroplasties performed 2017 to 2024. Voice was evaluated preoperatively and postoperatively with perceptual voice measures (grade, roughness, breathiness, asthenia, and strain [GRBAS]) and Voice Handicap Index-10 (VHI-10). Frailty was measured using the Modified Frailty Index-5 (MFI-5). Data were compared using analysis of variance. RESULTS: In total, 127 patients underwent surgery (59 female, 47%); 79 were for vocal fold motion impairment (62.2%) and 48 atrophy (37.8%). Mean age was 61.0 (95% confidence interval [CI] 58.5-64.5). In total, 39 had an MFI-5 score of 0 ("robust," 30.7%), 48 MFI-5 = 1 ("pre-frail," 37.8%), and 40 MFI-5 = 2 or more ("frail," 31.4%). Preoperative voice measures were similar across cohorts except for breathiness, which was greater among frail patients (P = .0245). Improvements in perceptual voice outcomes were seen in all groups. The improvement in breathiness was greater among frail patients (-1.4, 95% CI -1.0 to -1.8) compared to pre-frail (-0.8, -0.5 to -1.1) and robust (-0.7, -0.2 to -1.1, P = .0203). Forty-eight patients had preop and postop VHI-10 data. Patients had similar improvement in VHI-10 across levels of frailty (P = .5954). CONCLUSION: Improvements in voice after type 1 thyroplasty were similar across levels of frailty. This was true for both atrophy and unilateral vocal fold immobility.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Hospitalization Utilization Metric After Major Oncologic Head and Neck Surgery With Microvascular Free Flap.
OBJECTIVE: The primary length of stay (PLOS) metric fails to capture added time, costs, and reduced patient quality of life (QOL) associated with readmissions. To address these limitations, we propose a novel metric, the hospitalization utilization metric (HUM), which integrates PLOS and readmission LOS (RLOS). STUDY DESIGN: Retrospective review of 626 head and neck microvascular free flap (MVFF) cases from August 2019 to May 2024. SETTING: University of Pittsburgh Medical Center. METHODS: Main outcome measure was HUM, calculated as total length of stay (TLOS) (TLOS = [PLOS + RLOS]/60 days). High HUM, determined by median split, was >0.18. RESULTS: Our 626-patient cohort averaged 62.7 ± 11.9 years old. The majority of patients were male (68.2%), white (92.0%), with advanced tumors (III/IV: 74.1%), and public insurance (63.1%). The median (interquartile range [IQR]) PLOS was 9 (7-14), median (IQR) HUM was 0.18 (0.13-0.28), and the rate of 60-day re-presentation/readmission was 34.3%. Multivariable logistic regression identified postoperative complications (β: .08, P < .001; β: 4.44, P < .001, respectively) and private insurance (β: -.04, P < .02; -2.71, P < .01) as predictive factors associated with both higher HUM and PLOS (>9 days), respectively. Return to intensive care unit (ICU) (β: .08, P < .003) and duration of surgery (β: .005, P < .048) were independently associated with higher HUM, although both effect sizes are relatively small. Kaplan-Meier survival curves revealed that higher HUM (P = .030) but not PLOS (P = .098) was associated with worse survival 1 year postoperatively. CONCLUSION: HUM provides a comprehensive assessment of healthcare utilization compared to PLOS and re-presentation alone and may be a practical surrogate for patient QOL and healthcare costs.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
In-Office Tympanostomy Tube Placement in Awake Pediatric Patients: A Meta-analysis of Proportions.
OBJECTIVE: To evaluate the feasibility, effectiveness, and safety of in-office tympanostomy tube placement (TTP) performed in awake pediatric patients without general anesthesia. DATA SOURCES: We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception through March 20, 2025. REVIEW METHODS: We screened the abstracts of potentially eligible studies and subsequently assessed the full-text reports of those deemed relevant in detail. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Study quality and risk of bias were assessed using the ROBINS-I tool for non-randomized studies and the AXIS tool for the single cross-sectional study. Meta-analyses of proportions were conducted in R using the meta package. RESULTS: Eleven studies met inclusion criteria. Office-based TTP demonstrated a high pooled procedural success rate of 97% (95% CI, 0.89-0.99; P < .01; I= 86.4%). Pain levels were low, with a mean Face, Legs, Activity, Cry, and Consolability (FLACC) score of 1.26 (95% CI, 1.10-1.45; I= 0%), consistent with mild discomfort. Parental satisfaction was uniformly high at 95% (95% CI, 0.92-0.97; I= 0%). Adverse events were infrequent, generally mild, and comparable in severity to those reported for operating-room tympanostomy under general anesthesia. CONCLUSION: Office-based TTP in awake pediatric patients appears to be a safe, effective, and well-tolerated alternative to operative tympanostomy under general anesthesia, offering high success rates, minimal discomfort, and strong caregiver acceptance while reducing anesthesia exposure and healthcare costs.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Incidence of Chronic Rhinosinusitis in Patients Who Receive Rituximab.
OBJECTIVE: Rituximab causes B-cell depletion and hypogammaglobulinemia, increasing risk for infections. This study aims to determine the incidence of chronic rhinosinusitis (CRS) in patients following rituximab therapy. STUDY DESIGN: Retrospective cohort study using chart review of patients prescribed rituximab between January 2019 and January 2025. SETTING: Multisite study across Mayo Clinic Enterprise locations in Arizona, Florida, Minnesota, and Wisconsin. METHODS: Patients with documented rituximab use were included; those with pre-existing CRS were excluded. Demographic and clinical data-including timing and duration of rituximab therapy, CRS diagnosis, comorbidities (asthma, allergic rhinitis, GERD), and need for sinus surgery-were collected. Descriptive statistics summarized patient characteristics. Group comparisons were performed using t-tests, Mann-Whitney U, and chi-square tests. Analyses were conducted using SPSS v28. RESULTS: Among 17,851 patients prescribed rituximab (median age 64.0 years, M:F ratio 1.1:1), 1105 (6.2%) developed CRS, with an annual incidence of 1.03% (1032 cases per 100,000 person-years). The median duration of rituximab therapy for those diagnosed with CRS was 5.9 months (IQR, 0.5-42.6). Most CRS cases occurred after rituximab discontinuation (62.7%, n = 693) compared to during active treatment (37.3%, n = 412). The median delay between rituximab discontinuation and CRS diagnosis was 17.0 months (IQR, 4.3-41.7). CONCLUSIONS: This study demonstrates an annual incidence of 1.03% for CRS diagnoses following rituximab. While prior studies report varying CRS incidences in the general population (0.25%-0.73%), our findings suggest increased risk among rituximab users. Most CRS diagnoses occurred after rituximab discontinuation, emphasizing the need for a comprehensive medication history review during CRS evaluation.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Isolated Adenoidectomy for Pediatric Sleep-Disordered Breathing: A Systematic Review and Meta-analysis.
OBJECTIVE: To evaluate the efficacy of isolated adenoidectomy in managing pediatric sleep-disordered breathing (SDB) and upper airway obstruction (UAO). DATA SOURCES: MEDLINE, EMBASE, and CENTRAL were systematically searched from inception through March 2025. REVIEW METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we included studies reporting outcomes of isolated adenoidectomy in children with SDB and UAO. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A meta-proportion analysis was conducted to evaluate symptomatic improvement and the need for further surgical intervention. RESULTS: Twenty-two observational studies including 4460 children were analyzed. The weighted mean age was 5.2 years. Isolated adenoidectomy led to a mean apnea-hypopnea index reduction of 11.3 events/h across four studies. The pooled proportion of symptomatic improvement was 75% (95% CI 60-88), while the pooled rate of further surgical intervention was 17% (95% CI 11-24). Subgroup analyses suggested greater symptomatic improvement and lower reoperation rates in children older than 3 years. CONCLUSION: Isolated adenoidectomy improves both objective sleep parameters and subjective outcomes. In appropriately selected children, it may represent a conservative alternative to adenotonsillectomy. These findings, however, require confirmation through well-designed randomized controlled trials.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Management of Malignant Salivary Gland Tumors: A 20-Year SEER Database Analysis.
OBJECTIVE: Malignant salivary gland tumors represent a heterogeneous group of neoplasms with variable management. This study evaluated trends in therapeutic approaches to these cancers to inform evidence-based, personalized care and optimize patient outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Population-based analysis using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Cases of malignant salivary gland tumors diagnosed between 2000 and 2021 were categorized by treatment modality and stage at diagnosis. Trends over time were assessed using JoinPoint segmented log-linear regression. RESULTS: A total of 24,029 patients were included. Surgery alone (36.3%) and surgery with adjuvant radiation (36.5%) comprised the majority of treatments. Chemotherapy alone increased significantly over time (annual percent change [APC] +5.81%; 95% CI, 3.46-9.24; P < .05), though it remained infrequently used. Combined modalities including surgery, chemotherapy, and radiation also showed modest growth over the study period. Stage analysis revealed increasing proportions of localized and regional tumors and a decline in distant disease. CONCLUSION: Surgery remains the cornerstone of malignant salivary gland tumor management, but use of combined treatment approaches is rising, likely reflecting advances in systemic therapies and radiation techniques. Awareness of these trends is critical for guiding multidisciplinary, personalized care. Future studies integrating clinical outcomes and histologic subtype are warranted to clarify the role of expanding systemic and combined modalities.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Management Patterns and Outcomes of Vestibular Schwannoma in Older Adults: Assessment of the SEER Database.
OBJECTIVE: Vestibular schwannoma (VS) is a benign intracranial tumor that is increasingly diagnosed in older adults. The relative contributions of tumor burden and surgical management to overall survival in elderly and very elderly patients remain incompletely characterized at a population level in VS patients. STUDY DESIGN: Retrospective Cohort. SETTING: SEER Database study between the years 2000 and 2022 to identify patients aged 70 to 89 years diagnosed with VS. METHODS: Patients were stratified into very elderly (80-89 years) and elderly (70-79 years) cohorts. Overall survival was assessed using Kaplan-Meier methods and multivariable Cox proportional hazards models. RESULTS: A total of 4156 patients were included (950 aged 80-89 years; 3206 aged 70-79 years). Overall survival was shorter in patients aged 80 to 89 years (median 46 months) compared with those aged 70 to 79 years (median 61 months) (P < .001). In the 80 to 89-year cohort, tumor size was independently associated with mortality when modeled continuously (HR 1.07 per 10-mm increase; 95% CI 1.03-1.12; P < .001). In a subanalysis of surgical patients aged 80 to 89 years, tumors ≤32 mm were associated with better overall survival compared with tumors >32 mm (HR 0.23; 95% CI 0.10-0.57; P = .001). In patients aged 70 to 79 years, survival differed by resection group, and gross total resection was associated with overall survival in adjusted analyses (HR 1.48; 95% CI 1.13-1.93; P = .005). CONCLUSION: In this dataset, surgical resection status was not associated with overall survival in patients aged 80 to 89 years, whereas associations between resection status and overall survival were observed in patients aged 70 to 79 years. These findings should be interpreted cautiously because this study cannot account for treatment-selection factors such as frailty, comorbidity burden, symptom severity, or treatment intent.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Molecular Biomarkers in Meniere's Disease: A Scoping Review of Current Evidence.
OBJECTIVE: Meniere's disease is a complex chronic inner ear condition that is characterized by vertigo, tinnitus, aural fullness, and progressive hearing loss. Currently, diagnostic strategies remain symptom-driven, and treatments focus on management of discrete episodes rather than targeting underlying pathophysiology. This review sets out to evaluate the diagnostic and therapeutic utility of molecular biomarkers derived from blood and endolymphatic fluid in MD. DATA SOURCES: A comprehensive literature search was conducted using OVID Medline, Ovid EMBASE, EBSCO CINAHL, Web of Science Core Collection, ProQuest Dissertations, and the Cochrane Library, utilizing controlled vocabulary (MeSH/Emtree terms) and related keywords. REVIEW METHODS: Following PRISMA guidelines, 2 independent reviewers performed the study screening, data extraction, and bias assessment of the isolated studies. RESULTS: The 21 studies consisted of case-control (71.4%), randomized trials or reviews (14.4%), cohort (9.5%), and case series (4.8%). Isolated biomarkers were classified as structural (24%), regulatory (24%), immunologic/oxidative stress (38%), and miscellaneous (14%). Structural proteins, such as otolin-1, otoconin-90, demonstrated potential in distinguishing MD from other vestibular disorders. Regulatory biomarkers (aquaporin-2, vasopressin-related peptides) were linked to fluid abnormalities. Inflammatory cytokines (TNF-α, IL-6, and IL-1β) and oxidative stress markers (4-HNE) highlighted disease heterogeneity. Additional findings such as unique vitamin D, estradiol, and altered metabolomic profiles suggested hormonal and metabolic changes. CONCLUSION: Molecular biomarkers offer critical insights into MD pathogenesis as well as potential diagnostic and therapeutic advancements. However, methodological variability and lack of replication necessitate standardized validation before formal clinical application.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Preliminary Experience of Combined Endoscopic Tympanic Membrane Reinforcement and Tube Occlusion for Patulous Eustachian Tube.
OBJECTIVE: Tympanic membrane reinforcement and eustachian tube occlusion are procedures for treating chronic, refractory patulous eustachian tube (PET). But previous studies reported variable and unsatisfactory efficacy. This study aims to investigate the effect of combined tympanic membrane reinforcement and eustachian tube occlusion under transcanal endoscopic for treating PET. STUDY DESIGN: Retrospective study. SETTING: Academic medical center. METHODS: Outcomes were assessed using a three-item Visual Analog Scales (VAS) score including voice autophony, aural fullness, and breathing autophony at 1, 3, and 6 months postoperatively. RESULTS: A total of 19 ears from 19 patients were included. Transcanal endoscopic tympanic membrane reinforcement combined with eustachian tube occlusion was performed successfully in all cases without major complications. VAS scores for voice autophony, aural fullness, and breathing autophony were significantly decreased at 1, 3, and 6 months postoperatively. The overall efficacy rate was 84.2%. CONCLUSION: These preliminary findings reveal the feasibility of a transcanal endoscopic tympanic membrane reinforcement and eustachian tube occlusion combination approach as a potential therapeutic strategy for PET.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Regenerative Injection Laryngoplasty With Scaffold-Forming Oligomer and Autologous Motor Endplate-Expressing Cells: A 6-Month Porcine Study.
OBJECTIVE: Injection laryngoplasty is a standard-of-care intervention for unilateral vocal fold paralysis (UVFP), offering minimally invasive medialization with limited durability. We evaluated a regenerative injectable approach integrating an immunotolerant scaffold-forming collagen (Oligomer) with autologous motor-endplate expressing (MEE) cells to support long-term augmentation and neuromuscular recovery. STUDY DESIGN: Porcine UVFP model. SETTING: Translational research laboratory. METHODS: Twelve Yucatan minipigs underwent right recurrent laryngeal nerve transection. Autologous muscle progenitor cells were isolated, differentiated, and induced into MEEs. Approximately 1 month after denervation, Saline, Oligomer, or MEE+Oligomer was injected into the paralyzed vocal fold. Outcomes were assessed through 6 months using videolaryngoscopy and acoustic vocalization analysis. Neuromuscular function was evaluated at baseline and 6 months using laryngeal electromyography (L-EMG) and laryngeal adductor pressure (LAP). Larynges were also harvested for volumetric ultrasound, histology, and gene expression analyses. RESULTS: All injections were well tolerated, with no evidence of foreign body response. Oligomer and MEE+Oligomer produced persistent augmentation, with MEE+Oligomer demonstrating laryngeal adductor muscle volumes statistically similar to contralateral controls at 6 months. Both treatments improved vocalization outcomes, and MEE+Oligomer was associated with greater neuromuscular function, as indicated by improved stimulated vocal fold adduction, L-EMG activity, and LAP responses. Histological analysis demonstrated identifiable scaffold integration with preservation of muscle morphology. CONCLUSION: In a porcine UVFP model, scaffold-forming Oligomer provided persistent, immunotolerant augmentation with sustained voice improvement. MEE incorporation supported enhanced neuromuscular function consistent with improved reinnervation. This regenerative injection laryngoplasty strategy integrates structural and biological mechanisms to address both mechanical and physiological deficits following UVFP.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Safety and Efficacy of the Versius Surgical System in Transoral Robotic Surgery: A Prospective Study.
OBJECTIVE: To evaluate the safety and feasibility of the Versius surgical robotic system for transoral robotic surgery in benign and malignant head and neck indications. STUDY DESIGN: Open-label, prospective, single-arm, phase II clinical trial. SETTING: Liverpool Head and Neck Centre, United Kingdom. METHODS: Between December 2023 and March 2025, 62 patients were enrolled, with 60 undergoing transoral robotic surgery on the Versius system. Eligible adults had either confirmed oropharyngeal or unknown primary squamous cell carcinoma, or benign indications (recurrent tonsillitis or peritonsillar abscess). The primary endpoint was successful procedure completion without conversion, and safety was assessed by 30-day complication incidence. Secondary endpoints included operative and setup times, blood loss, length of stay, nasogastric tube use, readmissions, reoperations and margin status in malignant resections. RESULTS: All 60 procedures were completed successfully without conversion. Median setup time was 10 minutes and operative time 46 minutes. Estimated blood loss was <100 mL in 98% of cases, with no transfusions required. Median hospital stay was 1 day, with a 35% same day discharge rate. No patient required nasogastric tube feeding. Eleven postoperative complications occurred (18.3%), none device-related, and a secondary hemorrhage rate of 6.7%. Among 28 oncological resections, 25 (89.3%) achieved negative margins, including 21 of 22 (95.7%) cases with T1-T2 disease. CONCLUSION: The Versius surgical robotic system demonstrated high procedural success, low morbidity and oncological outcomes comparable to established robotic platforms. It represents a safe and feasible robotic platform for integration into a contemporary head and neck transoral surgery practice.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Serum Levels of Prestin, Otoferlin, Connexin 26, and Stereocilin: A Biomarker Approach to Tinnitus.
OBJECTIVE: Tinnitus is a prevalent auditory disorder lacking objective diagnostic tools. An outer hair cell (OHC) protein, prestin, has been implicated in the pathophysiology of tinnitus. This study adopts a biomarker approach by quantifying serum levels of prestin, as well as functionally important inner ear proteins, otoferlin, connexin 26 (CX26), and stereocilin in individuals with and without tinnitus, to test the hypothesis that prestin plays a role in tinnitus. STUDY DESIGN: Observational cohort study. SETTING: Tertiary academic center. METHODS: In all, 82 participants (41 with chronic, bilateral, non-pulsatile tinnitus and 41 controls) underwent audiometry, 1-week personal noise dosimetry, Tinnitus Handicap Inventory (THI) assessment, and venipuncture. Serum concentrations of the four cochlear proteins were quantified via enzyme-linked immunosorbent assays. Statistical analyses included multivariate Quade ANCOVA to account for age, hearing thresholds, and daily noise exposure. RESULTS: Serum prestin levels were significantly higher in tinnitus subjects compared to controls (P = .006), and this difference remained significant after controlling for key covariates, noise, hearing loss, and age (P = .003). No significant group differences were found for otoferlin, CX26, or stereocilin. Prestin and stereocilin levels were positively correlated across subjects (ρ = .51, P < .001), with stronger correlations observed in the Tinnitus group. CX26 and stereocilin levels correlated with age and hearing thresholds but did not distinguish tinnitus status. No protein levels correlated with THI scores. CONCLUSION: Prestin, but not other protein levels, were elevated in tinnitus subjects, supporting a role for the OHCs in the pathophysiology of tinnitus. Other inner ear proteins may have a role as biomarkers of cochlear health.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Structural Racism and Head and Neck Cancer Risks and Outcomes: A Scoping Review.
OBJECTIVE: Persistent health inequities exist in Head and Neck Cancer (HNC) outcomes among racial and ethnic minority populations. Structural racism creates inequitable population-level risk for health conditions, including cancer. This study is the first to review the effects of structural racism on HNC risk factors and outcomes. DATA SOURCES: PubMed, Embase, Scopus, ProQuest, PapersFirst, MedNar, and Open Access Theses and Dissertations. REVIEW METHODS: PRISMA guidelines were utilized to search 7 databases from inception to May 6, 2024. 6734 deduplicated titles and abstracts were screened, of which 45 underwent full-text review. Thirty-one studies met the inclusion criteria of reporting a domain of structural racism impacting head and neck cancer risk factors or outcomes. RESULTS: Survival outcomes of HNC in racial and ethnic minority populations were associated with and compounded by neighborhood factors and socioeconomic status. Insurance status affected survival disproportionately in Black compared to White participants. Black participants demonstrated stronger estimates of association for higher intensity and duration of cigarette smoking. Perceived barriers to access to care among Black males contributed to delays in seeking treatment. Native Hawaiian and other Pacific Islanders were more likely to present with advanced-stage disease and had worse disease-specific survival compared to White populations. CONCLUSION: Structural racism significantly contributes to disparities in HNC risk factors and treatment outcomes experienced by racial and ethnic minorities in the United States. Further research is needed to evaluate structural racism domains to inform multi-level interventions to eliminate inequities in HNC among racial and ethnic minority populations.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Audiologic and Otolaryngologic Phenotype in WHIM Syndrome.
OBJECTIVE: WHIM syndrome (warts, hypogammaglobulinemia, infections, and myelokathexis syndrome) is an ultra-rare primary immunodeficiency disease caused by autosomal dominant hyperfunctional mutations in the chemokine receptor CXCR4. Otolaryngologists are frequently consulted to evaluate WHIM patients because of recurrent acute ear and sinus infections, particularly in early childhood; however, a systematic assessment of otolaryngologic and audiometric phenotypes is lacking. This study comprehensively describes the auditory and otolaryngology phenotype of WHIM syndrome. STUDY DESIGN: Prospective observational case-series. SETTING: Quaternary Care Research Facility. METHODS: We report qualitative and quantitative otolaryngologic and audiometric assessments for 44 WHIM patients followed at the National Institutes of Health Clinical Center (NIH CC) for up to 17 years. RESULTS: Thirty-five patients gave a history of recurrent otitis media and 29 had a history of chronic or recurrent sinusitis. Hearing loss, usually bilateral and ranging from mild to profound, was identified in 43% (n = 18) of patients. Two previously unreported otolaryngologic phenotypes were also identified: maxillary sinus hypoplasia (n = 19, 51%) and defective olfaction (n = 22, 73%), including 6 patients (27%) with anosmia. Neither impaired olfaction nor maxillary sinus hypoplasia was associated with upper respiratory infection frequency or severity. Two patients were diagnosed with human papillomavirus head and neck squamous cell carcinoma (HNSCC). CONCLUSION: The results reveal a possible noninfectious direct effect of hyperfunctional CXCR4 on paranasal sinus development and odorant sensing and demonstrate a high risk of hearing loss. Further, the results emphasize the importance of baseline assessment and careful follow-up of WHIM patients by otolaryngologists and audiologists. CLINICALTRIALS: gov NCT02231879 and NCT00128973.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Diagnostic Performance of Afirma Genomic Sequencing Classifier in Black and Hispanic Patients With Indeterminate Thyroid Nodules.
OBJECTIVE: About 20% of thyroid nodules detected on ultrasound are cytologically indeterminate (Bethesda categories III and IV), but the rate of malignancy of these nodules is less than 36%. The ability of Afirma Genomic Sequencing Classifier (GSC) to further risk-stratify indeterminate thyroid nodules among Black and Hispanic patients is understudied. STUDY DESIGN: Retrospective Chart Review. SETTING: Two Academic Medical Centers. METHODS: Black and Hispanic patients who underwent Afirma GSC from 2017 to 2024 were included. Demographics, clinical history, GSC results, and surgical pathology reports were captured. Univariate analysis was conducted to elucidate demographic and clinical characteristics of this population, and confusion matrices evaluated GSC test performance. RESULTS: 160 patients were included in this cohort with a median age at diagnosis of 51 years, 142 (88.8%) females, 86 (53.8%) Black, and 74 (46.2%) Hispanic. Median nodule size was 2.4 cm, 167 were Bethesda III, and 17 were Bethesda IV. Of the 184 Bethesda III and IV thyroid nodules tested with GSC, 131 (71.2%) were reported as benign. In total, 59 nodules (29.4%) were resected, with 19 malignancies. The observed values of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 89.5%, 78.2%, 32.1%, and 98.5%. For all specimens with oncocytic cytology (n = 45), the sensitivity, specificity, PPV, and NPV were 83.3%, 69.2%, 29.4%, and 96.4%, respectively. CONCLUSIONS: This represents the largest study of Afirma GSC involving Black and Hispanic patients. In this cohort, the diagnostic performance of the Afirma GSC was comparable to that observed in the original validation study.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Impact of COVID-19 Pandemic Response on Pediatric Mastoiditis-The Australian Experience.
OBJECTIVE: To assess the impact of COVID-19 pandemic response on the incidence and severity of pediatric mastoiditis in the Australian context. STUDY DESIGN: Retrospective case series. SETTING: Single tertiary pediatric referral hospital in Australia. METHODS: Retrospective review of pediatric patients (<18 years) admitted with acute mastoiditis (AM) from January 2012 to June 2025 was performed. Patients were categorized into time periods: pre-COVID, COVID, and post-COVID based on Australian health policy timelines. Baseline demographic and admission data were collected. The primary outcomes were AM incidence per emergency department (ED) admissions, mastoiditis complications and disease severity, surgical intervention and microbial spectrum. A subanalysis comparing prerestriction and postrestriction population was performed. RESULTS: 176 patients were assessed. AM incidence per ED admissions sharply increased in the post-COVID era and exceeded pre-COVID levels. The proportion of patients with intracranial complications increased sharply over time. Mastoidectomy rates doubled from 13.43% (pre-COVID) to 28.40% (post-COVID). Streptococcus anginosus was associated with 100% mastoidectomy rate and very severe disease (80%). Patients in the postrestriction period had 3 times greater risk of very severe disease compared to prerestriction: 18.4% vs 6.0%, RR, 3.07 (95% CI, 1.1-8.6), P = .03. CONCLUSION: An alarming increase in incidence and severity of pediatric AM in the postpandemic Australian population was identified. Vigilance of intracranial complications and rapid escalation of therapy are strongly recommended.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Role of Ankyloglossia as a Protective Factor in Management of Infants With Robin Sequence.
OBJECTIVE: Robin sequence (RS) is an anomaly of micrognathia, glossoptosis, and airway obstruction. This study aims to assess the role of ankyloglossia as a protective factor in infants with RS. STUDY DESIGN: Single institution and population-based inpatient registry analysis. SETTING: Academic medical center. METHODS: A retrospective 15-year single-institution chart review examined medical records of infants with RS at an urban tertiary care center. Data included patient characteristics, comorbidities/complications, airway interventions, and length of stay (LOS). Conclusions from this smaller sample were compared with analyses from a larger, less detailed, population-based inpatient registry using the Kids' Inpatient Database (2016 and 2019). To quantify associations between patient characteristics and interventions and ankyloglossia, prevalence rates and unadjusted and adjusted odds ratios (ORs) were used. RESULTS: In the single-institution analysis, five (8.8%) of 57 infants with RS had ankyloglossia. Ankyloglossia was negatively associated with hypoventilation (P = .024), need for airway intervention (P < .001), number of airway interventions (P < .001), and total and NICU LOS (P = .001). In the nationwide analysis, 45 (3.7%) of 1207 weighted hospital births with RS had ankyloglossia. Ankyloglossia was negatively associated with respiratory failure of newborn in both univariate and multivariate analysis (unadjusted OR 0.44, P = .027; adjusted OR 0.19, P = .005), as well as need for mechanical ventilation in univariate analysis (unadjusted OR 0.39, P = .022). CONCLUSION: In infants with RS, ankyloglossia may be protective against hypoventilation, mechanical ventilation, and the need for airway intervention.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Updated Practice Patterns for Adjuvant Treatment of Recurrent Laryngeal Papillomatosis.
OBJECTIVES: Adjuvant medical treatments are used to reduce recurrence rates of recurrent respiratory papillomatosis (RRP). Prior consensus statements on initiation of adjuvants may not reflect current practices, particularly given safety data published in the interval. The objective of this study is to distribute information on current practices in management of RRP, including the use of adjuvant medications, use of surgical modalities and other treatments, monitoring, as well as attitudes and philosophies. STUDY DESIGN: Survey study. SETTING: Email-distributed survey. METHODS: A survey was distributed to a large group of laryngologists and pediatric otolaryngologists and responses were collected and analyzed. RESULTS: Responses were collected from 86 surgeons, including 71 specific to adult patients and 16 specific to pediatric patients. Laryngologists reported a threshold of 2 surgeries per year to initiate intralesional adjuvant treatments, while pediatric otolaryngologists reported thresholds of 4 surgeries per year for intralesional bevacizumab and 5 surgeries per year for cidofovir. Variable responses between groups were reported for other factors leading to initiation of adjuvants, surgical tools used, practices around HPV vaccination and testing, monitoring, and attitudes and philosophies regarding treatment of RRP. CONCLUSION: Current practice patterns and attitudes reflect increased comfort with the initiation of adjuvant treatments earlier in the disease course. New medical treatments that promise a shift away from primarily surgical treatment are highly anticipated.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Deciphering the Inflammatory Network in Pediatric Recurrent Tonsillitis: The Role of TRAF6, IRAK1, and miR-146a-5p.
OBJECTIVE: To investigate the role of TNF receptor-associated factor 6 (TRAF6), interleukin 1 receptor-associated kinase 1 (IRAK1), and miR-146a-5p expression levels in the pathogenesis of recurrent tonsillitis. STUDY DESIGN: Case-control study. SETTING: The study was conducted at the Department of Otorhinolaryngology, Muğla Training and Research Hospital, a tertiary referral center. METHODS: This study included 60 pediatric patients (aged 2-18 years) who underwent tonsillectomy according to American Academy of Otolaryngology-Head and Neck Surgery guidelines. 30 patients with recurrent tonsillitis were compared with 30 patients with tonsillar hypertrophy. Patients with chronic inflammatory diseases, recent steroid use, PFAPA syndrome, or asymmetric hypertrophy were excluded. Right palatine tonsil tissues were collected intraoperatively, and the mid-portion was analyzed. Expression levels of TRAF6, IRAK1, and miR-146a-5p were quantified using real-time polymerase chain reaction (qRT-PCR). In silico analyses evaluated related molecular pathways and target gene interactions. RESULTS: TRAF6 and IRAK1 mRNA levels were significantly increased in the recurrent tonsillitis group compared with controls (fold change: 1.64 and 1.43; P = .043 and P = .034, respectively), whereas miR-146a-5p expression was significantly decreased (2.17-fold; P = .012). Bioinformatic analysis identified nuclear factor kappa B (NF-κB), interleukin-1 (IL-1), and Toll-like receptor (TLR) signaling pathways. TRAF6, IRAK1, TLR4, epidermal growth factor receptor (EGFR), IL-6, and chemokine ligand 8 (CXCL8) were identified as potential miR-146a-5p targets. CONCLUSION: These findings suggest dysregulation of the TRAF6/IRAK1-miR-146a-5p axis in recurrent tonsillitis. While miR-146a-5p may represent a potential target within TLR/NF-κB-related pathways its therapeutic relevance remains speculative and requires validation through functional and translational studies.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Response to: Comment on "Association of Lead in Drinking Water With Head and Neck Cancer in the United States".
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
2025 American Thyroid Association Management Guidelines for Adult Patients With Differentiated Thyroid Cancer: What's New for Surgeons?
The American Thyroid Association (ATA) has published an update to the 2015 management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer (DTC). This updated version focuses solely on the management of differentiated thyroid cancer, offering a comprehensive set of guidelines for all stakeholders in the care of differentiated thyroid cancer, but no longer addresses the management of thyroid nodules in adults. Herein, we highlight the key updates and differences between the two versions, emphasizing those most pertinent to endocrine neck surgeons. These guidelines will form the basis for differentiated thyroid cancer care over the next few years, affecting millions of patients. For maximal impact, they will need to be widely disseminated, discussed, and dissected, to ultimately result in practice changes befitting the latest evidence-based care.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Comment on "Association of Lead in Drinking Water With Head and Neck Cancer in the United States".
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Letter Regarding "Reducing the Duration of 24-hour Multichannel Intraluminal Impedance-pH Monitoring for Laryngopharyngeal Reflux".
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
A Social Media Quality Review of Popular Ankyloglossia Videos on TikTok.
OBJECTIVE: To evaluate the accuracy, quality, and potential harm or benefit of TikTok videos related to ankyloglossia and to assess how uploader type influences informational reliability and educational value. METHODS: A cross-sectional analysis of TikTok videos was conducted using 4 search terms related to ankyloglossia. Videos posted between January 2021 and August 2024 were screened, yielding 66 eligible videos. Videos were categorized by uploader type (medical provider, influencer, layperson) and content type. Three independent reviewers assessed factual accuracy based on AAO-HNSF Clinical Consensus Statements, classified videos using a harm-benefit scale, and evaluated quality using the PEMAT-AV and Global Quality Scale (GQS). RESULTS: Of 66 videos, 78.8% were educational, but only 63.5% were factual. Medical providers produced significantly more factual content than influencers and laypersons (85% vs 50%, P = .045). Medical provider videos demonstrated the highest harm-benefit scores (P = .025) and the highest PEMAT-AV and GQS averages, though quality score differences were not statistically significant. Influencer-generated content achieved higher view counts despite lower accuracy. Views and shares did not correlate with quality or accuracy metrics. Lifestyle and medical advice videos were significantly associated with more negative harm-benefit scores. DISCUSSION: Although TikTok videos on ankyloglossia reach large audiences, misinformation remains prevalent, particularly among non-medical uploaders. Popularity metrics were poor indicators of educational quality, while videos aligned with the clinical consensus statement demonstrated higher clarity and benefit. IMPLICATIONS FOR PRACTICE: Medical professionals should play a proactive role in creating accurate, accessible social media content to counter misinformation and guide patient understanding of ankyloglossia. However, given that engagement metrics do not favor accuracy, broader platform-level strategies and collaborations may be necessary to meaningfully counter health misinformation on social media.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Chronic Postoperative Pain After Hypoglossal Nerve Stimulation Implant Surgery: Analgesia Options When Traditional Treatment Fails.
Hypoglossal nerve stimulation implant surgery (HNSIS) is generally associated with minimal postoperative pain; however, persistent postsurgical pain can occur and may significantly limit use of therapy. Opioid-induced hyperalgesia (OIH) is a known phenomenon that has not been previously described in the setting of HNSIS. We review proposed mechanisms underlying OIH and chronic postsurgical pain following HNSIS, including aberrant nociceptor re-innervation, nociceptor hyperexcitability, and neuroplastic changes associated with cranial nerve 12, cervical spinal nerve 1, and branches of trigeminal nerve V3. This commentary discusses the potential role of targeted regional nerve blocks for these cases. Specifically, blockade of the C2/C3 cervical nerve distributions and the trigeminal nerve V3 branch may provide effective analgesia when the traditional oral medications fail to provide adequate relief. This approach may offer a treatment option for select patients with chronic pain following HNSIS and must be considered in cases of complex postoperative pain management.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Conventional Reporting Standards Conceal High-Frequency Hearing Deficits After Favorable Ossiculoplasty.
OBJECTIVE: To evaluate high-frequency hearing outcomes in ossiculoplasty cases having favorable pure-tone average outcomes within the reporting range set by current guidelines. STUDY DESIGN: Retrospective cohort study. SETTING: Multi-center tertiary care ossiculoplasty outcome registry. METHODS: From 1679 registry cases, 499 ears with synthetic partial or total ossicular replacement prostheses and postoperative pure-tone average air-bone gap (PTA-ABG) ≤ 15 dB at 0.5, 1, 2, and 3 kHz were included (mean follow-up, 34.4 ± 35.7 months). Outcomes included postoperative 4-kHz ABG and frequency-specific preoperative to postoperative changes in ABG and air-conduction (AC) thresholds. RESULTS: Mean postoperative PTA-ABG was 9.6 ± 3.7 dB. The mean 4-kHz ABG was larger (18.2 ± 10.9 dB) than ABGs at 0.5 to 3 kHz (P < .001). Despite meeting success criteria, 51.5% of ears had a 4-kHz ABG ≥ 20 dB and 26.7% had a 4-kHz ABG ≥ 25 dB. AC improvement decreased with increasing frequency; gains at 4 to 8 kHz were smaller than at 0.5 to 3 kHz (P < .001). CONCLUSION: Current PTA-based reporting can suggest ossiculoplasty has been successful while substantial high-frequency conductive deficits persist. Future modification of hearing outcome reporting standards for conductive hearing loss might benefit from consideration of ≥4-kHz outcomes.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Emerging Ethical Considerations in Otolaryngology-Head and Neck Surgery.
OBJECTIVES: To perform a scoping review of ethics-based literature published in the last 5 years in otolaryngology-head and neck surgery (OHNS), and to identify and reflect on emerging topics of ethical consideration for otolaryngologists. DATA SOURCES: A comprehensive literature search was performed using the PubMed, SCOPUS, and Cochrane databases. REVIEW METHODS: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews protocol. Inclusion criteria included peer-review articles published from 2019 to 2024 that explored at least one foundational bioethical principle in a primary context of OHNS. Original research, literature reviews, editorials, and letters to the editor were included to capture the full extent of the academic ethics conversation. An inductive qualitative content analysis was performed in multi-step process to identify recurrent ethics issues and themes. RESULTS: The systematic review identified 1191 unique abstracts, of which 31 met inclusion criteria. This literature emphasized topics including conflicting physician obligations during the coronavirus-19 pandemic, integration of artificial intelligence into clinic practice, diversity and inclusion within OHNS, health equity, ethics education, pediatric autonomy, and considerations for global health programs. These conversations explored conflicting definitions of justice and divergence between personal and institutional ethical obligations. CONCLUSION: This scoping review identified salient topics within the current ethics OHNS literature and explores implications for practicing otolaryngologists.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Is Bilateral Neck Dissection Always Necessary for Hypopharyngeal Squamous Cell Carcinoma? Risk Factors for Occult Contralateral Metastasis.
OBJECTIVE: This study aimed to analyze risk factors for occult contralateral lymph node metastasis (LNM) in hypopharyngeal squamous cell carcinoma (HSCC) patients and provide evidence-based recommendations for neck dissection. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary general hospital. METHODS: We retrospectively analyzed 145 patients with HSCC who underwent primary tumor resection and neck dissection. Clinical and pathological data were collected, including tumor characteristics and lymph node status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for occult contralateral LNM. RESULTS: The overall occult contralateral LNM rate was 13.24% (n = 18/136). In cN0 patients with Type A & B(unilateral) tumors, occult contralateral LNM occurred in 9.30% (4/43), specifically 12.90% (4/31) for Type A and 0% (0/12) for Type B. In cN+ patients with Type A & B(unilateral) tumors, the rate was 15.05% (14/93), with Type A(unilateral without midline involvement) at 12.5% (9/72) and Type B(unilateral with midline involvement) at 23.81% (5/21). Macroscopic extranodal extension (ENE) in the ipsilateral neck significantly affected contralateral occult metastasis. In contralateral clinically negative necks, occult metastases were primarily concentrated in levels II and III. CONCLUSION: Central type tumors require bilateral neck dissection. For lateral lesions, contralateral levels II to III are dissected only if ipsilateral cN+, T3-4, or midline crossing is present. Macroscopic ENE in the ipsilateral neck significantly increases the risk of contralateral occult metastasis; intra-operative identification warrants contralateral neck dissection.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Postoperative Epistaxis After Endoscopic Endonasal Skull Base Surgery: Incidence, Timing, and Clinical Implications.
OBJECTIVE: To determine the incidence, timing, bleeding sources, and associated factors of clinically significant postoperative epistaxis after endoscopic endonasal skull base surgery in a large single-center cohort. STUDY DESIGN: Retrospective cohort with a frequency-matched case-control analysis. SETTING: Single tertiary center. SUBJECTS AND METHODS: Among 1070 adults who underwent endoscopic endonasal skull base surgery (2015-2025), patients who developed postoperative epistaxis requiring medical evaluation or surgical intervention (n = 13) were compared with 52 frequency-matched controls without bleeding. Bleeding timing, endoscopic bleeding sources, management, and exploratory univariable associations were evaluated. RESULTS: The incidence of clinically significant postoperative epistaxis was 1.2%. Bleeding occurred between postoperative Days 0 and 28 (mean ± SD, 13.1 ± 7.6 days; median, 14 days), and 76.9% occurred during Days 8 to 23. Identified bleeding sources included posterior septal branches of the sphenopalatine system (23%), flap donor site or inferior septal mucosal edge (15%), diffuse mucosal oozing (23%), and cerebrospinal fluid-mixed bleeding (15%). In exploratory univariable analyses, hypertension (odds ratio, 4.90; 95% CI, 1.35-17.80) and postoperative systemic steroid use (odds ratio, 3.60; 95% CI, 1.02-12.73) were associated with bleeding. Most patients (92.3%) required endoscopic surgical re-exploration for definitive hemostasis. CONCLUSION: Clinically significant postoperative epistaxis after endoscopic endonasal skull base surgery most often occurred during the second to third postoperative week and commonly originated from posterior septal branches or donor-site mucosa. These findings highlight the importance of careful postoperative monitoring and a low threshold for early endoscopic evaluation when clinically significant bleeding occurs.
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Publication Fate and Determinants of Registered Clinical Trials Investigating Sensorineural Hearing Loss.
OBJECTIVE: To evaluate the publication proportion of completed clinical trials regarding sensorineural hearing loss (SNHL) registered on ClinicalTrials.gov and identify factors associated with successful and timely publication. STUDY DESIGN: Cross-sectional observational study. SETTING: ClinicalTrials.gov registry and peer-reviewed literature databases. METHODS: We identified completed clinical trials related to SNHL with completion dates before November 1, 2022. Trials were categorized by intervention type, sponsorship, phase, age group, results and location. Publication status was determined by searching ClinicalTrials.gov, PubMed, and Google Scholar. Multivariate logistic regression and survival analysis were used to analyze factors influencing publication likelihood and time-to-publication. RESULTS: Of 250 completed SNHL trials, 31.2% were published. Multivariable logistic regression identified intervention type, results availability, and PI location as independent predictors of publication: device, behavioral, and other trials had significantly lower odds than drug trials, while reported results increased and US-based PI decreased publication odds. Kaplan-Meier and Cox proportional hazards analyses showed drug trials achieved significantly faster publication than device and other categories, with non-US PI location and results availability also predicting faster publication. CONCLUSION: The publication rate of SNHL-related trials is lower than that of other otolaryngology subfields, with significant disparities observed across intervention types. Our findings indicate that there is substantial room for improvement in the publication of sensorineural hearing loss trials to further mitigate publication bias in this field.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Quality of AI-Generated Patient Education for Pre- and Post-Operative Tracheostomy Care.
OBJECTIVE: To evaluate the accuracy, completeness, clarity, source transparency, and readability of leading AI chatbot responses to patient questions about tracheostomy and to determine whether AI tools can reliably support patient education where high-quality guidance is critical for safety. STUDY DESIGN: Cross-sectional content analysis. SETTING: Virtual study environment using publicly accessible AI platforms, with expert evaluation conducted via Qualtrics-based distribution. METHODS: Twelve frequently asked questions about tracheostomy care were identified using search-listening tools and clinician input, then submitted to 5 AI chatbots - ChatGPT4, Google Gemini 2.0, Microsoft Copilot, DeepSeek V3, and Grok 3 - and to a senior laryngologist. Three blinded laryngologists independently evaluated each response using the Quality Analysis of Medical Artificial Intelligence instrument. Readability was assessed using nine metrics. RESULTS: Gemini 2.0 achieved significantly higher completeness scores than physician responses (P < .001), with DeepSeek and Grok 3 (P < .05) also outperforming (P < .05). Accuracy did not differ significantly between AI- and expert-generated responses. On average, the AI models outperformed physician in clarity, completeness, and usefulness based on QAMAI scoring (P < .05). All AI and expert responses exceeded the NIH-recommended 6th-grade reading level, ranging from 10th-13th grade (P < .001). Inter-rater reliability was 78%. CONCLUSION: AI chatbots can generate accurate and comprehensive responses to common tracheostomy care questions, demonstrating potential to support patient education. However, they continue to lack guaranteed, verifiable sourcing, and this study did not assess actual patient comprehension of the AI-generated responses. Future efforts should focus on adapting AI-generated education materials to meet health literacy standards and evaluating their direct impact on patient understanding and outcomes.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Robot-assisted Parotidectomy: Improved Clinical and Patient-Reported Outcomes.
OBJECTIVE: To compare perioperative outcomes, postoperative safety, and patient-reported outcomes among conventional, endoscopic, and robot-assisted parotidectomy for primary benign parotid tumors. STUDY DESIGN: Retrospective comparative study. SETTING: Tertiary academic institution. METHODS: A total of 212 adults undergoing parotidectomy were enrolled from January 2022 to June 2025. All operations were performed by a single medical team; robot-assisted and endoscopic procedures were performed by a single surgeon to reduce learning-curve variation. Outcomes included perioperative metrics, short- and long-term complications, local recurrence, scar visual analog scale, and Parotidectomy Outcome Inventory-8 scores. Inverse probability of treatment weighting was used to reduce confounding; effect estimates are reported as weighted mean differences and odds ratios with 95% confidence intervals. RESULTS: Among 212 patients (78 conventional, 106 endoscopic, 28 robot-assisted), statistical analyses showed that despite longer operative times (vs endoscopic: +41.63 minutes; vs conventional: +56.04 minutes), robot-assisted parotidectomy resulted in lower blood loss (vs endoscopic: -14.03 mL; vs conventional: -10.30 mL). Compared to endoscopic surgery, it exhibited a lower risk of long-term complications, including facial nerve palsy (-78% in odds). Compared to conventional surgery, both minimally invasive approaches achieved shorter incisions (robot-assisted: -4.41 cm; endoscopic: -4.71 cm) and improved patient-reported outcomes, while robot-assisted surgery additionally reduced the risk of short-term complications. No increased perioperative or postoperative risk was observed. CONCLUSIONS: Robot-assisted parotidectomy was associated with improved clinical and patient-reported outcomes without evidence of increased risk. Its clinical value warrants further validation in prospective multicenter cohorts.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Scaling Up Endoscopic Tympanoplasty: A Dual-Station Workflow in Resource-Limited Settings.
OBJECTIVE: This study evaluated the feasibility, outcomes, and safety of a dual-station (DS) workflow for endoscopic tympanoplasty compared with conventional single-station (SS) surgery in a resource-limited hospital setting. STUDY DESIGN: A retrospective chart review. SETTING: Maesot General Hospital. METHODS: Patients aged 18 to 80 years undergoing endoscopic tympanoplasty were included. DS was implemented during outreach missions (March 2024 and March 2025), whereas SS was performed between August 2023 and August 2025. Primary outcomes included graft success rate, operative time, and complications; audiologic outcomes were secondary. RESULTS: Among 78 eligible patients, 68 met the final criteria and were included (DS, n = 28; SS, n = 40). The DS workflow achieved 7.75 ± 0.50 cases/room/day. Graft success (DS 82.14% vs SS 82.5%, P = .999) and operative time (DS 105.18 ± 27.23 vs SS 100.12 ± 35.56 minutes, P = .529) were comparable. No wound infections occurred in the DS group versus one in the SS group (P = .831), and no serious complications were observed. Both groups showed significant improvements in air-conduction thresholds and ABG (P < .001) without intergroup differences (P = .910 and P = .510). ABG ≤ 10 dB occurred in 46.43% (DS) vs 52.63% (SS), and 11 to 20 dB in 39.29% vs 39.47% (P = .724). CONCLUSION: The DS workflow for endoscopic tympanoplasty appears feasible and safe for increasing surgical capacity without compromising graft success, audiologic outcomes, or complication rates. This model may provide a practical framework for outreach or ear-camp endoscopic ear surgery in resource-limited settings.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Sex Differences in Congenital Aural Atresia: A Systematic Review and Meta-Analysis.
OBJECTIVE: To evaluate sex differences in the diagnosis and management of congenital aural atresia (CAA). DATA SOURCES: PubMed, SCOPUS, CINAHL, Cochrane Library. REVIEW METHODS: A comprehensive literature search was conducted from inception through January 2026. Eligible studies included patients diagnosed with CAA with data stratified by sex. Meta-analysis of proportions, relative risk (RR), mean difference (Δ), and continuous measures with 95% confidence intervals (CI) were performed using fixed- and random-effects models. RESULTS: Eleven studies met inclusion criteria, encompassing 345 patients with CAA. The mean age was 11.6 years (range 3-54), with a male predominance of 56.2% (CI 50.95-61.38). Most patients were Marx grade III (60%, CI 38.01-78.58) with a mean Jahrsdoerfer score of 8.2 (range 7-10). Bone conduction hearing devices (BCHD) were the most common intervention (n = 105), while canalplasty was less frequent (n = 31). Males underwent canalplasty more often, while females demonstrated higher risk for bilateral disease (RR = 1.57 [1.02-2.42], P = .04) and, when unilateral, right-sided defects (RR = 1.2 [1.01-1.42], P = .03). No significant differences were observed between sexes in Jahrsdoerfer scores, microtia grade, or preintervention audiometry. CONCLUSION: Sex may influence presentation and management in CAA, with females more likely to present with bilateral and right-sided disease and males more often undergoing canalplasty. These findings underscore the need for heightened awareness of sex-specific patterns and highlight the importance of future stratified studies to guide diagnosis, counseling, and treatment selection.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Tailored Mandibular Advancement Therapy Guided Through a Mandibular Positioner: Predictive Value in Obstructive Sleep Apnea.
OBJECTIVE: Mandibular advancement devices (MADs) are a recognized alternative to continuous positive airway pressure (CPAP) for treating obstructive sleep apnea (OSA), though patient selection is still challenging. Tailored MAD guided through drug induced sleep endoscopy (DISE) with a mandibular titratable positioner (SAM) offers a stable and reproducible simulation of MAD effects during DISE, potentially enhancing outcomes after this DISE-SAM protocol. We aim to assess its positive predictive value (PPV) in patients treated with MAD by analyzing changes in AHI, minimum oxygen saturation, and CT90, considering OSA severity and recommendations based on the expected response. STUDY DESIGN: Prospective cohort study. SETTING: Academic secondary medical centers. METHODS: A prospective, multicenter study was conducted including 77 OSA patients across 3 hospitals. After DISE with the SAM device, 66 patients concluded MAD therapy based on SAM recommendations: Single use (S), Alternative (A), or Multiple treatment approach (M). Pretreatment and posttreatment sleep studies measured AHI, Min OSat, and CT90. Response was analyzed with standard AHI-oxygen saturation-based criteria and newly tailored criteria per SAM recommendation category. RESULTS: MAD therapy led to significant improvement in AHI (from 32.26 to 7.19), min OSat (from 80.83% to 85.87%), and CT90 (from 11.33% to 3.99%). Stratified analyses showed significant treatment effects in moderate and severe OSA groups and across SAM recommendations. The MAD therapy guided through DISE-SAM protocol demonstrated high PPV, also when using tailored success criteria. CONCLUSIONS: The DISE-SAM protocol demonstrated a high positive predictive value and significant improvements in key respiratory parameters among the selected patients using MAD.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Impact of Septorhinoplasty on Work Productivity and Activity Impairment: A Multi-Institutional, Prospective Cohort.
OBJECTIVE: To evaluate the effect of septorhinoplasty on work productivity and activity impairment. STUDY DESIGN: Prospective cohort. SETTING: Four tertiary institutions. METHODS: Adults undergoing septorhinoplasty were administered surveys preoperatively and 3 to 8 months postoperatively. Preoperative and postoperative symptoms of nasal obstruction were measured with the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and Visual Analog Nasal Obstruction (VAS) scales. Work productivity and activity levels were measured using the Work Productivity and Activity Impairment Specific Health Problem (WPAI) survey. RESULTS: Among 212 patients, the average age was 42. 57% had allergic rhinitis, 22% had chronic sinusitis, and 22% had obstructive sleep apnea. The mean SCHNOS-O score was 74.1 ± 20.1 and VAS was 5.8 ± 2.7. 68.9% reported employment and missed an average of 1.5 ± 5.1 hours of work per week due to problems associated with nasal obstruction. On average, patients reported 32 ± 29% workplace impairment and 43 ± 29% daily activity impairment due to nasal obstruction. 94 underwent septorhinoplasty with improvement in SCHNOS-O (20.5 ± 18.2 vs 73.8 ± 19.1, P < .001) and VAS scores (1.5 ± 1.7 vs 5.6 ± 1.8, P < .001). Postoperatively, patients no longer missed work (0 ± 0.4 vs 2.1 ± 6.8 hours, P = .01), and significant improvements were seen in presenteeism (6.2 ± 15% vs 31 ± 27%, P < .001) and daily activity impairment (9.7 ± 18% vs 41 ± 25%; P < .001). CONCLUSIONS: Patients with moderate-severe nasal obstruction seeking septorhinoplasty report mild-moderate work impairment and moderate daily activity impairment as a direct result. Both work and daily activity impairment improve to minimal levels with surgical correction.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Status of Unmatched Applicants to Otolaryngology Residency.
OBJECTIVE: Investigate and characterize outcomes of unmatched otolaryngology applicants and the corresponding pathways. STUDY DESIGN: Retrospective cohort study. SETTING: National, web-based analysis of applicants participating in the Otolaryngology Program Directors Organization (OPDO) preference signaling process. METHODS: Applicants who participated in OPDO preference signaling during 2 consecutive application cycles (2020-2021 and 2021-2022) were identified. First-time applicants were analyzed for initial match outcomes. For those who did not match, gap-year activities and reapplication outcomes were determined using publicly available web sources. Subsequent match rates were compared between reapplicants who completed a research year and those who completed a clinical gap year. RESULTS: The first-time applicant match rate was 65%. A total of 218 (20%) first-time applicants did not secure a categorical position. Gap-year activity was identified for 151 of 218 (69%). Among the unmatched cohort, 113 of 218 (52%) re-signaled and reapplied to otolaryngology, of whom 64 of 113 (57%) matched on reapplication. Reapplicants who completed a research year matched more often than those who completed a clinical gap year (38 of 54 [70%] vs 21 of 45 [47%]; P = .036). CONCLUSION: Among first-time applicants who did not initially match, reapplication after a research year was associated with higher subsequent match rate compared with a clinical gap year. Cautious use of this data may guide mentors and unmatched applicants. However, recommendations should be individualized to reflect each candidate's circumstances. LEVEL OF EVIDENCE: Level 4.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Tongue Grooving During Drug-Induced Sleep Endoscopy: A Novel Tool to Evaluate the Airway.
OBJECTIVE: Posterior tongue grooving (PTG) is a well-documented morphologic change in tongue shape. Drug-induced sleep endoscopy (DISE) reveals variable degrees of posterior tongue grooving at the oropalatal junction. To elucidate our understanding of posterior tongue grooving, a retrospective study of its prevalence, demographics, and anatomic associations was performed. STUDY DESIGN: Retrospective cohort study. SETTING: Single Institution. METHODS: 71 patients were retrospectively reviewed after adult DISE from 2018 to 2021. Velum, oropharynx, tongue, and epiglottis (VOTE) collapse patterns, demographics, and sleep study variables were analyzed. Patients with previous upper airway surgery were excluded. Posterior tongue grooving was scored 1+ to 4+ with higher values indicating a greater groove. A linear regression analysis investigated the relationship between tongue grooving and oropharyngeal lateral wall collapse. RESULTS: Mean Apnea-Hypopnea Index was 35.7 [IQR: 34.1-37.4] events/hour and mean body mass index (BMI) was 30.7 [30.3-31.2] kg/m. Of 71 patients, 36% were 1+, 16.6% were 2+, 29.1% were 3+, and 18% were 4+. Increased grade of posterior tongue grooving was significantly associated with decreased levels of lateral oropharyngeal wall collapse (P < .03). BMI was positively correlated with increased oropharyngeal lateral wall collapse (P = .04). CONCLUSION: Tongue grooving is a variable morphologic finding observed during DISE. This study associates high tongue grooving scores with significantly lesser degrees of lateral oropharyngeal wall collapse, suggesting that posterior tongue grooving may serve as a surrogate for pharyngeal muscle tone during DISE. Further randomized, prospective research is warranted to uncover the etiology and physiologic significance of this phenomenon.
JAMA Network OpenArticle
JAMA network open
Completion Rates of Screening Examinations for Hearing Among Preschool-Aged Children.
IMPORTANCE: Preschool hearing screening is critical for early identification of hearing loss, yet factors associated with screening completion are not well described. OBJECTIVE: To evaluate completion rates of pure-tone audiometry (PTA) and otoacoustic emission (OAE) screening among preschool children in the community and identify factors, including child characteristics and screener-child language concordance, associated with completion. DESIGN, SETTING, AND PARTICIPANTS: This multicenter prospective cohort study across 204 preschools in 15 California counties included a population-based sample of 7035 children who underwent screening from November 7, 2023, to December 3, 2025. EXPOSURES: Child age (≤48 months vs >48 months), preferred home language, teacher-reported communication concerns (eg, speech, language, or hearing), and screener Spanish proficiency (low vs high). MAIN OUTCOMES AND MEASURES: Completion of PTA and OAE screening in both ears. Odds of completion were estimated using logistic regression, adjusted for age, screener experience, and teacher-reported concerns. Ratios of estimated probabilities were used to compare Spanish- and English-speaking children across screener proficiency levels. RESULTS: Among 7035 children screened (median age, 47 [IQR, 39-54] months; 3583 [50.9%] male; 4780 [67.9%] preference for English and 2683 [38.1%] preference for Spanish), OAE was completed in 6745 children (95.9%), whereas PTA was completed in 4601 (65.4%). Teacher-reported concerns included speech (1039 children [14.8%]), language (577 children [8.2%]), and hearing (298 children [4.2%]). Children 48 months or younger (odds ratio [OR], 0.17; 95% CI, 0.15-0.19), those with speech concerns (OR, 0.44; 95% CI, 0.36-0.53), and those with non-English home language preference (OR, 0.84; 95% CI, 0.74-0.94) had lower odds of PTA completion. For OAE, younger age (OR, 0.38; 95% CI, 0.29-0.50) and speech concerns (OR, 0.39; 95% CI, 0.28-0.55) had lower odds of completion; non-English home language preference was not associated with OAE completion (OR, 1.04; 95% CI, 0.80-1.35). Spanish-speaking children whose screeners had high Spanish proficiency had higher estimated PTA completion than those with low-proficiency screeners, achieving parity with English-speaking children in the high-proficiency group (ratio of estimated probabilities, 0.96; 95% CI, 0.91-1.02), while Spanish-speaking children had lower estimated probability of completion than English-speaking children when evaluated by low-proficiency screeners (ratio of estimated probabilities, 0.87; 95% CI, 0.80-0.94). Screener language proficiency was not associated with OAE completion. CONCLUSIONS AND RELEVANCE: In this prospective cohort study of 7035 preschoolers, PTA completion rate was significantly lower than that for OAE and varied by age, speech concerns, and home language, whereas OAE completion was consistently high. High Spanish proficiency by the screener was associated with higher PTA estimated probability of completion among Spanish-speaking children, supporting the importance of language-concordant screening in early childhood hearing assessment.
JAMA Network OpenRCT
JAMA network open
Differences in Cognitive Aging Assessments Associated With Retest Effects.
IMPORTANCE: Retest effects can inflate longitudinal cognitive test performance and complicate estimation of cognitive change. Whether retest effects influence estimated intervention effects in randomized clinical trials remains unclear. OBJECTIVE: To quantify the magnitude and heterogeneity of differences associated with retesting in longitudinal cognitive testing and examine whether accounting for retesting alters estimated treatment effects in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was an ad hoc secondary analysis of ACHIEVE, a multicenter phase 3 randomized clinical trial conducted from 2017 to 2022 with 3-year follow-up. Community-dwelling older adults with untreated hearing loss were enrolled at 4 US community sites: Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland. Analyses were completed in November 2025. EXPOSURE: Cognitive retesting, defined as a binary indicator (0 for baseline visit; 1 for follow-up visits). MAIN OUTCOMES AND MEASURES: The primary outcome was a global cognitive factor score derived from a neurocognitive battery. Secondary outcomes included domain-specific factor scores (language, executive function, memory) and individual test scores. Retest differences were estimated using linear mixed-effects models adjusted for covariates consistent with the main ACHIEVE analysis. Interactions tested whether retest differences varied by key factors. Model-based trajectories and intervention-control estimates were compared with and without retest adjustment. RESULTS: A total of 977 older adults (mean [SD] baseline age, 76.3 [4.0] years; 523 [54%] female) contributed 2571 in-person cognitive assessments , including 552 adults (57%) with mild hearing loss and 739 adults (76%) recruited de novo. Retest differences were significant for global cognition (β = 0.11; 95% CI, 0.07 to 0.15), executive function (β = 0.15; 95% CI, 0.10 to 0.20), and memory (β = 0.12; 95% CI, 0.06 to 0.18), approximately offsetting 1 year of model-estimated age-related cognitive decline. Language showed minimal retest differences (β = -0.03; 95% CI, -0.08 to 0.02). Retest differences did not meaningfully vary by hearing loss severity, trial intervention, or recruitment source. Retest adjustment altered estimated cognitive trajectories but did not meaningfully alter intervention outcomes. CONCLUSIONS AND RELEVANCE: This cohort study found that retest differences were substantial for global cognition, executive function, and memory but did not meaningfully alter estimated hearing intervention outcomes. Adjustment for retest differences is recommended to improve interpretation and intervention estimation in longitudinal cognitive studies.
JAMA Network OpenArticle
JAMA network open
Disability Status and Prostate Cancer Screening Among US Men Aged 55 to 69 Years.
IMPORTANCE: People with disabilities experience persistent inequities in preventive care, yet contemporary, nationally representative data on prostate-specific antigen (PSA) testing disparities are limited. OBJECTIVE: To evaluate the association between disability status and self-reported PSA testing among US men aged 55 to 69 years. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2023 data from the Behavioral Risk Factor Surveillance System (BRFSS), a US population-based telephone survey. The analytic sample included 10 508 male respondents aged 55 to 69 years with complete PSA testing and disability data; analyses incorporated BRFSS survey weights to generate nationally representative estimates. Data were analyzed from October 2024 to May 2025. EXPOSURES: Any disability and disability types (mobility, cognitive, hearing, vision, self-care, independent living) measured using the standard 6-question sequence. MAIN OUTCOMES AND MEASURES: The main outcome was self-reported PSA testing, assessed using BRFSS PSA items. Survey-weighted logistic regression was used to estimate adjusted odds ratios (AORs), controlling for sociodemographic factors, insurance, comorbidities, and health behaviors, with multiple imputation for missing covariates. RESULTS: The weighted analytic sample represented 5 058 866 US men aged 55 to 69 years; 29.6% reported at least 1 disability. Overall, 62.7% (95% CI, 61.1%-64.3%) reported prior PSA testing, with lower testing among men with disabilities than among those without (57.2% [95% CI, 54.2%-60.2%] vs 65.1% [95% CI, 63.2%-67.0%]; P < .001). In adjusted survey-weighted models, disability was associated with lower odds of PSA testing (AOR, 0.83; 95% CI, 0.69-0.99). Among disability types, mobility disability was associated with lower testing (AOR, 0.77; 95% CI, 0.62-0.96). In an unweighted sensitivity analysis, the association between any disability and lower PSA testing remained significant (AOR, 0.86; 95% CI, 0.77-0.98). CONCLUSIONS AND RELEVANCE: In this nationally representative cross-sectional study of US men aged 55 to 69 years, disability status was associated with lower PSA testing, with the most consistent disparity observed among men with mobility disability. These findings suggest disability, particularly mobility impairment, may be an under-recognized determinant of preventive care and may warrant targeted interventions to improve equitable access to shared decision-making and screening services.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Effect of Case Variation on Mastoidectomy Training Using 3D-Printed Temporal Bones Models-A Prospective, Randomized Trial.
OBJECTIVE: To investigate effects of repeated training with anatomically varied versus identical 3D-printed models on skill acquisition, cognitive load, and skill retention in novice mastoidectomy trainees. STUDY DESIGN: A prospective, randomized, controlled, educational trial conducted April to September 2024 including a 3-month retention test. SETTING: Simulation center at a single academic teaching hospital. METHODS: Twenty-four novice medical students were randomized 1:1 into 2 groups: The Identical Models (IM) group practiced repeated procedures on identical 3D-printed temporal bone models (control) and the Variable Model (VM) group practiced on a varied selection of models (intervention). Trainees completed 10 anatomical mastoidectomy procedures with posterior tympanotomy followed by 2 retention test procedures after 3-months of nonpractice. The primary outcome was performance assessed with 25-point modified Welling Scale. The secondary outcome was cognitive load estimated by relative reaction time measured on a secondary task. RESULTS: At end-of-training, the VM group scored 20.6 points (95% CI [19.2-22.0]), outperforming the IM group who scored an average of 18.2 points (95% CI [16.7-19.6], P = .02). At 3‑month retention testing, the VM group's scores decayed by a mean of 5.6 points on the repeated model (95% CI [-7.2 to-4.0], P < .001) and of 3.7 points when introduced to a new model (95% CI [-5.2 to-2.1], P < .001). The IM group showed no decay thereby demonstrating better skill retention which aligned with reduced relative reaction time (cognitive load) during training. CONCLUSIONS: Educators can optimize mastoidectomy skills acquisition and retention by instructional design that prioritize repeated practice on anatomically identical models until basic skills have been acquired.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Comparative Meta-Analysis of Complications of Maxillomandibular Advancement for OSA versus Orthognathic Surgeries for Dentofacial Deformities.
OBJECTIVE: Maxillomandibular advancement (MMA) surgeries for obstructive sleep apnea (OSA) and orthognathic surgeries for dentofacial deformities (DFDs) are both complex procedures with distinct indications. This meta-analysis and systematic review aimed to compare complications and recovery metrics between these surgeries. DATA SOURCES: CINAHL, Cochrane Library, PubMed, and SCOPUS. REVIEW METHODS: Included studies focused on MMA for OSA or orthognathic surgeries for DFDs. Included were 18 bimaxillary studies (n = 1734), 10 single-jaw (n = 3847), and 17 MMA studies (n = 601). Outcomes analyzed included operative time, hospital stay, and complications such as neurosensory disturbance, infection, and hardware removal. RESULTS: MMA demonstrated a surgical success rate of 79.6% and a cure rate of 39%. Compared to bimaxillary surgery, MMA was associated with longer operative time (343.87 vs 326.95 min; P = .021) and postoperative hospital stay (4.22 vs 3.25 days; P < .0001). Neurosensory disturbance was comparable between MMA (40.44%) and bimaxillary surgeries (44.91%; P = .2189), but highest in single-jaw procedures (55.18%; P < .001). MMA had higher postoperative infection (16.34%) and hardware removal rates (21.99%) than bimaxillary surgery (3.55% and 4.21%, respectively; P < .0001). Postoperative OSA developed in 12.25% of bimaxillary cases for DFDs. CONCLUSION: Our findings underscore the need for tailored preoperative counseling and risk stratification when selecting orthognathic surgical interventions. MMA offers a high surgical success rate but is associated with longer operative time, increased hospital stay, and higher rates of infection and hardware removal compared to bimaxillary and single-jaw surgeries. These findings highlight the need to balance efficacy with complication risk when selecting surgical approaches for OSA or DFDs.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Endoscopic Repair of Septal Perforation Using a Double-Layer Fascia Lata Technique.
Septal perforation repair remains technically challenging, particularly in defects requiring stable graft support for closure. We describe an endoscopic double-layer fascia lata technique and report surgical outcomes in a consecutive case series. Adult patients who underwent endoscopic septal perforation repair between 2022 and 2024 were reviewed, and 26 patients with perforations >1 cm were included. Perforations were measured in anterior-posterior and cranio-caudal dimensions, and graft size was determined according to the longest diameter. A fascia lata graft harvested from the thigh was folded to create a double-layer construct and secured with an absorbable suture. The graft was placed beneath the elevated mucoperichondrial flap and stabilized with bilateral splints for approximately 3 weeks. Complete closure was achieved in 24 patients (92.3%), while 2 patients with perforations ≥4 cm had partial closure. No perioperative or postoperative complications were observed.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
HPV Vaccination and Sexual Behaviors Among Middle-Aged United States Adults.
OBJECTIVE: This study aims to identify factors associated with HPV vaccination among adults aged 27 to 45 in the United States, emphasizing the relationship between vaccination rates and sexual behaviors. STUDY DESIGN: Retrospective cross-sectional cohort study. SETTING: National Survey of Family Growth (NSFG), 2022 to 2023. METHODS: We analyzed data from 6014 adults aged 27 to 45 years, representing approximately 82.8 million US adults. The primary outcome was HPV vaccination status. The primary independent variable was the presence of multiple sexual partners in the past year. Multivariable logistic regression analyses evaluated associations between demographic characteristics, sexual behaviors, and HPV vaccination. RESULTS: HPV vaccination rates were low overall in adults aged 27 to 45. Individuals with multiple sexual partners in the past year were significantly more likely to receive HPV vaccination aged 27 and older if previously unvaccinated (OR: 1.89, 95% CI: 1.08-3.31). However, an increased number of sexual partners did not demonstrate a linear relationship with vaccination likelihood. Female sex, higher educational attainment, private or public insurance coverage, recent healthcare access, and higher income levels were independently associated with greater vaccination rates. Race/ethnicity and age had variable influences, with younger adults significantly more likely to be vaccinated. CONCLUSION: HPV vaccination rates remain low among middle-aged adults despite expanded eligibility. Sexual activity, specifically having multiple partners, moderately increased vaccination likelihood. More robust predictors of vaccination include healthcare access, educational status, and socioeconomic factors, highlighting the importance of targeted educational initiatives and improved healthcare access to enhance vaccination uptake.
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
Nurse Navigation on Time to Postoperative Radiation Therapy after Transoral Robotic Surgery for Oropharyngeal Carcinoma.
OBJECTIVE: Postoperative radiation therapy (PORT) initiation within 6 weeks of surgery is associated with improved oncologic outcomes in head and neck cancer, but delays remain common. Oncology nurse navigators (ONN) may improve care coordination. This study evaluates time to PORT following transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) after ONN implementation. STUDY DESIGN: Retrospective chart review. SETTING: Academic tertiary care center. METHODS: Patients with HPV-associated OPSCC treated with TORS followed by PORT between January 2016 and March 2024 were included. RESULTS: Ninety-nine patients were included. Median age was 60 years and 85.9% were male. 57.6% were treated after ONN implementation. Most received PORT within our integrated academic health system (75.8%). Following ONN implementation, time from TORS to PORT decreased from 50 to 44 days (P = .02), and was associated with treatment within the integrated academic health system (52-43 days, P = .01), adjuvant chemoradiation therapy (CRT) (56-44 days, P = .02), and adjuvant proton beam therapy (PBT) (52-44 days, P = .004). Among PBT-treated patients, PORT initiation within 6 weeks increased from 6.7% to 38.3% (P = .02). The proportion of patients completing their adjuvant treatment within 100 days of TORS increased from 61.9% to 93% (P < .001). CONCLUSION: ONN implementation is associated with earlier PORT initiation and shorter treatment package time following TORS for HPV-associated OPSCC, with the greatest improvement observed among patients receiving PBT, CRT, and those treated within the integrated academic health system.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
CHARGE Syndrome: What an Otolaryngologist Should Know-A Systematic Review and Meta-Analysis.
OBJECTIVE: To synthesize the prevalence of otolaryngologic manifestations in CHARGE syndrome (CS) to support otolaryngologists in delivering comprehensive management. DATA SOURCES: PubMed/MEDLINE, Embase, and Google Scholar were searched for English- and French-language studies published from January 1980 through January 2025. REVIEW METHODS: This systematic review and proportional meta-analysis adhered to PRISMA guidelines. Screening and extraction were performed (January-May 2025) by 2 independent reviewers using a standardized template. Pooled prevalence estimates were generated using random-effects models with 95% confidence intervals (CIs);heterogeneity was assessed with I. Study quality was assessed with the Newcastle-Ottawa Scale. RESULTS: Seventy studies (1564 patients; predominantly case series) were included. Airway findings included choanal atresia (reported across 58 studies; unilateral 15.4%, 95% CI 11.6-19.2; bilateral 31.5%, 95% CI 23.3-39.7), laryngomalacia (8 studies; 27.7%, 95% CI 16.3-28.1), and tracheostomy (13 studies; 23.6%, 95% CI 16.9-27.5). Olfactory abnormalities were reported in 15 studies (28.8%, 95% CI 14.7-42.9). Craniofacial findings included facial palsy (39 studies; 35.2%, 95% CI 29.8-40.7) and cleft lip/palate (43 studies; 25.6%, 95% CI 23.1-28.2). Otologic abnormalities were frequent, including chronic otitis media with effusion (11 studies; 54.5%, 95% CI 48.4-60.7), semicircular canal hypoplasia/aplasia (29 studies; 73.6%, 95% CI 59.9-85.2), cochlear hypoplasia (26 studies; 49.8%, 95% CI 37.4-62.2), cochlear nerve hypoplasia (13 studies; 49.1%, 95% CI 34.4-63.8), and sensorineural hearing loss (27 studies; 56.9%, 95% CI 52.7-61.1). CONCLUSION: CS is associated with a substantial ENT disease burden extending beyond choanal atresia, including frequent airway compromise, olfactory dysfunction, craniofacial anomalies, and vestibulocochlear malformations. Early, comprehensive multidisciplinary assessment with otolaryngology involvement is warranted.
Oto-HNSSystematic review
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
RETRACTION: Efficacy of Intraoperative Facial Nerve Monitoring in Parotidectomy: A Systematic Review and Meta-Analysis (1970-2025).
Oto-HNSArticle
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · AAO-HNS
The Prognostic Role of CD8Tumor-Infiltrating Lymphocyte Density in Head and Neck Mucosal Melanoma.
OBJECTIVE: To explore the prognostic role of CD8+ tumor-infiltrating lymphocytes (TIL) density in head and neck mucosal melanoma (HNMM) using an automated, quantitative, immunohistochemistry-based methodology. STUDY DESIGN: Retrospective cohort study. SETTING: Single-institution, tertiary care hospital. METHODS: Forty-five patients with primary HNMM treated between January 2002 and December 2021 at the University of Pittsburgh were included. For patients with ample primary tumor specimens, CD8TIL density was quantified using an automated image analysis algorithm on digitized slides. Receiver operating characteristic curves were used to delineate a biomarker cutoff. Survival analysis using the Kaplan-Meier method and Cox proportional hazards was performed with recurrence-free survival (RFS) and overall survival (OS) as endpoints. RESULTS: Thirty-four patients had adequate pathologic specimens available for analysis. CD8TIL density threshold of 373.6 cells/mmbest delineated patients based on survival outcomes. On log-rank testing, TIL high patients trended toward improved 5-year RFS (p = 0.06) and OS (p = 0.074) when compared to TIL low patients. Using multivariate analysis, high TIL density was significantly associated with improved RFS (hazard ratio [HR] (95% confidence interval [CI]): 0.17 (0.03-0.83), p = 0.028) but not improved OS (HR (95% CI): 0.48 (0.08-2.90), p = 0.4). Tumor characteristics such as advanced nodal staging (HR (95% CI): 13.2 (1.68-104), p = 0.014), and presence of metastatic disease (HR (95% CI): 48.2 (1.94-1196), p = 0.018) were associated with worsened RFS. CONCLUSION: Automated, digital CD8TIL density enumeration is a reliable method of assessing TIL density in HNMM patients. High CD8TIL density is an independent factor associated with improved RFS and trended toward improved OS.
Trials
Showing 12 of 364 matching trials (5527 indexed).
TrialRECRUITINGPHASE1
NCT06465069
A Study of LY4052031 in Participants With Advanced or Metastatic Urothelial Cancer or Other Solid Tumors
The purpose of this study is to find out whether the study drug, LY4052031, is safe, tolerable and effective in participants with advanced, or metastatic solid tumors including urothelial cancer. The study is conducted in two parts - phase Ia (dose-escalation, dose-optimization) and phase Ib (dose-expansion). The study will last up to approximately 4 years.
Metastatic Solid Tumor · Recurrent Solid Tumor · Advanced Solid Tumor · Urinary Bladder Neoplasm
TrialRECRUITINGPHASE3
NCT05751512
A Study to Evaluate MRG003 vs Cetuximab/Methotrexate in in the Treatment of Patients With RM-SCCHN
The objective of this study is to compare the efficacy and safety of MRG003 versus cetuximab/methotrexate as second/third line of therapy in patients with RM-SCCHN who have previously failed PD-1 (L1) inhibitors and platinum-based therapy.
Squamous Cell Carcinoma of the Head and Neck
TrialRECRUITINGPHASE1
NCT07090499
A Study to Learn About the Study Medicine Called PF-08046876 in People With Advanced Solid Tumors
The purpose of the study is to explore the safety and effects of the study drug (PF-08046876) in people diagnosed with advanced cancer of the bladder, lung, head and neck, esophagus, or pancreas. PF-08046876 is an investigational anticancer therapy called an 'antibody drug conjugate' or 'ADC'. ADCs are anticancer drugs designed to stick to cancer cells and kill them. The study drug will be given to participants through a needle in a vein (intravenous infusion). This study includes multiple parts. In the first part of the study, there will be different groups of people receiving different doses of the study drug. The study may also test different schedules.
Advanced/Metastatic Solid Tumors · Bladder Cancer · Urothelial Carcinoma · Advanced Non-Small Cell Lung Cancer
TrialRECRUITINGPHASE1
NCT07613723
A Study to Test the Safety, Tolerability and Effect of ZI-MA4-1 for Patients With Locally Advanced or Metastatic Solid Malignancies
This study will recruit patients with the following cancer indications: ovarian cancer, squamous non-small cell lung cancer, synovial sarcoma and head and neck cancer, with inoperable locally advanced or metastatic solid tumours. Currently, these patients have a poor prognosis and a relatively short overall survival. There is a lack of meaningful, effective therapies available that improve the outcome for these patients. The treatment being investigated in this study is ZIMA4-1, an allogeneic cell therapy product. This is the first time ZI-MA4-1 will be administered to humans. The study is planned to consist of two parts (A and B). Part A includes up to four dose escalation cohorts and aims to identify the maximum tolerated dose of ZI-MA4-1 and give insight into the recommended Phase 2 dose (RP2D). Part B consists of an expansion cohort and is designed to further evaluate the RP2D identified in Part A across one or more indications. The study procedures and eligibility criteria will be the same for participants in Parts A and B, except for the dose level of ZI-MA4-1.
Ovarian Cancer · Squamous Non-Small Cell Lung Cancer (NSCLC) · Synovial Sarcomas · Head and Neck Cancer
TrialRECRUITINGPHASE2
NCT06064097
A Study Using Nivolumab, in Combination With Chemotherapy Drugs to Treat Nasopharyngeal Carcinoma (NPC)
This phase II trial tests effects of nivolumab in combination with chemotherapy drugs prior to radiation therapy patients with nasopharyngeal carcinoma (NPC). Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as gemcitabine and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Researchers want to find out what effects, good and/or bad, adding nivolumab to chemotherapy has on patients with newly diagnosed NPC. In addition, they want to find out if children with NPC may be treated with less radiation therapy and whether this decreases the side effects of therapy.
Stage II Nasopharyngeal Carcinoma AJCC v8 · Stage III Nasopharyngeal Carcinoma AJCC v8 · Stage IV Nasopharyngeal Carcinoma AJCC v8
TrialRECRUITINGPHASE2
NCT05136196
BiCaZO: A Study Combining Two Immunotherapies (Cabozantinib and Nivolumab) to Treat Patients With Advanced Melanoma or Squamous Cell Head and Neck Cancer, an immunoMATCH Pilot Study
This phase II trial studies the good and bad effects of the combination of drugs called cabozantinib and nivolumab in treating patients with melanoma or squamous cell head and neck cancer that may have spread from where it first started to nearby tissue, lymph nodes, or distant parts of the body (advanced). Cabozantinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. This trial may help doctors determine how quickly patients can be divided into groups based on biomarkers in their tumors. A biomarker is a biological molecule found in the blood, other body fluids, or in tissues that is a sign of a normal or abnormal process or a sign of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. The two biomarkers that this trial is studying are "tumor mutational burden" and "tumor inflammation signature." Another purpose of this trial is to help doctors learn if cabozantinib and nivolumab shrink or stabilize the cancer, and whether patients respond differently to the combination depending on the status of the biomarkers.
Clinical Stage III Cutaneous Melanoma AJCC v8 · Clinical Stage III HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8 · Clinical Stage IV Cutaneous Melanoma AJCC v8 · Clinical Stage IV HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8
TrialRECRUITINGNA
NCT05442957
Building a Renewed ImaGe After Head & Neck Cancer Treatment (BRIGHT) Multi-Site RCT
In this multi-center randomized clinical trial, head and neck cancer (HNC) survivors with clinically significant body image distress (BID) (N=180) will be randomized to BRIGHT (a brief video tele-cognitive behavioral therapy intervention) or Attention Control (AC, a manualized tele-supportive care intervention that controls for professional attention, dose, delivery method, and common factors). HNC survivors will complete IMAGE-HN (a validated patient-reported outcome measure \[PROM\] of HNC-related body image distress \[BID\]; primary endpoint), measures of psychological and social well-being and quality of life (QOL), and measures of theory-derived mechanisms of change underlying BRIGHT (mediators).
Head and Neck Cancer · Body Image Disturbance · Body Image · Survivorship
TrialRECRUITINGPHASE2
NCT07217938
Novel Treatment of Radiation Associated Dysphagia With Statins
The aim of this trial is to examine the feasibility, acceptability, and potential efficacy of a 12-month course of pravastatin as an antifibrotic agent for managing dysphagia (swallowing problems) in patients previously treated with radiotherapy for head and neck cancer (HNC). The purpose is to assess whether pravastatin, a medication approved in Australia for cholesterol management, can improve swallowing in people with long-term radiation-associated dysphagia following HNC treatment. The trial will recruit 48 patients, with an anticipated accrual period of approximately 6 months. Eligible patients will be identified from the Principal Investigator's current study, ERADICATE, or through referral by a radiation oncologist or speech pathologist diagnosing radiation-induced dysphagia. Participants will receive 40 mg of pravastatin daily for up to 12 months, with swallowing assessments conducted before, during, and after treatment.
Radiation-associated Dysphagia · Head &Amp; Neck Cancer
TrialRECRUITINGNA
NCT06125743
Self-Management for Head and Neck Lymphedema and Fibrosis [PROMISE Trial]
The goal of this study is to evaluate the effectiveness of a standardized lymphedema and fibrosis self-management program (LEF-SMP) to improve LEF self-management and reduce LEF-associated symptom burden, functional deficits, and improve quality of life in head and neck cancer (HNC) survivors.
Lymphedema of the Head and Neck
TrialRECRUITINGPHASE2
NCT06959511
Zanzalintinib for the Treatment of Advanced Thyroid Cancer Before Surgery
To look at the effectiveness of zanzalintinib, followed by surgery, in treating advanced thyroid cancer. The safety of this treatment will also be studied.
Neoadjuvant Treatment · Thyroid Cancer
TrialRECRUITINGPHASE1, PHASE2
NCT07405151
A Clinical Trial of Ifinatamab Deruxtecan in People With Advanced Esophageal Cancer (MK-3475-06F)
The purpose of this trial is to assess if ifinatamab deruxtecan (I-DXd) can treat esophageal squamous cell carcinoma (ESCC). I-DXd is an antibody-drug conjugate (ADC). An ADC attaches to a protein on cancer cells and delivers treatment to destroy those cells. The goal of this trial is to learn how many participants who receive I-DXd have the cancer respond, which means the cancer gets smaller or goes away.
Oesophageal Squamous Cell Carcinoma
TrialRECRUITING
NCT06163534
A Longitudinal Multi-Omic Biomarker Profiling Study of Patients With Head & Neck Squamous Cell Carcinoma (HNSCC)
The study is a prospective, longitudinal, non-interventional, multicenter study of participants with HNSCC who will have tissue and blood based molecular biomarker profiling during their standard of care treatment.
Head and Neck Squamous Cell Carcinoma