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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
