A vascularized nasoseptal flap (NSF) provides a novel transnasal option for repairing soft palatal fistulas when traditional transoral flaps have failed or are unavailable, potentially avoiding the morbidity of regional or free tissue transfer. In the current patient who had an 8 × 6 mm soft palatal fistula, the NSF was harvested from the septum and nasal floor, rotated through the nasopharynx to cover the fistula, and was suture-fixated transorally to the mobile soft palate to promote stable adherence and healing. Closure was successful, which resolved her nasal regurgitation, partially improved her velopharyngeal function, and did not cause Eustachian tube dysfunction.
OBJECTIVES:To define persistent and recurrent dysphagia after surgery for CPMD with and without diverticula. METHODS:Patients with CPMD with and without diverticula enrolled in the Prospective Outcomes of Cricopharyngeus Hypertonicity (POuCH) multicenter study who underwent surgery from November 2014 to August 2024 with at least 12 months of follow up were included. Surgical outcomes were evaluated using a validated patient reported dysphagia marker, Eating Assessment Tool 10 (EAT10), where normal is characterized as < 3. Persistent dysphagia is defined as patients with < 50% improvement in EAT-10 or EAT-10 score ≥ 3 at first follow up. Recurrent dysphagia is an initial surgical responder with a delayed worsening in EAT-10 scores during follow-up. RESULTS:A total of 160 patients were included. Six patients (3.7%) had recurrent dysphagia, with 5 undergoing re-operation. A total of 23 patients (14.3%) had persistent dysphagia immediately post-operatively; one underwent re-operation. Preoperative EAT-10 scores were higher in the persistent group (median 23.5, interquartile interval (IQR) 12.0-28.5) compared to responders (14.0, 8-24) (p = 0.05). Median first post-operative EAT-10 in the persistent dysphagia group was 14 (IQR 8-21) compared to 0 in the responders (0-2; p < 0.0001). There was no difference in esophageal pathology. There was no difference in rates of response to endoscopic versus open surgery. CONCLUSION:Patients with recurrent dysphagia are less common than persistent dysphagia, and there are no clear markers to predict surgical responders from persistent dysphagia (e.g., non-responders), however all non-responders occurred in the first 12 months after surgery. LEVEL OF EVIDENCE: 4:
OBJECTIVE:Research productivity among otolaryngology-head and neck surgery (OHNS) residency applicants has increased substantially in recent years, alongside growing participation in dedicated research years. However, the extent to which a research year contributes to meaningful scholarly output remains unclear. This study characterizes and compares research productivity among OHNS residency applicants with and without a dedicated research year. METHODS:We retrospectively reviewed applicants to a single OHNS residency program during the 2025 application cycle. Applicants were categorized by completion of a dedicated research year. Students with ambiguous reasons for a gap in medical education (e.g., personal) were excluded. Research products listed in ERAS were categorized by type, authorship, publication status, and presentation characteristics. Outcomes were compared using the Wilcoxon rank-sum test and reported as medians with interquartile ranges (IQR). RESULTS:The median number of total research products among all 196 applicants was 26 [IQR 17-37]. Applicants with a dedicated research year (n = 55) had more total research products than those without (n = 90) (32 [21-37] vs. 24 [15.75-37]), comprised primarily by unpublished work (5 [3-8] vs. 3 [1-5]) and oral presentations (6 [3-9] vs. 4 [2-7]). Published articles (5.5 [3-11] vs. 7 [3-12]) and first-author manuscripts (Median 1) did not differ significantly between groups. CONCLUSION:A dedicated research year is associated with modestly increased research productivity among OHNS applicants; however, this increase is largely driven by unpublished and middle author work. These findings suggest that volume-based metrics may incompletely capture scholarly engagement and may contribute to increased expectations without proportionate gains in research experience. LEVEL OF EVIDENCE:N/A.
OBJECTIVE:To evaluate a two-stage tracheal reconstruction strategy for repairing extensive tracheal defects in well-differentiated thyroid carcinoma (WDTC) with tracheal invasion. METHODS:Seventy-four patients underwent tumor resection and tracheal excision, followed by staged reconstruction using a free posterior tibial flap (n = 28), pedicled thoracoacromial flap (n = 36), or pedicled supraclavicular flap (n = 10). Functional recovery, decannulation, complications, and survival were analyzed. RESULTS:Demographic characteristics were comparable across groups. Tracheal defects were significantly larger in the free posterior tibial artery perforator flap group (9.14 ± 1.57 rings) versus the pedicled thoracoacromial (5.89 ± 2.59 rings) and supraclavicular (6.30 ± 1.49 rings) flap groups. The overall endotracheal tube removal rate was 95.9%, with no intergroup differences (p = 0.533). Functional recovery (swallowing, speech, and respiration) was comparable among groups. The 3-year survival rate was 78.4%, with no significant differences across groups (p = 0.633). CONCLUSIONS:Two-stage tracheal reconstruction is a safe and effective approach for long-segment tracheal defects in WDTC patients, offering satisfactory functional recovery. Further studies with larger cohorts and longer follow-up are warranted to confirm long-term efficacy. LEVEL OF EVIDENCE: 4:
OBJECTIVES:Surgical manipulation of the vocal folds carries a risk of mucosal injury. We used an established unilateral mouse vocal fold injury model to determine whether electronic cigarette (E-cig) exposure after injury induces remodeling and inflammatory responses in the vocal fold mucosa that differ from injury alone. METHODS:Adult mice underwent unilateral vocal fold injury using a wire brush under microscopy and were assigned to an Injury or Injury + E-cig group. The Injury + E-cig group received daily E-cig aerosol exposure after injury. Mice were sacrificed at 3, 14, and 28 days. A room air-exposed group served as Control. We quantified epithelial (EP) thickness and lamina propria (LP) area, measured expression of genes related to EP junctions, extracellular matrix (ECM) remodeling, and inflammation, and performed immunostaining to corroborate gene expression findings. RESULTS:Injury + E-cig mice exhibited blunted post-injury weight gain versus Controls. EP thickness and EP junction gene expression recovered similarly in Injury and Injury + E-cig groups. In contrast, early LP expansion and acute increases in TNF-α, F4/80, and Col3α1 were attenuated with E-cig exposure, indicating selective disruption of acute macrophage-associated inflammatory and ECM responses. CONCLUSION:This is the first study to examine the effects of E-cig exposure on vocal fold wound healing. Clinically, these findings raise concern about postoperative E-cig use after vocal fold surgery. Although often viewed as safer than smoking, E-cig use may alter early wound healing responses that are essential for restoring vocal fold structure and function. LEVEL OF EVIDENCE:N/A.
OBJECTIVES:Extracellular matrix (ECM)-based scaffolds and gels demonstrate promise for vocal fold scar treatment; however, these injectables necessitate invasive procedures and repeated dosing. Multiple injections to the folds can damage the tissue, leading to fibrotic outcomes. We hypothesize that a nebulized vocal fold lamina propria ECM (VFLP-ECM) formulation can provide an effective regenerative treatment for upper airway delivery in a novel delivery approach. METHODS:A porcine-derived, nebulized formulation of VFLP-ECM was synthesized for targeted VF delivery. Bilateral vocal fold injuries were induced in Sprague Dawley rats using micro forceps. Forty-eight hours postinjury, animals were assigned to a (1) injury alone/control group or a nebulized treatment group receiving (2) phosphate buffer saline (PBS), (3) collagen type I (COLI), or (4) extracellular matrix (VFLP-ECM), with six animals in each group. Larynges were harvested 14 days postinjury and histologically analyzed using Hematoxylin and Eosin and Masson's trichrome staining. RESULTS:Histological analysis demonstrated reduced collagen deposition and lower myofibroblast density in the VFLP-ECM treated group compared to PBS and injury alone controls. Additionally, treated tissues exhibited increased lamina propria thickness and improved extracellular matrix organization, indicative of regenerative rather than fibrotic remodeling. CONCLUSION:Nebulized delivery of VFLP-ECM improved VF tissue characteristics. This study suggests a potential application for nebulized decellularized ECM in supporting vocal fold tissue regeneration during the acute phase of wound healing, with long-term effects warranting further investigation. LEVEL OF EVIDENCE:NA.
OBJECTIVE:To evaluate hearing outcomes in postneonatal treatment of congenital cytomegalovirus (cCMV) infection and assess the effect of treatment initiated after the first month of life. DATA SOURCES:PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. REVIEW METHODS:Articles reporting antiviral treatment of cCMV, with Ganciclovir (GCV) or Valganciclovir (VGCV) in the postneonatal period were included. Outcomes of interest included viral load (urine and plasma), neutropenia, and hearing outcomes (return to normal hearing, improvement, deterioration, and no change). Mean difference (MD) was used for continuous outcomes and proportions for binary endpoints, with 95% confidence intervals (CI). RESULTS:Eight studies with 192 patients met inclusion criteria. Oral VGCV was associated with a reduction in viral load during the first 2 months. At 2 months, pooled MD for urine viral load was -3.67 (95% CI -4.33 to -3.02, I2 = 75.4%), and for plasma was -0.80 (95% CI -1.08 to -0.52, I2 = 31.6%). Among patients with hearing loss, normalization occurred in 42.29% (95% CI 13.48 to 77.51, I2 = 84.3%) and improvement in 38.48% (95% CI 16.77 to 66.00, I2 = 88.2%) of total ears. Hearing deterioration was uncommon, affecting 5.47% of total ears (95% CI 2.15 to 13.25, I2 = 60.9%). Neutropenia was infrequent, with 9.09% experiencing grade 1-2 and 3.67% grade 3-4. CONCLUSION:Postneonatal antiviral treatment for cCMV may reduce viral load and improve hearing in a substantial proportion of patients, with low rates of adverse events. However, long-term outcomes remain unclear, and larger prospective studies are needed to confirm efficacy. LEVEL OF EVIDENCE:N/A.
OBJECTIVE:To determine if intraoperative inspection of patient-specific 3D-printed TB models, as a supplement to standard imaging, affects the cognitive load of surgeons during cochlear implantation (CI). METHODS:This randomized controlled trial included 40 consecutive adult primary CI surgeries performed by seven attending and five trainee surgeons at a large CI center. Cases were randomized 1:1 to current standard with surgical planning based on imaging review (controls) or to current standard plus intra-operative inspection of a 3D-printed model (intervention). The primary outcome, intraoperative cognitive load, was measured using the Surgery Task Load Index (Surg-TLX) and analyzed with linear mixed-effects models. Secondary outcomes included ratings of model anatomy, utility, and user experience (Schlegel-questionnaire) and prediction of intraoperative challenges. RESULTS:Attending surgeons experienced lower overall cognitive load using 3D models versus controls (3.8 vs. 5.5; p < 0.01), driven by reduced physical fatigue (p = 0.01). Conversely, residents reported higher overall load (7.2 vs. 4.8; p = 0.02) with increased mental (p = 0.01) and physical fatigue (p < 0.001). Fellows showed no significant difference in overall load (8.2 vs. 8.0; p = 0.88) but noted lower case complexity (p = 0.02) offset by higher physical fatigue (p = 0.04). Models were viewed as accurate and useful, particularly for trainee education, anticipating case difficulty and anatomical boundaries. CONCLUSION:The clinical impact of intraoperative 3D-printed models during CI is modulated by surgical experience. For attendings, models act as high-fidelity references facilitating cognitive offloading, whereas they stimulate mental effort for trainees. Selective implementation is recommended to align use of models to surgical experience level to promote operative efficiency and surgical training. LEVEL OF EVIDENCE:Level II.
OBJECTIVES:Snoring is a major acoustic manifestation of upper airway obstruction and an indicator of sleep-disordered breathing (SDB). However, objective snoring quantification during polysomnography (PSG) remains challenging because of inconsistent scoring criteria. We evaluated the performance of a deep learning-based automated PSG analysis system for snoring scoring by comparing automated and manual analyses. METHODS:This retrospective study included 100 adults who underwent Level 1 PSG for suspected obstructive sleep apnea between January 2020 and December 2024. Manual PSG scoring followed American Academy of Sleep Medicine criteria. Automated analysis was performed using the SOMNUM clinical decision support system. Agreement was evaluated using intraclass correlation coefficients (ICC), Bland-Altman analysis, and Pearson correlation analysis. Respiratory parameters and OSA severity classification were also assessed. RESULTS:Automated snoring analysis showed good agreement with manual scoring for snoring time (ICC = 0.91; 95% CI, 0.84-0.94) and snoring percentage (ICC = 0.84; 95% CI, 0.76-0.89). Bland-Altman analysis demonstrated acceptable agreement, and Pearson correlation confirmed strong associations for snoring time (r = 0.86) and snoring percentage (r = 0.88) (both p < 0.001). Respiratory parameters also showed excellent agreement, including the apnea-hypopnea index (ICC = 0.97) and oxygen desaturation index (ICC = 0.97). No severe OSA cases were misclassified into lower-risk categories. CONCLUSION:Automated PSG analysis demonstrated strong agreement with expert manual scoring for snoring, respiratory parameters, and OSA severity. These findings support its clinical utility for objective, reproducible snoring assessment and its potential as a digital biomarker for SDB. LEVEL OF EVIDENCE: 3:
OBJECTIVE:There is increasing interest in the relationship between atrial fibrillation (AF) and peripheral vestibulopathy. The objective of this study was to investigate the association between peripheral vestibulopathy and prior AF in a nationwide, population-based cohort. METHODS:Using data from Taiwan's Longitudinal Health Insurance Database 2010, we carried out case-control research. In the period between 2016 and 2021, a total of 120,774 individuals aged ≥ 18 years were diagnosed with peripheral vestibulopathy for the first time. Using propensity-score matching based on sociodemographic characteristics and comorbidities, a control group of 483,096 people without peripheral vestibulopathy was chosen. Adjusted odds ratios (aORs) for the relationship between peripheral vestibulopathy and prior AF were calculated using multivariable logistic regression. RESULTS:This study revealed that individuals with peripheral vestibulopathy had a substantially greater prevalence of previous AF than controls (1.53% vs. 1.28%; p < 0.001). Patients with peripheral vestibulopathy demonstrated a significantly elevated probability of a history of AF, a finding that remained consistent after adjusting for confounding variables (aOR = 1.211, 95% CI = 1.148-1.278). Benign paroxysmal positional vertigo (aOR = 1.189, 95% CI = 1.045-1.352) and other/unspecified forms of peripheral vestibulopathy (aOR = 1.277, 95% CI = 1.199-1.360) among peripheral vestibulopathy subtypes showed a significant association. After adjustment, neither vestibular neuritis nor Meniere's illness showed any meaningful association. CONCLUSION:The present study shows that there is a significant association between peripheral vestibulopathy and a prior diagnosis of AF. The findings suggest a potential link between vestibular dysfunction and cardiac arrhythmias, highlighting the need for further research into the underlying pathophysiological mechanisms. LEVEL OF EVIDENCE: 3:
OBJECTIVES:The objective of this study is to determine whether radiologic tumor volume adds prognostic value for overall survival (OS) and disease-free survival (DFS) in laryngeal squamous cell carcinoma (LSCC) and to evaluate associations with T stage, nodal status, histologic grade, subsite, and treatment modality. METHODS:Patients with cT2-T4 LSCC treated with curative intent between 2018 and 2024 were included. Tumor volumes derived from CT, MRI, or radiotherapy planning contours were analyzed as continuous and binary variables using a threshold identified by log-rank maximization. Survival was assessed with Kaplan-Meier methods and Cox proportional hazards models. RESULTS:Eighty-eight patients were included (39.8% surgical and 60.2% nonsurgical). Median tumor volume was 3.7 cm3 (range 0.03-51.3 cm3). Volume threshold of 22.498 cm3 was associated with a 3.6-fold increase in mortality (60.0% vs. 16.7%; p < 0.001), with significantly worse OS and DFS in the high-volume group (both p < 0.001). On multivariable analysis, high tumor volume remained independently associated with OS after adjustment for age, T stage, and nodal status (HR = 9.66, 95% CI: 2.56-36.39). Tumor volume correlated with T stage (Spearman ρ = 0.569, p < 0.001), and node-positive tumors were larger than node-negative tumors (median 5.6 cm3 vs. 2.6 cm3; p = 0.017). Supraglottic and transglottic tumors had larger volumes than glottic and higher-grade tumors were associated with larger volumes. Nonsurgical patients had smaller tumors than surgical patients. CONCLUSION:Tumor volume was independently associated with survival outcomes in LSCC and may improve risk stratification beyond TNM classification alone. A threshold of 22.498 cm3 identifies a high-risk subgroup and warrants prospective validation for integration into staging and treatment planning. LEVEL OF EVIDENCE: 3:
OBJECTIVE:To investigate whether neighborhood-level sociodemographic deprivation, measured by the Area Deprivation Index (ADI), is associated with speech recognition and hearing-related quality of life (QoL) prior to and following cochlear implant (CI) surgery. METHODS:A retrospective review of 515 adult CI recipients (2017-2022) was conducted. Home addresses were geocoded to ADI percentiles representing neighborhood-level sociodemographic deprivation. Assessments collected pre-CI and at 6- and/or 12-months post-CI included speech recognition (CNC words, AzBio sentences in quiet-AzBioQ, and in noise-AzBioN) and patient-reported outcome measures (Speech, Spatial and Qualities-12-SSQ, Cochlear Implant Quality of Life-10-CIQOL). Bivariate Spearman correlations and multivariable linear regressions controlling for age, sociodemographic variables, duration of deafness, and electrode type evaluated associations between ADI and assessment measures. RESULTS:Participants from more deprived neighborhoods (i.e., with larger ADIs) demonstrated significantly poorer pre-CI CNC (rs = -0.11), AzBioQ (rs = -0.12), AzBioN (rs = -0.18), SSQ (rs = -0.13), and CIQOL (rs = -0.30) (all p < 0.05). In multivariable models, larger ADI remained an independent predictor of poorer pre-CI speech recognition and worse CIQOL (p's < 0.05). However, ADI was not associated with any post-CI outcomes (p's > 0.05). CONCLUSION:Greater neighborhood-level deprivation is associated with poorer speech recognition and patient-reported outcome measures at CI evaluation but not with postimplantation benefit. These findings suggest that socioeconomic disparities primarily influence access to intervention rather than outcomes following implantation. Incorporating ADI into clinical workflows may help identify patients at risk for delayed CI access. LEVEL OF EVIDENCE: 4:
OBJECTIVE:To synthesize the prevalence and subtype-specific patterns of airway manifestations in mucopolysaccharidoses (MPS) and summarize related morbidity and mortality. DATA SOURCES:PubMed, CINAHL, Ovid Embase, Ovid MEDLINE, and Ovid All EBM Reviews. REVIEW METHODS:PRISMA-ScR guided scoping review of English and French-language studies reporting airway manifestations in ≥ 5 patients up to June 2026. Pooled prevalences with 95% confidence intervals (CI) were estimated using proportional meta-analysis. RESULTS:Of 2359 records, 65 case series (3715 participants; Level 4 evidence) were included. Upper-airway soft tissue hypertrophy was common: adenoid hypertrophy ranged from 52.5% (MPS IV; 95% CI, 21.0-82.1) to 78.5% (MPS I; 95% CI, 23.9-97.7); tonsillar hypertrophy ranged from 38.5% (MPS I; 95% CI, 17.5-64.9) to 59.5% (MPS II; 95% CI, 34.6-80.4). Macroglossia was frequent, with the highest prevalence in MPS II (79.7%; 95% CI, 16.5-98.7). Laryngotracheal involvement varied, with tracheal narrowing reaching 92.3% (95% CI, 7.0-99.9) in MPS II and 85.4% (95% CI, 38.3-98.2) in MPS IV. Obstructive sleep apnea was highly prevalent across subtypes (MPS I, 61.7%; 95% CI, 45.3-75.9; MPS II, 75.3%; 95% CI, 43.1-92.4; MPS VI, 83.7%; 95% CI, 48.0-96.6). Tracheotomy was required in 7.0% (95% CI, 4.9-9.9), and respiratory-related deaths occurred in 10.4% (95% CI, 5.2-19.9) of patients with available data. CONCLUSION:Airway disease in MPS is common, multilevel, and clinically consequential, with substantial burdens of OSA and progressive laryngotracheal pathology. Early, systematic, longitudinal airway assessment is essential to guide counseling and management across MPS subtypes.
OBJECTIVE:To test whether smartphone-captured high-resolution 3D facial geometry can objectively quantify the severity of facial nerve palsy (FNP). METHODS:We enrolled 99 patients with peripheral acute unilateral FNP (207 visits) and 12 healthy volunteers (July 2021-February 2024). The facial dynamics were captured using a smartphone with a 3D front-facing camera, yielding a facial mesh comprising 1220 vertices. Recordings were obtained for multiple facial tasks. Clinical benchmarks included the House-Brackmann (HB) grading and electrophysiology. Features of displacement, velocity, acceleration, and asymmetry were extracted. Random forest regressors were trained for signed continuous HB (side-aware) score prediction and for region-specific prediction. Patient-wise cross-validation was used. Regressor performance was evaluated using Spearman's ρ, mean absolute error, R2, and area under the curve for HB ≥ III. RESULTS:The continuous HB regression model achieved a mean absolute error of 0.718, an R2 of 0.851, and a Spearman's ρ of 0.935. Predictions for healthy controls were tightly clustered. The area under the receiver operating characteristic curve for screening for HB ≥ III was 0.914 ± 0.052. Region-specific analyses showed the best performance for eyelid closure and teeth exposure. Regression using integrated electromyography demonstrated moderate correlations, while electroneurography showed weak correlations. CONCLUSION:Smartphone-captured high-frame-rate 3D facial geometry enabled accurate side-aware continuous HB estimation and robust screening for clinically significant palsy. This method can detect subtle residual asymmetry beyond human grading, is robust for healthy controls, and may facilitate early detection, standardized monitoring, and at-home rehabilitation of FNP. LEVEL OF EVIDENCE: 3:
OBJECTIVES:To evaluate the relationship between weight loss velocity following bariatric surgery and the onset and long-term persistence of Patulous Eustachian Tube (PET) symptoms. METHODS:Sixty patients who underwent laparoscopic sleeve gastrectomy were prospectively evaluated. Otological assessments and the Eustachian Tube Dysfunction Questionnaire (ETDQ-7) were completed preoperatively and postoperatively at 1, 3, 6, and 12 months. Patients were categorized into Asymptomatic (Group 1), Recovered (Group 2), and Persistent (Group 3) groups based on 12-month clinical trajectories. Postoperative weight loss velocity was calculated via periodic BMI (Body Mass Index) change rates (ΔBMI%). RESULTS:The overall PET symptom onset rate was 55.0% (n = 33), with 43.3% (n = 26) experiencing spontaneous resolution and 11.7% (n = 7) developing chronic symptoms. No significant difference was found in 12-month excess weight loss percentage (%EWL) success rates among groups (p = 0.577). However, BMI decline velocities demonstrated highly significant intergroup variances (p < 0.001). ROC analysis revealed that an initial 0-3 month BMI decline exceeding 25.0% significantly predicted symptom onset (p = 0.003). Remarkably, a 3-6 month BMI decline velocity above 22.4% predicted long-term symptom chronicity. (p < 0.001), yielding a sensitivity and negative predictive value of 100%. Higher preoperative BMI was significantly associated with symptom persistence. CONCLUSION:The onset and long-term persistence of post-bariatric PET symptoms are fundamentally dictated by postoperative weight loss velocity rather than absolute weight loss. A sustained high-velocity BMI decline between Months 3 and 6 serves as the definitive clinical predictor for chronicity, demanding close monitoring. LEVEL OF EVIDENCE: 3:
The sub-hyoid approach is a novel open surgical technique for selected deeply infiltrative base of tongue tumors, providing direct access and allowing full-thickness resection while preserving the tongue neurovascular structures. Thyro-hyoido-pexy restores hyo-laryngeal suspension without flap reconstruction, with the aim of preserving swallowing function.
OBJECTIVE:To compare hemithyroidectomy eligibility and completion thyroidectomy recommendations under the ATA 2015 and ATA 2025 criteria within the same patient cohort (primary aim) and, as a secondary descriptive analysis, to assess the concordance between these guideline-based classifications and the operations actually performed. METHODS:Retrospective cohort study of adult patients who underwent primary hemithyroidectomy for differentiated thyroid carcinoma at a tertiary center (January 2015-November 2025). NIFTP and tumors of uncertain malignant potential were excluded from the comparative analysis. Each case was independently reclassified by ATA 2015 and ATA 2025 criteria using final histopathology (a retrospective, hindsight reclassification that could not have informed preoperative decisions); paired comparisons used the McNemar test. RESULTS:Of 98 patients, 86 were eligible for comparative analysis. Hemithyroidectomy eligibility increased from 60.5% (52/86) under ATA 2015 to 81.4% (70/86) under ATA 2025 (absolute increase 20.9 points; 95% CI 12.3-29.5; p < 0.001). Completion thyroidectomy indications decreased from 44.2% (38/86) to 29.1% (25/86) (absolute reduction 15.1 points; 95% CI 7.5-22.7; p < 0.001). Despite this reduction, completion was actually performed in 40.7% (35/86) of the comparative cohort (vs. 35.7% overall; the difference reflects exclusion of NIFTP and tumors of uncertain malignant potential). CONCLUSION:The ATA 2025 criteria substantially expand hemithyroidectomy eligibility and reduce completion thyroidectomy indications compared with ATA 2015. Real-world completion rates nonetheless exceeded guideline-based projections, suggesting that additional pathological and clinical factors may influence individualized surgical decision-making. These findings characterize the guideline update's impact on surgical strategy and do not address long-term oncologic outcomes, which were beyond this study's scope. LEVEL OF EVIDENCE: 4:
