The COVID-19 pandemic has been linked to various psychological and physical health consequences; however, its impact on tinnitus and associated psychological distress remains unexplored. This study evaluated the association between severity of chronic tinnitus and psychological outcomes, comparing these outcomes between the COVID-19 restriction period (2020) and the living-with-COVID-19 period (2022). Data were drawn from the 8th (2020) and 9th (2022) Korea National Health and Nutrition Examination Survey. A total of 5,965 participants were classified into bothersome tinnitus (visual analogue scale [VAS] > 4), non-bothersome tinnitus (VAS ≤ 4), and non-tinnitus groups. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), with a cut-off score of 5. Complex sample analyses were performed using sampling weights. During the COVID-19 restriction period, the bothersome tinnitus group demonstrated significantly higher PHQ-9 scores and greater prevalence of depressive symptoms and high stress than the non-tinnitus group (p < 0.001 for all) and the non-bothersome tinnitus group (p < 0.05 for all). No significant differences were observed among groups during the living-with-COVID-19 period. Significant differences between the two periods were identified in the bothersome tinnitus group (PHQ-9, p = 0.048; depressive symptoms, p = 0.009; high stress, p = 0.039). Bothersome chronic tinnitus was independently associated with higher prevalence of depressive symptoms and high stress during the COVID-19 restriction period. These findings highlight the importance of tinnitus severity assessment for identifying psychological vulnerability and the need for integrated tinnitus and psychological management, including non-face-to-face approaches, when in-person access is restricted.
Postoperative hypocalcemia is a common complication after total thyroidectomy. While parathyroid hormone (PTH) is widely used for early prediction, its utility is limited by variable availability and accuracy. We explored the clinical utility of early postoperative calcium (Ca)–phosphate (P) patterns in predicting prolonged calcium supplementation. The primary outcome was the duration of calcium supplementation after surgery. Calcium supplementation was considered prolonged when continuation exceeded 90 days, reflecting persistent impairment of calcium homeostasis. Supplementation was discontinued when serum calcium levels were maintained at ≥ 8.5 mg/dL on sequential measurements without supplementation. Patients who were still receiving supplementation at the end of the observation period were included, with duration calculated to the date of last follow-up. All patients who initiated calcium supplementation had documented follow-up beyond 90 days or were still receiving supplementation at the time of analysis; therefore, the primary outcome was reliably ascertained in all cases. Prolonged supplementation rates differed across groups: 42.3
This study aimed to assess the feasibility and voice outcomes of medialization thyroplasty (MT) with the APrevent® Vocal implant system (VOIS) performed under general anesthesia with Ambu® laryngeal mask airway (LMA) and use intraoperative flexible videoendoscope-guided implant balloon adjustment. This prospective case series was conducted at a single tertiary referral center. Twelve adult patients with unilateral vocal fold paralysis (UVFP) and severe dysphonia (Voice Handicap Index-30 ≥ 33) underwent MT with the APrevent® VOIS under general anesthesia with LMA, followed by intraoperative flexible videoendoscope-guided implant balloon adjustment to optimize the medialization of paralyzed vocal fold and minimize the glottal gap. Objective voice outcomes and acoustic parameters were evaluated preoperatively and at defined postoperative intervals. All the patients were follow-up to 6 months and the results revealed significant voice improvements. Maximum phonation time increased within two weeks. Voice Handicap Index and cepstral peak prominence smoothed (CPPS) significantly improved at two months. Shimmer and signal-to-noise ratio improved at six months, while jitter showed minimal change. MT with the APrevent® VOIS under general anesthesia with LMA and intraoperative flexible videoendoscope-guided implant adjustment is feasible and yields favorable voice outcomes in UVFP patients.
To quantitatively characterize common cavity (CC) and cochlear aplasia (CA) deformities using three-dimensional(3D) shape radiomics, and to explore their morphological subtypes, continuous spectrum, and association with vestibulocochlear nerve (VCN) development. This retrospective study included 77 patients with 127 ears diagnosed with CC or CA. The malformed cavities were segmented from temporal bone CT images, and 3D shape radiomics features were extracted. Principal component analysis (PCA) and K-means clustering were used to identify major morphometric dimensions and subtypes. Uniform Manifold Approximation and Projection (UMAP) was applied to visualize morphological continuity. The VCN/facial nerve (FN) ratio was measured on MRI as an imaging surrogate of VCN development. Principal component analysis (PCA) identified two principal components that explained 91.7
Complete ossification of the basal turn of the cochlea represents a major challenge inrevision cochlear implantation, particularly in post-traumatic cases. Otic capsule violating temporal bone fractures need to be carefully managed to avoid future possible meningeal infections. To describe our surgical technique of middle turn cochleostomy combined with subtotal petrosectomy for revision cochlear implantation in the setting of total basal turn ossification due to an otic capsule-violating temporal bone fracture. We report a case of failed primary cochlear implantation due to post-traumatic ossification of the basal turn. Revision surgery was performed using subtotal petrosectomy to achieve wide exposure of the promontory. After removal of the previous device and confirmation of complete ossification of both scala tympani and scala vestibuli at the basal turn, promontory drilling was extended superiorly to identify and open the middle turn of the cochlea, allowing full electrode insertion. Complete insertion of the new electrode array was achieved through the middle turn. Postoperative imaging confirmed appropriate positioning, facial nerve function was preserved, and the patient experienced improvement in auditory thresholds. In cases of total basal turn ossification, middle turn cochleostomy following subtotal petrosectomy represents a feasible and safe alternative to enable cochlear implantation in selected revision cases.
To determine whether occupational noise exposure aggravates the progression of age-related hearing loss and to analyze frequency-specific annual threshold shifts. We analyzed cross-sectional data from 3,719 participants (aged ≥ 40 years) in the 9th Korea National Health and Nutrition Examination Survey (KNHANES, 2023). Occupational noise exposure was defined as working in an environment with loud noise for ≥ 3 years. Linear regression with an interaction term (age × noise exposure) was used to compare the annual rate of threshold deterioration (dB/year) for each frequency. The noise-exposed group (n = 617) showed worse hearing thresholds than the unexposed group (n = 3,102) across all ages. Across frequencies, the largest absolute threshold difference between groups was observed at 4 kHz (10.0 dB, p < .001). Among frequencies, 2, 4 and 8 kHz were significantly associated with noise exposure after adjusting for age, sex, educational level and household income, with 4 kHz being the most prominent (OR per 1 dB increase, 1.020; 95
Report the updated version of retrolabyrinthine meatotomy (RLM) to the whole internal auditory canal in hearing preservation surgery (HPS) via retrosigmoid approach (RS) in sporadic vestibular schwannoma (VS). Description of surgical technique of VS removal with microscopic RS approach and RLM. Fifty-six consecutive patients with intrameatal or small (up to 15 mm extrameatal size) sporadic VS, with fundus free or fundus involved by the tumor, and good hearing at diagnosis, who underwent HPS, were retrospectively reviewed. Elective (protocol) indication for HPS was ≤ 10 mm size, ≤ 30 PTA, and ≥ 70 SDS. Complete VS removal was achieved in all 56 cases, with no residual tumor or recurrence. The overall hearing preservation rate was 64
This study aims to evaluate the therapeutic outcomes of CO₂ laser resection of the sulcus and reconstruction under microlaryngoscopy. This retrospective analysis included 22 patients (10 females and 12 males, with an average age of 24.9 years) diagnosed with pathological sulcus vocalis who underwent our surgical procedure, which involved vaporization of the sulcus using a CO2 laser, followed by separation and suturing of the mucosal flaps. Outcome measures included the Voice Handicap Index (VHI)-30, jitter, shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), maximum loudness phonation time (MLPT), the RBH (Roughness, Breathiness, Hoarseness) perceptual voice evaluation, and strobolaryngoscopic assessments of mucosal wave, amplitude, and sulcus severity before and 7 months after surgery, and the measurements were compared. Subjective improvements were observed, with statistically significant improvements in VHI-30 scores and all subscales (P < 0.05). Voice analysis demonstrated improvements in jitter and shimmer(P < 0.05). As in the RBH perceptual assessment, statistically significant improvements were observed postoperatively in the B score of the postoperative vowel (P < 0.05). Mucosal wave, amplitude, and bilateral sulcus severity scores showed improvement postoperatively (P < 0.05). CO₂ laser resection and reconstruction of the sulcus under microlaryngoscopy is an effective surgical method for treating sulcus vocalis. This technique significantly improves patients' subjective voice and voice quality mightily by enhancing vocal fold vibration and restoring normal vocal fold shape.
Open surgical tracheostomy is a fundamental airway procedure in otolaryngology and an essential component of surgical training. Balancing resident autonomy with patient safety remains a central challenge in academic practice. Evidence evaluating outcomes across different levels of resident experience and supervision remains limited. A retrospective cohort study was conducted at a tertiary academic center including all open tracheostomy procedures performed between January 2020 and December 2023. Procedures were categorized according to operator seniority as attending surgeons, senior residents (≥ 48 months of training), and junior residents (< 48 months). Subgroup analyses evaluated the impact of supervision during resident-performed procedures. The primary outcome was postoperative complications. Secondary outcomes included operative duration, mortality, and survival. Multivariable logistic regression was used to identify predictors of complications, and Kaplan–Meier analysis assessed survival. A total of 288 tracheostomy procedures were included: 81 (28.1
Considering the favourable prognosis of thyroid tumours, the importance of quality of life, including functional and voice outcomes, is critically important. The impact of remote-access thyroidectomy on postoperative voice function remains unclear, and direct comparative data across major approaches are limited. This study compared patient-reported and objective voice outcomes following robotic transoral (TO), robotic retroauricular (RA), and open hemithyroidectomy. This retrospective observational cohort study included patients undergoing hemithyroidectomy between January 2022 and August 2025. Voice outcomes were evaluated preoperatively and at 3 months postoperatively using the Voice Handicap Index-10 and acoustic analysis. Between-group comparisons and multivariable general linear modelling were performed to identify factors associated with postoperative voice outcomes. A total of 150 patients were analysed (RA: 58; TO: 37; open: 55). Baseline VHI-10 and acoustic parameters were comparable across groups. The RA group demonstrated significantly higher postoperative VHI-10 scores and greater VHI-10 change scores compared with TO and open approaches (p < 0.01). No significant differences were observed in postoperative acoustic parameters, including jitter, shimmer, noise-harmonic ratio, soft phonation index, pitch range, or fundamental frequency. Female subgroup analysis demonstrated similar findings. On multivariable analysis, postoperative VHI-10 remained to be only affected by the type of surgical approach. All three surgical approaches showed comparable objective acoustic voice parameters. However, TO and open hemithyroidectomy were associated with better patient-perceived voice outcomes at 3 months compared with RA. When clinical conditions are comparable, TO may be considered as a viable robotic approach in patients who prioritise short-term subjective voice outcomes.
The aim of this study was to investigate the predictive value of preoperatively measurable anthropometric parameters for difficult suspension laryngoscopy (DSL) and to determine objective cut-off values that may be used in clinical practice. Between April 1, 2024, and September 1, 2024, a total of 70 patients undergoing suspension laryngoscopy were prospectively evaluated. Demographic characteristics and anthropometric measurements, including body mass index (BMI), mouth opening, hyomental, thyromental, and sternomental distances, were recorded in both neutral and extension positions. Laryngeal exposure was graded according to the classification proposed by Roh et al. Patients with Grade 1–2 exposure were classified as the easy suspension laryngoscopy (ESL) group, whereas those with Grade 3–4 exposure were classified as the difficult suspension laryngoscopy (DSL) group. Receiver operating characteristic (ROC) curve analysis and logistic regression were used to identify predictive factors and optimal cut-off values. Easy suspension laryngoscopy was achieved in 42 patients (60
To evaluate the hearing outcomes and surgical success of glass ionomer cement (GIC) in incudostapedial rebridging ossiculoplasty (ISRO) in patients with different middle ear pathologies. A systematic literature review was conducted on Medline (via PubMed), the Cochrane Database, and Scopus from database inception to July 4, 2025. Two independent authors reviewed selected studies assessing the short-, middle-, or long-term tone audiometry results, the air-bone gap (ABG) closure percentage, and cement failure outcomes. The review adhered to the PRISMA reporting standards. Meta-analysis calculated the mean differences between post- and pre-operative pure-tone audiometry values (pooled estimates and 95
To investigate the impact of anatomical variation (AV) on surgical skills acquisition, i.e., learning curves, and cognitive load (CL) during virtual reality (VR) simulation-based training (SBT) of mastoidectomy. A randomized, controlled educational trial. Trainees (medical students) were randomized to perform 12 virtual mastoidectomies on anatomically different temporal bones (intervention) or on the same temporal bone (controls). Training was organized as distributed practice. Mastoidectomy performances were evaluated by two blinded raters using the modified 26-points Welling Scale assessment tool and learning curves were established. CL was estimated by secondary task reaction time. The intervention group (AV) improved from baseline performance by 80
NF2-related schwannomatosis is a rare tumor-predisposition syndrome characterized by bilateral vestibular schwannomas (VS) that frequently lead to progressive hearing loss and neurological morbidity. Multi-modality strategies—microsurgery, radiosurgery, radiotherapy, systemic therapy, observation—are employed, but optimal treatment selection remains challenging due to disease heterogeneity, evolving practice patterns, and limited comparative evidence. This study assesses reported management strategies and outcomes for NF2-associated VS. A systematic review was performed for studies reporting management strategies and outcomes for NF2-associated VS, including cohort studies and case series describing treatment methods and outcomes. Data collected included treatment modalities, tumor control, hearing outcomes, and facial nerve function. Of 359 records, 32 studies met the inclusion criteria, mostly retrospective case series. Radiosurgery represented the most frequently reported modality, followed by microsurgery. Radiosurgery achieved tumor-control rates ranging of 66
Meniere’s disease (MD) is a fluctuating vestibulocochlear disorder with an unknown cause. Familial clustering occurs in 8–10
To describe the surgical and functional outcomes of modified posterior cordotomy in patients with bilateral vocal fold paralysis (BVFP), with particular attention to airway function, swallowing, and voice outcomes. This retrospective study included 30 patients with BVFP who underwent modified posterior cordotomy between June 2017 and August 2024. Preoperative and postoperative evaluation included videolaryngoscopy and patient-reported outcome measures, including the Voice Handicap Index (VHI-30), Eating Assessment Tool-10 (EAT-10), and Airway-Dysphonia-Voice-Swallowing (ADVS) scale. All 30 patients were women (mean age 55.53 years) who underwent modifiedposterior cordotomy for iatrogenic (100
Robot-assisted parotidectomy is a remote-access alternative to conventional open parotidectomy, but comparative data remain limited. This study evaluated perioperative safety, facial nerve preservation, complications, and pathological outcomes of da Vinci robot-assisted versus conventional open parotidectomy. Patients who underwent parotidectomy by a single experienced head and neck surgeon at a regional teaching hospital between January 2020 and January 2026 were retrospectively reviewed. Baseline characteristics, operative details, facial nerve outcomes, complications, pathological findings, and recurrence were compared between da Vinci robot-assisted and conventional open approaches. Seventy-four patients were included: 23 underwent robotic parotidectomy, including 17 da Vinci Xi and 6 da Vinci SP cases, and 51 underwent conventional open parotidectomy. The robotic group was younger, 44.52 ± 13.89 versus 51.78 ± 17.27 years, p = 0.015, and had more female patients, 60.9
Intraparotid lymph node (PLN) recurrence from oral cavity squamous cell carcinoma (OCSCC) is uncommon and inadequately characterised, with limited literature regarding its frequency, predictors, and prognostic implications. A retrospective analysis was conducted on consecutive patients with OCSCC who underwent upfront surgery at a tertiary care centre from 2022 to 2024. Patients with clinical or radiological evidence of PLN recurrence were identified. A site-matched cohort of 100 consecutive patients with OCSCC treated surgically during the same time frame, and patients with non-PLN recurrences served as controls. Among 939 surgically treated OCSCC patients, 22 (2.34
