Pediatric voice disorders are common conditions that may significantly affect communication, psychosocial development, and quality of life in children. Despite their clinical importance, considerable variation exists in diagnostic approaches and treatment strategies, partly due to difficulties in performing invasive examinations and limited high-quality evidence. To address these challenges, the Korean Society of Laryngology, Phoniatrics and Logopedics developed evidence-based clinical practice guidelines for the diagnosis and management of pediatric voice disorders. These guidelines were developed de novo through a systematic literature review addressing predefined key clinical questions related to pediatric vocal fold mucosal lesions and vocal fold paralysis. Searches were conducted in Medline, Embase, the Cochrane Library, and KoreaMed for studies published up to May 31, 2025. Evidence was critically appraised using standardized tools according to study design, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations were formulated by considering the balance of benefits and harms, quality of evidence, patient values and preferences, clinical feasibility, and resource implications. A total of nine key clinical questions were addressed, covering diagnostic strategies, voice assessment, noninvasive imaging, voice therapy, surgical intervention, and postoperative management in children with voice disorders. Most recommendations were conditional due to low or very low certainty of evidence, reflecting current limitations in pediatric voice research. These guidelines aim to support consistent, patient-centered clinical decision-making, reduce unwarranted practice variation, and promote optimal outcomes in the care of children with voice disorders.
Objectives.:Several studies have demonstrated the benefits of tonotopic fitting on speech-in-noise perception in new cochlear implant (CI) users. However, these studies used different coding strategies (CIS, HDCIS, FSP, FS4, or mixed) with different frequency spectra. The aim of this study was to assess the impact of fine structure (FS) cues on speech perception in noise and in quiet and music perception, in new CI users with a tonotopic fitting map. Methods.:A prospective, randomized, double-blind, 2-period crossover study was performed from April 2023 to June 2024. All participants had tonotopic fitting determined by using flat-panel computed tomography (CT) and reconstruction software based on the Greenwood function. 24 new CI users aged 18 years or older with either bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were recruited at a single tertiary referral center. Participants were randomized to FS followed by conventional coding, or the reverse sequence, for 6-week periods with speech and music assessments after each period. Results.:FS cues significantly improved speech recognition in noise for high signal-to-noise ratio (SNR = +9 dB, Mean Effect (ME) = 6.0%, Standardized effect size (SES) = 0.62, p = 0.010). A period effect was observed beyond + 6 dB of SNR (SNR = +9 dB, p = 0.010; SNR = +6 dB, p = 0.018) without a statistically significant group effect. Speech recognition and tonal audiometry in quiet were not affected by FS coding. Melodic contour identification was enhanced by FS cues (ME = 7.2%, SES = 0.51, p = 0.030), and, in an exploratory subset analysis, low-frequency pitch discrimination was also improved (ME = 8.5 Hz, SES = 0.72, p = 0.04). Over 75% of the participants retained the tonotopic map with FS coding after study completion. Conclusion.:FS coding strategies on tonotopic maps may improve speech recognition in noise at favorable SNRs, without compromising speech understanding in quiet. It may also enhance selected complex sound perception aspects, particularly pitch- and contour-related processing, while benefits for subjective music perception appear less consistent.
Objectives.:To evaluate multidimensional outcomes of cochlear implantation (CI) in adults with single-sided deafness (SSD) or asymmetric hearing loss (AHL), and to examine how duration of deafness influences speech perception, tinnitus severity, and hearing-related quality of life. Methods.:This retrospective cohort study included 124 adults with SSD or AHL who underwent unilateral CI at a tertiary referral center (September 2019-October 2024) with at least 12 months of postoperative follow-up. The primary outcome, hearing-related quality of life, was assessed using the Speech, Spatial, and Qualities of Hearing Scale (SSQ); secondary outcomes included the Hearing Handicap Inventory for the Elderly (HHIE), Tinnitus Handicap Inventory (THI), Short Form-36 (SF-36), and open-set speech perception (n = 61). The association between duration of deafness and postoperative outcomes was evaluated using duration as a continuous predictor in linear regression. Results.:Significant postoperative improvements occurred in SSQ Speech (+0.97; d = 0.53; p < 0.001) and Spatial domains (+1.60; d = 0.88; p < 0.001), HHIE (- 13.0; d = 0.50; p < 0.001), THI (-15.8; d = 0.61; p < 0.001), and SF-36 (+4.2; d = 0.27; p = 0.031). Speech perception improved markedly under CI-only conditions (monosyllabic d = 1.98; bisyllabic d = 2.92; sentence recognition d = 3.59). Longer duration of deafness was significantly associated with smaller THI improvement (β = 1.13 points/year, 95% CI 0.43-1.84; p = 0.002; adjusted β = 0.98, 95% CI 0.18-1.78; p = 0.017), whereas quality-of-life and sentence recognition outcomes were not associated with deafness duration. Conclusion.:Unilateral CI produces clinically meaningful improvements in hearingrelated quality of life, tinnitus severity, hearing handicap, and speech perception in adults with SSD and AHL. Quality-of-life and speech outcomes were preserved regardless of deafness duration, whereas tinnitus suppression declined with increasing deaf duration. These findings support earlier CI for candidates with bothersome tinnitus.
Objectives.:Accurate preoperative differentiation of salivary gland malignancies is critical for surgical planning. This study aimed to perform an updated systematic review and meta-analysis comparing the diagnostic accuracy of ultrasound-guided core needle biopsy (CNB) and fine-needle aspiration cytology (FNAC) in detecting salivary gland malignancies. Methods.:A systematic search of electronic databases (MEDLINE, Embase, and the Cochrane Library) was conducted to update a foundational review. Studies comparing the diagnostic accuracy of CNB and FNAC for salivary gland tumors, with definitive surgical histopathology as the reference standard, were included. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were estimated using random-effects models. A bivariate random-effects model was used to construct summary receiver operating characteristic (SROC) curves. Results.:Ten studies comprising 3,902 procedures (2,064 FNAC and 1,838 CNB) were included. The pooled sensitivity of CNB (0.905 [95% CI, 0.874-0.936]; I2 = 0.0%) was higher than that of FNAC (0.601 [95% CI, 0.526-0.676]; I2 = 42.7%). Pooled specificity was comparably high for both modalities (CNB: 0.979 [95% CI, 0.958-1.000]; I2 = 82.9%; FNAC: 0.970 [95% CI, 0.954-0.985], I2 = 66.6%). The pooled DOR for CNB was higher than that for FNAC (492.468 vs. 42.624). The area under the SROC curve was also higher for CNB than for FNAC (0.903 vs. 0.865). The QUADAS-C assessment indicated predominantly low risk in the comparative index-test domain, with no high-risk judgements in any domain. Conclusion.:Ultrasound-guided CNB demonstrates higher pooled sensitivity than FNAC, while both modalities showed high pooled specificity. Given this higher sensitivity for detecting malignancies, CNB may be considered a preferred diagnostic option within a risk-adapted approach to salivary gland cancer management, especially when malignancy is clinically suspected.
Objectives.:A 2013 nationwide survey described tinnitus management in Korean university hospitals. Since then, conceptual frameworks have broadened, and new therapies have emerged. We aimed to investigate tinnitus practice patterns among Korean university hospital otologists in 2025 and compared them with the findings in 2013. Methods.:A cross-sectional electronic survey was distributed in October 2025 to otologists registered with the Tinnitus Study Group of the Korean Otologic Society. We assessed classification, diagnostic work-up, treatment strategies, hearing-aid fitting, and perceived barriers. Comparisons with 2013 used a predefined item-level mapping; formal hypothesis testing was not performed because individual-level 2013 data were unavailable and several items were not directly comparable. Results.:Thirty-four otologists from 28 of 45 university hospitals responded. Compared with 2013, 2025 practice more often involved broader classification, psychological assessment, and structured questionnaires. Pharmacotherapy, tinnitus retraining therapy, and hearing-aid-based rehabilitation remained the main treatments. Cognitive behavioral therapy-related approaches, digital therapeutics, and neuromodulation were more widely represented but showed limited routine use. Auditory rehabilitation expanded to include CROS/BiCROS and cochlear implantation. Barriers included a lack of effective treatments, online misinformation, unrealistic expectations, and reimbursement limitations. Conclusion.:: Korean university hospital tinnitus care appears more structured and diversified than in 2013, emphasizing psychological assessment and auditory rehabilitation. However, universal pharmacotherapy, frequent intratympanic steroid use, heterogeneous minimal clinically important difference criteria, low real-ear measurement adoption, and limited routine use of newer modalities indicate persistent evidence-practice and outcome-standardization gaps. These findings underscore the need for stronger evidence, standardized outcomes, and health-system support for patient-centered care.
