Objective To assess venous thromboembolism (VTE) rates across the spectrum of otolaryngology-head and neck surgery (OHNS) between and within subspecialties.Study Design Retrospective national database study.Setting The Atropos database, a national aggregated cohort of 66 million patients across the United States, was queried for patients who underwent OHNS surgery.Methods Adult patients who had at least one Current Procedural Terminology code for OHNS procedures between 2015 and 2025 were assessed for the outcome of 90-day VTE. Postoperative VTE rates were compared within and between OHNS subspecialties. Risk factors for VTE outcomes were assessed using univariable analysis.Results 277,187 patients (mean age 58.6 +/- 18.7 years, 46.8% male) who had OHNS surgery were included. Postoperative VTE occurred in 1735 (0.63%) patients. VTE rates were highest in head and neck (1.3%), followed by laryngology (1.0%), rhinology (0.6%), facial plastic and reconstructive surgery (0.5%), otology (0.5%), and sleep surgery (0.3%). Differential VTE rates for procedural groups within each subspecialty were observed. The procedural groups with the highest VTE rates were free tissue transfer (6.1%), lateral skull base surgeries (4.4%), cricopharyngeal myotomies (3.1%), and anterior skull base surgeries (3.1%). Prior VTE (OR 12.3 [95% confidence interval, 11.2-13.4]) was the covariate with the highest risk for postoperative VTE.Conclusion Although the overall VTE rate was low (0.6%), intersubspecialty and intrasubspecialty variation in VTE rates were observed, and a subset of OHNS procedures had substantially higher VTE risk. These findings may inform surgeon decision-making regarding chemoprophylaxis.
Objective Drug-Induced Sleep Endoscopy with Positive Airway Pressure (DISE-PAP) provides quantitative evaluation of upper airway collapsibility, known as pharyngeal opening pressure (PhOP). Limited research exists on the relationship between PhOP and therapeutic continuous positive airway pressure (CPAP). This study investigated the relationship between therapeutic CPAP level and PhOP. Study Design Retrospective cohort study. Setting Single academic teaching hospital. Methods This study evaluated adults >= 18 years with obstructive sleep apnea (AHI >= 5) who underwent DISE-PAP from 2022 to 2024, had >2 h/d average PAP use, and well-controlled OSA on PAP. Primary outcome was the relationship between median CPAP level (mCPAP), CPAP level at 95% of time (t95CPAP), and PhOP. Secondary outcomes determined relationships between mCPAP, t95CPAP, and PhOP with AHI and BMI. Results Ninety-four patients were included (age 50.5 +/- 15.1 years, BMI 29.9 +/- 4.4 kg/m(2), AHI 35.3 +/- 23.3 events/h). Mean PhOP was 7.1 +/- 2.9 cmH(2)O, mCPAP 8.5 +/- 2.4 cmH(2)O, and t95CPAP 10.3 +/- 2.5 cmH(2)O. Positive correlation existed between PhOP and mCPAP. PhOP was 1.5 and 3.3 cmH(2)O lower than mCPAP and t95CPAP, respectively. As mCPAP and t95CPAP increased by 1 unit, PhOP increased by 0.33 and 0.36 cmH(2)O. BMI and AHI were mildly correlated with mCPAP; for each 10-point increase in AHI, mCPAP and PhOP increased by 0.4 and 0.3 cmH(2)O, respectively. However, the association between AHI and PhOP did not reach statistical significance. Conclusion Positive correlation exists between mCPAP, t95CPAP, and PhOP, with PhOP lower than therapeutic CPAP levels. These findings may allow surgeons to use therapeutic CPAP levels when DISE-PAP is unavailable to estimate upper airway collapsibility and determine surgical interventions. Level of Evidence Level 4.
Objective Olfactory function is influenced by nasal airflow dynamics and anatomical variations within the nasal cavity. This narrative review evaluates how nasal anatomy and airflow relate to olfactory outcomes, with a particular focus on olfactory changes following functional nasal surgery.Data Sources PubMed.Review Methods A comprehensive review was performed by searching the PubMed database for English-language publications from 2000 to 2025. Search terms included: "olfaction," "sense of smell," "nasal airflow," "nasal anatomy," "nasal obstruction," "septoplasty," and "functional septorhinoplasty."Conclusions Structural abnormalities such as a deviated nasal septum or a narrow internal nasal valve can impair olfactory function by altering nasal airflow patterns and limiting odorant access to the olfactory cleft. Functional nasal surgery, including septoplasty and functional septorhinoplasty, can modify these anatomical constraints and is frequently associated with improvements in psychophysical olfactory scores and patient-reported smell. While most patients report an improved olfactory function following nasal surgery, outcomes are still variable. Patient-specific factors, surgical techniques, and differences in subjective and psychophysical outcome measures likely contribute to variability in olfactory performance after surgery and are not yet fully understood.Implications for Practice Improving nasal airflow through functional nasal surgery can be associated with enhanced olfaction in patients with anatomical obstruction. Understanding airflow-olfaction relationships can aid surgical planning and patient counseling.
Objectives: Evaluate the association between comorbid depression and anxiety and postoperative complications following septoplasty with turbinoplasty, and assess whether treatment of these conditions influences surgical outcomes. Study Design: Retrospective cohort study with propensity-score matched analysis. Setting: Multi-institutional database study utilizing the TriNetX Research Network. Methods: The TriNetX Research Network was utilized to identify patients undergoing septoplasty and concurrent turbinoplasty; propensity score-matched analyses were conducted after adjusting for demographics and medical comorbidities. Postoperative complication rates for anosmia, epistaxis, opioid prescription, emergency department (ED) visits, sinusitis, readmission, and septal perforation were compared among patients without depression or anxiety, patients with untreated depression/anxiety, and patients with medication-treated depression/anxiety. Results: Patients (n = 5012 per group) without depression or anxiety had lower odds of epistaxis (OR 0.70, P = .0083), sinusitis (OR 0.62, P = .0019), ED visits (OR 0.52, P < .0001), hospital readmission (OR 0.55, P < .0001), and postoperative opioid prescription (OR 0.77, P < .0001) than patients with depression/anxiety. Patients (n = 4470 per group) with untreated depression/anxiety had higher odds of epistaxis (OR 3.94, P < .0001) but a lower 90-day risk of hospital readmission (OR 0.38, P < .0001) and opioid prescription (OR 0.69, P < .0001) compared to treated depression/anxiety. Conclusion: Comorbid depression or anxiety are associated with differences in outcomes following septoplasty with turbinoplasty. Future studies are needed to clarify the impact of treating psychiatric disorders on postoperative outcomes following otolaryngology procedures.
Objective To report institutional outcomes in pediatric suprastomal collapse and to describe a structured, phenotype-directed diagnostic and surgical management framework grounded in dynamic airway assessment and morphology-based operative selection.7,19Study Design Retrospective cohort study.Setting Tertiary pediatric airway reconstruction center.Methods Consecutive pediatric patients undergoing operative correction of suprastomal collapse between December 2020 and July 2024 were reviewed. All patients underwent rigid bronchoscopy followed by dynamic flexible bronchoscopy after tracheostomy tube removal. Collapse was classified as anterior, posterior, lateral, or combined according to dynamic behavior, segment length, and cartilage integrity. Operative intervention was selected based on phenotype and structural characteristics. The primary outcome was successful decannulation.Results Twenty-five patients underwent 28 procedures. Mean age at first intervention was 6.3 years (range 0.8-21.2 years). Anterior or combined collapse was present in 18 patients and treated with primary anterior closure (n = 5), anterior external bioresorbable stent reinforcement (n = 4), tracheal resection and reconstruction (n = 7), or slide tracheoplasty (n = 2); all were successfully decannulated. Posterior collapse (n = 4) treated with posterior external stent tracheopexy achieved 75% decannulation. Lateral collapse (n = 3) treated with vertical external stenting achieved 100% decannulation. Overall decannulation success was 92%.Conclusion Suprastomal collapse represents a heterogeneous spectrum of localized airway instability rather than a uniform pathologic entity. Phenotype-directed operative selection based on dynamic bronchoscopic classification is associated with favorable decannulation outcomes and offers a reproducible framework for surgical decision-making.
