ABSTRACTObjectivesAcute laryngeal injury (ALgI) is created as a result of endotracheal tube pressure ulcer formation leading to fibrosis and inflammation. This condition often leads to airway obstruction and voice and swallowing dysfunction. This study demonstrates a reliable animal model of ALgI to reproduce the acute wound process seen clinically, to explore the pathophysiology of this disease process, and to serve as a reproducible injury suitable for the evaluation of therapeutic interventions.MethodsAn ALgI model was developed in New Zealand White rabbits using precise mucosal stripping of the posterior larynx, followed by intubation with an oversized 4.0 endotracheal tube for 1 h to mimic intubation‐associated trauma and pressure ischemia. Laryngoscopy and laryngeal harvest were performed 2 weeks post‐injury for histologic and immunofluorescent evaluation.ResultsInjured rabbits demonstrated an eightfold increase in posterior glottic thickness (1.57 vs. 0.19 mm in controls; p = 0.0004) and an 11‐fold increase in collagen content (1.93 vs. 0.17 mm2; p = 0.005). Collagen subtype analysis revealed a shift toward active collagen within the injured larynx compared to the uninjured, with increased Type III Collagen (69.0% vs. 26.1%; p < 0.0001) and reduced Type I Collagen (27.2% vs. 73.9%; p < 0.0001) in the posterior glottis, consistent with the proliferative phase of wound healing. Collagen fiber alignment analysis demonstrated increased coherency in injured tissues (0.36 vs. 0.21; p = 0.023), indicating early organized collagen formation consistent with scar formation within the posterior glottis.ConclusionsThe model offers a robust platform for studying the acute pathogenesis of laryngeal injury and for testing the treatment options in the management of ALgI.Level of Evidence3.

ABSTRACTObjectiveThickness of torus tubarius (TT) surface mucosa overhanging the Eustachian tube (ET) ostium, and mucosa covering the posterior aspects of bilateral inferior turbinates (ITs) are potentially pertinent to ET balloon tuboplasty. Whether TT and IT mucosal thickness is fixed or varies cyclically is potentially important in therapeutic planning but remains unknown. We establish normative MRI morphometrics for mucosa of TTs, posterior ITs (post‐ITs), and anterior ITs (ant‐ITs) in healthy subjects, and test the hypothesis that post‐IT and TT mucosal thickness may vary during the nasal cycle akin to known changes in ant‐ITs.MethodsWe retrospectively selected 60 subjects with normal nasopharynx MRIs, and measured maximal contrast‐enhancing mucosal thickness for bilateral TTs, post‐ITs, and ant‐ITs. We conceived a novel indirect test for nasal cycle variations by computing likelihood ratio (LR) statistics comparing unimodal versus bimodal Gaussian distributions of left–right mucosal thickness differences, with significance assessed using bootstrapped p values. We validated this test by confirming detection of known nasal cycling in ant‐ITs, and then applied it to assess potential cycling in TTs and post‐ITs. Significance was set at p < 0.05.ResultsMean maximal mucosal thicknesses for TTs, post‐ITs, and ant‐ITs were 3.1 ± 0.8, 7.6 ± 1.9, and 4.5 ± 1.3 mm, respectively. LR testing revealed significant cyclical variations in ant‐ITs (LR = 4.599; p = 0.021), thus validating our methodology for inferring nasal cycling. There was no mucosal cycling for TTs (LR = −0.801; p = 0.728) or post‐ITs (LR = −1.208; p = 0.799).ConclusionTT and post‐IT mucosa unlikely exhibit nasal cycle variations. Single MRI views of TTs and post‐ITs would suffice for assessment during pre‐interventional planning of ET procedures.Level of Evidence4.

ABSTRACTBackgroundPatients with severe Bronchopulmonary dysplasia (BPD) are prone to upper airway complications due to their need for prolonged intubation, early tracheostomy placement, and chronic high‐pressure ventilation. This study examines structural changes over time in tracheostomy‐dependent BPD patients compared to those without BPD.MethodsA retrospective cohort study of children who underwent tracheostomy at an age less than 6 months at a tertiary‐care children's hospital between January 2012 and December 2022.ResultsA total of 82 patients underwent tracheostomy at an age of less than 6 months, of which 42 (51.2%) had BPD. Patients with BPD were older at the time of tracheostomy (4.44 vs. 3.36 months, p = 0.012) and had a younger gestational age (26.5 vs. 37.0 weeks, p < 0.001). Additionally, patients with BPD had higher rates of mechanical ventilation (42/42 vs. 24/40, p = 0.0018) and a greater number of days intubated prior to tracheostomy (92 vs. 21, p < 0.001). The median follow‐up period for all patients was 28.8 months [IQR = 36.8]. BPD infants were more likely to develop subglottic stenosis (30/42 vs. 16/40, p = 0.0082), glottic edema (32/42 vs. 19/40, p = 0.0074), require laryngotracheal reconstruction (16/42 vs. 5/40, p = 0.0095) and get decannulated (21/42 vs. 8/40, p = 0.0045) compared to infants without BPD.ConclusionsTracheostomy‐dependent infants with BPD had higher rates of glottic edema, subglottic stenosis, and laryngotracheal reconstruction but were more likely to be decannulated. These findings suggest that, despite increased airway pathology, tracheostomy is a safe and effective intervention in this population, with outcomes comparable to other pediatric cohorts.Level of Evidence4.

ABSTRACTObjectiveMastering otosclerosis surgery is challenging, especially in low‐prevalence Asian populations. This study defines the learning curve for a single surgeon's first 100 consecutive CO2 laser‐assisted stapedotomies by analyzing audiometric and complication outcomes. Despite widespread descriptions of laser‐assisted stapes surgery, there is a paucity of data examining the learning process in low‐incidence, low‐volume regions like East Asia. We aim to characterize the unique challenges and surgical adaptations required in such an environment.MethodsA retrospective review of 100 primary stapedotomy cases was performed. The proficiency changepoint was identified using Bayesian and cumulative sum (CUSUM) analyses based on success (postoperative air‐bone gap [ABG] ≤ 10 dB and no significant bone‐conduction deterioration). Audiometric outcomes—including postoperative ABG, achievement of “Negative ABGe” (postoperative air conduction superior to preoperative bone conduction), and change in high‐tone bone conduction—were compared between the pre‐proficiency (cases 1–30) and post‐proficiency (cases 31–100) phases.ResultsA proficiency changepoint was robustly identified at 30 cases. Subsequently, outcomes improved significantly: mean postoperative ABG decreased from 12.1 dB to 5.2 dB (p < 0.001), and the success rate (ABG ≤ 10 dB) increased from 53.3% to 91.4%. The rate of achieving a Negative ABGe surged from 3.3% to 50.0% (p < 0.001). The mean change in high‐tone bone conduction also shifted from −0.3 to +6.1 dB of overclosure (p < 0.001). All major complications occurred within the initial 30 cases.ConclusionFor CO2 laser‐assisted stapedotomy, proficiency significantly improves after approximately 30 cases. This study uniquely highlights how surgical mastery develops under conditions of limited disease prevalence and restricted training exposure. The findings suggest that even in low‐volume environments, structured experience enables not only consistent ABG closure but also meaningful gains in patient‐centered outcomes such as Negative ABGe and cochlear preservation. Our results advocate for simulation‐enhanced education strategies tailored to resource‐constrained surgical contexts.Level of Evidence4.

ABSTRACTObjectiveThis study aimed to investigate the therapeutic effects of eucalyptol (1,8‐cineole), a natural monoterpene oxide with known anti‐inflammatory and antioxidant properties, on the healing of nasal septal perforations (NSPs) using an experimental rat model. The study evaluated macroscopic closure rates, histological changes, and inflammation‐related outcomes.MethodsA total of 22 Sprague Dawley rats were used to create a standardized NSP model. The animals were randomly divided into two groups: a control group (n = 11) receiving 0.2 mL saline and a treatment group (n = 11) receiving 0.2 mL of topical eucalyptol daily for 14 days. One rat in the treatment group died due to anesthesia‐related complications, resulting in 10 animals in that group. After the treatment period, all rats were sacrificed, and macroscopic and histological assessments were performed. Histopathological parameters included epithelial regeneration and degeneration, fibroblast density, collagen deposition, vascularization, acute and chronic inflammatory cell infiltration, granulation tissue formation, and cartilage degeneration.ResultsMacroscopic closure occurred in 100% of the eucalyptol group vs. 45.5% of controls (p = 0.003). Histologically, eucalyptol increased epithelial regeneration, fibroblast proliferation, and collagen deposition, and reduced epithelial degeneration (p < 0.05); capillary density and eosinophils did not differ significantly. No significant differences were found in acute (p = 0.202) or chronic (p = 0.143) inflammatory cell infiltration. Granulation tissue formation was significantly higher in the eucalyptol group (p = 0.006). Cartilage degeneration scores were also significantly higher in the eucalyptol group compared to controls (p = 0.005).ConclusionEucalyptol significantly improved both macroscopic and histological healing outcomes in NSPs. Its anti‐inflammatory, antioxidant, and pro‐regenerative effects suggest that eucalyptol may serve as a promising and non‐invasive therapeutic agent in the management of nasal septal perforations.Level of EvidenceLevel 3.

ABSTRACTObjectiveThis study aimed to evaluate the relationship between clinical features, BPPV subtypes, and dizziness complaints in patients with BPPV to identify factors contributing to dizziness distress.MethodsThis study included 129 patients diagnosed with BPPV. Demographic and clinical features of the patients were determined. The degree of dizziness was assessed using the Dizziness Handicap Inventory (DHI) and Visual Analog Scale (VAS).ResultsFemale patients experienced longer BPPV durations and higher dizziness‐related distress. Recurrent BPPV was more common in females (46.5%), with higher physical distress reported in these patients. Cupulolithiasis was associated with significantly higher emotional and functional DHI scores. There was no correlation between age and dizziness severity, but a positive correlation was found between age and BPPV duration in patients without recurrence.ConclusionDizziness severity is influenced by sex, BPPV subtype, and recurrence. Females and patients with cupulolithiasis experience greater dizziness distress, particularly in functional and emotional domains.

ABSTRACTObjectivesPrior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow‐up.MethodsThis retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI‐SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were matched to the patient's county of residence, and univariate linear regressions were performed on the length of care and prognosis, while univariate logistic regressions were performed on advanced staging at presentation and treatment modalities across SVI quintiles.ResultsAcross 16,038 hypopharyngeal cancer patients, there was a significant 22.3% (35.41–27.50 months) decrease in survival time and a 16.6% (40.00–33.36 months) decrease in surveillance time between the lowest and highest overall‐social vulnerability groups. Patients with greater vulnerability were more likely to have advanced staging at presentation and to receive chemotherapy, but less likely to receive surgery or radiation, with each treatment being differentially associated with vulnerability factors.ConclusionThis study on SDoH in adults with hypopharyngeal carcinoma found significant declines in care and prognosis with higher social vulnerability, along with specific associations across SDoH themes, underscoring the need for targeted public health interventions to mitigate these disparities and improve cancer care equity.Level of Evidence3.

ABSTRACTBackground/ObjectivesCough is a prevalent clinical problem associated with comorbidities and environmental conditions. We seek to highlight the clinically measurable impact of the environment on cough physiology by modeling the incidence and prevalence of seasonal cough as a function of certain environmental factors.MethodsAn IRB‐exempt population‐based retrospective electronic record review was performed to analyze the incidence and prevalence of cough in an integrated rural healthcare system from January 1, 2021, through December 31, 2023. Using time series methods including dynamic regression models, these data were measured against the seasonal incidence and prevalence of influenza based on data from the Centers for Disease Control (CDC) and air quality metrics including Air Quality Index (AQI) and particulate matter counts (PM10) based on data from the Environmental Protection Agency (EPA).ResultsThere were 101,635 patients that met inclusion criteria involving 145,428 medical encounters for cough. There is a positive relationship between the seasonal prevalence and incidence of cough with influenza levels. AQI and PM10 demonstrated seasonality. While these were correlated with each other, we found no association between air quality metrics and the incidence and prevalence of cough. Results were validated within age groups, as each group independently demonstrated these associations.ConclusionThis study demonstrates a clear seasonal trend in our rural population in the diagnosis of cough, which also correlated with seasonal trends of influenza, illustrating the significance of seasonal factors in the development of informed healthcare practices.Level of Evidence4.

ABSTRACTObjectiveThe upper esophageal sphincter (UES) serves multiple functions in the management of the upper aerodigestive tract. Prior investigations have defined the roles of UES resting and nadir pressures in normal swallowing. The distinctly high‐amplitude UES peak pressures, a patterned feature of pressure propagation in the transition from the pharynx to the esophagus on high‐resolution manometry (HRM), have not been characterized beyond normative data reports. This study investigated the relationship between peak UES and pharyngeal pressures at the velopharyngeal and tongue base regions in both patients with dysphagia and healthy controls.MethodsSixty‐three adult patients with dysphagia underwent pharyngeal HRM to obtain peak measures of velopharyngeal, tongue base region, and UES pressures. Age‐ and sex‐matched healthy controls were analyzed for comparison.ResultsUES peak pressures in patients with dysphagia showed no significant correlation with velopharyngeal or tongue base region pressures (p > 0.05). In contrast, UES peak pressures were positively correlated with velopharyngeal (r = 0.525, p < 0.001) and tongue base (r = 0.415, p = 0.001) region peak pressures in healthy subjects. Velopharyngeal region pressures showed a significant correlation with tongue base region pressures in both patients with dysphagia (r = 0.377, p = 0.002) and healthy subjects (r = 0.406, p = 0.001).ConclusionsPharyngeal and UES peak pressures are correlated in healthy subjects; loss of this relationship in patients with dysphagia indicates that UES peak pressures may be influenced by factors independent of pharyngeal contractile responses and bolus‐related sensory feedback.Level of Evidence4.

ABSTRACTObjectiveFrequency of adjuvant treatment for clinically node negative (cN0) oropharyngeal cancer (OPC) patients, candidates for single modality treatment, is not well established. We aimed to determine the rate and clinical predictors of adjuvant radiation therapy (aRT) among cT1–T2 N0 patients undergoing transoral robotic surgery (TORS).MethodsThe National Cancer Database was retrospectively reviewed for cT1–T2 N0 OPC patients who received TORS as definitive treatment between 2010 and 2017. Demographic, oncologic data, and the proportion of patients receiving aRT were collected. Multivariable logistic regression was performed to determine clinical predictors of aRT. Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (95% CI) were calculated.Results1173 cN0 OPC patients underwent TORS (mean age 62 ± 9 years). 95% of patients were pT1–T2 and 59% were pN0. Overall, 29% of patients received aRT, including 21% of cT1 patients and 37% of cT2 patients. 32% of patients with tonsil/lateral pharyngeal wall and 29% with base of tongue tumors received aRT. Among those with negative margins, 25% received aRT. Positive margins (aOR 4.0, 95% CI 2.7–5.8), base of tongue subsite (aOR 2.7, 95% CI 1.5–4.7), and salivary gland malignancies (aOR 2.9, 95% CI 1.6–5.3) had an increased likelihood of adjuvant RT. Compared to pT1 patients, pT2 was associated with receiving adjuvant RT (aOR 1.9, 95% CI 1.4–2.6). HPV status was not a significant predictor of aRT.ConclusionNationally, most cT1–T2 N0 OPC patients undergoing TORS ultimately do not receive adjuvant radiation therapy, thus representing excellent candidates for single‐modality treatment in most cases.Level of EvidenceN/A.