To explore the clinical value of real-time ultrasound measurement of thyrohyoid space dynamics in assessing vocal hyperfunction mode (VHM). The 161 chronic laryngitis patients, 55 with vocal cord polyps, and 44 normal controls were studied at Sun Yat-sen Memorial Hospital, Sun Yat-sen University, from June 2024 to January 2025. Voice quality, aerodynamic parameters, and thyrohyoid space were assessed using VHI-10, GRBAS scale, voice analysis, aerodynamic profiling, palpation scoring, and ultrasound. Data analysis was conducted using Python. Significant differences (p < 0.05) in VHI-10 scores, G, R, B, S, Jitter, and Shimmer are observed between male and female vocal cord polyp groups. Aerodynamic analysis indicates distinct variations in mean airflow rate across both genders (p < 0.05), while maximum phonation time and subglottic pressure differ significantly in females alone (p < 0.05). Palpation scores for the thyrohyoid space and F0 do not show substantial differences (p > 0.05) between groups. Conversely, real-time ultrasound evaluations of the thyrohyoid space, including pre-phonation/phonation minimum distances (left/right), rates of unilateral (left/right) narrowing, and maximum narrowing rate, exhibit notable differences (p < 0.05) across three groups. Real-time ultrasound measurement of the thyroid-hyoid gap is simple, feasible, and provides a more quantitative assessment of VHM than subjective palpation or vocal aerodynamic measures. It therefore represents a useful clinical tool for evaluating voice function.

Eustachian tube dysfunction (ETD) is a common condition among patients presenting to audiology clinics, often accompanied by nonspecific symptoms that complicate diagnosis. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) was developed to aid in identifying ETD; however, despite its widespread clinical use, its diagnostic validity has not been consistently demonstrated across patient populations. We evaluate ETDQ-7 performance in a diverse group of patients seen in an audiology clinic and compare it to an objective test of ETD based on modified impedance audiometry. This retrospective study analyzed ETDQ-7 scores, responses to a custom tinnitus quality questionnaire, pure-tone audiometry, and tympanometry with pressure manipulation in a clinical sample of 300 patients. ETD-positive cases were identified based on the absence of a significant shift in tympanometric peak pressure during swallowing or the Valsalva maneuver. The total ETDQ-7 score showed low sensitivity and specificity in detecting objectively confirmed ETD, even when the analysis was limited to patients without hearing loss. ETDQ-7 scores did not differ significantly between patients with normal hearing and those with hearing impairment, regardless of ETD status. However, among patients reporting tinnitus, ETDQ-7 scores were positively correlated with the reported bothersomeness of tinnitus-even after excluding the "ringing in the ears" item from the total score. In patients with tinnitus, ETDQ-7 scores appear to reflect general subjective discomfort caused by tinnitus rather than the presence or severity of ETD. These findings raise concerns about the ETDQ-7's utility as a stand-alone diagnostic tool for ETD in heterogeneous clinical populations.

Risk stratification systems (RSSs) have had an increasing role in standardizing thyroid ultrasound reports. The VA Northern California Healthcare System (VA-NCHCS) Radiology department adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018. We aimed to assess what effect the adoption of TI-RADS at VA-NCHCS had on thyroid surgical practices. A 10-year retrospective review of the VA corporate data warehouse was completed (approximately 5 years prior and 5 years after universal adoption of TI-RADS) (i.e: 1/1/2013-7/1/2018 and 7/2/2018-12/30/2023). Using CPT and diagnosis codes, data were collected on all thyroid surgeries, including demographics, type of surgery performed, final pathology, staging of malignancy, and any incidental findings. A two-sample t-test with equal and unequal variances was used for comparative statistics. 3985 patients (1921 PRE-TIRADS vs. 2064 POST-TIRADS) and 7908 thyroid ultrasounds (3411 vs. 4497) were identified. 2859 FNAs were performed (1245 vs. 1614). One hundred and ninety-three surgeries (96 vs. 97) were performed with a decreasing trend in surgeries for benign pathology (56 vs. 45) and an increasing trend in surgeries for malignancy (39 vs. 51). We identified an increase in partial thyroidectomy surgeries for cancer diagnoses (11 vs. 18). Finally, there was a significant decrease in total thyroidectomies performed for benign pathology (30 vs. 13, p = 0.02). After the institution of TIRADs at our single institution, there was a dramatic increase in the number of ultrasounds and FNAs performed, despite near stable thyroid surgical numbers. There was a significant trend towards less-invasive surgical practices.

To identify factors associated with secondary surgery for velopharyngeal insufficiency in children following primary palatoplasty. A retrospective review was conducted of children with cleft palate who were seen at a single academic center between August 2014 and April 2024 and underwent primary palatoplasty. Demographic and clinical data were collected, and the need for and number of secondary velopharyngeal surgeries were recorded. Univariate analyses and multivariate logistic regression were used to identify associated factors. Of 251 children who underwent primary palatoplasty, 27 (10.8%) required secondary velopharyngeal surgery. Univariate analyses revealed no association between secondary surgery and cleft type, presence of a syndrome, or timing of palatoplasty. Multivariate logistic regression controlling for race, insurance type, age at primary palatoplasty, and presence of 22q11.2 microdeletion syndrome revealed private insurance was associated with decreased odds of secondary velopharyngeal surgery (OR = 0.230, 95% CI: 0.069-0.765, p = 0.017), whereas Asian race was associated with increased odds (OR = 5.853, 95% CI: 1.105-30.998, p = 0.038). Among those requiring velopharyngeal surgery, 74.1% underwent one procedure and 25.9% underwent two. The presence of 22q11.2 microdeletion syndrome was significantly associated with needing two surgeries (p = 0.042), while female sex was associated with requiring only one surgery (p = 0.006). Clinical and sociodemographic factors were predictive of secondary velopharyngeal surgery following primary palatoplasty, with different risk factors associated with the need for more than one procedure. Larger studies are warranted to corroborate these findings and guide risk stratification and family counseling.

This study presents a case of undiagnosed HIV presenting with Kaposi sarcoma (KS) of the head and neck with acute upper airway obstruction (UAO) and provides an updated scoping literature review to examine the patient characteristics, lesion characteristics, interventions, and outcomes of KS cases with UAO from the pharynx, larynx, and/or trachea.

The most common genes responsible for autosomal recessive nonsyndromic hearing loss (AR-NSHL) are GJB2 and STRC. STRC mutations are associated with mild-to-moderate sensorineural (SNHL)hearing loss and a lack of progression. However, our institutional experience suggested otherwise, prompting this review. A 10-year retrospective chart review was performed at a tertiary children's hospital after the University of Iowa added STRC to its OtoSCOPER panel in 2013. Subjects with positive OtoSCOPER results underwent audiologic review. Hearing progression was defined based on pure-tone average changes, and mutation subtypes were categorized. Of 354 subjects undergoing OtoSCOPER testing, 181 (51.1%) carried a pathogenic mutation; GJB2 (28.7%) and STRC (16.6%) were most common. The STRC cohort included 30 subjects (21 males, 9 females) with hearing loss severity classifiable in 26 subjects and the highest proportion in the mild-to-moderate range (n = 46 ears; 88.5%). Hearing progression was observed in 12/24 subjects (20 ears: 8 bilateral, 4 unilateral). Median annual progression was 1.1 dB (range -3.5 to 18.7 dB). Two STRC subjects had substantial progression requiring cochlear implantation (one performed, one recommended). Genetic subtyping revealed seven categories, including six males with STRC/CATSPER2 deletions (deafness-infertility syndrome). No association between subtype and severity or progression was identified. STRC is the second most common cause of childhood NSHL and the leading contributor to mild-to-moderate SNHL. Unlike most published literature, 50% of our STRC cohort exhibited progression, and 17.6% of progressing subjects had substantial unilateral loss. We recommend long-term audiometric monitoring and standardized genomic reporting for this population.

We hypothesized that Intracordal Trafermin Injection (ITI) provides greater voice improvement than standard voice therapy (VT) in age-related vocal fold atrophy (ARVA). To evaluate the efficacy of ITI versus VT using propensity score matching (PSM) in ARVA. This retrospective study was conducted at the Tokyo Voice Center between July 2014 and December 2024 using medical records in ARVA. The intervention group comprised 197 of 210 patients who received ITI (mean voice recording period: 40.98 days after injection). The control group included 412 of 488 patients who underwent voice therapy (VT) between April 2015 and December 2024 (mean voice recording period: 79.91 days after initial VT). The primary outcome was defined as the improvement in VHI, calculated as the difference between post-treatment and pre-treatment scores. PMS was used to compare ITI and VT. Before PSM, the mean age and sex (female) were 65.30 years (standard deviation [SD], 14.01) and 48 patients (24.67%) in the ITI group and 64.81 years (SD, 14.42) and 246 patients (59.71%) in the VT group, respectively. T-tests revealed no significant differences in outcomes. After PSM (C-statistic = 0.746), the baseline characteristics were balanced (standardized mean difference < 0.1). Post-matching, t-tests revealed significantly greater voice improvement in the ITI group (p = 0.023). ITI appears effective for improving voice outcomes in ARVA. Future studies should include prospective interventional trials and comparative analyses with other injectable agents to determine the most effective treatment.

This systematic review aims to describe and compare outcomes of innervation techniques for gracilis free muscle transfers for facial reanimation in the pediatric population. CINAHL, PubMed, and SCOPUS were systematically queried from inception to November 18, 2025. Eligible studies included pediatric patients (≤ 18 years old) who underwent free gracilis muscle transfer for facial reanimation. Outcomes extracted included commissure excursion, facial asymmetry, validated instruments, patient satisfaction, and complications. Study quality was assessed using the Joanna Briggs Institute appraisal tool. A total of 15 retrospective studies were included for review, covering cross-facial nerve graft, masseteric innervation, and dual-innervation. The mean age at time of surgery was 9.0 ± 0.8 years with a mean follow-up time of 3.0 ± 0.5 years. Muscle innervation was achieved primarily with CFNG (52.1%), followed by masseteric (33.2%). Masseteric innervation generally produced the largest amount of commissure excursion (range: 6.1-8.6 mm), while CFNG also yielded moderate improvements (range: 4.6-6.9 mm). Overall satisfaction was high for all innervation techniques, ranging from 83% to 100%. Complications were infrequent and minor. Gracilis free muscle transfer is safe and effective for pediatric facial reanimation. Masseteric innervation provides strong, volitional smiles, while CFNG provides spontaneous smiles, with dual-innervation offering a balance of the two.

Hardware exposure after microvascular free tissue transfer (MFTT) for mandibular reconstruction is a significant complication. While osteocutaneous MFTTs are the preferred option, some patients require soft tissue-only MFTTs due to medical or anatomic limitations. Data comparing hardware exposure risk between these approaches are limited. This study compares the rate and timing of hardware exposure between osteocutaneous and soft tissue MFTTs. We conducted a retrospective review of patients undergoing MFTT for mandibular defects at a tertiary care center (11/2011-6/2023). Patients with non-mandibular defects or under age 18 were excluded. The primary exposure was flap type (osteocutaneous vs. soft tissue). The primary outcome was time to hardware exposure; the secondary outcome was exposure rate at defined follow-up intervals. One hundred and seventy-eight patients met inclusion criteria. At 1 year, hardware exposure occurred in 5.2% of osteocutaneous and 8.7% of soft tissue MFTT patients. At 3 years, exposure increased to 14.2% and 17.4%, respectively. After adjustment, there was no significant difference in time to hardware exposure between flap types at 1 year [HR 1.69 (95% CI 0.34-8.37), p = 0.520] or 3 years [HR 1.69 (95% CI 0.59-4.43), p = 0.346]. Adjuvant radiation and/or chemoradiation was associated with increased hazard of hardware exposure at 1 year [HR 7.72 (95% CI 0.97-61.4), p = 0.053] and at 3 years [HR 3.68 (95% CI 1.38-9.78), p = 0.009]. Flap type was not associated with differences in hardware exposure timing, but adjuvant therapy significantly increased exposure risk. Exposure rates rose by ~10% from 1 to 3 years postoperatively.

To describe the use, indications, and outcomes of a limited transoral approach for segmental mandibulectomy reconstruction with minimal access vessel isolation and anastomoses in patients with mandibular osteoradionecrosis. Retrospective review of patients who have undergone FFF reconstruction of segmental mandibulectomy via transoral plating and inset at our institution from 2022 to 2024. Nine patients (median age of 66, 100% male) with mandibular ORN underwent FFF reconstruction via transoral approach with minimal access vessels isolation. The majority of patients failed conservative management of ORN, with eight patients receiving prior antibiotic therapy and seven undergoing hyperbaric oxygen therapy. Preoperative fracture/nonunion and fistula were noted in seven and four patients, respectively. The median length of hospitalization following this procedure was 6 days (range: 4-9). One patient developed nonunion in the postoperative period and required revision with anterolateral thigh fascia lata free flap and iliac crest bone grafting. An additional patient required takeback for hematoma and successful vascular salvage; however, complications were otherwise minimal, with no other patients experiencing operating room takeback, readmission within 30 days, hematoma, fistulas, or flap compromise. All patients demonstrated clinical and radiographic arrest of ORN at most recent follow-up. Median follow-up length was 13.9 months (range 7.7-34). Mandibular reconstruction using a transoral approach with FFF provides a promising alternative to the traditional transcervical approach for patients with osteoradionecrosis, potentially reducing morbidity and improving outcomes.