Robert E. Africa, Brian J. McKinnon, Charles A. Hughes, Scott A. Hardison
Objectives
To evaluate associations between a wide variety of autoimmune diseases and chronic rhinosinusitis without nasal polyposis (CRSsNP), CRS with nasal polyposis (CRSwNP), and the need for endoscopic sinus surgery.
Methods
This is a multicenter retrospective study from January 1, 2010 to July 31, 2025 utilizing data from 106 healthcare organizations in the United States. The TriNetX database was used to identify adult patients over 18 years with a specified autoimmune disease from a comprehensive list that were included in the study. These groups were compared to patients without autoimmune diseases. The evaluated outcomes included the rate of developing CRSsNP, CRSwNP, and the need for endoscopic sinus surgery.
Results
Higher rates of CRSsNP and CRSwNP were noted in patients with certain autoimmune diseases. In patients with CRSsNP, a higher likelihood of undergoing sinus surgery was identified for Graves' disease, multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus (RR: 1.84 [1.60–2.13]; 1.20 [1.02–1.43]; 1.19 [1.09–1.29]; 1.30 [1.05–1.61]). Among patients with CRSwNP, a higher rate of surgery was associated with eosinophilic esophagitis, Hashimoto's disease, and ulcerative colitis (RR: 1.08 [1.02–1.14]; 1.06 [1.02–1.11]; 1.15 [1.04–1.32]).
Conclusions
A wide variety of autoimmune diseases are associated with CRSsNP and CRSwNP. The autoimmune diseases that were associated with a higher rate of surgery were rheumatoid arthritis and Graves' disease.
{"title":"Chronic Rhinosinusitis and Autoimmune Diseases: A Comprehensive Large Population-Based Analysis","authors":"Robert E. Africa, Brian J. McKinnon, Charles A. Hughes, Scott A. Hardison","doi":"10.1002/lio2.70340","DOIUrl":"10.1002/lio2.70340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate associations between a wide variety of autoimmune diseases and chronic rhinosinusitis without nasal polyposis (CRSsNP), CRS with nasal polyposis (CRSwNP), and the need for endoscopic sinus surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a multicenter retrospective study from January 1, 2010 to July 31, 2025 utilizing data from 106 healthcare organizations in the United States. The TriNetX database was used to identify adult patients over 18 years with a specified autoimmune disease from a comprehensive list that were included in the study. These groups were compared to patients without autoimmune diseases. The evaluated outcomes included the rate of developing CRSsNP, CRSwNP, and the need for endoscopic sinus surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher rates of CRSsNP and CRSwNP were noted in patients with certain autoimmune diseases. In patients with CRSsNP, a higher likelihood of undergoing sinus surgery was identified for Graves' disease, multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus (RR: 1.84 [1.60–2.13]; 1.20 [1.02–1.43]; 1.19 [1.09–1.29]; 1.30 [1.05–1.61]). Among patients with CRSwNP, a higher rate of surgery was associated with eosinophilic esophagitis, Hashimoto's disease, and ulcerative colitis (RR: 1.08 [1.02–1.14]; 1.06 [1.02–1.11]; 1.15 [1.04–1.32]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A wide variety of autoimmune diseases are associated with CRSsNP and CRSwNP. The autoimmune diseases that were associated with a higher rate of surgery were rheumatoid arthritis and Graves' disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher P. Kruglik, Josephine Yalovitser, John L. Rustad, Sara F. Santagostino, Erin T. Ostby, Heather C. Herrington, Mirabelle B. Sajisevi
Objective(s)
This study examines the distribution of Otolaryngology-Head and Neck Surgeons (OHNS) in Vermont to identify gaps in OHNS clinic accessibility between rural and urban areas and better understand the disparities faced by Vermonters.
Methods
A geospatial, population-based cross-sectional study was conducted, and the OHNS workforce was assessed using public databases. The ArcGIS Pro Near Analysis tool was used to assess the travel burden to OHNS clinics. Wilcoxon rank sum tests were used to compare the average distances to Comprehensive Otolaryngology Care Centers (COCC) and General Otolaryngology Clinics (GOC) between rural and urban towns.
Results
Vermonters have access to 15 OHNS clinics in Vermont, with 10 additional clinics in counties of bordering states. Nearly 43% of counties in Vermont lacked any OHNS clinic. While urban areas of Vermont had the fewest OHNS clinics, they had the largest number of practicing otolaryngologists. On average, Vermonters in urban towns were 31.0 km from a COCC, while those in rural towns were 68.7 km away (p < 0.001). Conversely, on average, Vermonters in urban towns were 25.9 km from a GOC, compared to 22.0 km for those in rural towns (p < 0.001).
Conclusion
Rural residents in Vermont must travel farther distances to obtain OHNS services. However, rural Vermonters face significantly less travel burden to GOCs than urban residents, suggesting that GOCs are well-positioned to reduce disparities in travel burden to OHNS for rural populations. GOCs tend to provide less comprehensive care than COCCs and may, therefore, incompletely improve the distribution and availability of comprehensive otolaryngology services in rural areas.
目的：本研究考察了佛蒙特州耳鼻喉头颈外科医生（OHNS）的分布，以确定农村和城市地区OHNS诊所可及性的差距，并更好地了解佛蒙特州面临的差异。方法：进行了一项地理空间、基于人口的横断面研究，并使用公共数据库对OHNS劳动力进行了评估。使用ArcGIS Pro Near Analysis工具评估前往OHNS诊所的旅行负担。采用Wilcoxon秩和检验比较城乡居民到综合耳鼻喉科护理中心（COCC）和普通耳鼻喉科诊所（GOC）的平均距离。结果：佛蒙特人可以使用佛蒙特州的15个OHNS诊所，在边境州的县有10个额外的诊所。佛蒙特州近43%的县没有OHNS诊所。虽然佛蒙特州的城市地区拥有最少的OHNS诊所，但他们拥有最多的耳鼻喉科医生。佛蒙特州城镇居民与COCC的平均距离为31.0公里，而农村居民与COCC的平均距离为68.7公里。(p)结论：佛蒙特州农村居民必须走更远的距离才能获得OHNS服务。然而，与城市居民相比，佛蒙特州农村居民面临的goc旅行负担要少得多，这表明goc在减少农村人口到OHNS的旅行负担方面处于有利地位。GOCs提供的综合护理往往不如cocs，因此可能无法完全改善农村地区综合耳鼻喉科服务的分布和可得性。
{"title":"Geospatial Analysis of Rural–Urban Access of Otolaryngology-Head and Neck Surgeons and Clinics in Vermont","authors":"Christopher P. Kruglik, Josephine Yalovitser, John L. Rustad, Sara F. Santagostino, Erin T. Ostby, Heather C. Herrington, Mirabelle B. Sajisevi","doi":"10.1002/lio2.70308","DOIUrl":"10.1002/lio2.70308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective(s)</h3>\u0000 \u0000 <p>This study examines the distribution of Otolaryngology-Head and Neck Surgeons (OHNS) in Vermont to identify gaps in OHNS clinic accessibility between rural and urban areas and better understand the disparities faced by Vermonters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A geospatial, population-based cross-sectional study was conducted, and the OHNS workforce was assessed using public databases. The ArcGIS Pro Near Analysis tool was used to assess the travel burden to OHNS clinics. Wilcoxon rank sum tests were used to compare the average distances to Comprehensive Otolaryngology Care Centers (COCC) and General Otolaryngology Clinics (GOC) between rural and urban towns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Vermonters have access to 15 OHNS clinics in Vermont, with 10 additional clinics in counties of bordering states. Nearly 43% of counties in Vermont lacked any OHNS clinic. While urban areas of Vermont had the fewest OHNS clinics, they had the largest number of practicing otolaryngologists. On average, Vermonters in urban towns were 31.0 km from a COCC, while those in rural towns were 68.7 km away (<i>p</i> < 0.001). Conversely, on average, Vermonters in urban towns were 25.9 km from a GOC, compared to 22.0 km for those in rural towns (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural residents in Vermont must travel farther distances to obtain OHNS services. However, rural Vermonters face significantly less travel burden to GOCs than urban residents, suggesting that GOCs are well-positioned to reduce disparities in travel burden to OHNS for rural populations. GOCs tend to provide less comprehensive care than COCCs and may, therefore, incompletely improve the distribution and availability of comprehensive otolaryngology services in rural areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12754085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balloon dilation of the Eustachian tube (BDET) is typically performed by advancing a balloon through the nasal cavity into the Eustachian tube orifice using a guide catheter. However, in patients with challenging nasal or Eustachian tube anatomy, this transnasal approach may be unsuccessful. Here, we present a case in which transnasal BDET was not possible due to challenging Eustachian tube anatomy, but a transoral approach provided a successful alternative.
Methods
After unsuccessful attempts at BDET through the nasal passages, a Crowe-Davis mouth retractor was placed. With endoscopic visualization through the nasal passage, the guide catheter was advanced into the oral cavity and around the soft palate to the Eustachian tube orifice.
Results
The angle of insertion from the transoral approach enabled easy advancement into the Eustachian tube. After the procedure, the patient was able to ventilate the ears without difficulty.
Conclusion
We describe a transoral technique for BDET that bypasses obstructive nasal anatomy and offers greater flexibility in catheter angulation. This approach may serve as a useful alternative in select cases where standard access is not feasible.
{"title":"Transoral Approach for Balloon Dilation of the Eustachian Tube","authors":"Jared Zhao, Bryan K. Ward","doi":"10.1002/lio2.70339","DOIUrl":"https://doi.org/10.1002/lio2.70339","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Balloon dilation of the Eustachian tube (BDET) is typically performed by advancing a balloon through the nasal cavity into the Eustachian tube orifice using a guide catheter. However, in patients with challenging nasal or Eustachian tube anatomy, this transnasal approach may be unsuccessful. Here, we present a case in which transnasal BDET was not possible due to challenging Eustachian tube anatomy, but a transoral approach provided a successful alternative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>After unsuccessful attempts at BDET through the nasal passages, a Crowe-Davis mouth retractor was placed. With endoscopic visualization through the nasal passage, the guide catheter was advanced into the oral cavity and around the soft palate to the Eustachian tube orifice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The angle of insertion from the transoral approach enabled easy advancement into the Eustachian tube. After the procedure, the patient was able to ventilate the ears without difficulty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We describe a transoral technique for BDET that bypasses obstructive nasal anatomy and offers greater flexibility in catheter angulation. This approach may serve as a useful alternative in select cases where standard access is not feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan Patrick, Ann Birmingham, Paul Allen, Sveta Karelsky
Objectives
This study examines a combination anesthetic regimen of propofol and dexmedetomidine during drug induced sleep endoscopy (DISE) and its procedure time, VOTE findings, and perioperative hemodynamic profiles when compared to procedures conducted with either anesthetic agent alone.
Methods
Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared.
Results
With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; p = 0.0001) and 42% shorter than the propofol only (38.4 min; p = 0.0001) cohorts. Recent intra-system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra- and post-operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; p = 0.0003, p = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, p = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort.
Conclusion
This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability.
Level of Evidence
3.
目的：本研究考察了异丙酚和右美托咪定联合麻醉方案在药物诱导睡眠内窥镜检查（dis）期间的手术时间、投票结果和围手术期血流动力学特征，并与单独使用任何一种麻醉剂进行比较。方法：回顾性分析407例在同一机构接受DISE的患者，麻醉方案分别为右美托咪定、异丙酚或两者联合。比较了人口统计学信息、通过投票评分的疾病诊断结果、围手术期生命体征和时间间隔。结果：在手术时间方面，联合方案队列平均手术时间为22.1 min，比单用右美托咪定（25.8 min, p = 0.0001）短14%，比单用异丙酚（38.4 min, p = 0.0001）短42%。最近的系统内分析表明，目前联合治疗方案的平均DISE时间为14分钟。在围手术期生命体征方面，联合用药组术中和术后最低心率（61.7,60.9 bpm）高于右美托咪定治疗组（56.9,56.9 bpm; p = 0.0003, p = 0.0014），术中O2最低点（86.0%）低于右美托咪定治疗组（90.0%,p = 0.0001）。关于DISE的发现，与联合用药组相比，异丙酚组较少患者出现2级舌根梗阻，更大比例患者出现舌膜同心性塌陷。结论：右旋美托咪定与异丙酚复合麻醉方案可提高手术效率并保持生命体征稳定。证据等级：3。
{"title":"Novel Combination Dexmedetomidine and Propofol Anesthetic Regimen for DISE Improves Procedural Efficiency Compared to Single-Agent Regimens","authors":"Ryan Patrick, Ann Birmingham, Paul Allen, Sveta Karelsky","doi":"10.1002/lio2.70329","DOIUrl":"10.1002/lio2.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study examines a combination anesthetic regimen of propofol and dexmedetomidine during drug induced sleep endoscopy (DISE) and its procedure time, VOTE findings, and perioperative hemodynamic profiles when compared to procedures conducted with either anesthetic agent alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective chart analysis of 407 patients undergoing DISE at a single institution with anesthetic regimens of dexmedetomidine alone, propofol alone, or a combination of both. Demographic information, DISE findings via VOTE scoring, and perioperative vital signs and timing intervals were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>With respect to operative time, the combination regimen cohort demonstrated an average operative time of 22.1 min, 14% shorter than the dexmedetomidine only (25.8 min; <i>p</i> = 0.0001) and 42% shorter than the propofol only (38.4 min; <i>p</i> = 0.0001) cohorts. Recent intra-system analysis demonstrates a current average DISE time of 14 min with the combination regimen. With respect to perioperative vital sign findings, the combination regimen demonstrated a higher intra- and post-operative minimum heart rate (61.7, 60.9 bpm) compared to the dexmedetomidine regimen (56.9, 56.9 bpm; <i>p</i> = 0.0003, <i>p</i> = 0.0014) and a lower intraoperative O2 nadir (86.0%) than the dexmedetomidine regimen (90.0%, <i>p</i> = 0.0001). With respect to DISE findings, the propofol cohort demonstrated fewer patients with grade 2 tongue base obstruction and a greater portion with compete concentric collapse of the velum as compared to the combination cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This novel combination anesthetic regimen of dexmedetomidine and propofol during DISE leads to increased procedural efficiency with preservation of vital sign stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Objective</h3> <p>To compare postoperative CT images of different supracricoid partial laryngectomy procedures and to analyze the formation of a new laryngeal.</p> </section> <section> <h3> Study Design</h3> <p>Observation and retrospective study.</p> </section> <section> <h3> Methods</h3> <p>Imaging data of 16 patients with supracricoid partial laryngectomy surgery were collected before and 6 months after different supracricoid partial laryngectomy surgeries. Parameters of larynx CT images were read and measured by three senior otolaryngologists at different layers. Function analysis of the new larynx was mainly focused on voice and swallowing. Two-way analysis of variance was employed to analyze the course data. Spearman correlation analysis was performed to evaluate the relationships between imaging parameters and mPAS score, as well as between imaging parameters and GARBS scales.</p> </section> <section> <h3> Results</h3> <p>In cricohyoidopexy and cricohyoidoepiglottopexy, the body of the hyoid, the residual arytenoid cartilage, and part of the cricoid dorsal plate could be visualized at the same layer. In Tucker procedure, the first display layer of the free edge of the epiglottis was significantly lower than that before operation. The new glottis is shown at the arytenoid layer, most of which is irregular. When compared with the Tucker group, the cricohyoidopexy and cricohyoidoepiglottopexy groups showed a statistical difference in the postoperative distance between the hyoid bone and cricoid cartilage respectively (<i>p</i> < 0.001). The sagittal distance of the new laryngeal cavity increased in the cricohyoidoepiglottopexy and Tucker groups after surgery when compared with the cricohyoidopexy group (<i>p</i> < 0.01). The voice recovery function of cricohyoidopexy patients was better than that of the other two groups, while the three groups had different degrees of swallowing function recovery.</p> </section> <section> <h3> Conclusion</h3> <p>All supracricoid partial laryngectomy procedures showed varying degrees of shortening of the new laryngeal body. The shape of the new laryngeal cavity at the narrowest point was different, but none of them affected respiration and pronunciation. Patients could acquire voice and swallowing recovery in all types of SCPL. It is necessary to evaluate postoperative CT images combined with function analysis to make a better understanding of new larynx structure and function in patie
{"title":"Postoperative CT and Functional Analysis of New Larynx in Different Supracricoid Partial Laryngectomy Procedures","authors":"Chang Huang, Wei Liu, Kunyu Liu, Xiaohui Du, Weilin Dai, Rui Han, Pei Chen","doi":"10.1002/lio2.70336","DOIUrl":"10.1002/lio2.70336","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare postoperative CT images of different supracricoid partial laryngectomy procedures and to analyze the formation of a new laryngeal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Observation and retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Imaging data of 16 patients with supracricoid partial laryngectomy surgery were collected before and 6 months after different supracricoid partial laryngectomy surgeries. Parameters of larynx CT images were read and measured by three senior otolaryngologists at different layers. Function analysis of the new larynx was mainly focused on voice and swallowing. Two-way analysis of variance was employed to analyze the course data. Spearman correlation analysis was performed to evaluate the relationships between imaging parameters and mPAS score, as well as between imaging parameters and GARBS scales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In cricohyoidopexy and cricohyoidoepiglottopexy, the body of the hyoid, the residual arytenoid cartilage, and part of the cricoid dorsal plate could be visualized at the same layer. In Tucker procedure, the first display layer of the free edge of the epiglottis was significantly lower than that before operation. The new glottis is shown at the arytenoid layer, most of which is irregular. When compared with the Tucker group, the cricohyoidopexy and cricohyoidoepiglottopexy groups showed a statistical difference in the postoperative distance between the hyoid bone and cricoid cartilage respectively (<i>p</i> < 0.001). The sagittal distance of the new laryngeal cavity increased in the cricohyoidoepiglottopexy and Tucker groups after surgery when compared with the cricohyoidopexy group (<i>p</i> < 0.01). The voice recovery function of cricohyoidopexy patients was better than that of the other two groups, while the three groups had different degrees of swallowing function recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>All supracricoid partial laryngectomy procedures showed varying degrees of shortening of the new laryngeal body. The shape of the new laryngeal cavity at the narrowest point was different, but none of them affected respiration and pronunciation. Patients could acquire voice and swallowing recovery in all types of SCPL. It is necessary to evaluate postoperative CT images combined with function analysis to make a better understanding of new larynx structure and function in patie","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Renne, Maria Armache, Francis Deng, Jenny X. Chen
Objective
To evaluate the applicant characteristics associated with cross-applying to otolaryngology-head and neck surgery (OHNS) and at least one additional specialty.
Methods
We analyzed all Association of American Medical Colleges Electronic Residency Application Service applications submitted to OHNS residency programs between 2020 and 2023. Cross-applicants applied to OHNS and at least one other specialty. Chi-square tests and t-tests compared the characteristics of OHNS-only applicants and cross-applicants. Multivariable logistic regression identified independent predictors of cross-application.
Results
Among 2440 applicants to OHNS, 53.0% (N = 1293) cross-applied, most commonly to General Surgery (N = 894, 36.6%) and Internal Medicine (N = 508, 20.8%). Cross-applicants comprised the majority of international medical graduates (IMG, 88.4%), osteopathic applicants (DO, 86.0%), and applicants 30 years of age or older (70.6%). Compared to those who applied to only OHNS, cross-applicants had significantly fewer research experiences (difference [Δ] = −1.50 ± 0.11 [mean ± standard error]; p < 0.001) and publication entries (Δ = −3.70 ± 0.54; p < 0.001). Independent predictors of cross-applying included IMG (odds ratio [OR]: 7.15; 95% CI: 3.78–13.96; p < 0.001) or DO status (OR = 7.04; 95% CI: 4.37–11.63; p < 0.001), age ≥ 30 (OR = 1.76; 95% CI: 1.32–2.36; p < 0.001), being a reapplicant (OR = 5.35; 95% CI: 3.25–9.08; p < 0.001), and having fewer research experiences (OR = 0.89; 95% CI: 0.86–0.92; p < 0.001).
Conclusion
Cross-applying to other specialties is common for OHNS applicants. These findings illustrate the complexity of the residency application process and the importance of tailored advising for applicants.
{"title":"Patterns and Predictors of Cross-Applications Among Otolaryngology Residency Applicants","authors":"Angela Renne, Maria Armache, Francis Deng, Jenny X. Chen","doi":"10.1002/lio2.70337","DOIUrl":"10.1002/lio2.70337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the applicant characteristics associated with cross-applying to otolaryngology-head and neck surgery (OHNS) and at least one additional specialty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed all Association of American Medical Colleges Electronic Residency Application Service applications submitted to OHNS residency programs between 2020 and 2023. Cross-applicants applied to OHNS and at least one other specialty. Chi-square tests and t-tests compared the characteristics of OHNS-only applicants and cross-applicants. Multivariable logistic regression identified independent predictors of cross-application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2440 applicants to OHNS, 53.0% (<i>N</i> = 1293) cross-applied, most commonly to General Surgery (<i>N</i> = 894, 36.6%) and Internal Medicine (<i>N</i> = 508, 20.8%). Cross-applicants comprised the majority of international medical graduates (IMG, 88.4%), osteopathic applicants (DO, 86.0%), and applicants 30 years of age or older (70.6%). Compared to those who applied to only OHNS, cross-applicants had significantly fewer research experiences (difference [Δ] = −1.50 ± 0.11 [mean ± standard error]; <i>p</i> < 0.001) and publication entries (Δ = −3.70 ± 0.54; <i>p</i> < 0.001). Independent predictors of cross-applying included IMG (odds ratio [OR]: 7.15; 95% CI: 3.78–13.96; <i>p</i> < 0.001) or DO status (OR = 7.04; 95% CI: 4.37–11.63; <i>p</i> < 0.001), age ≥ 30 (OR = 1.76; 95% CI: 1.32–2.36; <i>p</i> < 0.001), being a reapplicant (OR = 5.35; 95% CI: 3.25–9.08; <i>p</i> < 0.001), and having fewer research experiences (OR = 0.89; 95% CI: 0.86–0.92; <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Cross-applying to other specialties is common for OHNS applicants. These findings illustrate the complexity of the residency application process and the importance of tailored advising for applicants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12717626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jerome M. Tullo, Graham M. Tooker, Michael A. Kokko, Daniel W. Shen, Ryan C. Stoner, Brian D. Barnacle, Kwame Wiredu, Travis T. Byrum, Pablo Martínez-Camblor, Darcy A. Kerr, Ryan J. Halter, Joseph A. Paydarfar, David A. Pastel
Background
Standard treatment for oral cavity and oropharyngeal squamous cell carcinoma (SCC) includes cervical lymph node dissection (LND), where lymph node yield (LNY) is directly correlated with survival. Validated preoperative or intraoperative LNY prediction tools are lacking. This pilot study evaluates the feasibility of preoperative CT-derived volume estimates (CTV) of level II–IV neck dissection targets and direct intraoperative mass measurements (IOM) of resected lymphadenectomy specimens as potential tools for LNY prediction.
Methods
12 patients underwent standard-of-care level II–IV cervical LND by a single experienced surgeon with IOM recorded at closure. LNY was recorded using a standard LNY count and an additional comprehensive (CLNY) protocol. A novel segmentation protocol was designed to generate patient-specific level II–IV CTV estimates. Five independent readers tested protocol reliability using the Dice Similarity Coefficient (DSC) for segmentation overlap and the intraclass correlation coefficient (ICC) of CTV measurements. Pearson correlation coefficients (PCC) between IOM CTV and LNY metrics were reported.
Results
This segmentation protocol showed high inter-rater reliability of CTV estimates (ICC = 0.85; 95% CI, 0.70–0.94) and substantial spatial overlap amongst readers (mean DSC = 0.72 ± 0.06). The strongest correlations, for which the study had adequate statistical power, included IOM with CLNY (Pearson correlation coefficient, PCC =0.87; 95% CI, 0.58–0.96) and mean CTV with IOM (PCC = 0.89; 95% CI, 0.65–0.97). Moderate correlations were observed between CTV and CLNY (PCC = 0.70; 95% CI, 0.20–0.91) and between IOM and standard LNY (PCC = 0.73; 95% CI, 0.26–0.92).
Conclusions
The novel segmentation protocol produced reliable CTVs with strong correlation to intraoperative tissue-mass measurements (PCC = 0.89). While IOM showed strong correlation with CLNY (PCC = 0.87), both findings exceeded the threshold for adequate statistical power in this pilot study. The moderate correlations between CTV and LNY metrics (PCC = 0.59–0.70), though statistically significant, were below the study's power threshold and require validation in larger cohorts before conclusions can be drawn about their predictive utility.
{"title":"Feasibility Study of Preoperative CT-Derived Volume and Intraoperative Tissue Mass Measurements for Lymph Node Yield Prediction in Cervical Lymphadenectomy","authors":"Jerome M. Tullo, Graham M. Tooker, Michael A. Kokko, Daniel W. Shen, Ryan C. Stoner, Brian D. Barnacle, Kwame Wiredu, Travis T. Byrum, Pablo Martínez-Camblor, Darcy A. Kerr, Ryan J. Halter, Joseph A. Paydarfar, David A. Pastel","doi":"10.1002/lio2.70328","DOIUrl":"10.1002/lio2.70328","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standard treatment for oral cavity and oropharyngeal squamous cell carcinoma (SCC) includes cervical lymph node dissection (LND), where lymph node yield (LNY) is directly correlated with survival. Validated preoperative or intraoperative LNY prediction tools are lacking. This pilot study evaluates the feasibility of preoperative CT-derived volume estimates (CTV) of level II–IV neck dissection targets and direct intraoperative mass measurements (IOM) of resected lymphadenectomy specimens as potential tools for LNY prediction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>12 patients underwent standard-of-care level II–IV cervical LND by a single experienced surgeon with IOM recorded at closure. LNY was recorded using a standard LNY count and an additional comprehensive (CLNY) protocol. A novel segmentation protocol was designed to generate patient-specific level II–IV CTV estimates. Five independent readers tested protocol reliability using the Dice Similarity Coefficient (DSC) for segmentation overlap and the intraclass correlation coefficient (ICC) of CTV measurements. Pearson correlation coefficients (PCC) between IOM CTV and LNY metrics were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This segmentation protocol showed high inter-rater reliability of CTV estimates (ICC = 0.85; 95% CI, 0.70–0.94) and substantial spatial overlap amongst readers (mean DSC = 0.72 ± 0.06). The strongest correlations, for which the study had adequate statistical power, included IOM with CLNY (Pearson correlation coefficient, PCC =0.87; 95% CI, 0.58–0.96) and mean CTV with IOM (PCC = 0.89; 95% CI, 0.65–0.97). Moderate correlations were observed between CTV and CLNY (PCC = 0.70; 95% CI, 0.20–0.91) and between IOM and standard LNY (PCC = 0.73; 95% CI, 0.26–0.92).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The novel segmentation protocol produced reliable CTVs with strong correlation to intraoperative tissue-mass measurements (PCC = 0.89). While IOM showed strong correlation with CLNY (PCC = 0.87), both findings exceeded the threshold for adequate statistical power in this pilot study. The moderate correlations between CTV and LNY metrics (PCC = 0.59–0.70), though statistically significant, were below the study's power threshold and require validation in larger cohorts before conclusions can be drawn about their predictive utility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ella Prebel Jackert, Oluwatobiloba Ayo-Ajibola, Eric X. Wei
Objective
This study seeks to characterize the impact of COVID-19 infection on endoscopic sinus surgery (ESS) outcomes.
Methods
The TriNetX database identified patients with chronic rhinosinusitis who underwent ESS from January 1, 2020 to December 31, 2024. Cohorts included patients who had a diagnosis of COVID-19 infection within 2 months before ESS (recent infection), and those who did not. A cohort of those with COVID-19 infection between 2 months and 1 year before ESS (distant infection), was compared to a control without recent or distant infection. Propensity score matching (PSM) controlled for demographics and comorbid conditions. Relative risks (RRs) were calculated to determine risks for postoperative complications and healthcare utilization.
Results
A total of 49,609 patients underwent ESS during the study period. After PSM, there were 10,803 patients with and without recent COVID-19 infection, and 3804 patients with or without distant COVID-19 infection. Recent COVID-19 infection increased the risk of epistaxis [RR: 1.236, 95% CI: (1.036, 1.474)], and nasal congestion [RR: 1.273, 95% CI: (1.016, 1.596)] within 2 months of ESS. There was no difference in risk for major complications identified between any cohort.
Conclusion
Recent COVID-19 infection may increase the risk of post-operative epistaxis, but not major complications, highlighting the overall safety of ESS after recent COVID-19 infection and the importance of considering the timing of COVID-19 infection when evaluating surgical risk and postoperative care needs for ESS patients.
{"title":"Assessing the Safety of Endoscopic Sinus Surgery After COVID-19 Infection","authors":"Ella Prebel Jackert, Oluwatobiloba Ayo-Ajibola, Eric X. Wei","doi":"10.1002/lio2.70326","DOIUrl":"10.1002/lio2.70326","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study seeks to characterize the impact of COVID-19 infection on endoscopic sinus surgery (ESS) outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The TriNetX database identified patients with chronic rhinosinusitis who underwent ESS from January 1, 2020 to December 31, 2024. Cohorts included patients who had a diagnosis of COVID-19 infection within 2 months before ESS (recent infection), and those who did not. A cohort of those with COVID-19 infection between 2 months and 1 year before ESS (distant infection), was compared to a control without recent or distant infection. Propensity score matching (PSM) controlled for demographics and comorbid conditions. Relative risks (RRs) were calculated to determine risks for postoperative complications and healthcare utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 49,609 patients underwent ESS during the study period. After PSM, there were 10,803 patients with and without recent COVID-19 infection, and 3804 patients with or without distant COVID-19 infection. Recent COVID-19 infection increased the risk of epistaxis [RR: 1.236, 95% CI: (1.036, 1.474)], and nasal congestion [RR: 1.273, 95% CI: (1.016, 1.596)] within 2 months of ESS. There was no difference in risk for major complications identified between any cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Recent COVID-19 infection may increase the risk of post-operative epistaxis, but not major complications, highlighting the overall safety of ESS after recent COVID-19 infection and the importance of considering the timing of COVID-19 infection when evaluating surgical risk and postoperative care needs for ESS patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felix E. Fernández-Penny, Anna Christina Clements, Michael Bindschadler, Ezgi Mercan, Huy Le, Tanya K. Meyer, Seth D. Friedman, Maya G. Sardesai
Objectives
To assess the utility of a novel 3D-printed model incorporating user-directed head position adjustments for flexible fiberoptic nasolaryngoscopy (FNL) training and simulation.
Methods
This proof-of-concept study utilized a CT-based, 3D-printed airway model permitting adjustments in head protrusion, flexion, and extension, with associated anatomical changes in oropharyngeal shape. Cervical flexion and atlantoaxial extension (“sniffing position”) represented the optimal head position (OHP) for laryngeal visualization, as determined by attending faculty otolaryngologists. During FNL trials, trainees simulated patient instruction for head adjustment and were asked to indicate their perceived OHP. Standardized photographs of trainees' OHP were taken and compared by training level using fiducial marker-based image analysis. Surveys evaluated trainee experience.
Results
A total of 26 medical students and residents (PGY-1 to PGY-4), completed FNL trials. Senior residents (R3+) showed little variability in their chosen OHP. While intermediate learners (R1–R2) showed the greatest variability in OHP there were no significant differences in final OHP among participants. Trainees rated the helpfulness of positional adjustments 8 ± 1.80 on a 10-point Likert scale.
Conclusions
Head position maneuverability improves fidelity and the FNL training experience. Using the model, participants at all training levels were able to achieve OHPs comparable with experienced practitioners. Greater OHP variability among those with moderate experience suggests this model feature may be used by trainees to optimize technique. This novel model presents an affordable, portable, and easily replicable tool to enhance FNL simulation and training.
{"title":"Ability to Adjust Head Position in a 3D-Printed Flexible Nasolaryngoscopy Model Improves Fidelity and Trainee Experience","authors":"Felix E. Fernández-Penny, Anna Christina Clements, Michael Bindschadler, Ezgi Mercan, Huy Le, Tanya K. Meyer, Seth D. Friedman, Maya G. Sardesai","doi":"10.1002/lio2.70332","DOIUrl":"https://doi.org/10.1002/lio2.70332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the utility of a novel 3D-printed model incorporating user-directed head position adjustments for flexible fiberoptic nasolaryngoscopy (FNL) training and simulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This proof-of-concept study utilized a CT-based, 3D-printed airway model permitting adjustments in head protrusion, flexion, and extension, with associated anatomical changes in oropharyngeal shape. Cervical flexion and atlantoaxial extension (“sniffing position”) represented the optimal head position (OHP) for laryngeal visualization, as determined by attending faculty otolaryngologists. During FNL trials, trainees simulated patient instruction for head adjustment and were asked to indicate their perceived OHP. Standardized photographs of trainees' OHP were taken and compared by training level using fiducial marker-based image analysis. Surveys evaluated trainee experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 26 medical students and residents (PGY-1 to PGY-4), completed FNL trials. Senior residents (R3+) showed little variability in their chosen OHP. While intermediate learners (R1–R2) showed the greatest variability in OHP there were no significant differences in final OHP among participants. Trainees rated the helpfulness of positional adjustments 8 ± 1.80 on a 10-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Head position maneuverability improves fidelity and the FNL training experience. Using the model, participants at all training levels were able to achieve OHPs comparable with experienced practitioners. Greater OHP variability among those with moderate experience suggests this model feature may be used by trainees to optimize technique. This novel model presents an affordable, portable, and easily replicable tool to enhance FNL simulation and training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145824689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catriona M. Steele, Makaya O' Grady, Sima Farpour, Melanie Peladeau-Pigeon, Sophia Werden Abrams, Maureen Folsom, Emily K. Plowman, Ashwini M. Namasivayam-MacDonald
Objective (s).
The C2–C7 Cobb angle is used to measure cervical spine curvature, an anatomical parameter that may be associated with swallowing difficulties in some patients. Challenges in visualizing lower cervical vertebrae on videofluoroscopic swallow study images led to the proposal of the C2–C4 modified Cobb angle (MCA) for use in swallowing research. Despite its initial promise, less than optimal reliability and validity suggested a need for improvement and further research. In this study, we aimed to explore the measurement properties of the MCA and a C2–C4 revised-MCA across key timepoints in healthy swallowing of thin liquid boluses.
Methods
This exploratory analysis examined inter- and intra-rater reliability, as well as criterion validity of the C2–C4 MCA and C2–C4 revised-MCA in comparison to other measures of cervical spine curvature and head extension (C0–C2, C2–C6, and C2–C7 Cobb angles). Videofluoroscopic images from 35 healthy participants were analyzed using frames from still positioning, bolus passing the mandible, maximum pharyngeal constriction, and swallow rest. Data were analyzed using intraclass correlation coefficients (ICCs), Pearson correlations, and mixed model analysis.
Results
The C2–C4 revised-MCA showed superior intra- and inter-rater reliability and moderate positive correlation with the C2–C6 Cobb angle, demonstrating criterion validity. No differences in C2–C4 revised-MCA were found across swallowing frames, or as a function of participant age, sex, or head extension.
Conclusions
The findings suggest that the C2–C4 revised-MCA has stronger psychometric properties than the MCA, confirming its utility as a cervical spine curvature measurement during swallowing.
{"title":"Introducing the Modified Cobb Angle for Measuring Cervical Spine Curvature During Swallowing","authors":"Catriona M. Steele, Makaya O' Grady, Sima Farpour, Melanie Peladeau-Pigeon, Sophia Werden Abrams, Maureen Folsom, Emily K. Plowman, Ashwini M. Namasivayam-MacDonald","doi":"10.1002/lio2.70333","DOIUrl":"10.1002/lio2.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective (s).</h3>\u0000 \u0000 <p>The C2–C7 Cobb angle is used to measure cervical spine curvature, an anatomical parameter that may be associated with swallowing difficulties in some patients. Challenges in visualizing lower cervical vertebrae on videofluoroscopic swallow study images led to the proposal of the C2–C4 modified Cobb angle (MCA) for use in swallowing research. Despite its initial promise, less than optimal reliability and validity suggested a need for improvement and further research. In this study, we aimed to explore the measurement properties of the MCA and a C2–C4 revised-MCA across key timepoints in healthy swallowing of thin liquid boluses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This exploratory analysis examined inter- and intra-rater reliability, as well as criterion validity of the C2–C4 MCA and C2–C4 revised-MCA in comparison to other measures of cervical spine curvature and head extension (C0–C2, C2–C6, and C2–C7 Cobb angles). Videofluoroscopic images from 35 healthy participants were analyzed using frames from still positioning, bolus passing the mandible, maximum pharyngeal constriction, and swallow rest. Data were analyzed using intraclass correlation coefficients (ICCs), Pearson correlations, and mixed model analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The C2–C4 revised-MCA showed superior intra- and inter-rater reliability and moderate positive correlation with the C2–C6 Cobb angle, demonstrating criterion validity. No differences in C2–C4 revised-MCA were found across swallowing frames, or as a function of participant age, sex, or head extension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that the C2–C4 revised-MCA has stronger psychometric properties than the MCA, confirming its utility as a cervical spine curvature measurement during swallowing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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