To evaluate the applicant characteristics associated with cross-applying to otolaryngology-head and neck surgery (OHNS) and at least one additional specialty.
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.
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).
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.
4.
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.
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.
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).
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.
This study seeks to characterize the impact of COVID-19 infection on endoscopic sinus surgery (ESS) outcomes.
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.
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.
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.
Level III.
To assess the utility of a novel 3D-printed model incorporating user-directed head position adjustments for flexible fiberoptic nasolaryngoscopy (FNL) training and simulation.
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.
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.
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.
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.
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.
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.
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.
4.
While palatal surgery is an established treatment for obstructive sleep apnea (OSA), variability in outcomes has prompted investigation into factors predicting surgical success. This study aimed to evaluate whether preoperative polysomnographic (PSG) parameters, along with drug-induced sleep endoscopy (DISE) findings, can predict surgical outcomes in patients with OSA.
This retrospective study included 56 adult patients with OSA who completed both pre- and postoperative PSG and DISE assessments. Patients were classified into a successful outcome group (SG; ≥ 20 events/h reduction in apnea–hypopnea index [AHI]) or a worse outcome group (WG; ≥ 20 events/h increase in AHI). Baseline PSG and DISE findings were compared between groups, and multivariate regression analysis was used to identify independent predictors of surgical success.
Patients in the SG exhibited significantly higher preoperative AHI and larger tonsil size compared to those in the WG. While DISE collapse patterns did not differ significantly between groups, key differences emerged in PSG metrics. SG patients had a significantly greater proportion of non-REM stage N3 sleep within non-REM sleep and a lower arousal index, both of which were independently associated with improved surgical outcomes. Additionally, respiratory events were more prominent during non-rapid eye movement sleep in SG patients. Multivariate analysis confirmed that a greater proportion of non-REM stage N3 sleep and lower arousal index were strong predictors of postoperative AHI reduction.
These findings may offer more reliable predictors of which OSA patients will benefit from sleep surgery and underscore the importance of incorporating detailed PSG analysis into preoperative evaluations.
4.
To determine whether resting heart rate (HR) or heart rate variability (HRV) derived from finger photoplethysmography (PPG) predicts 6-month pneumonia risk in patients with dysphagia. HRV reflects autonomic regulation of inflammation which may predispose to respiratory complications.
A total of 301 patients who underwent a videofluoroscopic swallow study (VFSS) in 2020–2021 were enrolled. Prior to VFSS, resting HR was measured using the CorSense HRV finger sensor (ELITE HRV). Additional HRV metrics, including the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD) were collected from a subset of 153 participants. Pneumonia incidence was assessed at 3 and 6 months through phone interviews and medical record review.
The mean age was 66.3 ± 12.5 years, and 38% were female. Twenty patients (7%) developed pneumonia, with 75% of cases occurring within 3 months. Patients who developed pneumonia had higher resting HR than those who did not (83.4 vs. 74.3 bpm, p < 0.01). This association remained significant after adjusting for age (p = 0.01). Pneumonia risk increased stepwise with higher HR thresholds, with a 2.4-fold greater risk observed at HR ≥ 82 bpm and a 2.8-fold risk at HR ≥ 90 bpm. HRV metrics were not significantly associated with pneumonia incidence.
Elevated resting HR, though within the normal range, was associated with increased pneumonia risk in patients with dysphagia. This may reflect underlying inflammation or autonomic dysfunction. Because comorbidities, medications, and VFSS severity were not accounted for, these findings should be interpreted as preliminary. Resting HR may represent a simple, non-invasive tool for pneumonia risk stratification in this population, but larger studies are needed for validation.
2.
This study aimed to determine the optimal placement of the cochlear implant (CI) magnet to ensure the visibility of the inner ear and internal auditory canal (IAC) on postoperative magnetic resonance imaging (MRI) scans in patients treated for vestibular schwannoma (VS).
Nine patients who underwent CI either simultaneously with VS resection or sequentially after gamma knife surgery between January 2021 and June 2024 were retrospectively reviewed. Three patients had the CI placed in the conventional position, while six had it positioned farther from the external auditory canal (EAC) at a more vertical angle (alternative positioning). Postoperative temporal MRI scans were analyzed for inner ear and IAC visibility. Postoperative brain computed tomography (CT) scans underwent three-dimensional reconstruction to measure the distances from the CI magnet to the EAC and IAC, and the nasion–EAC–magnet angle.
Among the six patients in the alternative positioning group, five showed unobstructed IAC visibility, with both magnet-to-EAC and magnet-to-IAC distances exceeding 90 mm. The remaining patient in this group, whose distances were below 90 mm, showed obscured IAC structures due to artifacts. All three patients in the conventional positioning group had distances less than 90 mm and exhibited obscured IAC visibility. A strong correlation was observed between the magnet-to-EAC and magnet-to-IAC distances.
Optimal positioning of the CI magnet, particularly maintaining a distance greater than 90 mm from the EAC, is crucial for achieving clear postoperative MRI visualization of the IAC in patients undergoing VS treatment.
3.
Olfactory dysfunction significantly impairs quality of life. Conventional treatments such as corticosteroids and olfactory training offer limited and inconsistent efficacy. Platelet-rich plasma (PRP), a biologically active agent, has shown potential regenerative effects in olfactory neuroepithelium. This study systematically evaluates the efficacy of PRP compared to placebo in improving olfactory function.
A systematic review and meta-analysis was conducted according to PRISMA guidelines and was registered in PROSPERO (CRD 420251045079). The databases searched included PubMed, Scopus, Embase, Central, and Web of Science. Seven studies (four RCTs, three non-RCTs) involving 789 patients were included. Subjective and objective outcomes were extracted and pooled using a random-effects model. Risk of bias was assessed using ROB-2 and ROBIN-I tools.
PRP was significantly more effective than placebo in improving subjective olfactory scores at 1 month (SMD = 1.16, 95% CI [0.29–2.03], p = 0.009), 3 months (SMD = 0.29, 95% CI [0.07–0.50], p = 0.01), and 12 months (SMD = 1.47, 95% CI [1.06–1.89], p = 0.00001). Objective testing also favored PRP at all timepoints, including 1 month (SMD = 1.55, 95% CI [0.36–2.73], p = 0.01), 3 months (SMD = 0.44, 95% CI [0.05–0.82], p = 0.03), and 12 months (SMD = 2.42, 95% CI [0.35–4.5], p = 0.02). Subgroup analysis showed younger age (< 40 years old) was associated with greater improvements. The safety profile was favorable with no serious adverse events reported.
PRP demonstrates both short- and long-term benefits in olfactory recovery compared to placebo, especially among younger adults. Given the promising results and safety profile, PRP represents a viable treatment option for olfactory dysfunction. Standardization of PRP protocols and further high-quality RCTs need to be further explored.
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