Laryngoscope Investigative Otolaryngology最新文献

{"title":"Burnout Syndrome Among Turkish Otolaryngologists Performing Rhinoplasty Surgery","authors":"Erkan Yıldız,&nbsp;Hüseyin Ruhullah Ercan,&nbsp;Orhan Kemal Kahveci,&nbsp;Abdulkadir Bucak,&nbsp;Fatih Çelenk,&nbsp;Selçuk Kuzu,&nbsp;Çağlar Günebakan","doi":"10.1002/lio2.70560","DOIUrl":"10.1002/lio2.70560","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Burnout syndrome represents a significant concern among physicians, particularly in surgical specialties. This study investigated burnout prevalence among Turkish otolaryngologists and examined the relationship between rhinoplasty practice and burnout dimensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted from December 2024 to February 2025, distributing 200 surveys to Turkish otolaryngologists, of whom 84 (42%) completed the validated Turkish 22-item Maslach Burnout Inventory (MBI) and a sociodemographic questionnaire. Statistical analyses included independent <i>t</i>-tests, one-way ANOVA, and correlation analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-four otolaryngologists participated (mean age 38.2 years; 88.1% male). Overall burnout prevalence was low (7.1%). Sixty-four participants (76.2%) performed rhinoplasty surgery. Rhinoplasty surgeons demonstrated significantly higher personal accomplishment scores versus non-rhinoplasty surgeons (3.55 ± 0.68 vs. 2.99 ± 1.02; <i>p</i> = 0.005). No significant differences were observed in emotional exhaustion or depersonalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Active rhinoplasty engagement is associated with significantly higher personal accomplishment among Turkish otolaryngologists, suggesting rhinoplasty practice may enhance professional fulfillment rather than contribute to burnout. These findings challenge prevailing assumptions about aesthetic surgery's psychological impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>4 (cross-sectional study).</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888790","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}

{"title":"Noninvasive Speech Restoration After Total Laryngectomy Using Surface Electromyography: Pilot Study","authors":"Naresh K. Kaushal,&nbsp;Daniel C. Comstock,&nbsp;Peter C. Belafsky,&nbsp;Adolfo Ramirez-Aristizabal,&nbsp;Lee M. Miller","doi":"10.1002/lio2.70559","DOIUrl":"10.1002/lio2.70559","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To demonstrate the feasibility of restoring intelligible, own-voice speech after total laryngectomy using noninvasive surface electromyography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One post-laryngectomy patient and one healthy reference speaker silently articulated a closed-vocabulary corpus of 499 dates and times while surface electromyographic (sEMG) signals were recorded from a 20-electrode face, jaw, and neck montage. A decoder mapped sEMG into speaker-independent speech tokens, which a public token-to-speech stack converted into audible speech; for the patient, the output was re-rendered in his own pre-surgical voice using approximately 8 min of audio recorded before surgery. A per-subject procedure identified a reduced electrode subset, and performance was evaluated by five human listeners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The system produced intelligible speech in the patient's own pre-surgical voice. Mean word error rate by human listeners was 20.2% (95% CI 11.0%–31.5%) for the patient and 14.9% (6.8%–24.9%) for the reference speaker. Electrode-selection analysis indicated that roughly half of the recorded electrodes captured 95% of the multi-channel signal (9 of 20 for the patient, 11 of 18 for the reference), supporting more compact hardware. Single-trial recordings showed coordinated muscle activity tracking each silently articulated word despite the absence of phonation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Noninvasive sEMG-based speech restoration is feasible after total laryngectomy. By decoding muscle activity into a speaker-independent representation, the approach sidesteps the absence of post-surgical own-voice audio and remains applicable to patients unable to phonate. Unlike existing alternatives (electrolarynx, esophageal speech, tracheoesophageal puncture), it can also restore the patient's own pre-surgical voice, offering a high-performing, low-complication path toward clinical use.</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":"11 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888794","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}

{"title":"Risk-Stratified Bilateral Tonsillectomy for Unilateral HPV-Associated Tonsillar SCC: Oncologic and Functional Outcomes From a Single Institution","authors":"Tereza Vitkovska,&nbsp;Crystal Z. Zhou,&nbsp;Ishna Pandey,&nbsp;Maxwell L. Weng,&nbsp;Lauran K. Evans,&nbsp;Song Hon Hwang,&nbsp;Christian Wooten,&nbsp;Dipti Sajed,&nbsp;Maie A. St. John","doi":"10.1002/lio2.70553","DOIUrl":"10.1002/lio2.70553","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize synchronous and metachronous contralateral second primary malignancy (SPM) rates across preoperatively defined risk strata in patients with HPV-positive tonsillar squamous cell carcinoma (TSCC) undergoing unilateral versus bilateral tonsillectomy and to evaluate associated postoperative morbidity and functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients with HPV-positive TSCC who underwent surgery between 2000 and 2023 were retrospectively reviewed. Fisher's exact test, Kaplan–Meier analysis, and log-rank tests were used to compare morbidity and survival, and multivariable regression models were employed to control for confounders, including patient demographics, substance use, tumor staging, and adjuvant therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 163 patients, 123 (75.5%) underwent unilateral tonsillectomy, 30 (18.4%) low-risk bilateral tonsillectomy, and 10 (6.1%) high-risk bilateral tonsillectomy. Across all patients undergoing bilateral tonsillectomy, synchronous tonsillar SPMs were identified in 10.0%, with rates of 6.7% in the low-risk bilateral group and 20.0% in the high-risk bilateral group. Of the 123 patients who underwent unilateral tonsillectomy, 0.8% developed a metachronous contralateral TSCC at 181.6 months. Among low-risk bilateral patients undergoing prophylactic contralateral tonsillectomy, the NNT for identification of one occult synchronous SPM was 14 (95% CI: 5–50). Bilateral tonsillectomy did not significantly alter discharge diet, postoperative length of stay, hemorrhage rates, return to the operating room, or 30-day emergency department visits. Disease-free survival did not differ significantly across risk-stratified groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Contralateral second primary TSCC clustered disproportionately among high-risk patients. Bilateral tonsillectomy was not associated with significantly increased postoperative morbidity. These findings support a selective, risk-stratified approach to bilateral tonsillectomy in HPV-associated TSCC, balancing the potential benefit of occult contralateral disease detection against procedure-related morbidity through shared decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875575","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}

{"title":"Airway Anatomy as a Predictor of Tracheostomy in Critically Ill Patients: A Multicampus Analysis of Airway Grade, Admission Diagnosis, and Clinical Trajectory","authors":"Michael Sramek,&nbsp;Dana Eitan,&nbsp;Darby Keirns,&nbsp;Bryant Noss,&nbsp;Hannah Gibbs,&nbsp;Austin R. Swisher,&nbsp;India Casaday,&nbsp;Payam Entezami","doi":"10.1002/lio2.70554","DOIUrl":"10.1002/lio2.70554","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Determine whether the Cormack–Lehane airway grade at intubation predicts subsequent tracheostomy in critically ill adults and whether this association persists after controlling for admission diagnosis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Retrospective multicenter cohort study of 10,234 ICU patients requiring ventilation across three campuses from April 2018 to June 2024. The primary predictor was Cormack–Lehane grade (1–4) during intubation; the primary outcome was tracheostomy. Principal problem documentation classified patients into 12 diagnostic categories. Multivariable logistic regression adjusted for age, sex, BMI, Charlson Comorbidity Index, intubation method, and admission diagnosis. Sensitivity analysis compared the initial versus the worst grade.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 6189 patients with documented airway grades, 922 (14.9%) underwent tracheostomy. Rates generally increased with grade severity through Grade 3B (24.5%), with Grade 4 (19.4%, &lt;i&gt;n&lt;/i&gt; = 31) showing wide confidence intervals consistent with small sample size and high mortality in this subgroup. Otherwise, each ordinal increase in grade conferred 14% higher unadjusted tracheostomy odds (OR: 1.14, 95% CI: 1.05–1.23, &lt;i&gt;p&lt;/i&gt; = 0.001). Rates varied by diagnosis, from 28.4% for COVID-19 respiratory failure to 6.5% for gastrointestinal/hepatic conditions. In the fully adjusted model (&lt;i&gt;N&lt;/i&gt; = 4770), airway grade remained independently significant (aOR: 1.13, 95% CI: 1.03–1.24, &lt;i&gt;p&lt;/i&gt; = 0.014). The strongest predictors were transplant (aOR: 2.95), COVID-19 respiratory failure (aOR: 2.60), and cardiac disease (aOR: 1.84). Patients with Grade ≥ 3 airways had 70% higher odds compared to Grade 1–2B (OR: 1.70, &lt;i&gt;p&lt;/i&gt; = 0.002). Patients with worsening grades across re-intubation had higher tracheostomy rates (38.8% vs. 14.2%; OR: 3.8, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The model achieved an AUC of 0.638.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Difficult airway anatomy predicts tracheostomy risk after controlling for admission diagnosis, comorbidities, and demographics. Diagnosis provides additional discrimination, with COVID-19, transplant, and cardiac patients at highest risk. Grade worsening across re-intubation identifies an ultrahigh-risk subgroup. These findings support systematic airway grade documentation integrated with clinical context for ICU risk assessment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867281","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}

{"title":"MicrotiaGPT: Appraisal of Microtia Care Recommendations From an Artificially Intelligent Chatbot","authors":"Oluwatobiloba Ayo-Ajibola,&nbsp;Simon Park,&nbsp;Beth Osterbauer,&nbsp;Krystina Kallemeyn,&nbsp;Gabriel Gomez","doi":"10.1002/lio2.70526","DOIUrl":"https://doi.org/10.1002/lio2.70526","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate the accuracy, comprehensiveness, and similarity to provider response of ChatGPT-4o in providing patient education regarding microtia and aural atresia management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten standardized inquiries were created across three domains (General Information, Hearing/Anatomy, Treatment Decision-Making) and entered into ChatGPT-4o. Responses were evaluated by an international multidisciplinary cohort of 23 experts, including pediatric otolaryngologists and audiologists. Using 5-point Likert scales, graders assessed factual accuracy, comprehensiveness, similarity to physician responses, and overall quality. Readability was analyzed using Flesch–Kincaid metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ChatGPT-generated responses demonstrated high accuracy (mean = 4.03 [SD = 0.66]), comprehensiveness (mean = 4.18 [SD = 0.54]), and similarity to the provider's response (4.02 [0.70]). Audiologists assigned significantly lower ratings than pediatric otolaryngologists regarding accuracy (mean = 3.76 vs. 4.13; <i>p</i> &lt; 0.001) and comprehensiveness (3.94 vs. 4.30; <i>p</i> = 0.046). Qualitative analysis included concerns regarding advanced terminology, omission of specific risks, and a lack of empathetic framing regarding parental guilt. Flesch–Kincaid Reading Grade Level often exceeded the 5th-grade average level for patient education materials (mean = 9.64 [SD = 1.21]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ChatGPT-4o provides reliable introductory information but lacks the technical nuance and multidisciplinary coordination essential for complex microtia care. While a useful adjunct for early information-seeking, ChatGPT-4o lacks the multidisciplinary framing and depth required for ideal counseling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 5","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823275","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}

{"title":"Beyond the Nerves: Thyroid Autoimmunity as a Non-Neural Factor for Post-Thyroidectomy Dysphonia.","authors":"Chih-Hao Liu, Tzu-Tang Lin, Shih-Wei Wang, Hsin-Yi Tseng, Wing-Hei Viola Yu, Yi-Chu Lin, Jia Joanna Wang, Cheng-Hsun Chuang, Leong-Perng Chan, Tzu-Yen Huang, Che-Wei Wu","doi":"10.1002/lio2.70549","DOIUrl":"10.1002/lio2.70549","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to investigate the impact of elevated preoperative thyroid autoantibodies, a proposed non-neural contributor, on postoperative voice outcomes, specifically within a cohort of patients undergoing nerve-preserved thyroidectomy verified by intraoperative neuromonitoring (IONM).</p><p><strong>Methods: </strong>A retrospective analysis included 212 patients who underwent primary nerve-preserved thyroidectomy with IONM-confirmed integrity of recurrent and superior laryngeal nerves. Patients were categorized into elevated antibody (EA) and normal antibody (NA) groups according to thyroglobulin antibody (TgAb) and anti-thyroid microsomal antibody (TMAb) levels. Objective and subjective voice analyzes (VHI, VRQoL, and IVST) were performed pre- and postoperatively.</p><p><strong>Results: </strong>The EA group had a significantly higher proportion of bilateral surgeries, larger tumors, and heavier specimens. Several postoperative voice parameters differed significantly between the two groups, and after adjustment for patient characteristics, EA levels remained independently associated with abnormal shimmer (adjusted OR 2.33, <i>p</i> = 0.021) and abnormal IVST-T (adjusted OR 2.72, <i>p</i> = 0.010). In the antibody-grade analysis, a preliminary non-linear pattern between antibody burden and postoperative voice outcomes was observed in shimmer, IVST-T, and IVST-S.</p><p><strong>Conclusion: </strong>In this retrospective exploratory study, elevated thyroid autoantibodies were associated with poorer objective voice stability and greater subjective voice impairment following IONM-verified nerve-preserved thyroidectomy. With standardized IONM minimizing the influence of major neural injury, these findings highlight a potential non-neural influence of thyroiditis on postoperative dysphonia. Shimmer and IVST are useful indicators for detecting subtle functional changes, supporting thyroid antibody status as a practical serological indicator for individualized perioperative counseling and rehabilitation.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 4","pages":"e70549"},"PeriodicalIF":1.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820059","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}

{"title":"Large Language Models for Optimizing Patient Recruitment Decisions in Voice Data Generation Projects.","authors":"James Anibal, Geetha Krishna Chaitanya Nama, Shrramana Ganesh, Yosef Nafii, Samantha Salvi Cruz, Veronica Daoud, Madeleine Zanin, Tram Le, Parsa Khorrami, Bradford J Wood, David Clifton, Jamie Toghranegar, Yael Bensoussan, Yael E Bensoussan, Olivier Elemento, Jean-Christophe Bélisle-Pipon, David Dorr, Satrajit Ghosh, Alistair Johnson, Phillip Payne, Maria E Powell, Anaïs Rameau, Vardit Ravitsky, Alexandros Sigaras, Shaheen Awan, Ruth Bahr, Donald Bolser, Kathy J Jenkins, Frank Rudzicz, Jennifer Siu, Stephanie Watts, Yassmeen Abdel-Aty, Toufeeq Ahmed Syed, James Anibal, Steven Bedrick, Isaac Bevers, Micah Boyer, Rahul Brito, Selina A Casalino, John Costello, Enrique Diaz-Ocampo, Mahmoud Elmahdy, Kenneth Fletcher, Alexander Gelbard, Karim Hanna, Bill Hersh, Lochana Jayachandran, Kaley Jenney, Andrea Krussel, Chloe Loewith, Tempestt Neal, Claire Premi-Bortolotto, Sarah Rohde, Samantha Salvi Cruz, Elizabeth Silberholz, Duncan Sutherland, Venkata Swarna Mukhi Talluri, Jamie Toghranegar, Kimberly Vinson, Claire Wilson, Madeleine Zanin, Theresa Zesiewicz, Robin Zhao","doi":"10.1002/lio2.70519","DOIUrl":"10.1002/lio2.70519","url":null,"abstract":"<p><strong>Objectives: </strong>Past studies have shown that many clinical machine learning models have performance limitations due to imbalances in the training data. For voice data generation projects, the origin of the problem may lie in the recruiting methods used during data collection efforts. This study introduces a generative AI pipeline for \"dataset decision support\", recommending recruitment decisions based on high-dimensional insights.</p><p><strong>Methods: </strong>The publicly available GOSSIS-1-eICU dataset was filtered to create patient populations that were relevant to voice data generation projects. Lab results and vital signs from the electronic health record were also used to train a neural network for prediction of disease type. Prediction uncertainty estimates were included in the dataset as approximate indicators of health complexity. To select the best recruitment choice for addressing imbalances, an open-source large language model (LLM) was then instructed to assess dataset statistics and the characteristics of possible participants. Simulations were run in which the system constructed datasets of 250 patients.</p><p><strong>Results: </strong>In over 90% of cases, the proposed system reduced categorical imbalances and widened continuous distributions when compared to randomly sampled counterfactual datasets (<i>q</i>-value < 0.05). Variables included race, age, BMI, sex, disease type, oxygenation status, co-morbidities, post-operative status, Glasgow Coma Scale verbal response score, the Acute Physiology Score III, prediction uncertainty, vital signs, and lab results.</p><p><strong>Conclusion: </strong>LLMs may provide useful, explainable recommendations when presented with dataset distribution statistics and candidate profiles. In the future, this simulated scenario may be extended to align with conditions in emergency departments or other high-volume settings.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 4","pages":"e70519"},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814223","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}

{"title":"Building OHNS Capacity in Low- and Middle-Income Countries: Insights From Global Training Programs.","authors":"Hudson Lin, Michelle H Zhang, Emma Finnegan, Annabelle Fischer, Nidanur Sinanoglu, James Lawrence, Tarika Srinivasan, Fiona Kabagenyi, Mary Jue Xu, Taseer Din","doi":"10.1002/lio2.70546","DOIUrl":"10.1002/lio2.70546","url":null,"abstract":"<p><strong>Objective: </strong>Describe the design, goals, and perceived impacts of global otolaryngology-head and neck surgery (OHNS) training programs, with emphasis on institutional factors shaping workforce development and surgeon retention in low- and middle-income countries (LMICs).</p><p><strong>Methods: </strong>We conducted a cross-sectional qualitative study from October 2024 to October 2025 using focused, semi-structured interviews on Zoom. Participants included program directors and faculty involved in training otolaryngologists from LMICs. Interview transcripts were analyzed using an inductive analysis approach to develop a codebook and identify emergent themes.</p><p><strong>Results: </strong>Sixteen otolaryngologists representing 15 fellowship-level programs in seven countries were interviewed. Collectively, programs had trained 49 fellowship graduates and nine current fellows from 23 countries. Thematic analysis identified four themes: program design and operational barriers, trainee recruitment and selection, trainee support and post-training mobility, and program impact. Directors emphasized shared goals of sustainable workforce development while describing substantial regulatory, financial, and structural constraints to recruitment and post-training mobility. Among LMIC trainees, 75% returned to their home country, though health system limitations, economic pressures, and credentialing barriers hindered reintegration. For faculty, the inclusion of foreign trainees fostered reciprocal learning environments that influenced perspectives on training adaptability and resource-conscious care.</p><p><strong>Conclusion: </strong>Understanding the shared motivations and barriers shaping international OHNS training programs may inform future program design strategies that support sustainable workforce development and successful trainee reintegration within LMIC health systems.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 4","pages":"e70546"},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820029","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}

{"title":"Impact of the COVID-19 Pandemic on Outcomes After Head and Neck Free Flap Reconstruction.","authors":"Christine Lee, Emma Nienaber, Adam Beucler, Siddhant Tripathi, Nicholas Hutchins, Jack Garcia, Abigail Haslinger, Alexander Karabachev, Josiah Brandt, Grace Zhang, Eric Wong, Yash Patil","doi":"10.1002/lio2.70545","DOIUrl":"10.1002/lio2.70545","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative management and clinical outcomes of patients undergoing head and neck free flap reconstruction before and during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Retrospective cohort study of 220 patients who underwent microvascular free flap reconstruction by a single surgeon at a tertiary academic medical center. Perioperative practices and postoperative outcomes, including length of stay, wound infection, complications, two-year survival, and recurrence, were compared between cohorts. Poisson regression with robust error variance was used to calculate adjusted relative risks (RRs).</p><p><strong>Results: </strong>Demographic and baseline oncologic characteristics were largely similar between cohorts. During the pandemic, patients were less likely to undergo intraoperative tracheostomy and PEG placement. Regression analysis showed the pandemic period was independently associated with increased wound infection risk and reduced recurrence.</p><p><strong>Conclusions: </strong>Head and neck free flap reconstruction remained safe during the COVID-19 pandemic, with stable cancer outcomes despite shifts in perioperative practice. However, the higher risk of wound infection highlights the need for targeted preventive strategies during times of healthcare disruption.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 4","pages":"e70545"},"PeriodicalIF":1.9,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820016","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}

{"title":"Osteotomy Techniques in Endoscopic Dacryocystorhinostomy: A Three-Decade Comparative Cohort Study.","authors":"Karl El Mendelek, Amjad Damaj, Jihad El Khoury","doi":"10.1002/lio2.70548","DOIUrl":"10.1002/lio2.70548","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic dacryocystorhinostomy (DCR) is a well-established surgical procedure used to restore lacrimal drainage in patients with nasolacrimal duct obstruction. Various instrumentation techniques have been used for lacrimal bone osteotomy; however, their comparative effectiveness remains debated. This study aimed to evaluate surgical outcomes of endoscopic DCR performed using four different instrumentation techniques.</p><p><strong>Methods: </strong>This retrospective comparative cohort study included 360 consecutive endoscopic DCR procedures performed on 312 adult patients between 1995 and 2024 in a tertiary care center. All surgeries were performed by a single surgeon. Osteotomy was performed using a drill, microdebrider, Kerrison punch, or thulium:YAG laser. Surgical success was defined as resolution of symptoms and confirmation of a patent neo-ostium on follow-up. Comparative statistical analysis was performed to evaluate differences in success rates among techniques.</p><p><strong>Results: </strong>The overall success rate was 95.3%. Success rates were comparable across all instrumentation techniques, with no statistically significant difference observed between groups (<i>p</i> = 0.99). Minor postoperative complications occurred in 2.8% of procedures.</p><p><strong>Conclusion: </strong>Endoscopic DCR demonstrated high success rates across all instrumentation modalities. Surgical outcome appears to depend more on surgical technique and experience than on the specific instrument used for osteotomy.</p>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"11 4","pages":"e70548"},"PeriodicalIF":1.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799747","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}