The Annals of otology, rhinology, and laryngology最新文献

{"title":"Current Utilizations and Limitations of Augmented Reality in Otolaryngology-Head and Neck Surgery: A Scoping Review.","authors":"Anthony Tang, Kelly E Daniels, Samuel Adida, Nicolás Kass, Stephen Canton, Jacob T Biehl, Edward Andrews, Noel Jabbour","doi":"10.1177/00034894261433644","DOIUrl":"10.1177/00034894261433644","url":null,"abstract":"<p><strong>Objective: </strong>Interactive technologies are evolving along with their applications in medicine. Under this umbrella lie both augmented reality (AR), the process of visually overlaying digital information on top of the physical world, and mixed reality (MR), which builds upon AR with the inclusion of interactions between the digital display and the physical world. Previous reviews of AR and MR in OHNS have been limited in their scope and do not address underlying technological shortcomings.</p><p><strong>Methods: </strong>A scoping review of relevant literature was conducted using PRISMA methodology. Electronic databases were screened using keywords including \"augmented reality,\" \"mixed reality,\" \"ENT, \"OHNS,\" and \"otolaryngology.\" Editorials, reviews, meta-analyses, unpublished, and -only articles were all excluded. Studies were individually assessed for quality using technological usability heuristics.</p><p><strong>Results: </strong>A total of 107 studies were reviewed with 46 studies meeting our inclusion criteria. Of the included studies, there were 4 (8.7%) studies on preoperative surgical planning, 37 (80.4%) on intraoperative surgical guidance, and 5 (10.9%) on surgical education. The majority of studies on AR or MR in OHNS were in subspecialty Otology/Neurotology with 19 studies, while 10 were in Rhinology, and 7 were in Head and Neck Surgery. The majority have been on intraoperative usage. However, almost all of these were preclinical studies (84.8%). Commonly cited challenges limiting the transition of intraoperative guidance from models to the OR include accuracy of registration and ease-of-use.</p><p><strong>Conclusion: </strong>Current studies in this field have focused on intraoperative guidance and were predominantly in the preclinical phase. The limitations in current AR/MR technology have prevented a greater level of evidence in studies and advancements in AR/MR implementation.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"580-590"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty and Steroid Treatment Outcomes in Patients with Sudden Sensorineural Hearing Loss.","authors":"Lina M Adwer, Ryan C Higgins, Elizabeth R Lyden, Anne K Maxwell","doi":"10.1177/00034894261435264","DOIUrl":"10.1177/00034894261435264","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between frailty and steroid treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL).</p><p><strong>Study design: </strong>Retrospective cohort studySetting:Tertiary-care institution.</p><p><strong>Patients: </strong>185 adult patients (≥19 years) with unilateral SSNHL presenting January 1, 2017 to May 24, 2023, stratified by 5-Factor Modified Frailty Index (mFI5).</p><p><strong>Interventions: </strong>Oral prednisone and/or intratympanic dexamethasone.</p><p><strong>Main outcome measures: </strong>Post-treatment changes in pure-tone average (PTA), speech reception threshold (SRT), and word recognition scores (WRS).</p><p><strong>Results: </strong>Female and younger patients were significantly less frail than male and older patients (<i>P</i> = .004, <i>P</i> < .001 respectively). Patients with higher frailty scores (≥2) were less likely to receive oral steroids (59.6% vs 82.8%, <i>P</i> = .004), though equally likely to receive intratympanic steroids (<i>P</i> = 1.000). However, patients classified as frail (≥1) were not more likely to receive intratympanic steroids alone compared to combination therapy (<i>P</i> = .220). Higher frailty scores were significantly associated with metabolic syndrome (<i>P</i> = .002), but specific treatment patterns in diabetic patients could not be delineated as treatment was individualized. Dizziness (<i>P</i> = .650) and vertigo (<i>P</i> = .200) did not correlate with frailty or treatment outcomes. The number of comorbidities increased with higher frailty scores (<i>P</i> < .001) but did not directly correlate with SSNHL outcomes. No significant differences were observed in audiometric outcomes (PTA/SRT/WRS) based on patient frailty scores across all comparisons (<i>P</i>'s > .05).</p><p><strong>Conclusions: </strong>While we found an association between frailty scores and treatment selection for SSNHL, we did not find a significant association between frailty scores and treatment outcomes. Therefore, treatment may be individualized in frail patients without compromising audiometric outcomes.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"616-623"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Control Status of Chronic Rhinosinusitis in Severe Asthma Patients Receiving Biologics: A Real-World Cross-Sectional Study.","authors":"Sevgi Çolak, Zeynep Çelebi Sözener, Ömür Aydin, Mustafa Çolak, Sevim Bavbek, Betül Ayşe Sin, Yavuz Selim Demirel, Dilşad Mungan","doi":"10.1177/00034894261434347","DOIUrl":"10.1177/00034894261434347","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the prevalence, subtypes, and control status of chronic rhinosinusitis (CRS) among patients with severe asthma receiving biologic therapy in a tertiary allergy clinic.</p><p><strong>Methods: </strong>A single-center, cross-sectional observational study was conducted in adult patients with severe asthma receiving biologics for at least 6 months. CRS diagnosis and control were assessed based on European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020 criteria. The Sinonasal Outcome Test-22 (SNOT-22) was also administered. Statistical analyses were performed using appropriate univariate and multivariate methods.</p><p><strong>Results: </strong>Among 148 patients with severe asthma receiving biologic therapy, 97 (65.5%) were diagnosed with comorbid CRS. Of these, 68 (45.9%) had CRS with nasal polyps (CRSwNP) and 29 (19.5%) had CRS without nasal polyps (CRSsNP). A total of 54 patients (55.6%) were treated with omalizumab and 43 (44.3%) with mepolizumab. Overall, 32.9% of patients had controlled CRS, 36.0% were partly controlled, and 30.9% were uncontrolled. In multivariable ordinal regression analysis, the presence of N-ERD and higher BMI were associated with poorer CRS control, whereas early-onset asthma and prior maintenance systemic corticosteroid use were associated with better control, suggesting that these factors may be related to CRS control status in this population.</p><p><strong>Conclusions: </strong>CRS is highly prevalent among patients with severe asthma receiving biologics, and approximately one-third remain uncontrolled despite treatment. These findings emphasize the importance of regular upper airway assessment and may inform future strategies for optimizing biologic selection and treatment outcomes in this population.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"591-599"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Cost-Effective 3D-Printed Model for Flexible Nasolaryngoscopy Training Provides Trajectory Information and Distinguishes Early Learners From Experts.","authors":"Anna Christina Clements, Michael Bindschadler, Huy Le, Seth D Friedman, Felix Fernández-Penny, Tanya K Meyer, Maya G Sardesai","doi":"10.1177/00034894261435702","DOIUrl":"10.1177/00034894261435702","url":null,"abstract":"<p><strong>Objectives: </strong>Flexible fiberoptic nasolaryngoscopy is among the most common procedures performed by otolaryngologists worldwide. Despite this, there is no standard training method. High-fidelity approaches typically require trainees to learn on live patients and provide general qualitative information about the scope's path. However, trainees lack objective quantitative procedural feedback to optimize their technique, and patients may be subjected to pain and epistaxis. A trainer that provides a safe, reusable interface and quantitative report would transform this learning experience.</p><p><strong>Methods: </strong>Our team developed a cost-effective 3D-printed task trainer for flexible fiberoptic nasolaryngoscopy and coupled this with a calibrated electromagnetic tracker to evaluate scope trajectory across users. Thirty-one subjects ranging from secondary school student to practicing otolaryngologist used the trainer. Participant confidence and perceived model realism were assessed with surveys. Scope trajectory was assessed using the electronic tracker.</p><p><strong>Results: </strong>Mean score on the realism of endoscopic appearance was 7.5 on a 10-point visual analog scale. All subjects reported stable or increased confidence in flexible nasolaryngoscopy after using the model, with novices demonstrating the most significant change (<i>P</i> = .005). Trajectory data from the fine-wire tracker demonstrated that less experienced trainees paused and backtracked more than more experienced trainees (<i>P</i> = .004).</p><p><strong>Conclusions: </strong>This novel 3D-printed model offers a feasible task trainer for flexible nasolaryngoscopy and yields trajectory information that distinguishes between novices and experts. This model can provide an accessible training method that does not compromise patient experience, while simultaneously offering objective feedback to trainees as they grow their skills.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"624-630"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13446141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges with Neural Anomalies in Hypoglossal Nerve Stimulator Implantation.","authors":"Jasmine Gulati, Alexander Knops, Stephen White, Henry Ideker, Phillip Huyett, Colin Huntley","doi":"10.1177/00034894261435705","DOIUrl":"10.1177/00034894261435705","url":null,"abstract":"<p><p>Hypoglossal nerve stimulation (HGNS) is an FDA-cleared therapy for obstructive sleep apnea (OSA) in patients who cannot or are unable to tolerate contentious positive airway pressure (CPAP) therapy. However, underlying neural anomalies may impair surgical efficacy and require intraoperative adaptability. We present 2 cases of HGNS in patients with preexisting neurologic conditions affecting nerve morphology. Case 1 involves a 66-year-old woman with OSA (REI 52.5) and neurofibromatosis (NF). Despite normal tongue motion and favorable drug-induced sleep endoscopy (DISE), intraoperative findings revealed diffuse enlargement of the hypoglossal nerve. The nerve exhibited weak and inconsistent stimulation responses, and the cuff could not be placed effectively. The procedure was aborted. Postoperative MRI confirmed diffuse left-sided hypoglossal nerve thickening consistent with a plexiform neurofibroma. Case 2 features a 64-year-old man with OSA (AHI 41.3) and chronic inflammatory demyelinating polyneuropathy (CIDP). Intraoperatively, the hypoglossal nerve was enlarged, firm, and lacked identifiable branches. Mixed stimulation patterns prevented functional cuff placement. A contralateral approach was pursued with successful implantation and device activation. These cases highlight challenges in HGNS when neural anomalies-such as those from NF or CIDP-alter nerve structure or function. Neurofibromas can diffusely infiltrate cranial nerves, complicating stimulation, while CIDP causes patchy demyelination and conduction variability. Preoperative imaging, including high-resolution T2-weighted MRI, is essential to assess nerve morphology and plan surgical approaches. Surgeons must be prepared for intraoperative variability, including the potential need for contralateral dissection. Anomalies of the hypoglossal nerve can compromise HGNS success. Preoperative identification of underlying neuropathies and adaptable intraoperative planning are critical for optimizing outcomes in complex patients.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"642-645"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Menopause and Hormone Replacement Therapy with Hearing Loss.","authors":"Jonathan Z Hsu, Kaiqi Gu, Breana Nguyen, Janet S Choi","doi":"10.1177/00034894261435259","DOIUrl":"10.1177/00034894261435259","url":null,"abstract":"<p><strong>Objective: </strong>Estrogen has been found to impact cochlear blood flow and auditory function, but epidemiological studies on menopause and hearing are inconsistent. This study investigates the associations of menopause, its age at onset, reproductive lifespan, and hormone replacement therapy (HRT) with hearing loss in adult women in the US.</p><p><strong>Methods: </strong>Study cohort includes 1778 adult women (40-69 years), from the National Health and Nutrition Examination Survey 2011 to 2012 and 2015 to 2016 who had complete data on audiometry and reproductive health. Hearing loss was defined based on speech-frequency pure-tone average (0.5, 1, 2, and 4 kHz) in better hearing ear. Menopause status was self-reported. Multivariable regression analyses were performed to explore the associations of menopause, age at onset, reproductive lifespan, and HRT with hearing loss.</p><p><strong>Results: </strong>After adjusting for age, demographics, medical comorbidities, and noise exposure, there was no significant association between binary postmenopausal status and hearing loss (β: 0.92 dB, [95% CI: -1.02 to 2.86]). When further considering age of menopause onset and reproductive lifespan, we found that late onset of menopause (vs early onset) was significantly associated with the better hearing (β: -4.60 dB, [95% CI: -8.42 to -0.79]) and longer reproductive lifespan was significantly associated with better hearing (β: -0.16 dB per year, [95% CI: -0.32 to -0.002]). Comparing reproductive lifespan quartiles, the fourth quartile was significantly associated with better hearing relative to the first quartile (β: -4.86 dB, [95% CI: -8.28 to -1.44]). Among post-menopausal women, there was no significant association between hearing loss and HRT (β: 0.45 dB, [95% CI: -1.69 to 2.58]).</p><p><strong>Conclusion: </strong>While menopausal status was not significantly associated with hearing loss, later onset of menopause and longer reproductive lifespan were associated with better hearing. Future studies should evaluate the clinical significance of the associations between hearing and reproductive health and potential causal relationships.</p><p><strong>Level of evidence: </strong>2b.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"607-615"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13333030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Squamous Papilloma in the Practice of Otolaryngology: A Case Series and Diagnostic Considerations for the otolaryngologist.","authors":"Yuval Nachalon, Nogah Nativ-Zeltzer, Kurt B Schaberg, Peter C Belafsky","doi":"10.1177/00034894261473345","DOIUrl":"https://doi.org/10.1177/00034894261473345","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous papilloma (ESP) is a rare, benign, often asymptomatic lesion of the upper aerodigestive tract. While historically managed by gastroenterologists, transnasal esophagoscopy has been incorporated into some otolaryngology practices, expanding the role of the otolaryngologist in diagnosing these lesions.</p><p><strong>Aims: </strong>To describe a case series of ESP within a tertiary dysphagia center and evaluate the association between human papillomavirus (HPV) and chronic mucosal irritation.</p><p><strong>Methods: </strong>A retrospective case series was conducted of all individuals diagnosed with ESP at a tertiary center over a 2-year period. Histopathology and DNA in-situ hybridization (ISH) for high and low-risk HPV were reviewed.</p><p><strong>Results: </strong>Five cases were identified. All patients presented with dysphagia or heartburn. ESP was an incidental finding in all cases, co-existing with cricopharyngeal dysfunction, hiatal hernia, or esophagitis. One patient had a history of HPV+ oropharyngeal carcinoma. All lesions were successfully resected endoscopically. ISH was negative for HPV in all specimens.</p><p><strong>Conclusions and significance: </strong>ESP is a benign entity frequently encountered incidentally during the workup of dysphagia. These results support chronic irritation rather than HPV as the primary etiology. Recognition is vital for otolaryngologists to ensure appropriate resection and surveillance.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894261473345"},"PeriodicalIF":0.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Allergy Testing: At What Age Is It Worth It?","authors":"Meera Garg, Mikhaylo Szczupak, Pooja D Reddy, Amber Dianne Shaffer, Marina V Rushchak, Amanda L Stapleton","doi":"10.1177/00034894261470546","DOIUrl":"https://doi.org/10.1177/00034894261470546","url":null,"abstract":"<p><strong>Background: </strong>Concordance between symptoms of allergic rhinitis and allergy testing varies in young children. The aim was to determine at what age serum specific IgE testing becomes clinically useful for the diagnosis of allergic rhinitis due to decreased rates of non-reactivity.</p><p><strong>Methods: </strong>This was a retrospective chart review of pediatric patients (0-18 years of age) with allergic rhinitis symptoms in an academic pediatric otolaryngology practice from 2020 to 2024. All patients underwent a standardized serum specific IgE testing panel and sensitivities to the aeroallergens on the tested panel were interpreted in a binary manner. Demographics such as age and sex were also collected.</p><p><strong>Results: </strong>A total of 606 patients met inclusion criteria. There were 31 patients who underwent allergy testing at <3 years and 575 patients who underwent allergy testing at ≥3 years. The prevalence of allergy testing with a negative result was 93.6% in the younger age group and 49.0% in the older group. Children age < 3 years demonstrated 15.1 (95% CI: 3.56-63.7) increased odds of negative allergy testing (<i>P</i> < .001). In the 295 patients with positive allergy testing, the odds of poly-sensitization (≥4 allergens positive) increased with age (OR: 1.09, 95% CI: 1.03-1.15, <i>P</i> = .004).</p><p><strong>Discussion: </strong>In early childhood, allergy testing results are not highly predictive for symptoms of allergic rhinitis. Concordance increases in an age dependent manner and becomes more reliable by age 3. These results can help promote cost-effective use of allergy testing in young pediatric patients with suspected allergic rhinitis by not testing prior to age 3.</p><p><strong>Level of evidence: </strong>4.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894261470546"},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Endoscopic Interventions for Subglottic Stenosis in Adults: A Systematic Review and Meta-Analysis.","authors":"Abdulsalam Alqutub, Ahmed Mogharbel, Mohammed A Awadh, Omar A Alsulami, Hanin A Alamoudi, Abdulrahman F Kabli, Ali N Jabbari, Rayan A Alshehri, Talal Al-Khatib","doi":"10.1177/00034894261467364","DOIUrl":"https://doi.org/10.1177/00034894261467364","url":null,"abstract":"<p><strong>Background: </strong>Subglottic stenosis (SGS) is a challenging clinical condition with several endoscopic treatments available. This systematic review aims to update the evidence on the efficacy and safety of endoscopic procedures for managing SGS in adult patients.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we conducted a comprehensive literature search across 4 databases, covering studies from inception to August 2024. We included studies that evaluate different endoscopic interventions for SGS in adult patients. The primary outcome was the success rate of endoscopic procedures, with secondary outcomes including recurrence rate, the need for open surgery, decannulation rate, and procedure-related complications.</p><p><strong>Results: </strong>Fifty-five studies involving 3091 patients were included. The overall success rate of endoscopic treatments was 72.9%, with CO₂ laser and YAG laser demonstrating success rates of 76.8% and 93.8%, respectively. Balloon dilatation exhibited a success rate of 66.8%. The recurrence rate across all endoscopic interventions was 60.5%, with specific procedures, such as balloon dilatation, showing a higher recurrence rate of 68.4%. The overall rate of requiring open surgery was 7%, and the overall decannulation rate after tracheostomy was 60.1%, with balloon dilation showing the highest rate of successful decannulation among (82.8%). The overall complication rate was 5%.</p><p><strong>Conclusion: </strong>Endoscopic management of adult subglottic stenosis yields variable success with high recurrence rates. Heterogeneity across studies limits interpretation, and comparative conclusions cannot be drawn. Future studies should standardize outcome definitions, disease severity reporting, and follow-up duration to guide evidence-based practice.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894261467364"},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Intrathecal Fluorescein in Transmastoid Repair of Temporal Encephaloceles.","authors":"Keshav V Shah, Kevin Wong, Kim Le, Randall James Harley, Christian Jung, Tiffany Hwa, Michael J Ruckenstein, Douglas C Bigelow","doi":"10.1177/00034894261470543","DOIUrl":"https://doi.org/10.1177/00034894261470543","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the safety and efficacy of intrathecal fluorescein administration during transmastoid repair of temporal lobe encephaloceles and identify predictors for intraoperative fluorescein identification.</p><p><strong>Methods: </strong>This was a retrospective case-control study of consecutive adult patients with temporal lobe encephaloceles repaired via transmastoid approach from October 2012 to October 2024 at a single tertiary academic medical center. Medical records of qualifying patients were searched for demographics, diagnostic workup, disease characteristics, and intraoperative and postoperative outcomes. Analysis incorporated the Wilcoxon rank-sum, Pearson's X², and Fisher's exact tests, along with unadjusted Kaplan-Meier estimates. Outcomes included encephalocele recurrence and symptomatic resolution rates, fluorescein complications, and rates and predictors of intraoperative fluorescein identification.</p><p><strong>Results: </strong>38 patients met inclusion criteria (age 59.8 + 11.9 years, BMI 35.8 + 8.7 kg/m², 23 [60.5%] female). Recurrence (0% vs 11.5%, <i>P</i> = .54) and symptom resolution (83.3% vs 88.5%, <i>P</i> = .64) rates did not differ between patients who received and did not receive intrathecal fluorescein. No fluorescein-related complications were reported. Fluorescein was intraoperatively detected in six-twelfths cases, yielding a sensitivity of 50%. No demographic or clinical variables, including higher BMI, history of prior encephalocele, and size of largest defect, were associated with intraoperative fluorescein identification.</p><p><strong>Conclusions: </strong>Intrathecal fluorescein administration preliminarily appears to be a safe adjunctive tool to identify the leak source in the transmastoid repair of temporal lobe encephaloceles, but its risk-benefit ratio remains up for debate. Higher-powered studies are necessary to explore its utility in specific circumstances and to determine which patients may benefit most.</p>","PeriodicalId":520787,"journal":{"name":"The Annals of otology, rhinology, and laryngology","volume":" ","pages":"34894261470543"},"PeriodicalIF":0.0,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}