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Objective: Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well‐characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC. Study Design: Retrospective case‐control study. Setting: National database. Methods: Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004‐2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short‐term surgical outcomes. Results: 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23‐1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23‐2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29‐1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55‐3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30‐1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11‐1.41) and 30‐day readmissions (ORadj: 1.26, 95% CI: 1.00‐1.58) than adult patients. Conclusion: These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short‐term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers. [ABSTRACT FROM AUTHOR]

Introduction: Microbiome research has predominantly focused on the oral cavity and oropharynx's role in disease, while the upper airway, specifically the larynx and trachea, has been relatively overlooked. Examining the microbial communities in these regions can shed light on how dysbiosis influences diseases and their management. This review evaluates laryngotracheal microbial compositions in both healthy and diseased patients. Methods: We conducted a systematic review in EMBASE, MEDLINE, and Cochrane Central databases, yielding 1383 studies in the initial search. Inclusion criteria involved participants aged over 18 years and the use of next‐generation 16s ribosomal sequencing methods. Results: We included 10 studies—seven focused on larynx sequencing and four on trachea sequencing (one investigated both sites). In a healthy larynx, diverse species such as Streptococcus, Cloacibacterium, Prevotella, and Helicobacter were found. Benign laryngeal diseases exhibited reduced microbial diversity, mainly dominated by Streptococcus. Subglottic stenosis patients showed diminished diversity in both idiopathic and iatrogenic scars. Laryngeal squamous cell carcinoma displayed increased diversity, primarily featuring Fusobacterium. Among non‐respiratory‐compromised surgery patients, the tracheal microbiome was more diverse in diabetics and those later developing lower respiratory infections. Pneumonia patients exhibited an abundance of Prevotella and Streptococcus, linked to an increased 28‐day survival rate, while Streptococcus and Haemophilus abundance correlated with successful extubation. Conclusions: The laryngotracheal region hosts a unique microbial community influenced by both benign and malignant conditions. Many lesions remain unexplored, underscoring the need for future studies encompassing diverse laryngotracheal conditions. Clinical trials assessing microbiome modifications may unveil novel therapeutic avenues. Level of Evidence: NA Laryngoscope, 134:4167–4175, 2024 [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes. [ABSTRACT FROM AUTHOR]

Objective: Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D‐printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single‐blinded randomized controlled trial. Methods: Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure‐specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D‐printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans‐thyrohyoid and trans‐cricothyroid approaches. Endoscopic and external performance recordings were de‐identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL‐specific checklist. Results: Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans‐thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. Conclusions: In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low‐cost, high‐fidelity 3D‐printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. Level of Evidence: NA Laryngoscope, 134:318–323, 2024 [ABSTRACT FROM AUTHOR]

Objective: Laryngoscopy corresponding with laryngeal electromyography (LEMG) is essential in diagnosing vocal fold paresis. However, baseline asymmetry or other diseases oftentimes confound the exam, making diagnosis difficult. There is currently no agreed upon endoscopic criteria proven to reliably correlate with LEMG findings. We define a set of endoscopic findings termed "paresis triad" that, when present together, reliably correlate with LEMG. The paresis triad consists of (1) hypocontraction of the weak side of the larynx with increased ventricular show, (2) hypercontraction of the intact side with bulging of the false fold covering the ventricle, and (3) tilting of the interarytenoid cleft to the weak side. Methods: We performed a retrospective review of patients with laryngeal asymmetry on laryngoscopy. Patients were divided into two groups: those with consistent paresis triad findings across all pitches and intensities, and those without. All patients underwent LEMG by a neurolaryngologist blinded to the laryngoscopic findings. The endoscopies were then rereviewed in a blinded manner by a second laryngologist to assess inter‐ and intrarater reliability for identification of the triad. Results: Twelve patients met inclusion criteria (age 50 +/−15, 7F:5M). Nine had the paresis triad. Three had an inconsistent triad. All patients with the paresis triad had LEMG findings consistent with neurologic injury on the suspected side. All patients with inconsistent triad findings had normal LEMG. Conclusions: Our findings suggest the proposed laryngoscopic paresis triad may be useful objective criteria to diagnose paresis without the need for LEMG. Further prospective studies should examine a larger series of patients. Level of Evidence: 4 Laryngoscope, 133:1712–1716, 2023 [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to evaluate patient satisfaction with speech‐language therapy televisits and to identify factors influencing the level of satisfaction. Methods: Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech‐language therapy with a speech‐language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7‐item survey. Demographic characteristics of participants were collected from a review of patient charts. Results: 65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans‐female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in‐person therapy. Conclusion: Clinicians are able to achieve high patient satisfaction with speech‐language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits. Lay Summary: Clinicians are able to achieve high patient satisfaction with speech‐language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in‐person therapy. Level of Evidence: 4 Laryngoscope, 133:895–900, 2023 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high‐volume public hospital. Study Design: Retrospective Observational Study. Methods: This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9‐month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9‐month period immediately following implementation of electronic consultation in 2019. Results: During the pre‐implementation (pre‐EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post‐implementation (post‐EC). 86% of referrals were scheduled for a clinic appointment pre‐EC, compared to 61% post‐EC (P <.00001) 24.5% of patients were evaluated within 30 days pre‐EC compared to 53.6% post‐EC (P <.00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre‐EC to 42.8 days post‐EC (P =.0029). There was a 50% decline in the percentage of appointments canceled by patients in the post‐EC period as compared to pre‐EC. Conclusions: In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no‐show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic. Level of Evidence: 4 Laryngoscope, 131:E1792–E1796, 2021 [ABSTRACT FROM AUTHOR]

Objective: To determine whether surgical case volume is a predictive factor of surgical outcomes when managing geriatric patients with head andneck cancer. Methods: A cross-sectional study design was used. Data were obtainedfrom the Vizient Database, which included a total of 93 academicinstitutions. Men and women aged between 65 and 100 years undergoing head and neck cancer surgery during 2009 and 2012,excluding cases of thyroid cancer and skin cancer of the head and neck(n = 4544) were included in the study. Hospital case volume was definedas low (≤21 cases/year), moderate (22-49 cases/year), or high (≥50 cases/year). The frequency of comorbidities and complications wasmeasured by hospital case volume using a χ2 test. Significancewas determined with an α level of.05. Results: The largest number of head and neck cancer cases involving comorbidities (90.54%) and the highest rate of overall complications(27.50%) occurred in moderate case volume institutions compared to athe complication rate of 22.89% in low volume hospitals and 21.50% in highvolume hospitals (P <.0001). The most common comorbidities across all3 hospital case volumes included hypertension, metastatic cancer,and chronic pulmonary disease and the most common complicationsincluded hemorrhage/hematoma and postoperative pulmonarycompromise. Conclusion: With more geriatric patients requiring surgery for head andneck cancer, it would be beneficial to manage the more complex cases at high volume centers and to develop multidisciplinary teams to optimizecase management and minimize complications. [ABSTRACT FROM AUTHOR]

Objective: To determine the natural history of vocal fold cysts, by undertaking a retrospective analysis of data from a single clinical institute.Methods: All patients diagnosed with vocal fold cysts were identified from January 2006 to June 2018. A total of 87 patients that elected not to have surgery or who had an interval of observation greater than 90 days prior to surgical intervention were further analyzed. The primary outcome was whether the cyst enlarged, reduced in size, resolved or ruptured. The secondary outcome measures were whether cyst characteristics (translucent or opaque by gross appearance and/or the presence of inflammation), voice therapy or duration of follow up (≤/> 300 days) had an impact upon natural history.Results: There were 65 females and 22 males (47 years ±17). The mean duration of follow up was 589 days (Range 21 - 4523 days). The majority of cysts did not change (70.11%). The rest enlarged (12.64%), reduced in size (13.79%), resolved (1.15%) or ruptured (1.15%). There was no statistically significant relationship between the presence or absence of clinical signs of inflammation (P = .633) or voice therapy (P = .785) on natural history. There was an equivocal relationship between gross cyst appearance and natural history (P = .054), however there was a statistically significant relationship between the duration of follow up (P = .006) and natural history.Conclusion: Most vocal fold cysts appear to remain static in size over time. About 30% change, with half of these enlarging and half shrinking. In addition to some possibility of change in size, there is a small chance of resolution or spontaneous rupture with potentially serious consequences to the voice.Level Of Evidence: 4. Laryngoscope, 130:2202-2207, 2020. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the presence of a concomitant upper respiratory tract infection (URI) impacts upon Botulinum toxin (BoNT) efficacy in spasmodic dysphonia (SD) patients.Study Design: Case series and literature review.Methods: All SD patients with a concurrent URI, presenting for BoNT therapy at a clinical research center from November 2016 to December 2017 were included. A total of 12 patients were identified. Patients were followed for at least two BoNT treatment cycles (approximately 6 months). The primary outcome measure was efficacy of the initial BoNT injection and the secondary outcome measure was the efficacy of the subsequent BoNT injection.Results: All subjects had adductor type SD (ADSD). There were 10 females and two males with a median age of 55 years (±19.5). All patients were well established on a consistent BoNT treatment regime, with an average administered dose of 1.0 unit (range 0.2-1.80 units). Bilateral injections were administered to 10 patients. Regarding the primary outcome measure, five failed to have any response to BoNT (41.7%), four had a partial response (33.3%), and three had a positive response to treatment (25.0%). When patients had their follow-up injection in the absence of URI symptoms, 11 patients had a positive response to treatment (91.7%).Conclusion: While the interplay between illness and BoNT efficacy is yet to be elucidated, we report that some patients are affected. We recommend that SD patients presenting for BoNT administration with a concomitant URI, should be counseled that their treatment might have decreased effect.Level Of Evidence: 4 Laryngoscope, 130:1746-1749, 2020. [ABSTRACT FROM AUTHOR]