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Background: Machine learning driven clinical decision support tools (ML‐CDST) are on the verge of being integrated into clinical settings, including in Otolaryngology‐Head & Neck Surgery. In this study, we investigated whether such CDST may influence otolaryngologists' diagnostic judgement. Methods: Otolaryngologists were recruited virtually across the United States for this experiment on human–AI interaction. Participants were shown 12 different video‐stroboscopic exams from patients with previously diagnosed laryngopharyngeal reflux or vocal fold paresis and asked to determine the presence of disease. They were then exposed to a random diagnosis purportedly resulting from an ML‐CDST and given the opportunity to revise their diagnosis. The ML‐CDST output was presented with no explanation, a general explanation, or a specific explanation of its logic. The ML‐CDST impact on diagnostic judgement was assessed with McNemar's test. Results: Forty‐five participants were recruited. When participants reported less confidence (268 observations), they were significantly (p = 0.001) more likely to change their diagnostic judgement after exposure to ML‐CDST output compared to when they reported more confidence (238 observations). Participants were more likely to change their diagnostic judgement when presented with a specific explanation of the CDST logic (p = 0.048). Conclusions: Our study suggests that otolaryngologists are susceptible to accepting ML‐CDST diagnostic recommendations, especially when less confident. Otolaryngologists' trust in ML‐CDST output is increased when accompanied with a specific explanation of its logic. Level of Evidence: 2 Laryngoscope, 134:2799–2804, 2024 [ABSTRACT FROM AUTHOR]

Objective: An increased prevalence of mood and anxiety disorders in patients with dysphagia has been noted previously, but whether dysphagia severity may be exacerbated by anxiety and depression has never been studied before. The purpose of this study is to identify the effect of pre‐existing diagnosis of anxiety and/or depression (anxiety/depression) on the Eating Assessment Tool (EAT‐10), a validated patient‐reported outcome measure for dysphagia. We hypothesized that patients with dysphagia and normal instrumental evaluation have higher EAT‐10 score in the presence of pre‐existing anxiety and depression. Methods: A retrospective chart review was conducted of patients seen at the multi‐disciplinary dysphagia clinic of an urban academic institution. EAT‐10 scores and pre‐existing diagnoses of anxiety/depression were collected at the first visit with laryngologists. The two‐sample t‐test was used to compare mean EAT‐10 scores between the anxiety/depression and no anxiety/depression groups, stratified by swallowing dysfunction etiology. Results: The study included 290 consecutive patients seen starting in January 2018. In this cohort, 60 (21%) had pre‐existing anxiety, 49 (17%) depression, and 36 (12%) both. Overall, 59 patients had normal swallowing based on instrumental swallowing testing (flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, esophagram, or esophagoscopy). Among those, mean EAT‐10 score was significantly higher in patients with anxiety and/or depression (n = 30) (14.63, SD = 11.42) compared to those with no anxiety and/or depression (n = 29) (8.93, SD = 6.59) (p = 0.023). Conclusion: While anxiety/depression may aggravate dysphagia in patients with normal swallowing function, this correlation may not hold in those with objective swallowing dysfunction. Level of Evidence: 4 Laryngoscope, 134:2115–2120, 2024 [ABSTRACT FROM AUTHOR]

Objective(s): This study examined the agreement in maximal expiratory (MEP) and inspiratory (MIP) pressure readings between two digital manometers: (1) the MicroRPM – the gold‐standard manometer for respiratory muscle strength testing; and (2) the LDM – a low‐cost, commercially available, alternative manometer. Methods: Positive (MEP) and negative (MIP) pressures were simultaneously applied to the MicroRPM and LDM using a 3‐liter syringe within a controlled laboratory setting. Pressure readings were compared, and agreement was analyzed using Lin's concordance correlation (ρc). Agreement was interpreted as 'poor' if <0.90, 'moderate' if 0.90 – <0.95, 'substantial' if 0.95 – <0.99, and 'excellent' if ≥0.99. Twenty percent of the pressure trials were repeated by a second researcher to examine test–retest reliability. Results: A total of 150 trials were completed, ranging from −167 to +208 cmH2O. There was a median absolute difference of 0.3 cmH2O in pressure readings between the MicroRPM and the LDM. Lin's concordance correlation revealed 'excellent' agreement between the LDM and MicroRPM devices, with test–retest reliability assessment revealing 'substantial‐to‐excellent' agreement between the LDM and MicroRPM devices, with a concordance correlation coefficient of ρc = 0.999 (95% CI: 0.999–0.999). Conclusions: There was a median difference of 1.0% in MEP and MIP pressure readings consistently observed between the LDM and MicroRPM. Despite these relatively small differences, excellent agreement between the two manometers was present. These data suggest the LDM may be a valid, lower cost alternative to the MicroRPM for objectively assessing respiratory strength in clinical practice; however, additional research is needed in healthy adults and in patient populations. Level of Evidence: NA Laryngoscope, 134:1831–1836, 2024 [ABSTRACT FROM AUTHOR]

Objective: To assess the readability of patient‐facing educational information about the most common otolaryngology diagnoses on popular social media platforms. Study Design: Cross‐sectional study. Setting: Social media platforms. Methods: The top 5 otolaryngologic diagnoses were identified from the National Ambulatory Medical Care Survey Database. Facebook, Twitter, TikTok, and Instagram were searched using these terms, and the top 25 patient‐facing posts from unique accounts for each search term and poster type (otolaryngologist, other medical professional, layperson) were identified. Captions, text, and audio from images and video, and linked articles were extracted. The readability of each post element was calculated with multiple readability formulae. Readability was summarized and was compared between poster types, platforms, and search terms via Kruskal‐Wallis testing. Results: Median readability, by grade level, by grade level, was greater than 10 for captions, 5 for image‐associated text, and 9 for linked articles. Captions and images in posts by laypeople were significantly more readable than captions by otolaryngologists or other medical professionals, but there was no difference for linked articles. All post components were more readable in posts about cerumen than those about other search terms. Conclusions: When examining the readability of posts on social media regarding the most common otolaryngology diagnoses, we found that many posts are less readable than recommended for patients, and found that posts by laypeople were significantly more readable than those by medical professionals. Medical professionals should work to make educational social media posts more readable to facilitate patient comprehension. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to examine applications of cough sounds towards screening tools and diagnostics in the biomedical and engineering literature, with particular focus on disease types, acoustic data collection protocols, data processing and analytics, accuracy, and limitations. Data Sources: PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, IEEE Xplore, Engineering Village, and ACM Digital Library were searched from inception to August 2021. Review Methods: A scoping review was conducted on screening and diagnostic uses of cough sounds in adults, children, and animals, in English peer‐reviewed and gray literature of any design. Results: From a total of 438 abstracts screened, 108 articles met inclusion criteria. Human studies were most common (77.8%); the majority focused on adults (57.3%). Single‐modality acoustic data collection was most common (71.2%), with few multimodal studies, including plethysmography (15.7%) and clinico‐demographic data (7.4%). Data analytics methods were highly variable, with 61.1% using machine learning, the majority of which (78.8%) were published after 2010. Studies commonly focused on cough detection (41.7%) and screening of COVID‐19 (11.1%); among pediatric studies, the most common focus was diagnosis of asthma (52.6%). Conclusion: Though the use of cough sounds in diagnostics is not new, academic interest has accelerated in the past decade. Cough sound offers the possibility of an accessible, noninvasive, and low‐cost disease biomarker, particularly in the era of rapid development of machine learning capabilities in combination with the ubiquity of cellular technology with high‐quality recording capability. However, most cough sound literature hinges on nonstandardized data collection protocols and small, nondiverse, single‐modality datasets, with limited external validity. Laryngoscope, 134:1023–1031, 2024 [ABSTRACT FROM AUTHOR]

Objective: High‐resolution esophageal manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM is typically performed in the office with local anesthesia only, and many patients find it unpleasant and painful. The aim of this study was to examine the effects of the use of a virtual reality (VR) headset on pain and anxiety outcomes in patients with dysphagia undergoing HRM. Methods: Patients with dysphagia were prospectively recruited and randomized to undergo HRM with and without VR distraction. Data collected included the State‐Trait Anxiety Inventory‐6 (STAI‐6), the Short‐Form McGill Pain Questionnaire, heart rate, and galvanic skin response (GSR) tracings. Results: Forty subjects completed the study, including 20 subjects in the intervention arm and 20 in the control arm. There was evidence of a significant positive effect of VR on calmness (p = 0.0095) STAI‐6 rating, as well as on physiologic measures of pain with significantly decreased GSR rise time (p = 0.0137) and average rate of change of conductance change (p = 0.0035). Conclusion: The use of VR during HRM catheter insertion increased calmness compared to control. Change of skin conductance was also reduced in the VR group, suggesting decreased physiologic pain. This study supports the consideration of the use of VR as a distraction tool to improve patient comfort during HRM. Level of Evidence: 2 Laryngoscope, 134:1118–1126, 2024 [ABSTRACT FROM AUTHOR]

Objective: To assess the nature and impact surgical ergonomic challenges experienced by female otolaryngologists. Study Design: National survey study. Setting: Female otolaryngology residents, fellows and attendings recruited via social media posting and email distribution. Methods: We distributed a survey study to female otolaryngologists throughout the United States. The height and glove size of participants reporting difficulties with equipment and instruments were compared to those not reporting difficulties. Results: Ninety‐six female otolaryngologists participated in our study, comprised of 43% residents, 10% fellows, and 47% attendings. Ninety percent of participants reported difficulties using equipment and 77% of participants reported difficulty with instruments, the most common being nasal endoscopic instruments (28%). The vast majority of participants reported pain during and (or) after the operation (92%). Head and neck (53%) and rhinology (44%) were identified as particularly challenging specialities, but only 25% of participants reported that ergonomics affected their career plans. Participants felt that adjustable equipment (60%), a variety of sizes of instruments (43%), and more discussion around ergonomics (47%) would help. Respondents reported adjusting the operating room to accommodate their size took extra time (44%) and was a mental burden (39%). Participants reporting difficulties with operating room equipment were significantly shorter than those without difficulties (64 inches vs 67 inches, P =.037), and those reporting difficulties with instruments had a smaller median glove size (6 vs 6.5, P =.018). Conclusion: Surgical ergonomics represent a challenge for female otolaryngologists, particularly those with smaller hands and shorter height. Partnering with industry, we must address the needs of an increasingly diverse workforce to ensure that all surgeons can operate effectively and comfortably. [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(s): This study examined the concurrent validity of two orofacial strength manometers: (1) the Iowa Oral Performance Instrument (IOPI) – the current, gold standard orofacial manometer; and (2) the Tongueometer – a newly‐available, lower cost, orofacial manometer. Methods: This study compared IOPI and Tongueometer pressure readings across three experimental conditions. Experiment 1 compared full setup (manometer + tongue bulb) pressure readings between the IOPI and Tongueometer. Experiment 2 compared IOPI tongue bulb and Tongueometer tongue bulb pressure readings, while controlling for manometer. Experiment 3 compared IOPI manometer and Tongueometer manometer pressure readings, while controlling for tongue bulb. Pressures were applied manually within a laboratory setting. Lin's concordance correlation (ρc) was used to calculate level of agreement, with ρc interpreted as 'poor' if <0.90, 'moderate' if 0.90 to <0.95, 'substantial' if 0.95 to <0.99, and 'excellent' if ≥0.99. Results: 539 trials were analyzed. There was a median absolute difference of 2.4 kPa in pressure readings between the IOPI and Tongueometer full setups (manometer + tongue bulb). Correlations revealed substantial agreement between IOPI and Tongueometer full setups (experiment 1: n = 292; ρc = 0.986), tongue bulbs (experiment 2: n = 146; ρc = 0.987–0.992), and manometers (experiment 3: n = 101; ρc = 0.970). Conclusions: Differences in pressures were consistently observed between the Tongueometer and IOPI. Despite these differences, substantial agreement was present. These data suggest the Tongueometer may be a valid, lower cost alternative to the IOPI for objectively assessing orofacial strength in clinical practice. Level of Evidence: Level 2 Laryngoscope, 133:3123–3131, 2023 [ABSTRACT FROM AUTHOR]

Objective: To explore the surgical ergonomic challenges experienced by women in otolaryngology, identify specific equipment that is ergonomically challenging, and assess the impact of suboptimal ergonomics on female otolaryngologists. Methods: We performed a qualitative study using an interpretive framework rooted in grounded theory. We performed semi‐structured qualitative interviews of 14 female otolaryngologists from nine institutions at various stages in training and across subspecialties. Interviews were independently analyzed by thematic content analysis by two researchers and inter‐rater reliability was assessed via Cohen's kappa. Differing opinions were reconciled via discussion. Results: Participants noted difficulties with equipment including microscopes, chairs, step stools, and tables as well as difficulty using larger surgical instruments, preference for smaller instruments, frustration with lack of smaller instruments, and a desire for a larger spectrum of instrument sizes. Participants reported neck, hand, and back pain associated with operating. Participants suggested modifications to the operative environment, including a wider variety of instrument sizes, adjustable instruments, and more focus and attention on ergonomic issues and the range of surgeon physiques. Participants felt that optimizing their operating room set‐up was an additional burden on them, and that lack of inclusive instrumentation affected their sense of belonging. Participants emphasized positive stories of mentorship and empowerment from peers and superiors of all genders. Conclusion: Female otolaryngologists face unique ergonomic challenges. As the otolaryngology workforce becomes increasingly diverse, it is important to address the needs of a diverse set of physiques to avoid inadvertently disadvantaging certain individuals. Level of Evidence: N/A Laryngoscope, 133:3034–3041, 2023 [ABSTRACT FROM AUTHOR]

Background: Current protocols for bedside swallow evaluation have high rates of false negative results. Though experts are not consistently able to screen for aspiration risk by assessing vocal quality, there is emerging evidence that vocal acoustic parameters are significantly different in patients at risk of aspiration. Herein, we aimed to determine whether the presence of material on the vocal folds in an excised canine laryngeal model may have an impact on acoustic and aerodynamic measures. Methods: Two ex vivo canine larynges were tested. Three liquids of different viscosities (1:100 diluted glycerin, pure glycerin, and honey‐thick Varibar) were placed on the vocal folds at a constant volume. Acoustic and aerodynamic measures were obtained in both adducted and abducted vocal fold configurations. Intraglottal high‐speed imaging was used to approximate the maximum divergence angle of the larynges in the studied conditions and examine its relationship to vocal efficiency (VE) and acoustic measures. Results: In glottic insufficiency conditions only, we found that several acoustic parameters could predict the presence of material on the vocal folds. Based on the combination of the aerodynamic and acoustic data, we found that decreased spectral energy in the higher harmonics was associated with decreased VE in the presence of material on the vocal folds and/or glottic insufficiency. Conclusion: Decreased spectral energy in the higher harmonics of the voice was found to be a potential biomarker of swallowing dysfunction, as it correlates with decreased vocal efficiency due to material on the vocal folds and/or glottic insufficiency, both of which are known risk factors for aspiration. Level of Evidence: NA Laryngoscope, 133:2517–2524, 2023 [ABSTRACT FROM AUTHOR]