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Granulomatosis with polyangiitis (GPA) is a rare systemic necrotizing vasculitis characterized by granulomatous inflammation of the upper and lower respiratory tracts, glomerulonephritis, and small vessel vasculitis. Otolaryngological manifestations are common in GPA and may precede systemic symptoms, often leading to delayed diagnosis. We report a case of GPA initially presenting as secretory otitis media, which was misdiagnosed and treated as infectious otitis media for a prolonged period. This study reports a case of atypical GPA in a 50-year-old woman. The patient presented with severe and complicated otitis media, accompanied by hearing loss and facial nerve palsy, as well as ear pain and high fever; however, she did not exhibit any other otolaryngological or systemic clinical manifestations associated with GPA. Diagnosing GPA is challenging due to its wide range of clinical manifestations. Otological signs and symptoms are relatively rare in this condition, though they may occasionally present as the initial manifestation. Early diagnosis and treatment are crucial for preventing serious and permanent complications caused by this disease. Early recognition and multidisciplinary collaboration are essential to prevent irreversible complications. Otolaryngologists should remain highly vigilant for systemic diseases such as GPA.

Geographic access to otolaryngologic care is a critical determinant of timely diagnosis and management for time-sensitive conditions, yet state-level disparities remain incompletely characterized. This study evaluated the geographic distribution of Virginia otolaryngologists and identified rural-urban differences in care access. A cross-sectional geospatial workforce analysis was conducted using public data from the Centers for Medicare & Medicaid Services National Plan and Provider Enumeration System and the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists in Virginia were geocoded to primary practice addresses. Counties and independent cities were classified using Rural-Urban Continuum Codes (RUCC). Otolaryngologist density per 100,000 population, jurisdictions lacking in-county access, adjacency to independent cities with otolaryngologists, and fellowship training distribution were analyzed across metropolitan and non-metropolitan regions. A total of 377 otolaryngologists were identified statewide. Per-capita availability was higher in metropolitan jurisdictions (RUCC 1-3), with a mean density of 4.67 per 100,000 population compared with 1.49 per 100,000 in non-metropolitan jurisdictions (RUCC 4-9). Overall, 67.4% of counties lacked an in-county otolaryngologist; after accounting for adjacency to independent cities with at least one provider, 55.8% remained without local access. Non-metropolitan jurisdictions were disproportionately affected. Although 35.8% of otolaryngologists reported fellowship training, approximately 98% of fellowship-trained physicians practiced in metropolitan jurisdictions. Otolaryngology care in Virginia remains geographically uneven, with many jurisdictions lacking local specialty access. These findings highlight gaps in access to care and may inform workforce planning and strategies to improve availability of otolaryngologic services in underserved regions. Level IV (cross-sectional observational study).

To evaluate whether the decline in tonsillectomy and adenoidectomy during the COVID-19 pandemic in Japan was age-dependent and to examine trends in postoperative hemostasis activity using nationwide claims data. We conducted a nationwide longitudinal descriptive study using National Database Open Data from fiscal years (FY) 2015-2023. Annual procedure counts were extracted for tonsillectomy (K377-1), adenoidectomy (K370), and postoperative hemostasis after tonsil surgery (K367-a). Pandemic phases were defined as pre-COVID (FY2015-FY2019), COVID onset (FY2020), COVID ongoing (FY2021-FY2022), and recovery (FY2023). Age-stratified analyses were performed for tonsillectomy. The postoperative hemostasis rate was calculated per 1000 tonsillectomies. Tonsillectomy and adenoidectomy volumes increased through FY2019, reaching 73,577 and 14,910 cases, respectively, before declining sharply in FY2020 to 47,097 and 7018. The reduction in tonsillectomy was strongly age-dependent and greatest among children aged 0-14 years, with a 48.9% decrease from FY2019 to FY2020 (29,340-14,992), whereas the decline among adults aged ≥ 60 years was smaller at 12.5% (5433-4752). Surgical volumes remained suppressed during FY2021-FY2022 and partially recovered in FY2023 but did not return to prepandemic peak levels. The absolute number of postoperative hemostasis procedures remained relatively stable over time; however, the hemostasis rate increased during the pandemic period because tonsillectomy volume declined. The pandemic-associated reduction in tonsillectomy and adenoidectomy in Japan was disproportionately concentrated in pediatric patients. Despite reduced surgical volume, the absolute postoperative hemostasis activity was relatively preserved. These findings provide nationwide evidence of age-dependent disruption in elective otolaryngologic procedures during the COVID-19 pandemic. 4.

To synthesize the prevalence of otolaryngologic manifestations in CHARGE syndrome (CS) to support otolaryngologists in delivering comprehensive management. PubMed/MEDLINE, Embase, and Google Scholar were searched for English- and French-language studies published from January 1980 through January 2025. This systematic review and proportional meta-analysis adhered to PRISMA guidelines. Screening and extraction were performed (January-May 2025) by 2 independent reviewers using a standardized template. Pooled prevalence estimates were generated using random-effects models with 95% confidence intervals (CIs);heterogeneity was assessed with I2. Study quality was assessed with the Newcastle-Ottawa Scale. Seventy studies (1564 patients; predominantly case series) were included. Airway findings included choanal atresia (reported across 58 studies; unilateral 15.4%, 95% CI 11.6-19.2; bilateral 31.5%, 95% CI 23.3-39.7), laryngomalacia (8 studies; 27.7%, 95% CI 16.3-28.1), and tracheostomy (13 studies; 23.6%, 95% CI 16.9-27.5). Olfactory abnormalities were reported in 15 studies (28.8%, 95% CI 14.7-42.9). Craniofacial findings included facial palsy (39 studies; 35.2%, 95% CI 29.8-40.7) and cleft lip/palate (43 studies; 25.6%, 95% CI 23.1-28.2). Otologic abnormalities were frequent, including chronic otitis media with effusion (11 studies; 54.5%, 95% CI 48.4-60.7), semicircular canal hypoplasia/aplasia (29 studies; 73.6%, 95% CI 59.9-85.2), cochlear hypoplasia (26 studies; 49.8%, 95% CI 37.4-62.2), cochlear nerve hypoplasia (13 studies; 49.1%, 95% CI 34.4-63.8), and sensorineural hearing loss (27 studies; 56.9%, 95% CI 52.7-61.1). CS is associated with a substantial ENT disease burden extending beyond choanal atresia, including frequent airway compromise, olfactory dysfunction, craniofacial anomalies, and vestibulocochlear malformations. Early, comprehensive multidisciplinary assessment with otolaryngology involvement is warranted.

Thermal injury of the upper aerodigestive tract related to inhalational drug abuse is uncommon but increasingly recognized. While airway injury associated with crack cocaine inhalation has been reported, the otolaryngologic manifestations of inhaled heroin vapor ("chasing the dragon") remain poorly described. We report the case of a 39-year-old woman presenting with progressive dysphonia and dyspnea. She had a history of polysubstance smoking including tobacco, cannabis, crack cocaine, and heroin vapor inhalation. Flexible fiber-optic nasopharyngolaryngoscopy demonstrated extensive bilateral necrosis of the vocal fold mucosa with preserved vocal fold mobility and abundant carbonaceous debris within the laryngeal lumen. Histopathological analysis of expectorated fragments confirmed ischemic necrosis of squamous mucosa. The patient was managed conservatively with corticosteroids, antibiotics, and close outpatient follow-up, with partial clinical improvement. Thermal injury from crack cocaine inhalation has been associated with supraglottic and laryngeal mucosal damage. In contrast, the effects of inhaled heroin vapor on the upper airway remain poorly documented. Combined inhalation of multiple substances may result in additive thermal and chemical mucosal injury, potentially explaining the extensive laryngeal necrosis observed in this case. This report highlights the need to consider polysubstance inhalational abuse in patients presenting with unexplained necrotizing laryngeal lesions.

Background/Objectives: Hybrid operating rooms combine advanced intraoperative imaging, endovascular capabilities, and multidisciplinary resources within a single procedural environment. However, their use in otolaryngology remains insufficiently characterized. This study evaluated institutional patterns of hybrid operating room use, principal clinical indications, multidisciplinary involvement, and perioperative resource utilization in otolaryngology. Methods: We conducted a retrospective single-center study of eligible otolaryngologic procedures performed between 1 October 2018 and 31 December 2025. Patient characteristics, operative sites, hybrid operating room applications, multidisciplinary involvement, intraoperative blood loss, postoperative intensive care unit admission, and length of hospital stay were analyzed. Results: A total of 55 unique procedures were included. The median age was 46.0 years (interquartile range, 33.0-58.5 years; range, 5-76 years), and 33 patients (60.0%) were male. Computed tomography-based localization and navigation represented the predominant application, accounting for nearly three-quarters of procedures. The sinonasal cavity, nasopharynx, and skull base were the most frequently treated anatomical regions, comprising approximately 60% of operative sites. Angiography and endovascular intervention constituted the second most common application. Multidisciplinary collaboration, most frequently involving cardiovascular surgery and interventional radiology, was required in nearly one-quarter of procedures. Procedures relying primarily on intraoperative imaging were associated with a median estimated blood loss of 20 mL and a median hospital stay of 3 days. Cases requiring vascular, cardiopulmonary, or other advanced hybrid capabilities showed greater postoperative resource utilization, including more frequent intensive care admission and longer hospitalization. Conclusions: The hybrid operating room served as a versatile platform for image-guided, vascular, and multidisciplinary procedures in otolaryngology. Its capabilities were used during the management of anatomically complex and high-acuity cases, while differences in postoperative resource utilization appeared to reflect procedural complexity and baseline clinical risk.

Functional dysphagia is defined as a persistent or recurrent sensation of abnormal bolus passage without demonstrable structural, inflammatory, or major neuromuscular abnormality. Despite its clinical relevance, otolaryngologic reports of this condition remain limited. We describe a 71-year-old man who presented with progressive swallowing difficulty following a self-limited pharyngeal infection. He reported severe subjective difficulty swallowing solids and restricted his diet to liquids. Flexible nasolaryngoscopy, videoendoscopic evaluation of swallowing (Hyodo score 1), videofluorographic swallowing study (VFSS), upper gastrointestinal endoscopy, and neurological evaluation were all essentially normal. No aspiration was documented. Functional dysphagia was diagnosed based on the marked discrepancy between symptom severity and objective findings. Conservative management with reassurance and gradual reintroduction of oral intake resulted in progressive recovery over 4 months. Functional dysphagia should be considered when subjective swallowing difficulty is disproportionate to objective findings. Recognition of this discrepancy prevents overtreatment and supports multidisciplinary management targeting sensory-perceptual recalibration rather than anatomical correction.

Sudden sensorineural hearing loss (SSNHL) is a common otolaryngological emergency. Its pathogenesis is associated with vascular dysfunction, viral infection, and autoimmune abnormalities. In recent years, endoscopic intratympanic steroid injection (ITSI), as a minimally invasive procedure, has been increasingly applied in the treatment of SSNHL. It presents prominent clinical advantages, especially for patients with contraindications to systemic steroid therapy or refractory cases unresponsive to conventional treatment. Herein, we systematically review the pathogenesis, epidemiological characteristics, diagnostic approaches and therapeutic regimens of SSNHL, and further discuss the controversies and future research prospects of endoscopic ITSI. Based on evidence-based medical findings, this article summarizes the efficacy and safety of endoscopic ITSI in enhancing hearing recovery in patients with SSNHL. Nevertheless, further optimization of surgical procedures and individualized therapeutic regimens is still required. Future research directions include the development of novel drug carriers, exploration of gene therapy, and application of artificial intelligence-assisted diagnosis, aiming to advance precise and individualized treatment for SSNHL.

This study aimed to examine the association between parental anxiety and preoperative anxiety in children and to clarify the role of parental anxiety in perioperative risk assessment. This was a single-center cross-sectional observational study based on standardized postoperative telephone interviews with parents or legal guardians. Eligible children who underwent ophthalmologic or otolaryngologic surgery under general anesthesia between July and September 2025 and their parents or legal guardians were included. During standardized postoperative telephone interviews, parents or legal guardians rated their own anxiety and the child's anxiety during the preoperative waiting and preparation phase using a numeric rating scale (0-10). Child cooperation, perioperative supportive measures, and parental satisfaction were also recorded. Multivariable logistic regression and receiver operating characteristic analyses were used to examine the association between parental anxiety levels and child preoperative anxiety. Higher parental anxiety was independently associated with an increased likelihood of preoperative anxiety in children, demonstrating a clear dose-response relationship. Compared with minimal parental anxiety, moderate (score 4-6) and severe anxiety (score ≥7) were associated with progressively higher odds of child anxiety. Incorporation of parental anxiety into multivariable models improved discrimination for identifying children with preoperative anxiety. Children with higher anxiety were more likely to receive supportive preoperative care measures. Parental anxiety is a practical and easily assessable correlate of preoperative anxiety in children. Incorporating parental anxiety assessment into routine perioperative nursing workflows may support early risk identification and facilitate targeted, family-centered nursing interventions.

Background/Objectives: Postoperative nausea and vomiting (PONV) is a frequent complication following general anesthesia. Ramosetron is a standard prophylactic agent for PONV; the efficacy of adjunctive dexamethasone in this specific population is not well established. We aimed to evaluate whether adding dexamethasone to ramosetron enhances antiemetic efficacy across diverse surgical procedures. Methods: This prospective, randomized, double-blind, multicenter trial enrolled adults undergoing gynecological, orthopedic, otolaryngologic, general, or plastic surgery managed without postoperative patient-controlled analgesia. We randomized 385 patients into two groups. Group D received 5 mg of dexamethasone immediately after anesthesia induction and ramosetron (0.3 mg) at the end of surgery, whereas Group C received only ramosetron. We assessed the incidence and severity of nausea and vomiting, pain scores, rescue antiemetic and analgesic requirements, and adverse events immediately after surgery and at 6 and 24 h postoperatively. Results: At 6 h, the incidence of nausea was significantly lower in Group D than in Group C (41.7% vs. 58.3%; p = 0.047). Group D also exhibited lower pain scores (VAS: 3.0 ± 1.8 vs. 3.5 ± 1.7; p = 0.012) and reduced consumption of additional analgesics (44.1% vs. 55.9%; p = 0.028). At 24 h, there were no significant differences between the two groups in the incidence of nausea, pain scores, or consumption of additional analgesics. Multivariable logistic regression analysis identified dexamethasone administration as an independent predictor of reduced postoperative nausea at 6 h (odds ratio 0.575; 95% confidence interval 0.344-0.962; p = 0.035). Conclusions: Low-dose dexamethasone to ramosetron substantially reduced postoperative nausea and improved analgesic profiles at 6 h in patients managed without PCA. However, no significant between-group differences were observed at 24 h.

The retrosigmoid approach is a standard surgical corridor to the posterior fossa but may lead to mastoid air cell opening and subsequent cerebrospinal fluid (CSF) leakage or infectious complications. Achieving durable closure can be challenging, particularly in revision surgery due to inflammatory changes and altered anatomical landmarks. We report the case of a 76-year-old patient who developed recurrent infectious complications following a right retrosigmoid approach for posterior fossa meningioma. Imaging revealed a subcutaneous abscess associated with persistent mastoid air cell opening. A combined neurosurgical and otolaryngological revision procedure was performed. The mastoid cavity was sealed using autologous bone powder mixed with biological glue and antibiotics, followed by a multilayer closure with fascia lata and surgical adhesive. This technique provides a simple and reproducible method for watertight mastoid sealing in complex revision cases.

Palatoplasty for cleft palate repair often incorporates adjunctive manoeuvres aimed at achieving tension-free closure. Fracture of the pterygoid hamulus has traditionally been performed for this purpose; however, its necessity and influence on postoperative outcomes remain controversial. This systematic review aimed to evaluate whether fracture of the pterygoid hamulus during palatoplasty is required and to assess its impact on surgical, otolaryngological, and speech outcomes. A systematic search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science were conducted for studies published between January 2000 and December 2024. Randomized controlled trials, cohort studies, and case-control studies comparing palatoplasty performed with and without pterygoid hamulus fracture were included. Primary outcomes were postoperative hearing and otological status; secondary outcomes included surgical success, complications, and speech outcomes. Seven studies encompassing 543 patients met the inclusion criteria. Across all included studies, audiological assessments-using brainstem evoked response audiometry, tympanometry, otoacoustic emissions, and otoscopy-demonstrated no statistically significant differences between patients who underwent hamulotomy and those who did not. Surgical outcomes and speech-related measures were also comparable. Minor differences in otoscopic findings were reported in isolated studies; however, these were not supported by corresponding audiometric changes and were considered clinically insignificant. Routine fracture of the pterygoid hamulus during palatoplasty does not confer additional benefit in terms of hearing, surgical success, or speech outcomes. The procedure may be considered selectively in specific cases where additional release is required to achieve tension-free closure, rather than being employed routinely.

Geriatric surgical patients often have clinical and social factors influencing their discharge destination. This retrospective study examines patient-related variables associated with home discharge in individuals aged &#x2265;65 years who underwent general, orthopedic, otolaryngologic, urologic, or vascular surgery in three northern Italian hospitals (January-December 2024). Functional status was assessed using the Barthel Index, along with sociodemographic and clinical data. Among 2015 patients, 77% were discharged home. Positive predictors of home discharge included older age (OR=1.040, p < 0.001), higher Barthel Index at discharge (OR=1.028, p < 0.001), and higher hemoglobin levels (OR=1.023, p < 0.001). Negative predictors included male sex (OR=0.496, p < 0.001), higher Barthel Index at admission (OR=0.983, p < 0.001), orthopedic surgery (OR=0.118, p < 0.001), and higher BRASS scores (OR=0.842, p < 0.001). Functional independence significantly influences discharge destination in geriatric surgical patients. Integrating standardized preoperative functional assessments alongside clinical and sociodemographic variables may improve discharge planning.

A 69-year-old woman presented to her primary care physician with new-onset dysphonia and increasing shortness of breath, without chest pain. She described her voice as "going in and out" intermittently and reported an occasional cough. She also reported globus sensation without dysphagia. Her medical history included long-standing allergic rhinitis, arthritis, anemia, and gastroesophageal reflux disease. She had a documented history of asthma and had been using the inhaled steroid fluticasone (100 &#x3bc;g/d) since at least 2013, along with an albuterol inhaler as needed for the past 3 years. The patient was a current smoker with a 40-pack-year smoking history, though she had made intermittent attempts to quit. She had undergone yearly lung cancer screening with low-dose CT since 2019. On examination, there was no increased work of breathing, and her lungs were clear to auscultation, with no crackles or wheezing. Echocardiogram was normal. Pulmonary function tests showed severe obstruction: a forced expiratory volume in 1 second (FEV1) of 0.6 L (lower limit of normal, 0.98 L), with a z-score of -2.5 to -4, and a ratio of FEV1 to forced vital capacity of 0.33 (lower limit of normal, 0.67). There was negligible improvement in FEV1 or forced vital capacity (less than 10%) after bronchodilator administration. Air trapping was present, with a residual volume greater than 120% predicted, and diffusion capacity for carbon monoxide was reduced to 51%. Oxygenation (oxygen saturation) on room air at rest was normal. An otolaryngologic consultation was requested for the patient's new dysphonia, and flexible laryngoscopy was performed. Laryngoscopy revealed normal bilateral vocal cord movement but pachydermatous changes in the mucosa outlining the interarytenoid fold, which can be associated with nasopharyngeal reflux or chronic infection. As a part of the diagnostic workup for the increased shortness of breath, CT screening studies acquired in the patient in 2019, 2023, and 2024 were reviewed.

A 72-year-old Caucasian woman from the Southwestern United States presented with chronic right ear pain, hearing loss, and progressive hoarseness. Prior treatments, including balloon sinuplasty and tympanostomy tube placement, failed to resolve her symptoms. Imaging revealed right mastoid opacification, while flexible laryngoscopy demonstrated erythematous and polypoid changes of the right larynx. Pathology from biopsies of both the middle ear and larynx revealed spherules consistent with Coccidioides infection. She was treated with systemic fluconazole and underwent tympanomastoidectomy with mastoid debridement. The patient's postoperative course was uneventful, and she reported symptomatic improvement at follow-up. A multidisciplinary approach, including close coordination with infectious disease, guided long-term antifungal therapy. Coccidioidomycosis is a rare but important consideration in patients presenting with chronic head and neck symptoms, especially in endemic regions. This case highlights the potential for multifocal otolaryngologic involvement and underscores the need for a high index of suspicion in persistent or unexplained laryngeal and otologic disease. Diagnosis relies on biopsy and culture, and management typically requires both surgical and prolonged antifungal therapy. Multidisciplinary care is essential to optimize outcomes, particularly in cases involving bony structures or immunocompromised hosts.

Palatine tonsil metastasis is an uncommon manifestation of disseminated malignancy and is exceptionally rare in small-cell lung cancer (SCLC). Because it may mimic benign tonsillar disease or a primary oropharyngeal tumor, diagnosis can be delayed. A 71-year-old man was admitted after pertrochanteric hip fracture. Preoperative evaluation revealed a left tonsillar mass and a left hilar pulmonary lesion. Computed tomography showed a 3-4cm lesion involving the left palatine tonsil, a 7.5cm left hilar mass with mediastinal lymphadenopathy and multiple brain metastases. Bronchial biopsy confirmed SCLC. Tonsillar biopsy showed metastatic SCLC with a matching neuroendocrine immunophenotype, including TTF-1, chromogranin, synaptophysin, and CD56 positivity and a high Ki-67 index. Palliative carboplatin-etoposide was started, but the patient died after two cycles. This case highlights that unilateral tonsillar enlargement may rarely represent metastatic lung cancer, particularly in the appropriate clinical context and advanced disease. Histopathology with immunohistochemistry is essential to distinguish metastatic SCLC from primary tonsillar malignancy. Early otolaryngologic assessment and biopsy remain the key diagnostic steps in this rare presentation.