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This Viewpoint offers a framework for aligning federal support with industry innovation in otolaryngology–head and neck surgery.
Malnutrition, common in patients with head and neck squamous cell carcinoma (HNSCC), may impair the effectiveness of immunotherapy. Understanding whether nutritional status affects outcomes can emphasize the importance of pretreatment nutritional optimization. To evaluate the associations of body mass index (BMI), pretreatment BMI change, and prognostic nutritional index (PNI) with progression-free survival (PFS) in patients with advanced HNSCC treated with immunotherapy. Cohort study using deidentified electronic health records from the Flatiron Health database between January 2014 to January 2024, with follow-up of 3000 days in multiple cancer institutions across the US. Patients were from community and academic practices in the US, diagnosed with all types of advanced head and neck cancer who received immunotherapy (nivolumab, pembrolizumab, cemiplimab, durvalumab, atezolizumab, avelumab, or ipilimumab) between January 2014 and January 2024. Exclusion criteria included age younger than 18 years, patients without a diagnosis of squamous cell carcinoma, missing stage information, missing treatment information (eg, a gap in documented care of ≥90 days or more), and incomplete data needed to calculate BMI or PNI prior to initiation of therapy. Baseline BMI, pretreatment BMI change (≥2% decrease vs stable), and PNI (low <45 vs normal ≥45). PFS following treatment with immunotherapy. Among 1108 patients (mean [SD] age, 66.2 [10.2] years; 236 [21.3%] female; 872 [78.7%] male), 214 (79%) experienced 2% or more pretreatment BMI loss. BMI loss was associated with worse PFS (hazard ratio, 1.17; 95% CI, 1.02-1.35); median PFS was 271 (IQR, 121-603) days with loss vs 415 days with stable BMI. In the 471 patients with laboratory data, 320 (67.9%) had a low PNI. Low PNI was associated with shorter PFS (adjusted hazard ratio, 1.58; 95% CI, 1.39-1.79); median PFS was 213 (IQR, 98-445) days for low vs 566 (IQR, 307-1094) days for patients with a normal PNI. Baseline BMI category was not independently associated with PFS. In this large, nationally representative cohort of patients with advanced head and neck squamous cell carcinoma treated with immunotherapy, pretreatment BMI loss and low PNI were independently associated with PFS, while baseline BMI was not. These findings suggest that dynamic measures of nutrition and immune status provide more meaningful prognostic information than static measures. Nutritional optimization may represent a modifiable factor to improve outcomes in patients receiving immunotherapy for advanced head and neck squamous cell carcinoma.
Radiomics is a field that establishes associations between quantifiable imaging biomarkers and histopathological characteristics or clinical outcomes. Radiomics holds particular promise in otolaryngology given anatomic intricacies, diverse pathologies, and many commonplace imaging modalities. Radiomics applications span diagnostic classifiers, long-term prognosticators, and predictors of treatment response. The objective of this Review was to establish methodological frameworks, identify common limitations, and evaluate the current landscape of radiomics within otolaryngology. Radiomics applications span the breadth of otolaryngology, with most focused on neoplasms of the upper airway, larynx, sinonasal passages, and skull base. Head and neck cancer applications include classifiers of clinically occult pathologic features (such as extranodal extension or nodal metastases) that can guide treatment options. Prognostic radiomics can reliably model recurrence and survival outcomes, with hybrid clinical radiomics models achieving superior performance compared with single-modality models. Treatment prediction through approaches like dosiomics (using radiotherapy dose distributions) and δ-radiomics (sequential imaging over time) have shown potential in improving the prediction of therapeutic response, tumor recurrence, and radiotherapy toxic effects. Beyond neoplastic classifiers, a growing body of work has sought to risk stratify or predict the evolution of rhinologic and otologic inflammatory conditions (eg, chronic rhinosinusitis, middle ear disease). Recently, there have also been radiomics applications in sleep and pediatrics. Despite these broad advances, radiomics models have several pitfalls, such as variable imaging protocols, resource-intensive manual segmentation, limited cohort sizes, and a lack of external validation, all of which hinder clinical translation. The results of this Review suggest that radiomics is a promising tool that can be integrated with clinical and pathologic data to enhance diagnosis, optimize prognostication, and personalize treatment in otolaryngology. Standardization of imaging protocols, rigorous validation in multi-institutional cohorts, and integration with clinical workflows remain critical prerequisites for clinical application. With continued refinement and integration, radiomics applications may help streamline clinical workflows and guide treatment planning.
Neoadjuvant chemoimmunotherapy has high rates of pathologic response and improved prognosis among solid tumors. Its role in head and neck squamous cell carcinoma (HNSCC) remains understudied. To summarize the efficacy associated with neoadjuvant chemoimmunotherapy regimens in HNSCC and to compare the efficacy associated with neoadjuvant chemoimmunotherapy vs immunotherapy alone in locoregionally advanced resectable HNSCC prior to definitive surgery. A librarian-led systematic review was conducted using multiple electronic databases, including Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, following Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. Databases were queried from inception to October 2024. Inclusion criteria included prospective interventional trials that have completed accrual, with results published in English. Only trials of resectable, treatment-naive HNSCC were included. Exclusion criteria included lack of reporting on pathologic response or Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 response. Two investigators independently conducted title, abstract, and full-text reviews per PRISMA guidelines. Primary outcomes extracted were major pathologic response (MPR) and complete pathologic response (CPR) at surgery and complete response (CR) on imaging by RECIST 1.1. Secondary outcomes included 1-year overall survival (OS) and toxic effects. A meta-analysis was performed using a binary random-effects model to determine the pooled proportion of primary outcomes in the immunotherapy and chemoimmunotherapy groups. Heterogeneity was reported as I2. A total of 751 patients (502 [77%] male; age range, 27-87 years) across 23 studies were included in the meta-analysis, including 357 patients (47%) who underwent chemoimmunotherapy, 102 patients (14%) who underwent dual-agent immunotherapy, and 292 patients (39%) who underwent single-agent immunotherapy. Pooled rates of MPR plus CPR were 66% (95% CI, 58%-73%; I2 = 0.59) for chemoimmunotherapy, 18% (95% CI, 6%-29%; I2 = 0.65) for dual-agent immunotherapy, and 6% (95% CI, 3%-9%; I2 < 0.01) for single-agent immunotherapy. Across all groups, 1-year OS rates ranged from 88% to 96% for single-agent immunotherapy, 88% to 96% for dual-agent immunotherapy, and 88% to 100% for chemoimmunotherapy. Grade 3 to 5 adverse events were reported in 61 of 210 patients (29%), 2 of 67 patients (3.0%), and 36 of 210 patients (17%) among the reporting studies in the single-agent immunotherapy, dual-agent immunotherapy, and chemoimmunotherapy groups, respectively. These findings suggest that neoadjuvant chemoimmunotherapy regimens were associated with higher pathologic and radiographic response rates compared with immunotherapy alone in locoregionally advanced HNSCC. These results call for phase 3 trials comparing these neoadjuvant regimens head to head.
The incidence of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) has increased, including among those with high-risk disease. Delays to access and initiation of care are associated with disease progression and worse outcomes. Capecitabine has previously been shown to be effective antitumor activity with low toxic effects. To evaluate the efficacy and tolerability of neoadjuvant capecitabine (NC) in advanced cSCCHN by evaluating the clinical and pathologic stage migration. This prospective case series was conducted from January 2024 to September 2025 at 2 academic centers in Montreal, Canada, and included consecutive patients with advanced cSCCHN who were awaiting surgery. The data were analyzed in November 2025. Two cycles of NC (1000 mg, twice daily, on days 1-14, followed by a 1-week rest period) were administered according to the Capecitabine Prior to Tumor Resection in ENT Oncology (CAPTURE) protocol, with surgical resection performed within 1 to 2 weeks after treatment completion. Clinical tumor response and clinical to pathologic stage migration, defined as the comparison of initial clinical stage with the postsurgical pathologic stage. The mean (SD) age of the cohort of 15 patients was 77 (8.1) years; 6 patients (40%) were female, and 9 patients (60%) were male. Clinical tumor regression was observed in 10 of 15 patients (67%). Among those who underwent resection, 5 (42%) achieved a complete pathologic response. Two patients avoided surgery due to complete treatment response and opted to receive radiotherapy. Nonresponse occurred for 5 patients, including 1 patient who experienced progression to metastatic disease. No grade 3 or higher capecitabine-related toxic effects were reported. This case series found that NC demonstrated significant tumor regression and pathologic response without severe treatment-related toxic effects. NC may be an effective treatment option for providing disease control and tumor downstaging in patients with advanced cSCCHN.
Lower socioeconomic status is a risk factor for poorer quality of life (QOL) among patients with head and neck cancer (HNC) after treatment; however, there is a paucity of literature describing baseline QOL in these patients, with much of the existing literature focused on financial characteristics rather than comprehensive, geographically based factors. Shifting focus to these factors could better capture the entire patient experience and allow clinicians to provide improved care. To examine the associations between area-level deprivation, a marker of socioeconomic disadvantage, and QOL among patients with HNC before treatment initiation. This cross-sectional single-institution study included patients diagnosed with HNC between 2015 and 2022 receiving care at a tertiary care center in a metropolitan setting who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) questionnaire before starting treatment. Data were analyzed between December 2024 and May 2025. Area-level deprivation (measured using the area deprivation index [ADI]), as designated by the patient's respective ADI quintile, with the first quintile being the least deprived or socioeconomically disadvantaged and the fifth quintile being the most deprived or disadvantaged. FACT-HN domains of social, emotional, functional, physical, HNC-specific, and overall well-being or QOL. Multivariable linear regression models (1 for each domain) were used to estimate associations between ADI quintiles and FACT-HN domains, adjusting for patient and clinical characteristics. A total of 600 patients (mean [SD] age, 62.5 [11.4] years; 72.3% males [n = 434]) were included in the analysis. The ADI quintiles were equally distributed, with approximately 20% of patients in each quintile. Patients residing in the most disadvantaged areas reported lower HNC-specific well-being scores (β = -3.62; 95% CI, -6.23 to -1.01) compared with those residing in the least disadvantaged areas. Associations between ADI quintile and other well-being scores were weak and not clinically meaningful. In this cross-sectional study, greater socioeconomic disadvantage is associated with poorer baseline QOL among patients diagnosed with HNC. These findings could be used to identify patients at higher risk of lower QOL and support the equitable allocation of resources from multidisciplinary cancer care teams.
Timely initiation of postoperative radiotherapy (PORT) within 6 weeks of surgery improves survival for patients with head and neck squamous cell carcinoma. Rural populations experience disproportionate delays, yet contextual drivers remain poorly understood. To identify barriers, facilitators, and themes influencing the receipt of timely PORT in rural settings to inform a future multilevel intervention. This qualitative study used a phased, patient- and caregiver-involved design at 2 rural northern New England cancer center clinics at Dartmouth Health. Phase 1 included 2 facilitated dialogues with patients, caregivers, and staff, followed by participant-led coding (referred to as Partnership Academies). Phase 2 included 3 facilitated dialogues focused on refining barriers, facilitators, and solutions-focused themes (2 with patients/caregivers and 1 with staff; referred to as Community Engagement Studios). Phase 3 included reviewing preliminary insights at a clinic staff retreat for feedback. Data were collected from November 2024 to April 2025 and analyzed from November 2024 to May 2025. Barriers, facilitators, and themes related to timely PORT initiation. Analysts used an inductive-deductive approach guided by Intervention Mapping and the Consolidated Framework for Implementation Research, version 2.0. Eleven individuals participated in the Partnership Academies and 18 in the Community Engagement Studios. Five barriers were identified (communication, care coordination, access to dental care, transportation, and confronting negative emotions), and 4 facilitators were identified (key staff as central contacts, caregivers as advocates, rural culture, and leveraging preexisting resources). Four themes emerged: (1) leveraging strengths, (2) managing the steep learning curve after cancer diagnosis, (3) the value of peer support, and (4) the desire for information support was far-reaching. This qualitative study examines PORT delays in a rural context with patient, caregiver, and staff voices. Findings highlight the importance of community resources, effective communication, and peer support to inform multilevel strategies aimed at reducing delays and improving equity in cancer care.
Despite its importance, little is known about engagement with structured, multidisciplinary head and neck cancer (HNC) survivorship care. We sought to identify clinical and sociodemographic factors associated with sustained attendance at an HNC Survivorship Clinic. Our retrospective cohort of 625 HNC patients was divided into a subset of patients who received radiotherapy (n = 510) and patients who did not (n = 115). We defined sustained attendance as 1) the total number of visits that occurred before completing treatment and within three years post-treatment, and 2) adherence scores, calculated as the number of timeframes during which at least one visit occurred: pre-treatment completion (for the radiotherapy subset only) and one-, two-, and three-years post-treatment. We used Fisher's exact test for descriptive statistics and Poisson regression to estimate prevalence ratios (PRs) for sustained attendance. In the overall cohort, 248 patients (39.7%) had only one visit to the Survivorship Clinic. In the radiotherapy subset, 211 patients (41.4%) had an adherence score of 1, compared to 81 (70.4%) in the non-radiotherapy subset. In adjusted analysis, treatment with radiotherapy was associated with more total visits (PR: 1.41, 95% confidence interval [CI]: 1.19-1.68), while greater neighborhood socioeconomic deprivation (PR: 0.82, 95% CI: 0.70-0.97) and farther distance from the Clinic (PR: 0.81, 95% CI: 0.69-0.95) were associated with fewer total visits. Clinical and sociodemographic factors are independently associated with sustained attendance at an HNC Survivorship Clinic. Disparities in engagement with HNC survivorship care highlight the need for targeted interventions to improve adherence to follow-up recommendations.
Immunotherapy is approved for first-line treatment of recurrent/metastatic head and neck cancer (HNC). The prescribing patterns are largely unreported, and assessment of immune-related adverse events (irAEs) in patients with HNC is limited. To assess the prescribing patterns of immunotherapy and the incidence and risk factors for irAEs using a claims-based database. A retrospective cohort study of MarketScan Commercial and multistate Medicaid databases of all patients with HNC from January 1, 2016, to December 31, 2022, was performed. Inclusion criteria were patients with HNC, defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes with 6 months or longer of insurance enrollment prior to diagnosis and 1 or more months of follow-up. The databases excluded patients 65 years or older. Statistical analysis was conducted from October 1, 2024, through December 31, 2024. Prescription of an immunotherapeutic within 12 months after HNC diagnosis. The primary outcome measure was prescribing rate of immunotherapeutics overall and per year. The relative use of each immunotherapeutic was also explored. Secondary outcome measures were incidence of irAEs, severe irAEs, and univariable/multivariate risk factors for irAEs. A total of 47 365 patients with HNC were included, and 2254 (4.8%) of these patients received immunotherapy. Overall, 32 195 participants were male individuals (68%) and 14 607 were female individuals (32%), with a mean (SD) age of 54 (9) years. The rate of immunotherapy prescriptions slightly increased over time from 2.3% of patients with HNC in 2017 to 2.8% in 2022 (percent change, 0.5%; 95% CI, 0.1%-0.9%). Following initial approval by the US Food and Drug Administration (FDA), prescribing patterns of pembrolizumab and nivolumab were similar, but divergence in 2019 led to 87% of the market share dominated by pembrolizumab by 2022. The 90-day overall irAE-rate was 41.2% and severe irAE rate was 2.7%. There was no association between medication use and irAEs. Comorbidity score was associated with severe irAEs at 90 days (odds ratio [OR], 1.02; 95% CI, 1.02-1.03). Baseline hypothyroidism (adjusted OR [aOR], 6.7; 95% CI, 5.0-9.0) and liver disease (aOR, 1.7; 95% CI, 1.1-2.7) were independently associated with the development of irAEs. This cohort study found that pembrolizumab dominated the immunotherapy prescribing market, but the relative use of immunotherapy has minimally increased in patients younger than 65 years since FDA approval. irAEs were frequent and associated with key individual comorbidities. Severe irAEs were rare and associated with overall comorbidity status.
Adverse social determinants of health (SDoH) are associated with disparities in head and neck cancer (HNC) and lead to delayed diagnosis and treatment. Despite this recognized association, there is limited research assessing SDoH identification tools within HNC care. To summarize existing literature on SDoH identification tools used for patients with HNC in the US and characterize the scope of domains assessed by these tools. A scoping review was conducted using the Medline, Embase, and Web of Science databases through February 9, 2026. Studies were included if they reported on SDoH identification tools studied in HNC care in the US. Inclusion criteria required that tools be applied in clinical settings and include data relevant to patients with HNC. Data were analyzed on September 5, 2024, and February 15, 2026. Seven studies published between August 2019 and October 2024 met inclusion criteria (512 patients), identifying 5 unique SDoH identification tools (Comprehensive Score for Financial Toxicity, Financial Distress Questionnaire, Patient Satisfaction Questionnaire, and NCCN Distress Thermometer Problem List). These tools were categorized based on the 5 key domains outlined by Healthy People 2030. Among the identified tools, survey items assessed 4 domains: economic stability, social and community context, health care access and quality, and neighborhood and built environment. Four of 5 tools only assessed 2 domains or fewer, and 1 tool assessed 3 domains. Economic stability was the most commonly examined domain across the 4 tools. This scoping review highlights a substantial lack of validated SDoH identification research within patient populations with HNC. Existing tools capture a limited scope of SDoH domains, which may hinder efforts to address existing disparities in HNC care. Future research should focus on assessing the use of SDoH instruments in guiding the integration of SDoH screening into routine clinical care and targeted follow-up interventions aimed at improving equity in HNC outcomes.
Unilateral vocal fold immobility (UVFI) is a common complication of cardiothoracic surgery in pediatric populations, yet no standardized treatment guidelines exist. The current literature supporting pediatric injection laryngoplasty (IL) has been limited by heterogeneity in patient populations, treatment approaches, and outcomes analysis. To implement a standardized, multidisciplinary protocol for managing pediatric UVFI after cardiothoracic surgery and describe recovery patterns and outcomes observed among patients treated with IL vs conservative approaches. This prospective cohort study was conducted at a tertiary care referral center and included patients who were undergoing cardiothoracic surgery involving the aortic arch at age 1 year or younger between August 2015 and September 2024. Data were analyzed from September 2024 to October 2024. Patients with adjusted age of 36 weeks or younger at the time of surgery or a preoperative diagnosis of dysphagia were excluded. Additional exclusion criteria removed patients who did not complete postoperative feeding evaluations due to clinical decline and those who underwent IL outside the initial admission after cardiothoracic surgery. Injection laryngoplasty. The primary outcome was oral diet advancement at time of discharge after cardiothoracic surgery, which was defined by improvement in frequency, volume, or consistency of oral intake. Secondary outcomes included nasogastric feeding tube (NGT) requirements, rate of gastrostomy tube placement, and hospital length of stay. A total of 128 patients (53 [41.4%] female and 75 [58.6%] male; median [IQR] age, 17 [6-87] days) were included. Of the 45 patients (35.1%) with UVFI, 17 underwent IL and 28 did not. More IL patients achieved oral diet advancement by discharge compared with non-IL patients (17 of 17 [100%] vs 18 of 28 [64.3%]; difference, 35.7%; 95% CI, 12%-54%). Fourteen IL patients (82%) were discharged with an NGT vs 18 (64%) non-IL patients (difference, 18%; 95% CI, -9% to 40%). The median (IQR) time to NGT removal for IL vs non-IL patients was 30 (24.5) days vs 58 (89.5) days (difference, -28 days), and the median (IQR) hospital length of stay for IL vs non-IL patients was 28 (14.0) vs 23 (19.5) days (difference, 5 days). Implementing a clinical pathway for managing UVFI after cardiothoracic surgery may standardize treatment and outcome assessment. In this cohort study, IL patients more frequently achieved oral diet advancement during the immediate postoperative period than those treated conservatively. However, these groups differed in baseline clinical characteristics that were associated with treatment selection; therefore, the observed differences in outcomes cannot be attributed to treatment choice alone.
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Suboptimal practices in the evaluation and workup of nasal masses may lead to patient outcomes that could be improved. Recognizing common pitfalls and mishandled clinical scenarios underscores the need for clear, consensus-driven recommendations. To provide expert consensus recommendations regarding the appropriate workup and evaluation of nasal masses to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes. A systematic review from 1990 to 2025 was conducted in PubMed to identify gaps and discrepancies in practice guidelines and to assist in the development of consensus statements. Expert physicians from both academic and private practice environments from the US, UK, and Canada were identified and included specialties of comprehensive otolaryngology, head and neck surgery, rhinology, neurosurgery, and medical oncology. A modified Delphi approach was used to conduct an expert consensus survey. The statement generation and surveys were conducted from February 2025 to June 2025. The formulation and expert evaluation of 23 consensus statements. A total of 25 multidisciplinary experts, including 17 male and 8 female physicians spanning comprehensive otolaryngology (n = 3), head and neck surgery (n = 7), rhinology (n = 12), neurosurgery (n = 1), and medical oncology (n = 2), participated in the survey. Of the 23 statements, 20 reached consensus during the initial iteration among the initial evaluation, biopsy, imaging, pathologic evaluation, and additional workup subgroups. Two of these statements underwent revision and were ultimately accepted, while the last statement did not achieve expert consensus. This multidisciplinary expert consensus statement can guide physicians and medical practitioners in adopting the proper evaluation and workup of nasal masses, helping them to avoid common pitfalls, optimize management practices, and ultimately improve patient outcomes.
Transoral robotic surgery (TORS) yields excellent oncologic outcomes in patients with oropharyngeal squamous cell carcinoma (OPSCC). The outcomes of early swallow rehabilitation with speech-language pathologists (SLP) in this population have not been fully investigated. To evaluate swallow physiology and patient perception of swallow function in the perioperative period after TORS. This retrospective cohort study reviewed medical records of adult patients with OPSCC who underwent TORS from 2017 to 2024 at a single tertiary care center. Patients were included if they had a histologic diagnosis of SCC and a videofluoroscopic swallow study (VFSS) prior to undergoing treatment with TORS. TORS. At various perioperative time points, SLP performed a VFSS that generated a Dynamic Image Grade of Swallowing Toxicity (DIGEST) score and patients completed the MD Anderson Symptom Inventory (MDADI) questionnaire for subjective assessment of swallow function. For most patients, on postoperative day (POD) 1, SLP performed a bedside swallow evaluation and recommended compensatory swallow maneuvers, if necessary. Oral diet was initiated using the International Dysphagia Diet Standardization Initiative (IDDSI) for pureed solids and thin or mildly liquids for 2 weeks. Data on hospital stay and enteral tube placement were collected. Primary outcomes included swallowing at 6 weeks postoperatively assessed before potential adjuvant therapy by VFSS and MDADI. Secondary outcomes included complications and enteral tube feeding requirements. Among the 212 patients included, median age was 61 (IQR, 55-68) years and 31 patients (14.6%) were female. At baseline, 207 patients (97.6%) had normal VFSS scores. A total of 203 patients (95.8%) were evaluated by SLP on POD 1, and the remainder of the patients were evaluated by the surgical team. Median hospital length of stay was 2 days (IQR 1-2 days), and by the time of discharge, 207 patients (97.6%) were tolerating an oral diet. Fourteen patients (6.6%) required enteral feeding tube placement in the immediate postoperative period. At 6 weeks, 21 of the 33 patients (63.6%) with paired baseline and 6-week postoperative MDADI data reported a significant worsened swallowing perception. Six of the 66 patients (9.1%) with a postoperative VFSS at 6 weeks showed an objective decrease in swallowing compared with baseline. Of the 169 patients with diet documented at 6 weeks postoperatively, 95.3% (n = 161) were consuming a soft to regular diet. In this cohort study, patients with OPSCC treated with primary TORS had excellent short-term swallowing outcomes. Only a small proportion required a nasogastric tube at discharge, and at 6 weeks although most reported a worsening in swallow perception, they did not have an objective decrease in swallow function as measured by VFSS and most were tolerating a soft to regular diet.
To evaluate longitudinal trends in female authorship in high-impact otolaryngology journals and assess changes in representation across first and last author positions over a 20-year period. Cross-sectional bibliometric analysis. Three high-impact otolaryngology journals: JAMA Otolaryngology-Head & Neck Surgery, The Laryngoscope, and Otolaryngology-Head and Neck Surgery. Research articles published in 2004 and 2024 were identified. First and last author genders were determined using publicly available sources. Descriptive statistics and proportional comparisons were performed to compare gender distribution across authorship positions and time points. A total of 3733 authors across 1948 original articles were analyzed. Overall female authorship increased from 15.5% in 2004 to 33.5% in 2024 (P < .001). Female first authorship more than doubled from 15.9% to 39.9% (P < .001), while female last authorship rose more modestly from 15.6% to 26.4% (P < .001). Female authorship in otolaryngology has grown substantially over the past 2 decades, reflecting progress in early-career scholarly participation. However, persistent underrepresentation in senior authorship positions highlights enduring barriers to academic advancement. Continued efforts to improve mentorship, sponsorship, and equitable promotion practices are essential to achieving gender equity in otolaryngology scholarship.
Performing otolaryngology operations requires sustained static posture and precision in confined spaces, placing surgeons at high risk of musculoskeletal strain. Ergonomic challenges have been implicated in acute discomfort and long-term disability, yet prospective intraoperative assessments remain limited. To quantify intraoperative ergonomic risk and acute musculoskeletal pain among otolaryngologists during surgical procedures and to examine demographic and procedural factors associated with discomfort. This prospective cross-sectional study was conducted at a single academic institution from August 2024 to March 2025. Eligible participants included otolaryngology surgeons (residents, fellows, or attending physician faculty) actively performing head and neck operations during the study period. Primary outcomes included preoperative and postoperative numeric pain scores (0-10 scale) and intraoperative ergonomic risk, assessed using the Rapid Upper Limb Assessment (RULA). Secondary outcomes included baseline Neck Disability Index, Oswestry Low Back Disability scores, and associations of demographic and procedural variables with pain. Seventeen otolaryngology surgeons (12 residents/fellows, 5 attending physicians) actively performing head and neck operations participated in the study. The mean (SD) age of surgeons was 35.6 (10.6) years; 5 participants (29%) were female, and 12 (71%) were male. Among the 17 otolaryngologists observed across 80 operations, 970 intraoperative RULA scores were collected. Overall, 143 of 386 attending physician (37%) and 249 of 584 resident scores (43%) indicated medium to high ergonomic risk (RULA 5-7). In mixed-effects modeling, greater case difficulty was associated with increased pain scores, and larger glove size was associated with higher pain scores. No significant associations were observed between pain scores and surgeon weight, sex, age, training level, or the length or type of procedure. RULA scores increased with operative duration, especially among surgeons 40 years and older. Postoperative surveys indicated that 23 of 80 procedures (28.8%) required intraoperative position changes due to discomfort, with 7 (8.8%) reporting distraction due to pain, 2 (2.5%) requiring a break, and 1 (1.3%) reporting interference with surgical performance. In this cross-sectional study, otolaryngology surgeons experienced measurable increases in pain and sustained high rates of intraoperative ergonomic risk, even during routine procedures. Hand size was associated with greater intraoperative discomfort, underscoring the multifactorial nature of ergonomic strain during operations. These findings highlight the urgent need for increased ergonomic awareness, targeted training, and equipment redesign to mitigate risk and preserve surgeon longevity.
For diagnostics and presurgical planning in otology, both magnetic resonance imaging (MRI) and computed tomography (CT) are frequently required to visualize soft tissues and bone structures. Ideally, visualization of both soft and bony tissues would be obtained using a single, radiation-free imaging modality. To train and evaluate a machine learning algorithm designed for generating synthetic CT images from MRI of the head. This diagnostic study assessing the feasibility of generating synthetic CT images from MRI of the head was conducted in a tertiary referral center in the Netherlands from September 2022 to September 2023. Paired MRI and CT scans were obtained from patients for whom CT of the head was requested as part of routine clinical care. Sixty-seven paired scans were used to train a machine learning algorithm to generate synthetic CT images from MRI data by a third party. Generated synthetic CT images of 15 patients were used for clinical evaluation by clinicians not associated with the third party. The primary outcomes were geometric and radiodensity accuracy, conspicuity of clinically relevant landmarks, and suitability of scans. Conspicuity on synthetic CT and true CT were independently rated by 2 ear, nose, and throat surgeons and 2 radiologists on a 4-point Likert scale ranging from poor (score of 1) to excellent (score of 4). Qualitative assessment of suitability of the scans for various clinical purposes was done by the 4 raters. Paired MRI and CT scans were obtained from 73 patients (median age, 54 years [range, 18-81 years]; 38 [52%] male). Geometry and radiodensity on synthetic CT were sufficiently accurate (mean [SD] surface distance error, 0.38 [0.37] mm; mean [SD] radiodensity error, 4 [44] Hounsfield units) compared with true CT (gold standard). Conspicuity of the landmarks was generally deemed to be comparable. The thickness of the tegmen bone was sometimes overestimated by the algorithm, while the ossicles were often not depicted. Among 15 synthetic CT scans, each reviewed twice, most were considered suitable for localization (29 [97%]), navigation (25 [83%]), and surgical planning prior to cochlear implantation (21 [70%]) but not for diagnostic purposes. In this study, CT-like images of the temporal bone could be generated from MRI of the head using a machine learning algorithm, which allowed for visualization of bony structures next to soft tissues using a single, radiation-free modality. The findings suggest that synthetic CT images are suitable for localization of anatomic structures in otologic procedures and reliable in estimating the extent of mastoid pneumatization for preoperative planning.