Dysphonia affects a growing number of individuals in the United States, but many do not receive targeted care. This study explores trends in speech-language pathology (SLP) and otolaryngology utilization in a large, national cohort of individuals with dysphonia. Of 287,012 participants with EHR data who enrolled in the NIH All of Us Research Program between May 2018 and July 2022, those with dysphonia were identified using ICD codes. SLP and otolaryngology utilization rates were determined using CPT codes for relevant diagnostic and therapeutic interventions. Multivariate logistic regression analyses evaluated associations between sociodemographic characteristics and specialist care. Of 8308 individuals with dysphonia, 4136 (49.8%) received specialist care, with 1740 (20.9%) having utilized SLP services and 3973 (47.8%) having utilized otolaryngology services. In adjusted analyses, older age, female sex, and lower education were associated with decreased SLP utilization, while female sex and lower income were associated with decreased otolaryngology utilization. Higher rates of otolaryngology utilization were seen in individuals identifying as Black or Other versus Non-Hispanic White. Insurance status and rural location did not independently correlate with specialist utilization. 49.8% of individuals with dysphonia accessed specialist care, with 20.9% of the individuals with dysphonia receiving SLP services and 47.8% receiving otolaryngology services. Utilization rates varied significantly across age, sex, race and ethnicity, education level, and annual income, but not insurance status or geographical setting. 3.
To evaluate current trends and management strategies for post-tonsillectomy hemorrhage (PTH) among otolaryngology (ENT) and emergency medicine (EM) physicians. A survey was developed by a panel of pediatric ENT, critical care, and EM physicians. Questions assessed therapies and definitions of PTH. Survey distribution was to members of the American Society of Pediatric Otolaryngology (ASPO) and a common pediatric emergency medicine listserv (PED-EM-L). Overall response rate was low at 6.5% (ENT: 110, EM: 134, Total: 244). Compared with EM respondents, ENT providers were more likely to have over 10 years of experience (60% vs. 46%; p = 0.023). ENT providers were less likely to include "return to the operating room" as a defining feature of post-tonsillectomy hemorrhage (59% vs. 81%; p < 0.001) and less likely to estimate that ≥ 10% of patients require reoperation for bleeding (17% vs. 71%; p < 0.001). PTH non-operative managements selected as most likely to be used in the past 6 months were observation (ENT: 44% vs. EM: 55%), nebulized tranexamic acid (TXA) (ENT: 29% vs. EM: 66%), intravenous TXA (ENT: 16% vs. EM: 31%), direct pressure (ENT: 4% vs. EM: 10%), and topical agents such as salt water gargle (ENT: 7% vs. EM: 19%). After adjusting for confounders (gender, PTH definition, percent returning to operating room, years in practice, practice setting), ENT providers were less likely to use nebulized TXA compared to EM respondents (p < 0.001). Significant variability exists between ENT and EM providers in the definition and use of TXA for PTH. Larger, well-designed studies and targeted educational initiatives are needed to validate and standardize non-operative strategies for PTH management.
To introduce the concept and provide a unifying framework for multimodal intraoperative data-capturing technologies and to describe their role in otolaryngology. This narrative review synthesizes the current evidence and developments on intraoperative data-gathering technologies. It introduces the framework of Multimodal Operating-room Data Acquisition and Leveraging (MODAL) systems, which integrate data from surgical equipment, physiologic monitors, electronic health records, and ambient audiovisual sources. Emerging multimodal data-capturing technologies are now enabling systematic collection and analysis of OR data to improve safety, quality, and efficiency in surgery. Otolaryngology is particularly well suited to adopt MODAL systems, given its large volume of video-based procedures such as endoscopic sinus surgery, most forms of ear surgery, airway surgery, and transoral robotic surgery. MODAL technologies have demonstrated value in intraoperative checklist compliance, surgical education, and postoperative safety analysis. There is also growing potential for real-time decision support through computer vision and artificial intelligence integration. Despite the growing adoption of these technologies, the terminology, implementation methods, and governance frameworks are not well standardized. The implementation of MODAL systems also requires attention to patient and physician privacy, data governance, technical infrastructure, and collaboration among providers, informaticists, and institutional leaders. While the current scope of MODAL systems is limited, their capabilities are evolving. Within otolaryngology, these technologies hold the most promise for video-intensive subspecialties. However, realizing their full benefits will require carefully planned institutional policy, governance, and continued refinement. 5.
To develop and validate a modular, low-cost, and anatomically realistic microsurgical simulator for endolaryngeal training, including CO2 laser procedures and microsuturing. We developed a dual-module simulator consisting of a laryngeal specimen fixation unit and a flexible laryngoscope holder. The device accommodates porcine larynges and enables adjustable exposure and instrument manipulation under microscopic or exoscopic visualization. Junior and senior otolaryngologists performed standardized tasks, including subepithelial vocal fold dissection, microsuturing, and CO2 laser cordectomy. Participants completed a post-session Likert-scale survey assessing realism, usability, and perceived educational value. Twenty one otolaryngologists evaluated the simulator. Across survey items, mean scores ranged from 4.29 to 4.95 (SD: 0.22-0.78), with 81.0%-100% agreement (Likert ≥ 4). Perceived training benefit was highest for hand-eye coordination (4.95 ± 0.22, 100%), basic instrumentation for microscopic laser surgery (4.95 ± 0.22, 100%), and bimanual dexterity (4.90 ± 0.30, 100%). Overall satisfaction with the model was high (4.71 ± 0.46, 100%). This novel modular porcine-larynx simulator provides a practical platform for microlaryngeal skills training with high user-rated realism and educational utility. Its simple design, affordability, and adaptability may facilitate broader implementation in surgical education. 4.
Vocal fold paralysis or paresis (VCP) is a possible complication of lung transplant surgery. The otolaryngology service is often consulted to evaluate these patients via laryngoscopy and flexible endoscopic evaluation of swallowing (FEES). This study aims to quantify vocal fold pathologies via direct visualization. A retrospective chart review was conducted at a single quaternary medical center over a 3.5-year period, from December 2019 to May 2023. The presence of abnormal laryngoscopic findings in these patients was reviewed with specific descriptions of vocal fold findings reviewed and described in further detail. A total of 78 patients met the inclusion criteria out of 127 lung transplants performed. Of these, 46 patients (59.0%) were found to have abnormal laryngoscopy findings on inpatient examination. Average time from the date of transplant to FEES examination was 10.3 days. Thirty-two patients (42.0%) were found to have pathologies at the site of the true vocal folds. Nine patients exhibited new VCP (11.5%), 13 with granuloma (16.7%), six with hemorrhage (7.69%), and four with polyp (5.13%). Only 13 patients (16.7%) followed up with laryngology once discharged. Vocal cord pathologies, including VCP, frequently occur in patients post-lung transplantation. It is vital for the transplant team and laryngologists to monitor and help institute appropriate care and follow-up for these patients. 2B.
To evaluate national trends in Advanced Practice Provider (APP) participation in Otolaryngology (ear-nose-throat [ENT]) care and assess their role in improving access to ENT services within the Medicare population from 2018 to 2022. We analyzed Medicare Provider Utilization and Payment Data from 2018 to 2022, including the Physician and Other Supplier Detailed and Aggregate Files. We examined 25 ENT-relevant CPT codes for provider type, procedural volume, and Medicare reimbursement. Providers were categorized as either ENTs or APPs based on their reported formal specialty designation. Descriptive statistics, t-tests, chi-square tests, and regression analyses were utilized to evaluate differences in service delivery, geographic distribution, and provider trends over time. Between 2018 and 2022, the number of ENTs declined by 2.1% (95% CI, -2.4% to -1.8%), while the number of APPs increased by 36.1% (95% CI, 35.8%-36.4%). APPs performed an increasing share of ENT procedures, including diagnostic nasal endoscopy, laryngoscopy, and sinus debridement, and were more likely to practice in rural areas. APP participation grew across all U.S. regions. Although ENTs maintained higher mean procedural volumes and reimbursement rates, APPs demonstrated a broader geographic distribution and expanded independent billing capabilities. APPs have become essential contributors to the delivery of ENT care in the United States. Their involvement in procedures and presence in underserved areas highlight their role as an effective strategy to address workforce shortages and improve access to otolaryngologic services.
This study aimed to evaluate the time-dependent changes in olfactory threshold and identification ability during olfactory rehabilitation in patients who had undergone laryngectomy and to investigate the recovery process for different odor types. Nineteen patients who underwent laryngectomy participated in olfactory rehabilitation using the nasal airflow-inducing maneuver (NAIM). Olfactory function was assessed at baseline and at 1, 3, 6, and 12 months post-NAIM. Of the 19 participants, 12 (63.1%) continued the program for 6 months, whereas 8 (42.1%) completed the 12-month assessment. The mean olfactory threshold improved from 2.7 at baseline to -1.5 at 12 months, reaching normal levels by 1 month. The recognition threshold (identification ability) improved from 4.1 at baseline to -0.3 at 12 months, with significant recovery observed by 3 months. Odor-specific recovery patterns varied: Isovaleric acid showed improvement at 1 month; methyl cyclopentenolone, γ-undecalactone, and skatole at 3 months; and β-phenylethyl alcohol at 6 months. In patients who underwent laryngectomy, the olfactory thresholds recovered earlier than the identification abilities. The rate of recovery differed among odor types, with more rapid improvement observed for odors of physiological importance, such as putrid smells. 4 Laryngoscope, 2024.
Modified barium swallow studies (MBSS) are one of two gold-standard assessments for oropharyngeal swallowing. It is unclear how many patients referred for outpatient MBSS have normal swallowing despite a subjective complaint of dysphagia. This study examined the rate, referral diagnoses, and referral patterns of outpatient MBSS. A retrospective descriptive case series was conducted of outpatient adult MBSS between January 1, 2019 and December 31, 2019. Normal MBSS were identified and stratified by present/absent history of neurological disease or head and neck cancer (HNC). Referral sources and diagnoses were tracked. Six hundred fifteen patients were referred for MBSS. 285 (46%) studies were normal; of these, 209 (73% of normal MBSS; 34% of total MBSS) had no history of neurological disease or HNC and were predominately female (female 128, 61%, male 81, 39%). The primary referral diagnoses for MBSS are: Dysphagia, unspecified (48, 23.0%), Dysphagia, other (6, 2.9%), Dysphagia, pharyngeal (8, 3.8%), Dysphagia, esophageal (14, 6.7%), Dysphagia, oropharyngeal (43, 20.6%), Dysphagia, pharyngoesophageal (12, 5.7%), GERD/LPR (7, 3.3%), Chronic cough (11, 5.3%), Chronic throat clearing (2, 1.0%), Other (including Zenker's diverticulum 58, 27.8%). The primary referral sources were: ENT (72, 34.4%), Gastroenterology (57, 27.3%), PCP: (23, 11.0%). Nearly half of all patients referred for MBSS were judged to have normal oropharyngeal swallowing. There may be a discrepancy between patient complaint and evaluation results necessitating revision of referral patterns and evaluation methods and consideration of transient or poorly understood presentations of dysphagia. 4.
Humans continuously emit respiratory particles during routine activities (breathing, speaking, coughing), and these can carry pathogens. Particle size and site of origin determine suspension time, deposition, and transmission risk. Tracheostomy makes the airflow bypass the upper airway partly or in full. Its effect on aerosol generation is unclear; therefore, we compared emissions between tracheostomized and healthy volunteers during tidal breathing, deep breathing, speaking, and coughing, and examined differences across activities within the tracheostomized group. Aerosol emissions of 10 tracheostomized, uninfected volunteers and 16 healthy volunteers were measured with a portable aerosol spectrometer. Tracheostomized participants were measured with and without a heat moisture exchanger. A Mann-Whitney U-test was used to compare aerosol emissions between tracheostomized participants and healthy controls. Wilcoxon signed-rank test was used to compare paired measurements within the same individuals in the tracheostomized group. Tracheostomy, whether occluded or not occluded, does not produce significantly more aerosol than healthy participants. Most detected particles were < 1 μm (≈90% of measurements), with medium particles ≈50% and large particles uncommon. In stable outpatients, aerosol emissions did not differ between the three groups across common respiratory activities, suggesting the exhalation route is not a major determinant of emission under these conditions. The impact of tracheostomy care procedures, such as suctioning, was not evaluated in this study. 2.
We aimed to evaluate the long-term auditory outcomes of early antiviral therapy with valganciclovir (VGCV) in children with congenital cytomegalovirus (cCMV) infection, regardless of initial symptomatology. This retrospective cohort study included 56 pediatric patients (112 ears) diagnosed with cCMV infection between 2004 and 2022 at our institution. The participants were divided into those who received (treated group, n = 19) and did not receive (untreated group, n = 37) VGCV or ganciclovir therapy. Audiological assessments were conducted over a minimum 2-year follow-up period (range, 2-15 years). Furthermore, hearing thresholds were evaluated longitudinally, with a decline of ≥ 10 dB being defined as significant. The primary outcomes were hearing loss progression and age at onset. At the final follow-up, there were no significant between-group differences in the prevalence or severity of hearing loss. However, fewer ears showed significant hearing deterioration in the treated group (26%) than in the untreated group (41%, p < 0.01). Furthermore, the magnitude of hearing decline was smaller in the treated group (35.0 ± 13.8 dB) than in the untreated group (67.4 ± 19.2 dB) (p < 0.002). Hearing loss in treated patients stabilized by the age of 3 years; in contrast, untreated patients experienced multiple deterioration episodes even after this age. Early VGCV treatment may help stabilize hearing and reduce long-term hearing deterioration in children with cCMV infections. This highlights the importance of early intervention and hearing surveillance, especially in untreated individuals. 4.
Acquired subglottic stenosis (SGS) is commonly caused by prolonged intubation and elevated cuff pressures. Severe COVID-19 patients requiring extended ventilation are at higher risk of laryngotracheal injury. However, SGS incidence in COVID-19 versus non-COVID-19 patients remains underexplored. To compare the incidence of SGS and frequency of subglottic dilation procedures following intubation in patients with or without a history of recent COVID-19 infection. Utilizing the TriNetX database, queries were conducted for adult patients intubated between January 20, 2020 and December 31, 2023. Demographics, comorbidities, and COVID-19 infection histories were collected. Patients were divided into two cohorts based on their COVID-19 status < 2 weeks prior to hospitalization and propensity-score matched for demographics and comorbidities. Incidence of SGS and frequency of subglottic dilation/tracheostomy procedures occurring during the same hospitalization as the patient's intubation were compared. About 105,443 COVID+ and 79,848 COVID- patients had histories of intubation. After matching, each cohort had 70,000 patients; 39% (N = 54,661) female, 58.5% (N = 81,852) male. Mean age at time of intubation was 57 years. COVID+ patients were more likely to develop SGS, odds ratio (OR) 1.3 (95% CI 1.1-1.5; p = 0.0004), and more likely to undergo tracheostomy, OR = 1.2 (95% CI = 1.1-1.2; p < 0.001). COVID+ patients with SGS were more likely to undergo subglottic dilation procedures, OR 1.3 (95% CI 1.0-1.7; p = 0.02). There was no significant difference in the number of dilation procedures or mortality rates between cohorts. Intubated patients with COVID-19 were more likely to develop SGS than those without infection and were more likely to require invasive procedures to address complications of long-term intubation.
To translate, culturally adapt, and validate a Swedish version of the Tonsillectomy Outcome Inventory-14 (TOI-14) and to evaluate an extended version including three additional sleep-disordered breathing (SDB) items (TOI-17) among adult tonsil surgery patients. This prospective multicenter study was conducted across five Swedish ENT departments between 2022 and 2023. One-hundred-and-eight adults scheduled for tonsil surgery and 84 controls without tonsil disease completed the TOI-14, TOI-17, and EQ-5D VAS at baseline and 2 weeks later, and patients repeated the questionnaires 6 months after surgery. Psychometric evaluation included internal consistency, test-retest reliability, convergent and known-groups validity, responsiveness, confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). At baseline, patients reported markedly higher TOI-14 (39.5 ± 17.8) and TOI-17 (50.7 ± 19.8) scores than controls (3.9 ± 4.5 and 4.9 ± 5.0; p < 0.001). Both instruments showed excellent internal consistency (α = 0.88 and 0.82) and high test-retest reliability (ICC = 0.89 and 0.83). Scores correlated with EQ-5D VAS (r = -0.54 and -0.55; p < 0.001) and improved significantly 6 months postoperatively (p < 0.001). The CFA of the Swedish TOI-14 showed suboptimal fit of the original four-factor model, while EFA of the TOI-17 supported a five-factor solution, with the three SDB items forming a distinct, internally coherent domain (loadings 0.6-0.8). The Swedish TOI-14 and TOI-17 are valid, reliable, and responsive patient-reported outcome measures for adults with tonsil disease. The extended TOI-17 version adds clinically relevant coverage of sleep-related symptoms, enhancing applicability for both clinical use and registry-based quality assessment. III-non-randomized controlled cohort.
Thyroid cancer incidence has risen sharply in the US, with disparities in diagnosis and treatment outcomes disproportionately affecting marginalized populations. Despite mandates for diversity in clinical trials, underrepresentation of these groups remains a critical barrier to equitable health outcomes. This study evaluates recruitment and retention strategies in thyroid cancer trials and highlights areas for improvement to enhance inclusivity and generalizability. This cross-sectional analysis examined the reporting of recruitment and retention strategies for historically marginalized populations in thyroid cancer clinical trials. Following PRISMA guidelines, we searched MEDLINE, Embase, and Cochrane databases for trials published between 2018 and 2023. Eligible studies assessed thyroid cancer treatment interventions and were conducted in locations with a national or multinational Ethnic Fractionalization Index (EFI) of ≥ 0.3. Data extraction included trial characteristics and reporting of recruitment and retention practices. Descriptive analyses were performed using Stata. Of 708 articles identified, 28 clinical trials met inclusion criteria. None reported recruitment or retention strategies targeting underrepresented populations, nor established diversity goals. The absence of such strategies highlights persistent gaps in addressing the needs of marginalized groups in thyroid cancer research. The lack of effective recruitment and retention strategies in thyroid cancer trials perpetuates the underrepresentation of marginalized populations, limiting the generalizability of findings. To address these disparities, clinical trials must adopt inclusive methodologies and transparent reporting practices, supported by policy changes and stronger enforcement of diversity mandates. These steps are essential for ensuring equitable health outcomes and advancing the quality of thyroid cancer research. 3.
This ASPO survey investigates pediatric peri-operative tracheostomy care practices through a nationwide survey. It aims to identify challenges, explore opportunities for standardization across institutions, and recommend strategies that could reduce complications and enhance patient care. A 19-question survey was administered online to pediatric otolaryngologists. Descriptive statistics summarized respondent demographics and responses. Of 138 respondents, 90% practiced in the US, primarily in the Mid-Atlantic and Great Lakes. Over 60% performed fewer than 10 pediatric tracheostomies annually. A majority (98%) used stay sutures for accidental decannulation, and 25% did not mature the stoma. Notably, 92% adhered to standardized post-operative protocols. Bivona tracheostomy tubes were most commonly used (72%). First tube changes were typically on postoperative Days 5 and 7, with false passage creation (46%) and bleeding (41%) as primary complications. Routine surveillance bronchoscopy was conducted by 63%, mainly twice in the first year (34%). The survey highlights wide variation in pediatric tracheostomy practices and underscores the importance of standardized protocols. Most respondents perform fewer than 10 procedures each year, yet adherence to institutional guidelines reflects a strong commitment to safety. This study identifies key areas of variability such as the timing of the first tube change, use of surveillance bronchoscopy, and reported complications-and outlines opportunities for further research and standardization aimed at improving consistency and clinical outcomes. 5.
Use of costal cartilage grafts for longer segment anterior graft laryngotracheal reconstruction can pose a risk for the inferior aspect of the graft prolapsing into the airway lumen. This is particularly true when incorporating a tracheostoma into the reconstruction. Use of two costal cartilage grafts combined to form an inverted T-shape can be helpful in addressing this issue. This technique has been previously described in two reports but is not widely used. We review the technical aspects of this approach and outcomes in two patients. Two pediatric patients with subglottic/tracheal stenosis and tracheostomy underwent SS-LTR using inverted T-shaped costal cartilage grafts. The vertical limb was secured to expand the subglottic/proximal tracheal airway, while the horizontal segment provided wider coverage of the stomal defect and supported the inferior aspect of the vertical limb. The technical details and postoperative course are reviewed. Both patients exhibited successful airway healing without evidence of graft prolapse or dehiscence. The T-graft supported the inferior aspect of the reconstruction effectively and closed the stomal defect without tension. Follow-up endoscopic evaluation confirmed a patent airway with stable graft integration. Serial excision of foci of granulation was required postoperatively. The previously described but infrequently reported inverted T-graft technique is a useful approach for longer segment stenosis. Larger series with longer follow-up are needed to clarify long-term outcomes. 4.
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To determine whether middle meatal spacers reduce postoperative synechiae following endoscopic sinus surgery (ESS) and to compare the effectiveness of absorbable versus nonabsorbable spacer materials. A PRISMA 2020-guided systematic review and meta-analysis was performed. PubMed/MEDLINE, Embase, and Web of Science were searched (January 2012-March 2025) for randomized controlled trials in adults undergoing ESS comparing middle meatal spacers versus no-spacer controls. The primary outcome was synechiae within 3 months. Random-effects meta-analysis generated pooled relative risks (RR) with 95% confidence intervals (CI); prespecified subgroup and sensitivity analyses assessed robustness. Nine randomized controlled trials comprising 703 patients met inclusion criteria, with eight studies providing dichotomous synechiae data for meta-analysis. Middle meatal spacers significantly reduced postoperative synechiae compared with no spacer (RR 0.43; 95% CI 0.26-0.71; p = 0.001), with moderate heterogeneity (I 2 = 52.3%). Absorbable spacers demonstrated a statistically significant protective effect (RR 0.48; 95% CI 0.25-0.93; p = 0.03), whereas nonabsorbable spacers showed a nonsignificant protective trend under random-effects modeling. No significant difference was observed between absorbable and nonabsorbable spacer subgroups. Trials evaluating steroid-eluting spacers did not demonstrate clear superiority over nonsteroid absorbable spacers for synechiae prevention. Middle meatal spacers reduce postoperative synechiae after ESS, with the most consistent evidence supporting absorbable materials. Given wide variation in baseline synechiae risk, selective rather than routine use is supported.
To evaluate whether tongue base motion patterns, assessed by submental ultrasonography during unilateral hypoglossal nerve stimulation (HNS), are associated with treatment response in obstructive sleep apnea patients. This cross-sectional study included 64 patients with unilateral HNS. Standardized submental B-mode ultrasound was performed to assess tongue-base motion under awake stimulation. Two independent, blinded raters evaluated the magnitude of anterior tongue base movement in the axial and sagittal planes. Further, the symmetry of bilateral tongue protrusion and tongue shape was classified. The primary endpoint was the correlation between apnea-hypopnea (AHI) reduction and ultrasonographic findings. Ultrasonographic assessment showed substantial to excellent agreement between the two raters. No significant correlation was found between AHI reduction and anterior tongue displacement in either the axial (Spearman's ρ = 0.20, p = 0.12) or sagittal plane (ρ = -0.08, p = 0.64). Clinically meaningful bilateral activation was present in 33% of patients but was not associated with treatment outcome (ρ = 0.03, p = 0.84). Neither tongue shape was predictive of AHI improvement (buckling p = 0.13 and trough sign p = 0.79). Tongue movement patterns were not associated with stimulation voltage. Ultrasonographic assessment of tongue base motion under HNS does not correlate with treatment response. Neither symmetry, magnitude, nor qualitative shape was associated with AHI reduction. These findings suggest that visible tongue motion may not reliably reflect functional improvement in the airway. Future research should define the role of ultrasound in HNS evaluation and optimization. 3b. ClinicalTrials.gov Identifier: NCT06154577.
Limited literature focuses on delays in accessing head and neck cancer (HNC) care across the entire care continuum. This study aims to describe the time to care from symptom onset to treatment completion and identify predictors of delays for oral cavity cancer patients. We reviewed patients with oral cavity squamous cell carcinoma (OCSCC) treated with curative surgery followed by adjuvant treatment at a tertiary center. Delays were defined per published thresholds for: time to treatment initiation (TTI, diagnosis to surgery), time to adjuvant treatment (stratified by whether adjuvant treatment was at the same or different facility as surgery), and total treatment package time. We also measured symptom duration, reported median times, and used logistic regression to assess predictors of delay. Among 93 patients, median (IQR) symptom duration was 17.4 weeks (IQR: 6.8-42.8); TTI 6.9 weeks (IQR: 4.4-10.4); time to adjuvant radiation 8.4 weeks (IQR: 7.4-9.3) at the same institution as surgery was performed and 9.3 weeks (IQR: 7.4-14) at a different facility; and total treatment package time 15.4 weeks (IQR: 12.6-20) for surgery and adjuvant radiation, and 16.3 weeks (IQR: 15-18.6) for surgery and adjuvant chemoradiation. 73% of patients experienced delays in reaching a healthcare facility, 39% in TTI, 89% in starting adjuvant treatment, and 64%-81% in total treatment time. In univariate analyses, late-stage disease, residing in a community with higher social vulnerability index (SVI), longer time from surgery to pathology report, need for free flap, and social worker interaction were associated with higher odds of delay in any care interval following diagnosis. Higher SVI was associated with delays in multivariate analyses. HNC patients experience delays during all phases of cancer care. Interventions and future research need to address social determinants of health and health system factors that contribute to multifactorial delays across the care continuum.
Repairing nasal septal perforations (NSPs) is a complex procedure involving various surgical techniques, with success rates that vary significantly. As the size of the perforation increases, the surgical challenge intensifies and success rates tend to decline. This highlights the need for more effective and reliable repair methods. The aim of this study is to evaluate the effectiveness of a three-layer sandwich technique using a polydioxanone (PDS) plate, tragal cartilage, and temporalis fascia in repairing medium- and large-sized NSPs. Between March 2022 and November 2024, 21 patients who underwent surgery for nasal septal perforation at our clinic were evaluated. Of these patients, 6 had medium-sized perforations (11-20 mm), while 15 had large perforations (> 20 mm). In all cases, the perforation was repaired using a combination of a PDS plate, tragal cartilage, and temporalis fascia grafts. The patients were followed for an average of 8 months postoperatively. Complete closure of the perforation was defined as the criterion for surgical success. Complete closure of the septal perforation was achieved in 18 out of 21 patients (85.7%). Two patients experienced partial closure, yet both reported symptomatic improvement. No major postoperative complications were observed during the follow-up period. The surgical technique utilizing a combination of PDS plate, tragal cartilage, and temporalis fascia appears to be a reliable method for the repair of medium and large septal perforations, with a high success rate and a low risk of complications. Compared to techniques described in the existing literature, this approach offers significant advantages in terms of structural support and mucosal healing.