Faculty Bibliography

Vocalizations are ancient behaviours that require the complex coordination of breath and display. Understanding how laryngeal anatomy shapes vocalization provides insights into this diversity, its mechanisms and their evolution. Rodents are ideal for exploring this variation because of their diverse mechanisms and vocal structures. Here, we describe the laryngeal morphology and sound production mechanisms underlying the vocalizations of Alston's singing mouse (Scotinomys teguina) and compare these results to those of other vocalizing mammals. We reconstructed the three-dimensional laryngeal morphology with micro-computed tomography, recorded laryngeal sound production using high-speed video and investigated frequency control using surgical ablations. We found that singing mice use a whistle mechanism that uniquely relies on the inflation of an enlarged air sac called the ventral pouch. Song frequency can be controlled by pouch volume, airflow and cricothyroid muscle action. Singing mouse laryngeal morphology and vocal mechanism are distinct from those of other Neotomids; singing mice appear to use inflation-mediated whistles for both distant and close exchanges. Inflatable air sacs have evolved repeatedly for sound modulation and filtering. Our results indicate a novel role for these structures in being required to generate sound. Together, our results expand on an emerging story of how biomechanic and morphological variation contributes to vocal diversity.

The relation between the vocal capacities of animals and those of humans is a long-standing topic of interest for scientists, philosophers, and lay people alike. While similar neural and physiological substrates underlie the production of vocal signals in humans and animals, the most celebrated and prototypical aspects of language are cognitive phenomena that go far beyond speech sensorimotor processes. These include a subset of features that have begun to be systematically investigated in nonhuman animals, namely: (i) the presence of statistical laws, (ii) hierarchical syntactic rules, and (iii) the capacity for meaning and reference. Here we review recent progress describing and quantifying language-like structure in animal vocalizations. We highlight agreement and disagreement about the similarities that may exist between human language and animal vocal repertoires, with an eye toward what these phenomena may reveal about the evolution of language and its neural control.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Surgery in NF2-related schwannomatosis (NF2-SWN) vestibular schwannoma (VS) carries a higher risk of facial nerve damage, hearing loss, and partial resection, than in sporadic cases. Radiosurgery is also associated with higher failure compared with sporadic schwannomas. Nowadays, bevacizumab (BEV) is frequently considered in the NF2-SWN population. However, some patients experience progression despite treatment. Among other surgical risks, in BEV-treated patients, hemorrhage and impaired healing are specific considerations. These concerns have led manufacturers to recommend stopping BEV 6 to 8 weeks preoperatively. The aim of our multicentric study was to assess the perioperative bleeding risk and postoperative outcomes in NF2-SWN patients undergoing VS surgery after preoperative BEV treatment. METHODS:Our retrospective analysis included medical and surgical records along with imaging reviews from 4 high-volume tertiary academic referral centers for NF2-SWN and VS. RESULTS:A total of 21 patients met the inclusion criteria. VS had a mean volume of 13.2 ±7.6 cm3 corresponding to 1 KOOS III and 20 KOOS IV. BEV was stopped at a mean of 5.8 ± 4.0 months before surgery with a total mean treatment duration of 33.7 ± 20.7 months and a monthly dose of 10.2 ± 4.1 mg/kg. Intraoperatively, the tumor was assessed to be bloody by the operating surgeons in 7 patients. Late BEV discontinuation and high cumulative dose independently predicted perioperative bleeding and longer surgery duration. No other complication such as wound dehiscence was reported. CONCLUSION/CONCLUSIONS:Our findings suggest that a higher cumulative BEV dose (∼600 mg/kg) and a longer interval between BEV discontinuation and surgery (∼8 months) are associated with a modest but statistically significant increase in intraoperative bleeding risk. Based on these observations, a BEV-free window between 6 weeks and 6 months (depending on the clinical scenario) before tumor resection seems optimal, particularly for patients with high cumulative exposure.

The Society of Thoracic Surgeons (STS) 2026 Expert Consensus Pathway on Robotic Cardiac Training outlines principles for the safe initial introduction and subsequent expansion of robotic cardiac programs. The 25-year history of robotic cardiac surgery has established safety and efficacy while providing multiple innovations. There is currently a unique opportunity to coalesce best practices and evidence to inform a recent global surge in interest in incorporating robotic techniques into standard cardiac surgical practice. This consensus is a collaborative effort between the STS Workforce on Evidence Based Surgery, the STS Robotic Cardiac Surgery Taskforce, and multinational leaders in robotic cardiac surgery that aims to standardize initial core principles of preparatory elements, followed by 4 phases of robotic cardiac training to proceed from program commencement to mastery.

OBJECTIVES/HYPOTHESIS/OBJECTIVE:This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures. STUDY DESIGN/METHODS:This was a prospective, case-control observational study conducted at a single outpatient site. METHODS:Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations. RESULTS:Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant. CONCLUSIONS:There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.

OBJECTIVE:To develop an expert consensus statement (ECS) on the diagnosis and treatment of refractory chronic cough (RCC) in adults. RCC was defined as cough lasting longer than 8 weeks and refractory to standard management of pulmonary, gastrointestinal, sinonasal, and medication-induced etiologies. METHODS:An expert panel of otolaryngologists used published consensus statement methodology to develop statements guiding the diagnosis and management of RCC from an otolaryngologic perspective. A modified Delphi method was used to iteratively select, eliminate, and refine statements based upon accepted methodology until consensus was achieved. RESULTS:Three iterative Delphi surveys were performed with discussion rounds between each of the voting sessions. Twenty-seven statements met consensus while six statements did not. The clinical statements were grouped into 9 categories: operational definition, pathophysiology, assessment of prior work-up, phenomenology and symptomatology, four treatment categories (neuromodulators, superior laryngeal nerve blocks, behavioral cough suppression, and emerging treatments), and overall treatment approaches. CONCLUSION/CONCLUSIONS:The panel reached consensus for 27 statements related to the diagnosis and treatment of adults with RCC from an otolaryngologic perspective. These statements may be used to standardize evaluation and improve quality of care, while also identifying areas for future investigation in the management of RCC.

BACKGROUND:There is little data on the relationship between socioeconomic factors and immunotherapy in advanced cutaneous squamous cell carcinoma of the head and neck (cSCCHN). METHODS:Our study analyzed patients with Stage IV cSCCHN diagnosed between 2018-2026 using the EPIC Cosmos database. Socioeconomic status was measured based on the social vulnerability index (SVI) and corresponding themes. Immunotherapy receipt was evaluated with Robust Poisson models. RESULTS:A total of 1140 patients were identified with Stage IV cSCCHN, with 338 (29.6%) of whom received immunotherapy. Higher SVI was associated with a lower likelihood of receiving immunotherapy (incidence rate ratio = 0.96). Patients in the most vulnerable overall SVI quintile had a 29% lower rate of receiving immunotherapy compared to the least vulnerable quintile (p = 0.018). Participants' race/ethnicity, insurance status, and urbanicity were not significantly associated with immunotherapy receipt. CONCLUSION/CONCLUSIONS:Increased social vulnerability is associated with reduced likelihood of treatment with immunotherapy among patients with Stage IV cSCCHN.

INTRODUCTION/BACKGROUND:Sustained ventricular vocal fold (VVF) phonation is an uncommon and often uncomfortable method of vocal production. However, among some singers, including metal vocalists, beatboxers, and throat singers, VVF phonation is common and produced without reported discomfort. Although computational studies and qualitative self-reported data suggest increased air pressure and flow are necessary to produce VVF phonation, quantitative in-vivo aerodynamic data is lacking. OBJECTIVE:To determine the aerodynamic differences between modal true vocal fold (TVF) phonation and two VVF phonation styles (Kargyraa throat singing and mixed vocal distortion) in a trained adult male singer METHODS: TVF and both VVF phonation styles were produced at approximately C3 (∼130Hz) while the singer sustained [a], [i], and [u] three times each, repeated the syllables [pa], [pi], and [pu] five times each, spoke the all-voiced sentence "We were away a year ago," and transitioned between phonation styles on sustained vowels. Sound pressure levels, mean airflow, and mean peak air pressure were compared across tasks and styles. RESULTS:Both styles of VVF phonation showed higher airflow than TVF phonation. Mixed distortion demonstrated instances of 4-fold greater transglottal flow while Kargyraa demonstrated instances of 2-fold greater transglottal flow. Additionally, mean peak air pressure was 2-4-fold greater during the repeated syllables for both VVF styles. Intensity was greater by 2-6 dB SPL in all instances of VVF productions. CONCLUSION/CONCLUSIONS:Overall, airflow, pressure, and intensity were greater in all tasks during VVF phonation. These findings suggest that greater airflow and air pressure are used to sustain these styles of phonation. Future studies will seek to confirm these findings across a diverse set of singers with expertise in VVF phonation and address didactic applications of targeting increased airflow for VVF phonation.

Electrical and structural remodeling of the heart can contribute to the development of cardiac arrhythmias. Ex vivo optical mapping has been used to visualize cardiac electrophysiological properties, activation and phase maps to further elucidate the mechanisms of atrial fibrillation and ventricular fibrillation initiation and persistence. Here we show an epicardial three-dimensional panoramic optical mapping tool integrated with micro-computed tomography automatically segmented with a deep learning model relying on a convolutional neural network to provide structural and electrical activation information in a single three-dimensional volume of a mouse heart. This technique allows for the acquisition and analysis of electrical activity of the entire epicardial surface with submillimeter spatial resolution and a temporal resolution of 1 ms. We establish the use of this method in transgenic mouse hearts with spontaneous atrial fibrillation and ventricular fibrillation, and mouse surgical models of myocardial infarction and left ventricular hypertrophy.