Faculty Bibliography

OBJECTIVE:To evaluate cochlear implant (CI) speech perception and usage outcomes in patients after prolonged unilateral deafness. METHODS:Retrospective cohort study at five tertiary academic centers of adult patients with prolonged (> 10 years) unilateral severe to profound hearing loss who underwent cochlear implantation. Main outcome measures included post-operative word recognition scores (WRSs) and average daily usage of CI. RESULTS:A total of 68 patients were analyzed with a median duration of unilateral deafness of 17 years (IQR, 12-35 years). The mean individual average daily CI usage was 8.4 h (SD, 4.5 h) at ≤ 1 year after implantation and 7.1 h (SD, 5.0 h) at > 1 year. The majority of patients (54.5%, 30 patients) had an absolute increase in WRS of ≥ 20% after implantation and 32.7% (18 patients) had an absolute increase of ≥ 50%. Univariate analysis comparing pre- and post-operative speech recognition in patients who completed the same test revealed a clinically and statistically significant improvement, with a mean change of 28.4% (SD 31.6%; p < 0.001) at their latest audiogram. In the analysis excluding those without post-operative data, duration of deafness was not predictive of post-CI WRS on multivariable analysis. CONCLUSIONS:Most patients with prolonged unilateral auditory deprivation in our study benefited from a CI. Although the duration of auditory deprivation was found to be inconsistently associated with poorer CI speech perception performance, our findings support individualized CI candidacy assessment and suggest that prolonged deafness alone should not be used as an absolute exclusion criterion for cochlear implantation.

BACKGROUND:Starting a pediatric subspecialty fellowship presents numerous challenges to trainees. Virtual Symposium of Pediatric Hematology/Oncology of New York (v-SYMPHONY), an educational collaborative organized by 18 pediatric hematology-oncology (PHO) programs, initiated an annual bootcamp in 2022 aimed at easing the transition from pediatric residency to PHO fellowship. METHODS:The bootcamp consisted of virtual clinical lectures and fellow-led panels, which were created with input from diverse program leadership, educators, and past fellows using Kern's six-step module of curriculum development. It was offered to incoming fellows, first in the NY/NJ/CT region, and subsequently expanded nationally. RESULTS:Over 4 years (2022-2025), 147 pediatric residents completed this virtual bootcamp. The number of residents attending the live sessions increased from 19 in 2022 to 62 in 2025. Forty-four participants completed pre- and post-bootcamp surveys over this period, which showed significant improvement in both self-reported medical knowledge and preparedness and reported a decrease in transition to fellowship anxiety scores. CONCLUSION/CONCLUSIONS:These results highlight the need and benefits of a standardized orientation program that can be delivered virtually to ease the transition of PHO trainees from residency to fellowship. Such a standardized curriculum is feasible, adaptable, and potentially scalable to a national level.

BACKGROUND:Posterior circulation large-vessel occlusion strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT perfusion-based critical area perfusion score (CAPS), CT angiography-based basilar artery treatment management and posterior circulation CT angiography scores, and CT angiography source image or noncontrast CT-based posterior circulation Alberta Stroke Program Early CT Score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared. METHODS:We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: posterior circulation Alberta Stroke Program Early CT Score, basilar artery treatment management score, posterior circulation CT angiography score, and CAPS. The primary outcome of interest for the study was a favorable functional outcome at 3 months (modified Rankin Scale score, 0-3). We calculated sensitivity, specificity, positive and negative predictive values, and generated receiver operating characteristic curves measuring area under the curve (AUC), which were compared with nonparametric methods. RESULTS:=0.23, respectively). CAPS ≤3 demonstrated 100% sensitivity and negative predictive value (95% CI, 92.6-100.0%; 95% CI, 75.7-100.0%, respectively) for good outcome but had low specificity (24.0% [95% CI, 14.3-37.4]). CONCLUSIONS:The CT perfusion-based CAPS had the best performance for predicting good functional outcome at 3 months and had high sensitivity and negative predictive values though our finding is limited by the small number of patients who had CAPS >3. The CAPS should be validated in prospective studies.

Myelofibrosis (MF) is a chronic, progressive myeloproliferative neoplasm characterized by bone marrow fibrosis, ineffective blood cell production, and neoplastic extramedullary hematopoiesis (EMH) occurring primarily within the spleen. To explore the molecular mechanisms underlying splenic EMH, we performed single-cell transcriptional and chromatin profiling of cells from MF spleens that had been surgically removed. We demonstrate significant expansion of hematopoietic stem and progenitor cells, coupled with aberrant differentiation toward the erythroid and megakaryocytic lineages, associated with a significant enrichment of inflammatory pathways with enhanced NF-κB signaling and IFN responses, as well as dysregulation of the inferred function of differentiation-defining transcription factors. Finally, we report a significant remodeling of the immune microenvironment in MF spleens, characterized by emergence of dysfunctional T cell subsets and inflammatory memory B cells, suggesting the concomitant establishment of a pro-inflammatory and immune-tolerant tumor microenvironment within the spleen that influences hematopoietic cell differentiation and impairs tumor immune surveillance.

What is a 'natural' behavior? I argue that the study of natural behaviors is often the study of the spontaneous behaviors of animals placed in quantifiably different environments. For behavioral generalists such as rodents, humans, and many other species, there may be no such definable construct as a native habitat or 'natural behavior', due to their successful abilities and needs to rapidly adapt to a wide range of different ecosystems. Instead of prioritizing naturalness, it may be more essential to determine objective outcome measures related to specific behaviors; i.e., which sequences of behaviors and adaptive mechanisms allow animals to survive and reproduce across a range of dynamic or hazardous physical and social environments.

OBJECTIVE:Belting is a vocal quality commonly used across contemporary singing genres. Despite its ubiquity, belting production and perception are highly debated. Variable methodologies and terminology used to discuss, teach, and study belting limit our understanding of underlying mechanisms and restrict the development of science-informed voice pedagogy. We systematically examined the published literature on belting to identify commonalities, disagreements, and directions for future research. METHODS:We conducted a scoping review surveying English-language peer-reviewed scientific studies and pedagogical publications on belting in adult singers that were published between January 1978 and November 2025. Data were extracted and grouped into the following categories: perception, acoustics, physiology, and pedagogy. RESULTS:In total, 2018 publications were reviewed. 472 underwent full-text review, and 112 met inclusion criteria, comprising 58 scientific studies and 54 pedagogical publications. Most scientific studies were cross-sectional comparing the same group or population across variable tasks (n = 25), and pedagogical publications were largely expert commentary (n = 32). Perceptually, belting was characterized as having "bright" or "forward" resonance and increased loudness. Acoustic findings included higher first and second formant frequencies, with the first formant tuned to the second harmonic. Physiologically, belting was associated with an elevated laryngeal position, pharyngeal narrowing, closed quotient >50%, high subglottal pressure, and "megaphone" mouth shape. High individual variability was a hallmark of all findings. Terminology was highly variable, with over 100 words and phrases used to describe belting. CONCLUSIONS:High variability of findings suggests that belting is better understood as a family of related vocal behaviors than as a single, homogeneous phenomenon. We propose three tenets for future work: (1) use of objective acoustic and physiological terminology to define belting, (2) inclusion of multiple terminologies where appropriate to reflect the diversity of learning styles and individual physicality, and (3) use of auditory anchors to supplement written definitions and reduce perceptual ambiguity.

OBJECTIVE:Maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnea (OSA) after tracheotomy. However, the influence of patient characteristics such as age and gender on MMA outcomes remains understudied. This meta-analysis evaluates MMA outcomes stratified by age and gender. DATA SOURCES/METHODS:A comprehensive literature search of CINAHL, Cochrane Library, PubMed, and Scopus was performed from inception through 2026. Studies reporting age- or gender-specific outcomes of MMA for adults with OSA were included. REVIEW METHODS/METHODS:Extracted data included cephalometric measurements, apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), SpO2 nadir (LSAT), surgical success, and cure rates. Meta-analysis was performed. RESULTS: = 1.17 [95% CI 0.51-2.69]). Increasing age was associated with decreased surgical success and cure, although only the decline in odds of cure reached statistical significance (OR = 0.97 annually, p = 0.029). CONCLUSION/CONCLUSIONS:Maxillomandibular advancement yields significant improvements in OSA outcomes regardless of age or gender. While outcomes are generally consistent across groups, clinicians should counsel older adults on the reduced likelihood of surgical cure. LEVEL OF EVIDENCE/METHODS:N/A.

PURPOSE/OBJECTIVE:Laser surgical management of human papillomavirus (HPV)-related disease, such as recurrent respiratory papillomatosis (RRP), in the upper aerodigestive tract generates surgical smoke, which may represent a source of occupational viral exposure for laryngeal surgeons, phoniatricians, anesthesia providers and scrub nurses. Despite growing awareness, protective measures remain inconsistently implemented. This study aimed to develop an evidence-informed clinical consensus statement (CCS) to guide occupational HPV risk management in laryngology. METHODS:A modified Delphi consensus process was conducted under the auspices of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP). A panel of 26 international experts undertook three rounds of voting on 18 statements across five domains: definitions and risk perception, personal protective measures, smoke evacuation and ventilation, preventive vaccination, and areas for further research. RESULTS:All panellists completed all three rounds. Of the 18 statements, one reached strong consensus, seven reached consensus, one reached near consensus and six did not reach consensus. Three statements were merged across rounds. Key areas of consensus included the recognition of surgical smoke as a potential occupational HPV exposure risk, the inadequacy of standard surgical masks, the importance of offering HPV vaccination to healthcare workers with potential occupational exposure, alongside areas for further research. CONCLUSION/CONCLUSIONS:This joint ELS and UEP CCS represents the first internationally coordinated effort to address occupational HPV exposure in laryngology. While consensus was reached in several key areas, the findings underscore the need for targeted research and greater consistency in protective measures, educational provision and regulatory frameworks.

BACKGROUND:Although medications for opioid use disorder (MOUD) improve outcomes for persons with opioid use disorder (OUD), it is unclear whether augmentation with mutual help groups (MHGs), such as 12-Step programs, enhances abstinence following jail release. This study examined how MHG and MOUD together affect abstinence in persons with problematic opioid use in the 6 months post-incarceration. METHOD/METHODS:We subset to 328 adult participants who completed baseline, 3- and 6-month follow-ups. All screened positive for problematic opioid use upon discharge from jail, primarily in Chicago. Participants reported days of MHG and MOUD participation and days abstinent from illicit opioids. Both supports could be accessed in any combination. Beta-binomial models estimated the effects of MHG and MOUD participation at 3 months on abstinent days at 3 and 6 months, adjusting for relevant baseline factors. RESULTS:At 3 months, each day of MHG participation was associated with + 0.4 days of opioid abstinence. MOUD days showed a similar effect (+0.3 abstinent days). At 6 months, 3-month MHG and MOUD days continued to predict greater abstinence to a smaller degree (+0.3 and +0.1 days, respectively). Together, MHGs were associated with greater abstinence only among individuals receiving low levels of MOUD at 3-months. No MHG×MOUD interaction was observed at 6-months. CONCLUSION/CONCLUSIONS:Our findings highlight the benefits of incorporating MHGs and MOUD to support abstinence from illicit opioids while extending prior work to a predominately Black, post-incarceration sample. Further research should examine factors influencing the combined effects of MHG and MOUD participation.