Faculty Bibliography

OBJECTIVE:Pregnancy produces physiologic adaptations that may affect laryngeal tissues, respiratory support for phonation, and voice quality. We performed a scoping review exploring the influence of pregnancy on voice and laryngeal outcomes. DATA SOURCES/METHODS:PubMed, CINAHL, and Web of Science. REVIEW METHODS/METHODS:A scoping review was conducted per PRISMA-ScR guidelines. Searches of PubMed, CINAHL, and Web of Science yielded 1350 studies screened in Covidence by two reviewers. Of 107 full texts reviewed, 22 met inclusion criteria. We included human studies in which pregnancy was the primary exposure and voice-related outcomes were measured. Pregnancy-specific animal studies were included when modeling mechanisms of laryngeal change. RESULTS:Twenty-two studies met inclusion criteria and were grouped into domains: acoustic/aerodynamic (n = 16), patient-reported/perceptual (n = 12), physiologic laryngeal (n = 5), mechanistic animal studies (n = 4), singing voice (n = 4), and respiratory (n = 1); several studies contributed to multiple domains. Acoustic measures (fundamental frequency, jitter, shimmer) were generally unchanged, while multiple studies reported reduced maximum phonation time (MPT) during pregnancy. Subjective voice measures tended to worsen, and singer studies reported reduced vocal range and timbre changes. Physiologic studies noted increased vocal fold edema and reduced motility, most prominent in the third trimester. Mechanistic models supported hormone-associated mucosal changes and altered laryngeal protein expression. CONCLUSIONS:The literature on voice changes during pregnancy is limited and heterogeneous, with evidence concentrated in late pregnancy. Pregnancy is more consistently associated with reduced phonatory efficiency and worse perceived voice function than with major acoustic vocal changes. LEVEL OF EVIDENCE/METHODS:N/A.

BACKGROUND:Mild autonomous cortisol secretion causes substantial cardiometabolic morbidity, yet evidence for benefits following adrenalectomy remains mixed. Prior studies are limited by small sample sizes and heterogeneous definitions. This study evaluates the metabolic impact of adrenalectomy compared with nonoperative management in mild autonomous cortisol secretion using standardized biochemical criteria from the Epic Cosmos database. METHODS:Mild autonomous cortisol secretion was defined biochemically using dexamethasone suppression test cortisol 1.8-10 μg/dL, dexamethasone, and adrenocorticotropic hormone levels. Surgical patients underwent unilateral adrenalectomy with biochemical resolution of hypercortisolism. Inverse probability of treatment weighting was performed, adjusting for demographics, baseline cardiometabolic parameters, dexamethasone suppression test cortisol level, and glucagon-like peptide-1 receptor agonist use. The starting time point was the adrenalectomy date or, for nonoperative patients, the dexamethasone suppression test date plus the median time to surgery. Follow-up outcomes (A1C, lipid profile, body mass index, and blood pressure) were assessed for categorical improvement at last follow-up within 3 years using a weighted logistic regression model. RESULTS:From 2018 to 2025, 395 patients met inclusion criteria (54 surgical, 341 nonoperative). Surgical patients had a higher adjusted likelihood of categorical improvements in A1C (25.6% vs 9.5%, odds ratio, 3.30; P = .002), total cholesterol (14.6% vs 3.9%, odds ratio, 4.25; P = .004), and body mass index (24.9% vs 12.1%, odds ratio, 2.42; P = .018). There were no differences in blood pressure between groups (28.4% vs 26.7%, odds ratio, 1.09; P = .803). CONCLUSION/CONCLUSIONS:This is the largest cohort study to date evaluating metabolic outcomes after surgery for mild autonomous cortisol secretion. Adrenalectomy was associated with categorical improvement in A1C, body mass index, and total cholesterol, supporting more widespread consideration for selective operative management.

OBJECTIVE/UNASSIGNED:We evaluated the Spatial AI model on the Fortell AI hearing aids to see if it improves speech intelligibility in single-azimuth multitalker babble relative to a commercially available control hearing aid employing neural-network-based noise-reduction. DESIGN/UNASSIGNED:In a pre-registered, double-blind, randomised controlled trial, hearing aid users completed a QuickSIN test wearing the Fortell and control devices. Both devices were set to maximise directionality and noise reduction. Objective metrics were also calculated. SAMPLE/UNASSIGNED:Thirty adults with mild to moderately-severe bilateral sensorineural hearing loss. RESULTS/UNASSIGNED:≪ 0.0001). The SNR-50 improved by 9.2 dB and all participants identified more words correctly using the investigational device. Lab measurements showed an SNR improvement over unaided of 2.3 dB with the control device and 15.5 dB with the investigational hearing aid. HASPI v2 showed a similar level of SNR improvement. CONCLUSIONS/UNASSIGNED:Spatial AI yields substantial intelligibility benefits in a controlled single-azimuth multitalker configuration. The effect sizes greatly exceeded established thresholds for clinical significance, suggesting that the algorithm may help address the cocktail party problem for hearing-impaired listeners.

OBJECTIVES/OBJECTIVE:To compare relative proteomic abundance across the human true vocal fold cover (epithelium and superficial lamina propria; TVFC), vocal ligament (intermediate and deep lamina propria; VL), and thyroarytenoid muscle (TA), and to characterize shared and distinct molecular pathways. METHODS:Cross-sectional exploratory proteomic study using tandem mass tag-based quantitative mass spectrometry on tissue from five human male cadaveric larynges (mean age 56.6 years) obtained from a national tissue bank. Differential protein abundance was assessed using linear mixed modeling, and Gene Ontology (GO) enrichment analysis characterized functional specialization across layers. RESULTS:Of 895 quantified proteins, 554 were detected in all three layers, with 181 jointly detected in the TVFC and VL, and 160 detected only in the TA. Differential expression analysis revealed minimal divergence between TVFC and VL (all FDR > 0.10) but robust separation of TA from both the TVFC and VL (FDR < 0.05). GO enrichment demonstrated that TVFC was enriched for inflammatory and immune processes, VL occupied an intermediate position sharing features with both TVFC and TA, and TA demonstrated contractile specialization. CONCLUSION/CONCLUSIONS:This exploratory study provides an initial descriptive comparison of protein expression across human vocal fold layers, with VL serving as a potential transitional zone between the immunomodulatory cover and contractile muscle. These findings confirm the well-established histological, cellular, and functional differences among these layers, and provide preliminary data to inform future studies of laryngeal biology, pathology, and intervention.

OBJECTIVES/OBJECTIVE:This study examined the medical school experiences of current U.S. otolaryngology residents to better understand gender biases that may persist within the specialty and to inform strategies that could improve workforce excellence. METHODS:-value < .05 was considered statistically significant. RESULTS: < .0005). CONCLUSIONS:Persistent gender disparities continue to shape otolaryngology residents' experiences and perceptions, from mentorship access to perceptions of bias. Key targets for intervention include gender-concordant mentorship, early medical school exposure, and addressing inherent bias through educational and department-wide initiatives. Meaningful progress requires collective institutional commitment to structural and cultural change to ensure a more supportive environment for all trainees. LEVEL OF EVIDENCE/METHODS:4.

OBJECTIVE:To evaluate the impact of prolonged unaided duration of deafness (DoD) on speech perception outcomes following cochlear implantation in adults. METHODS:A retrospective review was performed of adult cochlear implant recipients at a single high-volume center between 2012 and 2023. Patients with ≥ 5 years of documented unaided deafness meeting cochlear implant (CI) criteria were stratified into three groups (5-9, 10-19, and ≥ 20 years DoD). The primary outcome was CNC word recognition scores at 3 and 12 months post-operatively. RESULTS:Forty-one patients met inclusion criteria. At 3 months, patients with ≥ 20 years DoD demonstrated lower CNC word recognition scores compared with shorter duration groups. No significant differences were observed between groups at 12 months. Patients without measurable pre-operative hearing thresholds were more likely to be device non-users or fail to achieve open-set speech perception. CONCLUSION/CONCLUSIONS:Patients demonstrated meaningful speech perception outcomes across a range of deafness durations, though longer DoD was associated with slower early improvement. Absence of measurable pre-operative hearing thresholds may identify a subgroup at higher risk for limited functional benefit and should be considered during pre-operative counseling.

PURPOSE/OBJECTIVE:To assess the survival and complication rates of 140 monolithic zirconia implant-supported full-arch fixed complete dental prostheses (IFCDPs) with an up to 8-year follow-up at a private practice setting. MATERIALS AND METHODS/METHODS:A total of 140 edentulous jaws underwent complete-arch fixed implant treatment with a digital workflow and were rehabilitated with monolithic zirconia IFCDPs. The primary outcome was to assess survival and complication rates, whereas the secondary outcome was to measure the cross-sectional surface area (CSSA) dimensions (prosthetic space) of those 140 monolithic zirconia IFCDPs and to correlate potential technical complications with the prosthetic space dimensions. RESULTS:greater, and the difference was statistically significant (p < 0.001). Non-fractured maxillary IFCDPs had a mean posterior linear height measurement (prosthetic space) of 10.58 mm, whereas fractured ones measured 9 mm. The 1.58 mm difference was statistically significant (p = 0.018). Non-fractured mandibular IFCDPs had a mean posterior prosthetic space of 11.89 mm, compared to 9.55 mm in fractured ones. The 2.34 mm difference was statistically significant (p < 0.001). CONCLUSION/CONCLUSIONS:, and the linear measurements should be more than 10 mm during CAD design of the final prosthesis to ensure zirconia prosthesis strength against fracture.

Cochlear implant stimulus phase duration can vary clinically to ensure adequate loudness growth while avoiding current-source compliance limits. These manipulations are typically done without consideration of any possible perceptual changes beyond loudness. However, limited reports in the literature suggest that changing phase duration can also impact pitch. It is well established that changes in multiple perceptual dimensions may be reported as pitch. In this study, phase duration and electrodes were systematically varied, and a multidimensional scaling paradigm was used to test whether perceptual changes caused by changes in phase duration lie along the dimension of place-pitch when observed.

OBJECTIVES/OBJECTIVE:This study aims to validate vocoders as acoustic models of cochlear implants by determining whether they capture both perceptual sound quality and speech performance. We hypothesize that valid acoustic models of cochlear implants require listener-specific amounts of frequency mismatch between input filters and output tones or noise bands. DESIGN/METHODS:Forty-four adult single-sided deaf cochlear implant users were tested 1 to 5 times for a total of 73 sessions at different time points after initial stimulation. Participants had a cochlear implant in one ear and normal or near-normal hearing in the contralateral ear, allowing within-subject comparisons. In Experiment 1, participants used a method-of-adjustment procedure to select acoustic models most similar to their cochlear implant by adjusting three parameters: low- and high-frequency cutoffs of the acoustic output, and channel interaction (overlap among output sound carriers). In Experiment 2, participants rated the perceptual similarity of five acoustic model types using questionnaires assessing overall similarity and four acoustic dimensions (intelligibility, pleasantness, harshness, and loudness). The five model types included the self-selected model, two all-channel frequency-matched vocoders (tone and noise), and two six-channel frequency-matched vocoders (tone and noise). Frequency-matched acoustic models had output noise bands or tones that were frequency-matched to the analysis filters. In Experiment 3, speech perception was evaluated under six conditions: with the cochlear implant alone and with each of the five acoustic model types presented to the normal hearing ear. RESULTS:Nearly all participants (69 of 73 sessions) selected acoustic models with frequency ranges different from their clinical frequency allocation tables. The low-frequency edge of self-selected models was significantly higher than clinical allocations (456 Hz for Cochlear Ltd. and 266 Hz for MED-EL). Over 80% of selections used minimal channel interaction (tones, nonoverlapping noise bands, or adjacent noise bands). Self-selected models received significantly higher similarity ratings (mean of 6.11, where 6 means "somewhat similar" and 7 "very similar") compared with all frequency-matched models, which were rated around 3 ("not very similar"). Self-selected models were rated most similar to the cochlear implant across multiple acoustic dimensions and were the only models not rated significantly different from the cochlear implant on any dimension. For speech perception, all-channel frequency-matched models significantly overestimated performance compared with the cochlear implant for both words and sentences. Self-selected models provided speech scores closest to cochlear implant performance. Joint analysis of similarity ratings and speech perception scores demonstrated that self-selected models were the only acoustic models achieving both perceptual similarity to the cochlear implant (rating of 6.11 with 7 being "very similar") and comparable speech perception scores (within five percentage points). CONCLUSIONS:Frequency-matched acoustic models fail to replicate the sound of a cochlear implant and all-channel frequency-matched acoustic models also significantly overestimate speech perception. In contrast, self-selected acoustic models incorporating listener-specific perceptual frequency mismatch provide substantially better matches in both subjective sound quality and speech intelligibility. However, variability in similarity ratings across individuals may suggest that additional perceptual components remain unaccounted for in the current parameter set. These findings question the validity of frequency-matched acoustic models of cochlear implants in research applications.