Faculty Bibliography

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.

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.

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.

INTRODUCTION/BACKGROUND:With expanded candidacy, cochlear implantation candidates increasingly present with residual acoustic hearing. The level and stability of residual hearing is particularly relevant when considering electro-acoustic stimulation (EAS). While adult data suggest relative stability, the natural history of residual hearing in children-who often have distinct and potentially progressive etiologies-remains poorly defined. METHODS:We conducted a retrospective cohort study of pediatric (<18 years) and adult patients who underwent unilateral cochlear implantation. Inclusion required contralateral (non-implanted) low-frequency pure-tone average (LF-PTA; 250-500 Hz) ≤85 dB HL and interaural difference ≤15 dB HL. One-year changes in LF-PTA, mid-frequency PTA (MF-PTA; 750-2000 Hz), and PTA (500-4000 Hz) were compared using Mann-Whitney U tests. The proportion with clinically meaningful decline (≥15 dB HL) was compared using Fisher's exact test. Longitudinal trajectories were assessed descriptively. RESULTS:Mean one-year LF-PTA, MF-PTA, and PTA changes between children and adults were not statistically different. However, clinically meaningful LF-PTA decline (≥15 dB) occurred more frequently in children (5/24; 20.83%) than adults (2/46; 4.34%) (p = 0.04). Longitudinal trajectories demonstrated substantial inter-individual variability without a consistent pattern of progressive loss. Etiology-specific trends showed relative stability in birth-related hearing loss, whereas ototoxic, genetic, and enlarged vestibular aqueduct etiologies demonstrated greater decline. CONCLUSIONS:Residual low-frequency hearing in children is generally stable but more variable, with a higher rate of clinically significant decline than in adults one year post-implant. These findings suggest underlying disease progression contributes to hearing changes and should inform counseling and EAS candidacy.

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.

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.

OBJECTIVES/UNASSIGNED:To better understand the implications of tumor size on auditory brainstem implant (ABI) categories of auditory performance (CAP) score to facilitate more precise patient counselling. DESIGN/UNASSIGNED:Single-center retrospective chart review. SETTING/UNASSIGNED:Tertiary referral center. PARTICIPANTS/UNASSIGNED:Patients > 18 years old with neurofibromatosis type 2 who underwent ABI placement between the years 2009 and 2023 were included. Patients with prior surgical resection were excluded to reduce the potential of previous cochlear nucleus trauma confounding results. MAIN OUTCOME MEASURES/UNASSIGNED:Ipsilateral tumor volume was measured from the preoperative MRI, and the primary endpoint was the 1-year CAP score. RESULTS/UNASSIGNED: = 0.010). CONCLUSION/UNASSIGNED:Increased tumor size has a negative correlation with ultimate ABI performance. There were patients in this study with larger tumor sizes who still benefited from ABI placement. While larger tumor size should not be a contraindication for ABI placement, understanding the role tumor size can have on performance variation can serve to improve tumor management strategies and preoperative counselling.

BACKGROUND:Women have historically been underrepresented in surgical subspecialties like facial plastic surgery. Authorship is a key metric in career progression; hence, it is important to assay progress in this domain. STUDY OBJECTIVES/OBJECTIVE:To identify trends in female authorship within facial plastic surgery over time. METHODS:Publications from three facial plastic surgery journals were reviewed for the gender of authors from 2007 to 2022. Female authorship across time was compared using chi-squared and Cochrane-Armitage trend tests. RESULTS:= 0.02). CONCLUSION/CONCLUSIONS:Female authorship in facial plastic surgery is increasing over time. First/single authorship is advancing more rapidly, possibly reflecting more female trainees advancing their careers. Further work is needed to support female representation in the facial plastic surgery literature.