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Background: Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal‐abnormal ratings, objective measurements have been developed. We compared the inter‐rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods: Two blinded raters analyzed the subjective normal‐abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter‐rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results: In the pharyngeal findings, the subjective analysis inter‐rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter‐rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions: The subjective analysis had moderate to strong inter‐rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter‐observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Videofluoroscopy (VFS) is the gold standard in evaluating dysphagia. Water swallow tests (WST) and the Eating Assessment Tool (EAT‐10) are commonly used in dysphagia screening. We aimed to determine the feasibility of WST and EAT‐10 as screening tools for referral to VFS. Methods: Patients (n = 150, median age: 70.0 years, range: 19–92 years, 58.7% female) referred to VFS completed the WST and EAT‐10 before the examination. In the WST, we evaluated both the qualitative parameters (coughing, possible change in voice) and quantitative parameters (average drinking bolus size, swallowing speed). Correlations of EAT‐10 total scores and WST parameters to the VFS findings were analyzed both individually and combined. Results: In the WST, the most specific (89.7%) predictor of normal VFS findings was the absence of coughing, and the most sensitive (79.1%) parameter to predict abnormal findings was a bolus size of ≤20 mL. Using a combination of coughing and a bolus size ≤20 mL (simplified WST), the sensitivity of predicting abnormal findings increased to 83.5%. The most sensitive (84.6%) predictor of penetration/aspiration was failing any parameter in the WST. Lack of coughing indicated an absence of penetration/aspiration with an 82.5% specificity. Swallowing speed or combining the EAT‐10 results with the WST results did not enhance the sensitivity or specificity of the WST for predicting the VFS results. Conclusions: Coughing and average drinking bolus size are the most important parameters in WST when screening for referral to VFS, whereas the swallowing speed does not seem to be useful. The WST is superior to EAT‐10 in predicting VFS findings. Level of Evidence: 4 Laryngoscope, 134:1349–1355, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To assess malignant transformation rate, non‐sinonasal malignancies, and factors contributing to recurrence in patients treated for sinonasal inverted papilloma (SNIP). Study Design: Retrospective study. Methods: We retrospectively reviewed medical records of all patients treated for SNIP (n = 296) between the years 1984–2014 at Helsinki University Hospital. Data from the Finnish Cancer Registry confirmed the number of those patients with sinonasal and non‐sinonasal malignancies. Results: Only 2 of 296 (0.7%) patients primarily diagnosed with benign SNIP developed sinonasal cancer in a mean follow‐up of 5.8 years. The most common non‐sinonasal cancer sites were similar to those reported for the whole Finnish population. None of the patients presented with an HPV‐associated non‐sinonasal malignancy. The recurrence rate among patients who underwent attachment‐oriented surgery was significantly lower compared to those operated on with other approaches (40.2% vs. 56.6%, p = 0.006). Dysplasia in SNIP was associated with a higher recurrence rate (p < 0.001). Conclusions: Malignant transformation of SNIP was rare. Patients with SNIP were not prone to HPV‐associated non‐sinonasal malignancies. Endoscopic resection and attachment‐oriented surgery have become predominant approaches in the treatment of SNIP; meanwhile, the total number of SNIP recurrences has decreased. Level of Evidence: 3 Laryngoscope, 133:506–511, 2023 [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to evaluate human papillomavirus (HPV) occurrence in sinonasal inverted papilloma (SNIP), and to assess factors associated with HPV positivity and SNIP recurrence. Study Design: Prospective study. Methods: We prospectively collected clinical data and fresh tissue specimens from 90 consecutive patients treated for SNIP at Helsinki University Hospital, between 2015 and 2019. Fourteen patients with recurrent SNIP underwent repeated tumor sampling. All tissue specimens were analyzed for the presence of HPV. Factors associated with SNIP recurrence and HPV positivity were assessed. Results: Among 107 SNIP specimens, 14 (13.1%) were positive for low‐risk HPV and 6 (5.6%) were positive for high‐risk HPV. HPV positivity was associated with an increased risk of recurrence (P =.004). Smoking was significantly associated with HPV positivity in SNIP (P =.01), but a history of HPV‐related diseases or patient sexual habits did not correlate with HPV positivity. The recurrence rate was lower among patients with SNIP that underwent an attachment‐oriented resection, compared to patients treated without attachment‐oriented resections (78.6% vs 25.8%, P <.001). Conclusions: The risk of SNIP recurrence was highly associated with 1) HPV positivity and 2) surgery without an attachment‐oriented resection. Oncogenic HPV was rare in SNIP. Level of Evidence: 3 Laryngoscope, 132:1714–1718, 2022 [ABSTRACT FROM AUTHOR]