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Objectives/hypothesis: The aim of this study was to define the coprevalence of tremor with spasmodic dysphonia (SD).Study Design: A single-institution, prospective, case-control study was performed from May 2010 to July 2010.Methods: Consecutive patients with SD (cases) and other voice disorders (controls) were enrolled prospectively. Each participant underwent a voice evaluation and an evaluation for tremor.Results: There were 146 voice disorder controls and 128 patients with SD enrolled. Of patients with SD 26% had vocal tremor, 21% had nonvocal tremor. Patients with SD were 2.8 times more likely to have coprevalent tremor than the control group (odds ratio = 2.81; 95% confidence interval, 1.55-5.08), and only 35% of patients with SD had been seen by a neurologist for the evaluation of dystonia and tremor.Conclusions: Tremor is highly prevalent in patients with SD. It is important for each patient diagnosed with SD to undergo an evaluation for tremor, and this is especially important in patients diagnosed with vocal tremor. [ABSTRACT FROM AUTHOR]

It is a growing belief that cellular phone use may be hazardous to the voice. This study aims to assess voice production in different conversational scenarios to identify any changes in vocal production that may be specific to cellular phone use. Twenty healthy participants were randomized to seven conversational scenarios: quiet conditions face to face; quiet conditions over a landline; quiet conditions using a cellular phone (QCP); quiet conditions using cellular phone with earpiece (QCPE); noisy conditions face to face (NFF); noisy conditions using cellular phone (NCP); and noisy conditions using cellular phone with earpiece (NCPE). In each condition, participants performed spontaneous speech, a standardized reading passage, and sustained voicing. Sound pressure levels (dB SPL) and fundamental frequencies (F(0)[Hz]) were measured. Subjects completed a 100-mm visual analog scale measuring vocal effort after each speaking scenario. Statistical analysis was performed using analysis of variance (ANOVA). There was a significant difference in dB SPL and F(0) between all quiet conditions relative to all noisy conditions (P<0.001). There was no difference in cellular phone use relative to any other conversational condition in mean dB SPL, respective of ambient noise. Vocal effort was rated greater for noisy conditions compared with quiet conditions. Cellular phone use does not lead to a significant change in voice production relative to other speaking conditions. Voice problems associated with cellular phone use may simply be a function of the increased amount of voice use and increased vocal loudness (Lombard effect) associated with speaking in noisy situations rather than a variable inherent to the phone. [ABSTRACT FROM AUTHOR]

To determine the effectiveness of Botox treatment for adductor spasmodic dysphonia (ADSD), the clinician and patient judge changes in voice symptoms and the effect on quality of life. Currently, there is no standard protocol for determining the effectiveness of Botox injections in treating ADSD. Therefore, clinicians use a variety of perceptual scales and patient-based self-assessments to determine patients' impressions of severity and changes after treatments. The purpose of this study was to assess clinician-patient agreement of the effects of Botox on voice quality and quality of life in ADSD. Retrospective chart review of 199 randomly selected patients since 2004. Results indicated a weak correlation between the patient's assessment of voice impairment (EIS) and patient's quality of life impairment (Voice-Related Quality of Life [V-RQOL]) in the mild-moderate dysphonia severity group and the moderate-to-severe dysphonia group. There was a weak correlation between the patient's assessment of voice impairment EIS and the clinician's perceptual judgment of voice impairment (Consensus Auditory Perceptual Evaluation of Voice [CAPE-V]) only in the moderate to severe dysphonia group. There was a weak correlation between the patient's quality of life impairment (V-RQOL) and the clinician's perceptual judgment of voice impairment (CAPE-V) only in the severe to profound dysphonia group. The poor relationship among commonly used outcome measures leads us to question how best to assess the effectiveness of Botox in ADSD. Clinicians are required to document treatment outcomes, making it important to use scales that are valid, reliable, and sensitive to change. Future research directions include examining relationships between measures both before and after Botox injections, examining the specific factors that determine quality of life changes, and further research on specific parameters of the CAPE-V as well as comparing perceptual and quality of life scales with acoustic and aerodynamic measures in this population would be beneficial in the move toward more effective ways of measuring change. [ABSTRACT FROM AUTHOR]

SUMMARY: The purpose of this study was to investigate the correlation between the Voice Handicap Index (VHI) and the Voice-Related Quality of Life Measure (V-RQOL), and to test conversion of scores between the two instruments. Understanding the relationship between instruments will facilitate comparison of voice outcome studies using different measures. A retrospective medical chart review of 140 consecutive patients with a chief complaint related to their voice presenting for speech pathology voice evaluation following laryngology evaluation and diagnosis was adopted. Each patient who filled out the VHI and V-RQOL within a 2-week period with no intervening treatment was included in the study. Correlation analysis for total scores was performed for the patients meeting inclusion criteria (n=132). Correlations were also performed as a function of diagnosis. Calculated VHI score based on measured V-RQOL score was compared to measured VHI score. Pearson correlation between scores on the VHI and V-RQOL was -0.82. There was no significant difference between the mean measured and mean calculated VHI scores. For individual scores, however, regression analysis did reveal a significant difference between calculated and measured VHI. The VHI and V-RQOL are highly correlated; however, this study suggests that the two instruments are not interchangeable for individuals. [ABSTRACT FROM AUTHOR]

The article discusses the clinical case of a 67-year-old woman who experiences dysphagia for solids at the area below the cricoid cartilage. The patient also had a previous revision anterior cervical spine surgery. Results of a transnasal esophagoscopy show a partial esophageal obstruction being caused by an anterior cervical spine hardware. It notes that diagnostic information that was not provided clearly by other diagnostic modalities such as laryngoscopy and barium swallow study was yielded by transnasal esophagoscopy.

Purpose: Research and lived experience demonstrate that sexual orientation and gender identity (SOGI) can change over the life course; however, little empirical work exists to understand the prevalence of such changes. To address this gap, we used data from a large nationally representative panel of adults and adolescents to assess changes in self-reported SOGI over time and identify trends by sex assigned at birth, age, race and ethnicity, and survey mode. Methods: We reviewed SOGI data collected between 2014 and 2022 for a sample of 19,469 adults and 970 adolescents. Up to eight SOGI measurements per panelist were available over the nine-year period, collected through a combination of panel recruitment and demographic refresh surveys and topic-specific surveys. Results: Among adults older than 18 years, 4.1% reported a change in sexual orientation and 3.6% reported a change in gender identity. Among teens, who are developmentally more apt to change identity, 13.5% reported a change in sexual orientation and 9.3% reported a change in gender identity. Conclusions: Findings demonstrate that SOGI can change over time, particularly for adolescents, so it is important to re-ask SOGI questions to ensure current information. We recommend re-asking SOGI questions at least every three years of adults and every two years of adolescents. Potential undercounting of sexual and gender minority (SGM) respondents decreases visibility and our ability to understand health and economic disparities affecting these populations. Improvements in SOGI measurement can help advance data quality and, ultimately, evidence-based interventions in support of SGM communities that these data help to inform.

Objective: Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features., Methods: Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality., Results: One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, ( p  < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%)., Conclusions: In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs., Level of Evidence: Level 3: Retrospective cohort study., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Although outcomes account for 45% of the total ranking score in otolaryngology in the 2023-2024 U.S. News Best Hospitals rankings, little attention has been paid to the representativeness of their outcomes or volume analyses. Through retrospective review of finance data from an academic otolaryngology department, we found the overall 2023-2024 USNWR volume estimate accounted for only 10.0% (n = 2, usw 024/20,334) of all adult admissions and outpatient procedures and did not adequately represent the overall case mix or caseload., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function., Methods: In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated., Results: In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases., Conclusions: PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs., Level of Evidence: 3: Prospective cohort study, with blinded analysis Laryngoscope, 134:5021-5027, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To describe the clinical courses and interventions of symptomatic patients with bilateral vocal fold motion impairment (BVFMI) attributed to diffuse idiopathic skeletal hyperostosis (DISH)., Study Design: Retrospective cohort study., Setting: Single Institution Academic Health Center., Methods: Retrospective chart review of patients ≥18 years old evaluated and treated for symptomatic BVFMI secondary to DISH between February 2021 and March 2023. A literature review was conducted., Results: A total of 4 cases were identified. All patients were male and had symptomatic BVFMI attributed to cervical spine DISH, as seen on imaging. Symptoms ranged from life-threatening dyspnea to breathy dysphonia in addition to dysphagia. Each patient was offered surgery for DISH. Two patients underwent osteophyte removal at the C5-C6 level with improved vocal fold (VF) mobility, breathing, and voice quality. Two patients elected serial observation as voice, swallow, and airway symptoms were manageable. The literature review showed a male-dominant (100%) presentation with an average of 70 years of age. Hypertension (45%) and diabetes mellitus (36%) were the most common comorbidities. Most patients were treated surgically (55%)., Conclusion: Both surgical and conservative interventions may be considered for symptomatic relief and improvement in VF mobility on a patient-to-patient basis. Further study is warranted to investigate the etiology and treatment outcomes in these cases., Competing Interests: None., (© 2024 The Author(s). OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: To determine postgraduate job selection, percentage of career movement, factors influencing these decisions, and job satisfaction of laryngologists within academic and nonacademic fields., Study Design: Cross-sectional survey., Setting: Nonacademic and academic laryngology practices across the United States., Methods: A 21-question survey including the Job Satisfaction Questionnaire (JS-Q) was electronically administered between October and December 2023. Student's t test and logistic regression analysis were used for statistical analysis., Results: There were 134 (49.26%) complete responses, including 99 (64 males, 34 females, 1 undisclosed) laryngologists in the academic cohort and 35 (25 males, 9 females, 1 undisclosed) in the nonacademic cohort. No association was found between year of initial employment and probability of choosing an academic job (coefficient of variation = 0.02, odds ratio = 1.02, P = .56). A higher percentage of physicians transfer from nonacademics to academics (22.86%) than vice versa (5.05%, P = .002). Factors including lifestyle, pay, leadership, and research support influence career movement and satisfaction. There was higher job satisfaction in the nonacademic group in all domains of JS-Q except for Training and Development (3.81 vs 3.84, P = .81)., Conclusion: Over time, the rate of laryngologists pursuing nonacademic versus academic positions has been stable, despite the increasing number of laryngologists. Career satisfaction is high in both academic and nonacademic laryngologists, although higher in nonacademic. Despite this, a higher percentage of physicians transfer from nonacademic to academic positions than the converse. Factors including lifestyle, pay, lack of leadership support, and research support influence career movement and satisfaction., (© 2024 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Objective: Vocal fold injection medialization (VFIM) is widely used as an initial treatment for unilateral vocal fold paralysis (UVFP). Current practices employ materials that share the limitation of temporary clinical effect from variable resorption rates. A novel silk protein microparticle-hyaluronic acid-based material (silk-HA) has demonstrated cellular infiltration and tissue deposition that may portend a durable medialization effect. We report on ≥12 months outcomes after VFIM with silk-HA., Methods: Prospective open-label study of patients with UVFP that elected treatment with VFIM with silk-HA. Blinded experts rated laryngeal stroboscopic exams., Results: Seventeen patients with UVFP underwent VFIM with silk-HA. Twelve of the 17 patients have ≥12 months follow-up. Seven patients demonstrated durable treatment benefit ≥12 months after injection with median improvement of 19 (p = 0.0156) in VHI-10. There was no significant change in VHI-10 between 1 and 12 months for these patients. Blinded ratings indicated that 5/7 patients with sustained improvements in VHI-10 exhibited complete or touch glottal closure at 12 months. Two of the seven patients exhibited a small (<1 mm) glottal gap at 12 months. Seven patients experienced initial benefit with later regression 3-4 months after injection., Conclusion: VFIM with silk-HA can offer durable improvement in voice-related outcomes for UVFP past 12 months. A subset of patients treated with silk-HA experienced early loss of effect around 3-4 months postinjection. Clinical factors predictive of sustained treatment response to silk-HA injection require further exploration., Level of Evidence: 3 Laryngoscope, 134:3679-3685, 2024., (© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI-generated information sources. This study assessed the quality of ChatGPT responses to such queries., Methods: In this cross-sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self-care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p  < .05., Results: On a scale of 1-5, with 5 representing the greatest appropriateness or overall score and a 4-point scale with 4 representing the highest accuracy, the responses exhibited moderately high appropriateness (mean = 4.10, SD = 0.90), high accuracy (mean = 3.55, SD = 0.50), and moderately high overall scores (mean = 4.02, SD = 0.86). Scoring between response categories (self-care recommendations, complication recommendations, lifestyle adjustments, and special device considerations) revealed no significant scoring differences. Suboptimal responses lacked nuance and contained incorrect information and recommendations. Readability indicated college and advanced levels for FRE (Mean = 39.5, SD = 7.17) and FKRGL (Mean = 13.1, SD = 1.47), higher than the sixth-grade level recommended for patient-targeted resources by the NIH., Conclusion: While ChatGPT-generated tracheostomy care responses may exhibit acceptable appropriateness, incomplete or misleading information may have dire clinical consequences. Further, inappropriately high reading levels may limit patient comprehension and accessibility. At this point in its technological infancy, AI-generated information should not be solely relied upon as a direct patient care resource., Competing Interests: None., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objective: To compare patient, disease and treatment characteristics of patients treated for recurrent respiratory papillomatosis (RRP) at a public county versus a private hospital., Methods: A retrospective cohort study was conducted of adult patients undergoing treatment for RRP at a tertiary-care academic center (TAC, n = 48) versus public safety net hospital (PSNH, n = 14), both staffed by the same Otolaryngology providers., Results: There was no difference between cohorts in age, gender, medical comorbidities, history of juvenile-onset presentation, or history of prior treatment at a different institution. PSNH patients were more likely to be Hispanic/Latino, primarily speak Spanish, have public or no insurance, and reside in a zip code with lower median income compared with TAC patients. Despite living significantly closer to the hospital, PSNH patients were more likely than TAC patients to present with respiratory symptoms (50% versus 20.8%, P = 0.04), and exhibit more than one involved laryngeal subsite at their first surgical intervention (78.6% versus 27.1%, P = 0.001). They also had high rates of referral for otolaryngologic care via the emergency department (42.9%) rather than outpatient specialty referral (35.7%) and were more likely than TAC patients to require urgent intervention (21.4% versus 2.1%, P = 0.03). There was no difference in time interval from first clinic visit to procedure date or total number of treatments., Conclusions: PSNH patients present with more severe and symptomatic RRP disease compared with TAC patients. This finding may be related to sociodemographic disparities leading to poorer access in care., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Transgender and gender diverse youth experience multiple disproportionate adverse sexual health outcomes. Sexual health education teaches knowledge, attitudes, and skills for promoting sexual health, including reducing risk for sexually transmitted infection, HIV acquisition, and unintended pregnancy. Provision of sexual health education may be protective, but research remains scarce., Methods: We conducted a multi-stage thematic analysis of 33 in-depth interviews among transgender and gender diverse youth (ages 15-24) living in the southeastern United States on their sexual health education experiences., Results: Our study participants described school-based sexual health education as unhelpful due to a lack of relevant information, inadequately prepared teachers, and a perceived negative tone toward sexuality. They reported relying on online sources of sexual health information, finding relevant content and community despite some limitations. Participants desired content and pedagogy that expands beyond binary and white-centric presentations of sexuality and gender and sought resources that provide relevant, accurate, and judgment-free information while holding positive framing around sexuality and gender., Conclusion: There is much work needed to improve the breadth, quality, and relevance of school-based sexual health education. Sexual health education can improve by strengthening critical media literacy skills of youth; raising staff cultural competency on gender, race, and sexual identity through training and supports; using culturally relevant and inclusive curricula; and partnering with community-based organizations. Transgender and gender diverse youth would benefit from sexual health education from multiple sources which is queer-friendly, affirms their existence, and provides information on gender, race, and sexuality in positive and expansive ways., (© 2024 University of Ottawa. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Objective: Decision-making regarding behavioral versus procedural intervention in the treatment of presbyphonia has not been well defined. The study objective was to survey laryngologists' reported practice patterns and decision-making in presbyphonia., Methods: All laryngology faculty in U.S. academic medical centers with residency programs were recruited to complete an anonymous 29-item survey regarding decision-making in presbyphonia treatment. The survey included 5 sections: demographics, first-line treatment distribution, factors that drive decision-making toward procedural intervention, treatment progression if first-line treatment is insufficient, durable treatment., Results: Of 153 laryngologists surveyed, 89 responded (58%). Voice therapy (VT) was the most often reported first-line treatment, with 57% of respondents indicating the majority of their patients receive VT initially. Most respondents (83%) indicated they occasionally use procedural intervention as first-line treatment. Factors driving first-line procedural intervention were severe glottal insufficiency (87%), high occupational/social voice demands (76%), voice not stimulable for change (73%), difficulty attending VT (70%), severe dysphonia (65%), and dysphagia (61%). The majority of respondents indicated the following do not affect their decision to pursue procedural intervention: patient age (88%); medical comorbidities (63%); patient's desire for a "quick fix" (55%); patient-reported outcome measures (51%). Most respondents (81%) use trial injection augmentation before durable treatment. Of durable treatments, bilateral thyroplasty was preferred (71%), followed by CaHA (15%) and lipoinjection (11%)., Conclusions: This study is the first to our knowledge to examine factors that influence decision-making in presbyphonia treatment. While VT remains the most frequent first-line treatment, study results better inform decision-making regarding first-line procedural intervention., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: 1. To survey how vocal fatigue manifests itself in the vocal range of a sample of professional, female opera singers. 2. To assess laryngeal videostroboscopic changes of one professional, female opera singer before and after extended operatic singing., Methods: Survey study: 296 professional, female opera singers were recruited to participate in an anonymous research survey querying the temporary impact of vocal fatigue in professional, female opera singers. 46.3% of participants described themselves as singing mainstage roles at large, A-level opera houses. Singers were asked to report where in their vocal range they experienced the effects of vocal fatigue and could choose more than one response. Single-subject study: One professional, female opera singer (the author) underwent two laryngeal videostroboscopic exams pre and post vocal loading. The exams were evaluated and compared independently by two blinded laryngologists., Results: The results of the survey found that 42.9% of the total responses from professional, female opera singers indicated a temporary impact on the lower middle range (≈C4-F4) as a result of vocal fatigue. 36.5% of participants experienced a temporary impact on their lowest range (≈below C4) and 19.6% reported a temporary impact on their higher range due to vocal fatigue. The results of the single-subject study showed reduced glottal closure pattern in the postloading, lower middle range, head voice condition., Conclusions: A large proportion (64.9%) of the professional, female opera singers surveyed reported increased difficulty navigating their lower middle range and/or lowest range after extended operatic singing. These results support the single-subject study, which found that after vocal loading, there was a decrease in glottal competence while singing in head voice in the lower middle range., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Idiopathic subglottic stenosis (iSGS) is a rare condition involving the subglottic larynx and upper trachea, commonly affecting Caucasian females between 30 and 50 years of age. Despite its homogeneous presentation, clinical management for iSGS is yet to be standardized, leading to variability in outcomes between predominant interventions. In recognition of the heterogenicity in iSGS treatment and the need to improve patient outcomes, this study aimed to survey laryngologists to understand the factors influencing clinical decision-making and the incorporation of new treatment modalities for iSGS., Methods: An online survey was sent to 145 academic laryngologists. The survey assessed respondents' professional backgrounds, experience treating iSGS, treatment algorithms, and how various patient factors affect management., Results: Of the 87 (60%) laryngologists who responded to the survey, the most common clinical assessments were tracheoscopy/bronchoscopy (96.8%) and pulmonary function tests (43.6%). Endoscopic dilation (ED) was the most common primary treatment offered (97.5%): 28.7% of surveyed laryngologists offer SISI as a primary treatment, and 74.7% perform SISI as a planned postoperative treatment. The most common SISI protocol was repeated injections every 4-6 weeks for a series of 1-3 total injections. Notably, 9.2% perform the Maddern procedure. Routine algorithms of care involving surgery were most often based on prior experience and prior patient outcomes (75.9%) and conversations with colleagues (64.4%). Only 31% report using the same protocol learned during their fellowship training., Conclusion: This survey highlights significant variation in the management of patients with iSGS. Understanding the factors that influence decision-making may lead to potential standardization in heterogeneous treatment approaches and may improve clinical outcomes., Level of Evidence: 5 Laryngoscope, 134:865-872, 2024., (© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

School connectedness is an important factor in the lives of youth and are a leverage point for optimizing youth's social, emotional, and physical health. This study presents a meta-analysis examining the relationship between school connectedness and four health domains that are prevalent in adolescence, have implications for adult health, and often co-occur: mental health, sexual health, violence, and high-risk substance use. Ninety articles published between 2009 and 2019 were included in the analysis. The study found that school connectedness had a protective average effect size across all health domains (Hedges' g  = -0.345, p -value<0.001). When examined separately, school connectedness had a significant protective relationship with substance use ( g  = -0.379, p  < 0.001), mental health (Hedges' g  = -0.358, p  < 0.001), violence (Hedges' g  = -0.318, p  < 0.001), sexual health (Hedges' g  = -0.145, p  < 0.001), and with co-occurring risks (Hedges' g  = -0.331, p  < 0.001). These results provide strong evidence that school connectedness has the potential to prevent and mitigate multiple health risks during adolescence., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Reputation score has been shown to be the strongest predictor of ranking in the US News & World Reports (USNWR) Best Hospitals report. However, the extent to which physicians participate in the underlying USNWR reputation survey is not well-characterized. We conducted a retrospective cross-sectional study of USNWR public methodology reports from 2015 to 2023 to characterize trends in physician response rates by specialty, region, and Doximity membership. Overall response rates declined between 2015 (24.0%) and 2023 (8.9%). In 2023, rates ranged from 4.7% (psychiatry) to 13.9% (otolaryngology). Otolaryngology had the highest response rate among all specialties between 2017 and 2023. Within otolaryngology, both response rates (25.0% to 13.9%) and count (2106 to 1724 physicians) declined between 2015 and 2023. Among Doximity members, response rates were consistently higher for otolaryngologists in the Northeast and Midwest compared to other regions. Though hospital rankings often influence where patients seek care, our findings suggest USNWR reputation scores may not be reliable or representative., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Introduction: It is well understood that hearing plays an important role in accurate vocal production. Singers in particular rely on auditory cues and auditory feedback to reproduce specific pitch contours. Therefore, even mild hearing loss may have a detrimental effect on a singer's ability to perform. This study investigates the effect of hearing loss on self-reported vocal production in singers, specifically in the domains of pitch matching, pitch maintenance, vowel production, and dynamic control as well as the effect of hearing loss on vocal handicap., Methods: An 18-item electronic self-report survey was distributed to the members of the National Association of Teachers of Singing and to the Voice Foundation. Data collected included demographics, the Singing Voice Handicap Index-10 (SVHI-10), and a series of closed and open-ended questions. Demographic variables, variables related to the SVHI-10, and variables related to the newly introduced survey were included in a hierarchical regression analysis to determine significant relationships., Results: Among 206 eligible participants, 37 individuals reported a voice problem, 58 reported hearing loss, and 19 reported concurrent hearing loss and a voice problem. Among males, there were no significant differences between hearing impaired and normal hearing singers in reported pitch matching, pitch maintenance, dynamic control, and vowel matching when those with voice problems were excluded and included. However, in females, when singers with voice problems were excluded, there was a significant difference between hearing impaired and normal hearing singers in pitch matching (P = 0.38). Additionally, when singers with voice problems were included in the female subset, significant differences emerged between the hearing impaired and normal hearing singers in areas of pitch matching (P = 0.01) and vowel matching (P = 0.02). Further, controlling for gender, when excluding voice problems, there was a significant difference between the SVHI-10 scores of normal hearing (mean = 9.03) and hearing impaired participants (mean = 11.30, P = 0.02). This difference continued to be significant when including those with voice problems (normal hearing mean = 9.97, hearing impaired mean=14.1, P <0.0001). Additionally, individuals with hearing impairments were more likely to report higher perceived vocal handicap scores as reflected on the SVHI-10 than normal hearing respondents (P = 0.002). Other factors associated with higher likelihood of SVHI-10 score include older age (P = 0.008), having a voice problem (P <0.0001), and being paid to sing within the past six months (P = 0.001)., Conclusion: When controlling for voice problems, singers with hearing impairments subjectively did not perceive that they performed less accurately on pitch matching, pitch maintenance, dynamic control, and vowel matching, yet they scored higher on the SVHI-10 indicating vocal handicap. Further study is needed to characterize the relationship between perceived and measured vocal accuracy in singers with hearing loss., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the effect of virtual and in-person head and neck physical examination training events on medical student confidence in performing examination maneuvers and seeking mentorship from otolaryngology faculty and residents., Methods: Training events were held with first-year medical student volunteers in 2020 (in-person) and 2021 (virtual). Participants in both cohorts were given didactics on head and neck cancer, trained to perform a head and neck physical examination, and demonstrated their clinical skills to otolaryngology faculty and residents. Pre- and post-training surveys were utilized to assess the following outcomes: participant head and neck cancer knowledge, confidence in performing examination maneuvers, and confidence in seeking mentorship in otolaryngology. Differences in outcomes between training settings were assessed by comparing participant survey responses pre- and post- training., Results: Both in-person and virtual training modalities improved participant confidence in performing the physical examination. There was no significant difference in the degree of improvement between training types. In-person training significantly increased participant confidence in seeking mentorship from otolaryngology faculty and residents ( P  = .003), while virtual training did not ( P  = .194)., Conclusion: Virtual training modalities are feasible methods of teaching the head and neck physical examination. Instruction through a video conferencing platform has the potential to be incorporated into traditional in-person medical education in a permanent fashion. This pilot study can inform future studies directly comparing in-person and virtual physical examination training modalities.

Objective: This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points., Methods: This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres., Results: During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers., Conclusion: No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre., Level of Evidence: 2 Laryngoscope, 133:2317-2324, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth., (© 2023. Society for Prevention Research.)

Objectives: Auditory-perceptual assessments are the gold standard for assessing voice quality. This project aims to develop a machine-learning model for measuring perceptual dysphonia severity of audio samples consistent with assessments by expert raters., Methods: The Perceptual Voice Qualities Database samples were used, including sustained vowel and Consensus Auditory-Perceptual Evaluation of Voice sentences, which were previously expertly rated on a 0-100 scale. The OpenSMILE (audEERING GmbH, Gilching, Germany) toolkit was used to extract acoustic (Mel-Frequency Cepstral Coefficient-based, n = 1428) and prosodic (n = 152) features, pitch onsets, and recording duration. We utilized a support vector machine and these features (n = 1582) for automated assessment of dysphonia severity. Recordings were separated into vowels (V) and sentences (S) and features were extracted separately from each. Final voice quality predictions were made by combining the features extracted from the individual components with the whole audio (WA) sample (three file sets: S, V, WA)., Results: This algorithm has a high correlation (r = 0.847) with estimates of expert raters. The root mean square error was 13.36. Increasing signal complexity resulted in better estimation of dysphonia, whereby combining the features outperformed WA, S, and V sets individually., Conclusion: A novel machine-learning algorithm was able to perform perceptual estimates of dysphonia severity using standardized audio samples on a 100-point scale. This was highly correlated to expert raters. This suggests that ML algorithms could offer an objective method for evaluating voice samples for dysphonia severity., Competing Interests: Declaration of Competing Interest The authors affirm that they have no conflicts of interest, financial or otherwise, that could be perceived as potentially influencing the objectivity or integrity of the research presented in this publication. We hereby declare that no competing interests exist, ensuring that this work has been conducted with complete transparency and in accordance with ethical guidelines., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: When children and youth feel connected to their school, family, and others in their community, they are less likely to engage in risky behaviors and experience negative health. Disruptions to school operations during the COVID-19 pandemic have led many teachers and school administrators to prioritize finding ways to strengthen and re-establish a sense of connectedness among students and between students and adults in school., Methods: We conducted a systematic search of peer-reviewed literature that reported on US-based research and were published in English from January 2010 through December 2019 to identify classroom management approaches that have been empirically tied to school connectedness-related outcomes in K-12 school settings., Findings: Six categories of classroom management approaches were associated with improved school connectedness among students: (1) teacher caring and support, (2) peer connection and support, (3) student autonomy and empowerment, (4) management of classroom social dynamics, (5) teacher expectations, and (6) behavior management., Implications for School Health Policy, Practice, and Equity: Prioritizing classroom management approaches that emphasize positive reinforcement of behavior, restorative discipline and communication, development of strong, trusting relationships, and explicitly emphasize fairness has potential to promote equitable disciplinary practices in schools., Conclusions: Classroom management approaches most linked to school connectedness are those that foster student autonomy and empowerment, mitigate social hierarchies and power differentials among students, prioritize positive reinforcement of behavior and restorative disciplinary practices, and emphasize equity and fairness., (© 2022 American School Health Association. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Importance: The gold-standard treatment for laryngeal dystonia (LD) and essential tremor of the vocal tract (ETVT) is botulinum toxin (BoNT) chemodenervation. Although safe and effective, it is not curative, and periodic injections are required. Some medical insurance companies only cover injections at a 3-month interval, though some patients benefit from injections more frequently., Objective: To determine the proportion and characteristics of patients who receive BoNT chemodenervation treatment in intervals shorter than 90 days., Design, Setting, and Participants: This retrospective cohort study across 3 quaternary care neurolaryngology specialty practices in Washington and California recruited patients who underwent at least 4 consecutive laryngeal BoNT injections for LD and/or ETVT in the past 5 years. Data were collected from March through June 2022 and analyzed from June through December 2022., Exposure: Laryngeal BoNT treatment., Main Outcomes and Measures: Biodemographic and clinical variables, injection characteristics, evolution during the 3 interinjection intervals, and lifetime laryngeal BoNT treatment data were collected from patient medical records. Logistic regression was used to assess association to the short-interval outcome, defined as an average injection interval shorter than 90 days., Results: Of 255 patients included from the 3 institutions, 189 (74.1%) were female, and the mean (SD) age was 62.7 (14.3) years. The predominant diagnosis was adductor LD (n = 199 [78.0%]), followed by adductor dystonic voice tremor (n = 26 [10.2%]) and ETVT (n = 13 [5.1%]). Seventy patients (27.5%) received short-interval injections (<90 days). The short-interval group was younger than the long-interval group (≥90 days), with a mean (SD) age of 58.6 (15.5) years and 64.2 (13.5) years, respectively, and a mean difference of -5.7 years (95% CI, -9.6 to -1.8 years). There were no patient-related differences between the short- and long-interval groups in terms of sex, employment status, or diagnosis., Conclusions and Relevance: This cohort study demonstrated that while insurance companies often mandate a 3-month or greater interval for BoNT chemodenervation financial coverage, there is a considerable subset of patients with LD and ETVT who receive short-interval treatment to optimize their vocal function. Short-interval chemodenervation injections demonstrate a similar adverse effect profile and do not appear to predispose to resistance through antibody formation.

The North American Airway Collaborative (NoAAC) previously published a 3-year multi-institutional prospective cohort study showing variation in treatment effectiveness between 3 primary surgical techniques for idiopathic subglottic stenosis (iSGS). In this report, we update these findings to include 5 years of data evaluating treatment effectiveness. Patients in the NoAAC cohort were re-enrolled for 2 additional years and followed using the prespecified published protocol. Consistent with prior data, prospective observation of 487 iSGS patients for 5 years showed treatment effectiveness differed by modality. Cricotracheal resection maintained the lowest rate of recurrent operation (5%), followed by endoscopic resection with adjuvant medical therapy (30%) and endoscopic dilation (50%). These data support the initial observations and continue to provide value to providers and patients navigating longitudinal decision-making. Level of evidence: 2-prospective cohort study., (© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Purpose: In youth, gender nonconformity (GNC; gender expression that differs from stereotypes based on assigned sex at birth) is associated with a higher likelihood of peer and caregiver victimization and rejection. However, few studies have examined the relationship between GNC, overall family conflict, perceptions of school environment, and emotional and behavioral health problems among children ages 10-11., Methods: The Adolescent Brain Cognitive Development Study data release 3.0 was used (n = 11,068; 47.9% female). A path analysis was used to examine whether school environment and family conflict, mediated the relationship between GNC and behavioral and emotional health outcomes., Results: We found significant mediation of the relationship between GNC and behavioral and emotional health by school environment a 2 b 2  = .20, 95% CI [0.13, 0.27] and family conflict a 1 b 1  = 0.34, 95% CI [0.25, 0.42]., Discussion: Our results suggest that youth who present as gender nonconforming experience elevated family conflict, poorer perceptions of their school environment and elevated behavioral and emotional health problems. Further, the relationship between GNC and elevated emotional and behavioral health problems was mediated by perceptions of school environment and family conflict. Clinical and policy suggestions to improve environments and outcomes for youth who present as gender nonconforming are discussed., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability., Study Design: Prospective cohort study; blinded comparison., Methods: Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ 2 . Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement., Results: RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P<0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01)., Conclusions: There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Vocal fold injection augmentation (VFI) is a common procedure for the treatment of glottic insufficiency. Material options for VFI and decisions regarding material selection are not standardized and often based on clinician preference., Objective: This study aims to understand the variations in provider preference and utilization of injectable materials for VFI., Methods: A 40-question survey was sent to 158 academic laryngologists. Questions pertained to the type of injectable materials used including brand preferences and rationale for preferences., Results: Ninety-seven of the 158 laryngologists contacted participated in the survey (61.4%). The most frequently used injectable materials were Hyaluronic Acid (HA)-based products. Carboxymethylcellulose (CMC)-based products were preferred for trial augmentation (57.2%), HA-based products were preferred for acute/subacute vocal fold paralysis, presbyphonia, and sulcus/scar (54.2%, 61.5%, 44.7%, 41.7% respectively), and Calcium Hydroxyapatite (CaHA)-based products were preferred for long-term paralysis (28.1%). CMC-based products were discontinued by 21.8% of participants, largely due to quick material resorption. 17.8% of participants discontinued HA-based products largely due to adverse events and 26.0% abandoned CaHA-based products mostly due to inflammatory properties causing vocal fold stiffness and material unpredictability. Over 30% of respondents reported wanting to reinitiate micronized alloderm Cymetra® as an available injectable., Conclusion: Our survey demonstrated that there are significant variations in practice and preferences in regard to injectable material selection for VFI. As there is limited data on the direct material comparison, understanding the rationale behind these variations is crucial to guide new providers in material selection and provide information to patients undergoing these procedures., Level of Evidence: 5 Laryngoscope, 133:1176-1183, 2023., (© 2022 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: This state of the art review aims to examine contemporary advances in applications of artificial intelligence (AI) to the screening, detection, management, and prognostication of laryngeal cancer (LC)., Data Sources: Four bibliographic databases were searched: PubMed, EMBASE, Cochrane, and IEEE., Review Methods: A structured review of the current literature (up to January 2022) was performed. Search terms related to topics of AI in LC were identified and queried by 2 independent reviewers. Citations of selected studies and review articles were also evaluated to ensure comprehensiveness., Conclusions: AI applications in LC have encompassed a variety of data modalities, including radiomics, genomics, acoustics, clinical data, and videomics, to support screening, diagnosis, therapeutic decision making, and prognosis. However, most studies remain at the proof-of-concept level, as AI algorithms are trained on single-institution databases with limited data sets and a single data modality., Implications for Practice: AI algorithms in LC will need to be trained on large multi-institutional data sets and integrate multimodal data for optimal performance and clinical utility from screening to prognosis. Out of the data types reviewed, genomics has the most potential to provide generalizable models thanks to available large multi-institutional open access genomic data sets. Voice acoustic data represent an inexpensive and accurate biomarker, which is easy and noninvasive to capture, offering a unique opportunity for screening and monitoring of LA, especially in low-resource settings., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Objective: To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy., Methods: Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires., Results: Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results., Conclusion: This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study., Level of Evidence: 4 Laryngoscope, 133:647-653, 2023., (© 2022 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)