Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background: Respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma (SH) are uncommon benign epithelial lesions of the sinonasal tract. Their clinical and endoscopic appearance may overlap with inflammatory nasal polyps, and a definitive diagnosis usually requires histopathologic examination. Case presentation: A 37-year-old man presented with several years of nasal obstruction, hyposmia, and facial pressure over the paranasal sinus regions. He had no history of asthma or previous sinonasal surgery. Nasal endoscopy revealed bilateral polypoid lesions involving the middle meatus. Computed tomography showed extensive chronic sinonasal inflammatory disease, including complete opacification of the right maxillary sinus, bilateral frontal sinus involvement, and bilateral ethmoidal opacification. The patient underwent endoscopic sinonasal surgery with bilateral uncinectomy, bilateral antrostomy, and anterior and posterior ethmoidectomy. Polypoid tissue was excised and submitted for histopathologic examination. The final diagnosis was a hybrid epithelial hamartomatous lesion with features of both REAH and SH. At the 4- and 8-week postoperative visit, the patient reported clear symptomatic improvement, mainly in nasal obstruction, smell and nasal breathing. Conclusions: Hybrid REAH and SH may clinically resemble bilateral inflammatory nasal polyposis, especially in patients with chronic rhinosinusitis. This case highlights the importance of routine histopathologic examination of sinonasal polypoid lesions after endoscopic surgery. Full article

Background/Objectives: Primary thyroid lymphoma accounts for approximately 0.2–2% of thyroid malignancies. Plasmablastic lymphoma (PBL), an aggressive large B-cell neoplasm with plasma-cell differentiation and frequent loss of conventional B-cell markers, is a rare thyroid presentation. We report a thyroid PBL presenting as an acute surgical airway emergency in an immunocompetent patient and highlight the diagnostic and management pitfalls that distinguish this from anaplastic thyroid carcinoma. Case Presentation: A 75-year-old man without any significant past medical history presented with rapidly progressive right-sided neck swelling, dysphagia, inspiratory stridor, and respiratory failure. Imaging demonstrated a large, thyroid-centered mass with tracheal involvement, initially raising concern for anaplastic thyroid carcinoma. Histopathology revealed a diffuse infiltrate of large, atypical cells with immunoblastic and plasmablastic morphology. The neoplastic cells were CD20- and CD138-negative but strongly MUM1-positive, with lambda light-chain restriction, bright CD38 by flow cytometry, a Ki-67 proliferation index exceeding 95%, aberrant cytoplasmic CD3 expression, and a MYC::IGH rearrangement, supporting a diagnosis of PBL. Staging identified extranodal perinephric disease and mesenteric lymphadenopathy, consistent with disseminated extranodal Ann Arbor stage IV disease. The patient underwent systemic treatment and initially had an excellent response; however, one month after the last treatment cycle they presented to the hospital with a mass consistent with recurrence. Discussion: Rapid growth, fixation, and tracheal invasion strongly suggest anaplastic thyroid carcinoma in routine clinical practice. However, plasmablastic lymphomas can present similarly and require fundamentally different treatment. In this case, loss of conventional B-cell markers, CD138 negativity, and aberrant cytoplasmic CD3 expression created substantial diagnostic challenges. Light-chain restriction, plasma-cell-associated markers, flow cytometry, and MYC cytogenetics were vitally important. Conclusions: Thyroid-presenting PBL is exceptionally rare and may closely mimic anaplastic thyroid carcinoma, including presentation with life-threatening airway compromise and tracheal involvement. This case highlights several diagnostic pitfalls: CD138 negativity despite plasma-cell differentiation, and aberrant cytoplasmic CD3 expression. Prompt airway stabilization, adequate tissue acquisition, broad immunophenotyping, light-chain assessment, flow cytometry, EBV/HHV8/ALK testing, and MYC cytogenetics are essential for accurate diagnosis and lymphoma-directed treatment. Full article

Patulous Eustachian Tube (PET) is a rare otologic disorder, which is caused by abnormal patency of the Eustachian tube. Rapid weight loss is a recognized predisposing factor for PET potentially because of the reduction in peritubal adipose tissue that contributes to normal tubal closure. Although there is increasing awareness of this association, the best treatment of PET is still debated with several conservative, medical and surgical operations reported in the literature. This narrative review summarizes the available evidence regarding conservative, medical, minimally invasive, and surgical management of PET, with particular consideration of PET associated with rapid weight loss. Relevant literature was identified through searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library, with attention to studies using standardized diagnostic criteria and outcome measures. Conservative approaches, including hydration, nasal saline instillation, and behavioral modifications such as cessation of habitual sniffing, have been associated with symptomatic improvement and considered as initial options because of their accessibility and low procedural burden. Medical therapies, such as topical irritants, estrogen-based preparations, and mucosal-thickening agents, may provide temporary symptom relief, although their long-term effects require further evaluation. Among interventional strategies, silicone (Kobayashi) plug insertion has demonstrated encouraging symptom improvement and reductions in symptom scores in selected patients with refractory PET. Minimally invasive techniques, including autologous fat injection, cartilage augmentation, and soft tissue bulking procedures, have also demonstrated encouraging outcomes. Trans-tympanic interventions, including ventilation-tube insertion and catheter-based techniques, provided additional options with variable reported outcomes. Management of PET remains heterogeneous and largely individualized. Conservative and medical therapies are considered reasonable first-line options, while surgical and minimally invasive approaches may be considered for selected patients with persistent symptoms. Full article

Background/Objectives: Tinnitus can have an adverse impact on some patients’ lives, affecting the daily functioning for a proportion of patients. In recent years, audiologists in Singapore who are specialised in tinnitus and hyperacusis rehabilitation have increasingly been providing tinnitus and/or hyperacusis management. The aim of this study was to evaluate the outcome of audiologist-delivered tinnitus management at a public hospital in Singapore. Methods: Retrospective data from patients seen between 2016 and 2019 were extracted from the hospital’s electronic medical record system. Outcomes were analysed using pre-treatment and three-month post-treatment Tinnitus Handicap Inventory (THI) scores among patients referred to the audiologist-led tinnitus clinic. Results: A total of 201 patients aged 18 to 86 years received tinnitus management. Among patients who returned for follow-up, 93% showed a reduction in THI score three months after treatment. Mean THI scores decreased significantly from 46.9 to 24.3, with a corrected effect size of 1.16, indicating a large treatment effect. Among patients with moderate or greater tinnitus handicap at baseline, 81% improved by at least one severity grade. Conclusions: This is one of the first studies to report outcomes of an audiologist-led tinnitus management service in Singapore. The findings are consistent with a potential role for structured, audiologist-led tinnitus services in Asian healthcare settings, although controlled studies are needed to confirm treatment effectiveness. General practitioners, otolaryngologists and other healthcare providers can play an important role in recognising tinnitus-related distress, offering early reassurance and directing patients to appropriate audiological and supportive care. Full article

Objectives: To describe a rare case of delayed diagnosis of a subglottic foreign body (FB) in an adult, resulting in subglottic stenosis, and to evaluate the effectiveness of Suspension Microlaryngoscopy (SML) as a minimally invasive technique for its management. Case presentation: An adult patient presented with persistent respiratory symptoms and was ultimately diagnosed with a retained subglottic FB after a delayed clinical course. The FB was managed using endotracheal intubation and SML, which allowed precise visualization and extraction. Associated granulation tissue and mucosal overgrowth were treated with targeted resection and controlled cauterization. Discussion: The delayed presentation and nonspecific clinical manifestations posed significant diagnostic challenges, contributing to the persistence of the FB and the development of subglottic stenosis. SML provided excellent exposure of the subglottic region, enabling safe FB removal while minimizing trauma to surrounding tissues. Postoperative follow-up demonstrated complete symptom resolution and restoration of airway patency without complications. Conclusions: Subglottic FB impaction is an exceptionally rare condition in adults and may be overlooked because of its nonspecific presentation, leading to delayed diagnosis and airway complications. This case highlights the importance of maintaining a high index of suspicion for retained airway FBs in patients with persistent respiratory symptoms or unexplained subglottic stenosis. SML represents a safe and effective therapeutic option, offering precise visualization, atraumatic FB extraction, and successful management of associated granulation tissue, with favorable clinical outcomes. Full article

Background/Objectives: As patients increasingly rely on large language models (LLMs) for Chronic Rhinosinusitis (CRS) diagnosis, surgical candidacy, and perioperative care, evaluating the accuracy of LLM-generated information against established clinical practice guidelines for surgical management of CRS is essential. Methods: ChatGPT, Google AI, Google Gemini, and Grok were queried using a 21-question guideline-mapped prompt set (long) and a single patient-focused prompt (short). Two physician reviewers independently scored responses using a 3-point rubric across 21 fields. Primary outcomes were guideline-concordant scores; secondary outcomes included readability measured with the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient (ICC). Analyses were performed in SPSSv31. Results: Guideline concordance ranged from 55.36% to 77.98% (p > 0.05), highest for Grok (77.98%, 95% CI 63.67–92.28), followed by Google Gemini (66.67%, 95% CI 35.42–97.91), ChatGPT (55.95%, 95% CI 29.25–82.65), and Google AI (55.36%, 95% CI 29.97–80.75), with Grok significantly outperforming both ChatGPT and Google AI. Prompt structure significantly affected scores. Long-form prompting resulted in higher guideline concordance scores than short-form prompting (+26.19, p < 0.001). The CPG demonstrated a more readable structure, with a higher FRE (44.1), exceeding scores generated by Grok (31.7), ChatGPT (39.9), Gemini (39.2), and Google AI (32.5). In contrast, the CPG was a higher reading grade level (FKGL score of 11.7) than Grok (11.4), Gemini (10.5), and ChatGPT (10.3), but was lower in reading grade compared to Google AI, which produced the highest FKGL score (12.5). IRR was high (ICC = 0.961). Conclusions: LLMs demonstrated similar guideline concordance, suggesting patients can expect comparable accuracy across platforms. While LLMs generally improved FKGL scores compared to the AAO-HNS CPG, they demonstrated lower FRE scores, indicating mixed results on overall readability. However, longer prompt structure meaningfully influenced output quality, highlighting how a user’s ability to frame precise prompts is critical to obtaining accurate information. Full article

Background: The management of pediatric microtia and congenital hearing loss typically necessitates coordinated multidisciplinary input. Traditional fragmented care pathways across multiple specialties may contribute to delayed diagnosis and treatment intervention, inconsistent counselling, increased logistical burden, and suboptimal care integration. Objectives: We aimed to evaluate family-reported outcomes following implementation of a multidisciplinary Hearing Disorder and Microtia (HDM) clinic, focusing on family satisfaction, perceived care efficiency, understanding of disease and treatment, and early uptake of hearing rehabilitation. Methods: A prospective observational study was conducted on families attending the HDM clinic at a tertiary pediatric center between 2022 and 2024. A structured post-visit survey assessed satisfaction, perceived efficiency, understanding of disease and treatment options, and overall experience. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis. Results: Twenty families were included. Overall satisfaction was high, with 95% rating the clinic experience as very good to excellent and expressing willingness to recommend the service. Improved care coordination and clarification of counselling were reported by the majority of respondents, alongside reduced logistical burden. Notably, 65% of families initiated hearing rehabilitation at the first visit. Thematic analysis identified convenience, unified specialist communication, and clarity of management planning as key strengths of the multidisciplinary model. Conclusions: A structured multidisciplinary HDM clinic significantly improves caregiver experience and facilitates earlier hearing rehabilitation in children with microtia and congenital hearing loss. Integrated care delivery enhances communication, reduces fragmentation, and supports timely, family-centered decision-making. This model may serve as a framework for other complex pediatric otologic conditions requiring longitudinal multidisciplinary management. Full article

Background/Objectives: Nasopharyngeal cancer generally has a good survival rate with chemoradiotherapy, but a significant side effect is irreversible hearing loss, for which there is currently no preventive intervention. Given that dexamethasone (Dex) and D-methionine (dMet) have individually shown potential to prevent hearing loss in in vitro and animal studies, we hypothesized that combining Dex and dMet may offer greater protection against cytotoxicity induced by cisplatin and radiation treatments. Methods: Organ-of-Corti-derived OC-k3 cells exposed to cisplatin and/or radiation were used as an in vitro model of treatment-induced cytotoxicity to investigate the protective mechanisms of Dex and dMet. Results: Dex was associated with reduced apoptosis, accompanied by decreased p53 phosphorylation and increased Bcl-XL expression. Dex also reduced COX2 expression and showed trends toward attenuation of ERK1/2 and NFκB signaling. Conversely, dMet effectively blocked cisplatin-induced apoptosis but did not protect against radiation-induced cytotoxicity. Conclusions: The combination of Dex and dMet provided greater protection against cisplatin- and radiation-induced cytotoxicity in the OC-k3 cells than either agent alone. These findings support further investigation of combined Dex and dMet as a potential strategy to mitigate treatment-induced ototoxicity. Full article

Background: The current literature suggests that screening for symptoms of pediatric obstructive sleep-disordered breathing (SDB) is low despite guidelines from the American Academy of Pediatrics to screen all children at well visits. Specific factors that affect screening rates for snoring have not been well delineated. Materials and Methods: This study is a retrospective chart review of children ages 2–12 who presented for well-child visits at an academic hospital network. Multivariable logistic regression was used to identify factors associated with documentation for SDB screening. Results: Of 1001 charts reviewed, 809 children met inclusion criteria (median age 5 IQR [3–8] years, 50.3% female). Less than half (45.4%) of the children were screened for snoring, and 16.1% of those screened had symptoms of SDB. Adjusted multivariable regression showed that screening was significantly higher in older children (OR: 2.19 [1.46–3.29]; p < 0.001 for 5- to less than 8-year-old children; OR: 2.37 [1.57–3.57]; p < 0.001 for 8- to less than 12-year-old children). Children of the Other race group were also found to have significantly lower screening rates than Black and White children (OR 0.44 [0.23–0.84]; p = 0.014). The odds of being screened were 94% lower in visits in which a medical trainee was involved (p < 0.001). The odds of being screened at a well-child visit were 3.7 times higher in encounters in which a templated note was used (p < 0.001). Conclusions: Less than half of the children presenting for well visits were screened for snoring in this cohort. Differences in screening were attenuated by trainee involvement and the use of templated notes, which presents further avenues to explore meeting guideline recommendations for SDB screening. Full article

The work of anesthesiologists–intensivists, critical care specialists, and medical emergency teams is multifaceted and complex, with airway management representing a cornerstone and a common denominator of many procedures and interventions. Tracheal intubation has represented and still represents today the gold standard for airway control. This narrative review, conducted through a comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Library from database inception to December 2025 and supplemented by manual reference searches and retrieval of key historical sources, aims to trace the evolution of laryngoscopy for airway management and tracheal intubation—from its nineteenth-century origins to the current state of the art—while simultaneously addressing the clinical, educational, and safety implications of this evolution. Laryngoscopy evolution progressed in parallel with technological development and innovation, resulting in the expansion of clinical possibilities and in the improvement of patient safety. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, culminating in the widespread adoption of the Macintosh laryngoscope. Almost 50 years later, a pivotal turning point occurred around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that succeeded one another introduced new problems, driving the search for new solutions. At present, tracheal intubation with videolaryngoscopy has achieved success and safety standards substantially superior to those of the early days of the technique. In this review we retrace the historical milestones of laryngoscopy, analyze the problems that emerged over time with various devices and the solutions adopted, examine the evolution of videolaryngoscopes and the impact of these devices on both technical and non-technical skills, discuss the ongoing debate surrounding their routine use (universal videolaryngoscopy) and the selection of optimal adjunct devices, and outline the emerging role of artificial intelligence in improving success rates and facilitating the learning curve. This journey, after 150 years of evolution, has reached a high level of maturity in terms of safety and efficacy. Full article

Positional obstructive sleep apnea (POSA) is a subtype of obstructive sleep apnea in which the apnea–hypopnea index (AHI) is significantly greater in the supine position than in non-supine positions. However, POSA remains underrecognized and lacks a universally accepted clinical definition. POSA’s prevalence can exceed 50% of OSA patients and occurs most frequently in patients with mild/moderate disease. In the supine position, gravity-dependent posterior displacement of the tongue and soft palate can increase upper airway collapsibility and drive the pathophysiology of POSA. These disturbances can carry meaningful cardiovascular consequences, including acute blood pressure surges that correlate with oxygen desaturation severity. As OSA is increasingly understood as a heterogeneous disorder shaped by variable anatomical and physiological traits, POSA offers a clinically actionable framework for precision sleep medicine. Current therapeutic strategies demonstrate that targeting the specific mechanisms of POSA can improve outcomes beyond what standardized CPAP treatment achieves alone. Racial and ethnic disparities in both POSA prevalence and treatment adherence further highlight the importance of individualized, culturally informed care. This review synthesizes the current understanding of the mechanisms, epidemiology, and therapeutic implications of POSA and evaluates its role as a model for individualized therapy in obstructive sleep apnea treatment. Full article

Horizontal nystagmus is still commonly interpreted at the bedside through a pragmatic peripheral-versus-central dichotomy. Although this heuristic is often clinically useful, it may be misleading because distributed brainstem–cerebellar disorders can generate peripheral-appearing phenotypes. This paper presents a narrative clinical–conceptual review proposing that a substantial subset of horizontal nystagmus patterns may be understood more coherently as expressions of dysfunction within a coupled vestibulo-ocular integrative network rather than as direct signatures of a single lesion site. Within this framework, two core dynamical domains are separated conceptually: a vestibular nuclei (VN)-centered velocity-storage process and an NPH-centered gaze-holding integrator. These processes are proposed to operate under cerebellar regulatory influence, with the nodulus–uvula (NU) acting as a plausible regulator of storage gain, temporal persistence, adaptation stability, and oscillatory behavior. Clinically, the velocity-storage domain is expressed through low-frequency vestibulo-ocular reflex behavior and optokinetic after-nystagmus-related dynamics, whereas the gaze-holding domain is expressed through eccentric gaze stability, gaze-evoked nystagmus, and post-saccadic drift. This framework carries a clinically relevant implication: horizontal nystagmus phenotypes may be interpreted more effectively by asking which functional process is predominantly abnormal—gaze holding, storage-related vestibular persistence, or cerebellar regulatory stability—rather than by relying solely on a binary peripheral–central label. On this basis, we outline a clinician-facing workflow linking gaze dependence, periodicity, direction reversals, head-shaking behavior, and Alexander-law mismatch to operational bedside criteria and candidate quantitative readouts. The proposed model is intended as a clinical–conceptual framework rather than a deterministic localization tool. Its main value lies in organizing discordant vestibular findings, strengthening the mechanistic interpretation of bedside and instrumented observations, and identifying testable directions for future validation studies in acute dizziness and ocular motor disorders. Full article

Background and Clinical Significance: Localized amyloidoma rarely affects the tongue base, a site far less commonly involved than the larynx. When it does occur at this location, the clinical and radiological presentation can closely mimic oropharyngeal malignancy, making it a genuine diagnostic pitfall for head and neck surgeons. Establishing the diagnosis demands histological proof, and ruling out systemic amyloidosis is an essential prerequisite. Case Presentation: An 80-year-old nonsmoking woman was evaluated for progressive dysphagia and globus sensation that had worsened over several years. Endoscopy revealed a firm, lobulated mass at the tongue base, centered on the glossotonsillar sulcus. Incisional biopsy under local anesthesia showed amyloid deposits. MRI demonstrated an avidly enhancing, well-circumscribed lesion without invasion of the deep neck spaces. A comprehensive systemic evaluation—including serum and urine protein electrophoresis with immunofixation, serum free light chains (κ/λ ratio 1.05), echocardiography, and bone marrow biopsy—yielded no evidence of systemic AL amyloidosis or plasma-cell dyscrasia. The mass was excised through transoral robotic surgery (TORS). Histopathology confirmed Congo red-positive, apple-green birefringent amyloid with lambda light-chain restriction; staining for AA amyloid and transthyretin was negative. The patient was diagnosed with primary localized lingual amyloidoma of the AL lambda type and remained symptom-free, with no endoscopic evidence of recurrence, at 12-month follow-up. Discussion: Amyloidoma deserves a place in the differential diagnosis of tongue base masses, particularly when the clinical picture does not fit squamous cell carcinoma. Congo red staining under polarized light, immunohistochemical light-chain typing, and a rigorous systemic workup are the cornerstones of diagnosis. Robotic-assisted transoral excision provides excellent access to the tongue base with low morbidity. Conclusions: This case underscores the need to consider amyloidoma when evaluating tongue base lesions, the central role of Congo red staining and light-chain typing, and the utility of TORS as an effective treatment option for selected symptomatic cases. Full article

Background/Objectives: Hyperventilation-induced nystagmus (HVIN) has been described as a sensitive clinical sign in vestibular schwannoma (VS), potentially reflecting a reversible conduction block in partially demyelinated vestibular nerve fibers. However, its relationship with tumor size and instrumental vestibular deficits remains controversial. This study aimed to investigate the association between HVIN, tumor size, clinical presentation, and vestibular function assessed by the video Head Impulse Test (vHIT) and functional Head Impulse Test (fHIT). Methods: Eighty consecutive patients with unilateral VS were retrospectively evaluated. All underwent bedside vestibular examination, the vHIT, the fHIT, and the Hyperventilation Test (HVT). Tumors were classified according to the modified Koos–Sanna grading system. Associations between HVIN (presence and direction), demographic and clinical variables, vestibular deficits, and tumor size were analyzed using binary logistic regression, Fisher’s exact test, Welch’s independent samples t-test, and the Mann–Whitney U test. Results: HVIN was observed in 73% of patients. Among the patients with HVIN, ipsilesional horizontal nystagmus occurred in 57% of cases, 41% of the subjects showed contralesional nystagmus and one patient had downbeat nystagmus. vHIT abnormalities were identified in 54% of patients, while 30% of these also demonstrated fHIT deficits. No patient presented isolated fHIT abnormality. HVIN was detected even in patients with intracanalicular or small tumors and in some asymptomatic individuals. No statistically significant correlations were found between tumor size and HVIN presence, HVIN direction, or vestibular deficits in the vHIT/fHIT (all p > 0.05). Conclusions: HVIN is frequently observed in patients with VS, including those with small or asymptomatic lesions. However, neither its presence nor direction correlates with tumor size or objective vestibular deficit. The Hyperventilation Test should not be considered a prognostic tool but may serve as a simple and valuable adjunctive bedside examination in the early diagnostic suspicion of vestibular schwannoma. Full article

Background/Objectives: Spontaneous intracranial hypotension (SIH) is a rare pathology that arises in the context of a known or suspected cerebral spinal fluid (CSF) leak. A key symptom of SIH is an orthostatic headache; however, additional neurological complications are common. This case study not only highlights the co-existence of Menière’s disease and SIH but describes a subsequent complication of benign paroxysmal positional vertigo (BPPV) and management thereof. Case Description: The patient is a 61-year-old female who presented to the emergency department due to an intractable headache, right sided weakness and aphasia. CT/MRI revealed a subdural hematoma overlying the left cerebral hemisphere measuring up to 8 mm with 4 mm left to right midline shift. Fluoro-guided total spine myelogram, cisternogram, and lumbar epidural blood patch were performed for suspected SIH. As headache, right sided weakness and aphasia resolved, the patient began reporting onset of constant “spinning” dizziness, tinnitus and aural fullness mimicking symptoms of a Menière’s attack. The vestibular examination was consistent with compensated bilateral Menière’s disease (left > right) and right horizontal canalithiasis BPPV. The patient was treated with Gufoni and Lempert maneuvers with complete resolution of positional dizziness and associated nystagmus along with improved balance and gait. Discussion/Conclusions: This case study highlights the importance of multidisciplinary assessment in complex neurological cases and specifically recommends that patients with Menière’s disease accompanied by intractable headaches undergo extended neuroradiological examination of the brain to exclude underlying spontaneous intracranial hypotension syndrome. Full article

Background/Objectives: Individuals with listening difficulties (LiD) report problems understanding speech despite normal hearing sensitivity. This study investigated how speech characteristics (clarity, speaking rate, and loudness) influence subjective speech understanding in adults with LiD under quiet and noisy conditions, compared with individuals with normal hearing (NH) and those who are hard of hearing (HH). Methods: A questionnaire-based survey assessed perceived speech intelligibility across 12 listening conditions created by combining two environments (quiet and noisy) and six speaking styles. Participants included 77 adults with LiD (50 LiD without developmental disorders [DD] and 27 LiD and DD), 30 adults with NH, and 26 individuals with HH. Ratings were analyzed using analysis of variance and correlation analyses. Results: Both the LiD and HH groups demonstrated significantly reduced speech understanding in noisy environments when the speaking style was suboptimal, compared with the NH group. In contrast, the LiD group uniquely reported difficulties even under quiet conditions with clear, slow, and loud speech. Loud speech in quiet conditions was not consistently beneficial, particularly in the LiD and DD group, possibly reflecting auditory hypersensitivity. Conclusions: Listening difficulties in the LiD group are influenced by environmental and speaker-related factors and cannot be addressed solely by conventional strategies used for hearing loss. Although individualized communication approaches may be required, further investigation, including experimental studies, is necessary to validate this interpretation. Full article

Background/Objectives: Patient understanding during healthcare appointments is essential for positive health outcomes and effective healthcare delivery. There is limited research exploring patient understanding for patients with swallowing difficulties (dysphagia) and voice disorders, where treatment engagement is often low. Dysphagia and voice disorders can affect communication, nutrition, and quality of life; therefore, it is essential to understand how to support this population effectively. This exploratory study aimed to identify barriers and facilitators to perceived patient understanding in clinical settings. Methods: A survey was administered to adults receiving assessment results for dysphagia or voice disorders from a speech–language pathologist or laryngologist at outpatient clinics in Ontario, Canada. The survey included demographics, health literacy levels (HLS19) and facilitators and barriers to comprehension. Descriptive statistics and content analysis were used to summarize responses. Results: Twenty-nine participants completed the survey (mean age of 64; 38% identifying as women). Facilitators to perceived understanding included the use of clear language (83%), being encouraged to ask questions (76%), and prior knowledge of their condition (59%). Reported barriers included rushing (28%), using a fast rate of speech (21%), and receiving short explanations (17%). Additionally, emotional and environmental factors such as the clinic atmosphere (55%) and the nature of assessment results (45%) influenced perceived patient comprehension. Conclusions: These findings suggest the need for consistent use of patient-centered communication strategies. Recommendations for clinicians include slowing speech, avoiding medical jargon, encouraging patient questions, incorporating visual aids, and creating a supportive environment. Implementing these strategies may improve understanding and health outcomes for patients with dysphagia and voice disorders. Full article

Background: Endoscopic sinus surgery (ESS) is a core operative technique in otolaryngology and is associated with a steep learning curve due to complex sinonasal anatomy, limited depth perception with two-dimensional endoscopy, and the requirement for precise bimanual coordination. Given the potential for serious complications, including cerebrospinal fluid leak and visual loss, simulation provides an important opportunity for trainees to develop technical skills in a controlled environment without risk to patients. Recent advances in three-dimensional (3D) printing have enabled the development of high-fidelity models for ESS training. Methods: We describe an evidence-based, graded approach to ESS simulation using two commercially available 3D printed sinus surgery models tailored to the trainee’s stage of training. Early-stage simulation focuses on development of anatomical orientation, endoscopic hand–eye coordination, tissue handling, and basic procedures such as middle meatal antrostomy and anterior ethmoidectomy. Advanced simulation targets more complex procedures, including frontal and sphenoid sinus surgery, transsphenoidal approaches, and management of intraoperative complications. Results: Validation studies demonstrate high face and content validity for both models. Early-stage simulators support acquisition of fundamental technical skills, while advanced models allow simulation of complex anatomy, pathology, and operative complications. Conclusions: A structured, stage-appropriate simulation strategy using high-fidelity 3D printed models may enhance technical skill acquisition and support safe and effective training in endoscopic sinus surgery. Full article