Caroline C. Jeffery

Objective: To identify the preoperative assessments and criteria surgeons use to assess the suitability of transfeminine patients for voice feminization surgery. Data Sources: Electronic search of Ovid MEDLINE, Ovid Embase, APA PsycINFO, Cochrane Library, CINAHL, and PubMed excluding MEDLINE records was performed on February 11, 2025 for articles that were published from inception to the search date. No language or date limits were applied. Study Selection: The inclusion criteria were developed using the PICOTS framework. Inclusion criteria included all studies reporting (1) assessments and surgical criteria used in; (2) transfeminine adult patients who; (3) underwent feminization voice surgery. Studies involving transmasculine patients and those addressing nonsurgical interventions for voice were excluded. Non‐feminization voice surgeries were excluded. Data Extraction: Screening and extraction followed PRISMA‐ScR guidelines by two authors. Extracted data included study type, origin, and intervention. Clinical criteria were emphasized, including voice training, acoustic and perceptual parameters, and patient‐reported outcomes. Other factors included medical/psychiatric evaluation and hormonal therapy. Results: Of 520 studies screened, 42 met inclusion. Most were retrospective case series/reports (2000–2025) with sample sizes from 1 to 506. Acoustic parameters, especially fundamental frequency, were commonly assessed. Perceptual tools included GRBAS, CAPE‐V, and clinician judgment by speech‐language pathologists. Patient‐reported outcomes such as the Voice Handicap Index and Trans Woman Voice Questionnaire were also used. Endoscopic evaluation was frequently performed, and CT imaging was often used for cricothyroid approximation cases. Conclusions: There is significant variability in preoperative criteria across studies, with limited reporting on key factors like prior voice training or psychological evaluation.

Objectives: Head and neck cancer (HNC) survivorship issues are areas of increasing research interest. Laryngeal dysfunction in HNC patients is particularly important given the importance of the larynx in voice, swallowing, and airway protection. The objective of our study is to characterize late laryngeal dysfunction in a cohort of long‐term HNC survivors.Methods: HNC survivors who were at least 2 years post‐treatment were recruited prospectively for standard collection of videolaryngoscopy findings, videofluoroscopic swallowing studies, and assessment of clinical outcomes. Descriptive statistics were performed and clinical presentation and outcomes were compared between survivors >10 years and r = .182, p = .34), and no correlation was found between age, sex, time since treatment, or primary site and the presence or absence of VFMA, G‐tube status, or tracheostomy‐tube status.Conclusion: Late laryngeal dysfunction in HNC survivors contributes to significant morbidity, is difficult to treat, and remains static decades after treatment for their original cancer.Lay Summary: The voice‐box, or the larynx, plays an important role in voice, swallowing and airway protection. It is particularly vulnerable to radiation‐related damage and changes. This study demonstrates the sequelae of long‐term damage of the larynx in head and cancer survivors.Level of Evidence: IV.

Background: Dysphagia is a consequence of oropharyngeal squamous cell carcinoma (OPSCC) treatments and often results in a devastating reduction in quality of life (QoL; Nguyen et al., 2005; Pauloski, 2008). Objectives: This study aimed to report temporal trends in swallowing outcomes using the Modified Barium Swallow Impairment Profile (MBSImP) and the M.D. Anderson Dysphagia Inventory (MDADI) and to study the relationship between these two measures. Method: This was a retrospective review of clinical data collected in January 2013 to December 2017 from a tertiary care center. MBSImP PI scores and MDADI composite scores were collected pretreatment and 1, 6, and 12 months posttreatment. Data were analyzed in aggregate and stratified by treatment modality. To address the primary objective, descriptive statistics were used. To address the secondary objective, four Spearman tests were run between MBSImP PI and MDADI composite scores. Results: A total of 123 OPSCC participants were included. With respect to trends, MBSImP PI scores worsened 1 month posttreatment and remained impaired at 6 and 12 months. For MDADI composite scores, patient reports worsened 1 month posttreatment and subsequently improved at 6 and 12 months. MBSImP PI and MDADI composite scores were weakly negatively correlated (i.e., in agreement) at the pre- and 12-month posttreatment appointments. Conclusions: Swallowing outcomes in OPSCC patients have distinct yet predictable trends for both clinician-assessed and patient-reported swallowing outcomes during the first year following cancer treatment. However, unlike previous findings, these two types of measures were in agreement at the pretreatment and 12 months posttreatment appointments.

Background: Microlaryngoscopy is a basic technical skill in Oto‐HNS. It is essential for residency programs to have a competency‐based assessment tool to evaluate residents' performance of this procedure. An Objective Structured Assessment of Technical Skills (OSATS) is a procedure‐specific assessment, which consists of the following: (a) Operation‐Specific Checklist and (b) Global Rating Scale (GRS).Objective: The objective of this study was to create an OSATS for adult microlaryngoscopy.Methods: This was a prospective study, with an initial qualitative phase for OSATS development (Phase I), and a clinical pilot phase (Phase II). In Phase I, interviews were conducted with three laryngologists to establish a stepwise description of adult microlaryngoscopy and review a previously validated GRS for relevance to microlaryngoscopy. Responses were used to create a framework for the OSATS. The OSATS was then presented to Oto‐HNS residents and laryngologists in an alternating fashion, for review of clarity and relevance. A pilot study was then performed to evaluate the resident performance of adult microlaryngoscopy. Multiple regression analysis was carried out to investigate whether training level, case complexity, and previous OSATS exposure could predict participant scores.Results: Phase I of this study led to the creation of a 34‐item OSATS. The pilot study (N = 28 procedures) revealed that training level was significantly correlated with increased OSATS scores. There was no statistically significant correlation between case complexity and resident scores. Assessors reported the perceived utility of the OSATS and intent for use in residency training.Conclusion: Application of the proposed OSATS will allow for competency‐based assessment of the resident performance of microlaryngoscopy.Level of Evidence: NA Laryngoscope, 133:2719–2724, 2023

Mucous membrane plasmacytosis (MMP) is rare condition characterized by diffuse plasma cell infiltration of upper aero‐digestive tract mucosa. It results in epithelial hyperplasia that has a classic papillary appearance. We describe a case of MMP primarily affect laryngeal and oropharyngeal mucosa resulting in progressive airway obstruction. We highlight airway management and histopathology. The patient had near complete clinical response with inhaled budesonide, which has not yet been described as a treatment option in the literature. Laryngoscope, 133:70–72, 2023

Objectives We aimed to evaluate the reliability of laryngoscopic features of vocal fold atrophy as assessed by novice otolaryngology trainees and expert laryngologists. Design Two expert fellowship-trained laryngologists and three non-expert otolaryngology resident trainees were recruited to view 50 anonymised laryngo-stroboscopic examinations of patients presenting with dysphonia and non-voice, laryngeal complaints. Reviewers were asked to stratify the patient's age, provide an opinion about the presence of age-related vocal fold atrophy and specify which laryngoscopy features were present to make the diagnosis. Setting Tertiary care laryngology practice. Participants Two fellowship-trained laryngologists and three trainee otolaryngologists. Main outcome measures Accuracy of age categorisation was determined and Kappa analysis was performed to assess inter-rater agreement. Results The mean age of patients was 54.9 years old with near equal male to female distribution. The overall accuracy of age category determination by raters was only 30.8%. Kappa analysis demonstrated fair agreement regarding the presence of vocal fold atrophy in non-expert reviewers, and moderate agreement amongst expert reviewers. Features of glottic gap, muscular atrophy of vocal folds and prominent vocal processes were all identified with high agreement (>80.0%). Conclusion Our study illustrates that while raters can agree on the presence of age-related vocal fold atrophy, the findings may be non-specific and do not necessarily correlate with age.

Objective: There is a strong relationship between reading and articulation (Lervag & Hulme, 2009; Pan et al., 2011). Given the tight coupling of these processes, innovative approaches are needed to understand the intricacies associated with print-speech connections. Here we ran a series of tightly controlled experiments to examine the impact of mouth perturbations on silent reading. Method: We altered the mouth, via somatosensory feedback, in several ways: (a) a large lollipop in the mouth (E1), (b) a candy stick (bite bar) held horizontally between the teeth (E2), and (c) lidocaine that served to numb the mouth (E3). Three tasks were completed: (a) picture categorization, (b) "spell" lexical decision (Spell-LDT; " does the letter string spell a real word, yes or no?"), and (c) "sound" lexical decision (Sound-LDT; "does the letter string sound like a real word, yes or no?"). Participants (N = 97; E1 = 27; E2 = 32; E3 = 38) completed each of the tasks two times: once with a somatosensory perturbation (lollipop, bite bar, or lidocaine) and once without. Results: For each experiment, a linear mixed effects analysis was run. Overall, we found that the lollipop (E1) and lidocaine (E3) had some specific effects on word recognition (e.g., for "no" responses), particularly in the Spell-LDT, whereas the bite bar (E2) had no effect on word recognition. The picture categorization task was not impacted by any perturbations. Conclusion: These findings provide evidence that sensorimotor information is connected to reading. We discuss how these findings advance our understanding of a print-to-speech framework.