Daniel H. Coelho

Objectives: The retrolabyrinthine approach is a presigmoid, potentially hearing‐preserving option for internal auditory canal (IAC) lesions, though exposure is limited by a narrow corridor. Endoscopic assistance may improve lateral visualization. This study compared projected radiographic versus postdissection IAC exposure using simulated 0° and 30° endoscopy and evaluated anatomic predictors of exposure. Methods: Thirteen cadaver temporal bones underwent high‐resolution computed tomography before and after IAC dissection with posterior semicircular canal preservation. The retrolabyrinthine approach was simulated using 3D segmentation in 0° and 30° endoscopic views. Total and accessible IAC volumes and the percentage of IAC accessible were compared between projected and postdissection models. Projections were compared with observed volumes using Wilcoxon signed‐rank testing. Associations between anatomic covariates (corridor width, angle of approach, surgical freedom) and exposure were evaluated using Theil–Sen regression. Results: Median IAC volume was 230.1 mm ³ (range 148.1–446.9). Surgical freedom ranged from 123.3–319.2 mm ² (median 182.9), and angle of approach from 13.9° to 27.1° (median 19.9°). Projected exposures were 59.2% at 0° and 92.2% at 30°, versus 65.1% and 75.6% postdissection. Projection underestimated 0° exposure (−5.9%, p = 0.01) and overestimated 30° exposure (+16.7%, p = 0.048). Thirty‐degree endoscopy improved exposure ( p < 0.001). Each 1 mm increase in corridor width increased accessible volume by 8.46 mm ³ (0°) and 5.31 mm ³ (30°), and each 1° increase in angle of approach increased accessible volume by 4.98 mm ³ (0°) and 5.11 mm ³ (30°) (all p ≤ 0.04). Conclusions: Endoscopic assistance improves exposure, although projections overestimate 30° exposure. Corridor width and angle of approach may inform preoperative selection. Level of Evidence: N/A.

The goal of this study was to determine the best approach to the olfactory tract for implantation of an olfactory electrical stimulator to treat anosmia. Tertiary Academic Medical Center. In this retrospective cohort study (n = 50), computed tomography scans from Virginia Commonwealth University Medical Center (July–October 2025) were reconstructed in three dimensions using syngo.via (Siemens Healthcare). Five standardized points corresponding to the supraorbital keyhole craniotomy (SOKC) footprint were plotted on the exterior skull: the supraorbital notch (1), 2 cm superior to the supraorbital notch (2), superior temporal line by the orbital rim (3), 2 cm superior to the third point (4), and the centroid of points 1 to 4 (5). Trajectories were drawn bilaterally from each point to the anterior (posterior crista galli) and posterior (anterior edge of the pituitary fossa) olfactory tracts, yielding 20 per subject. Each was evaluated for bony and sinonasal obstruction. All subjects had at least one unobstructed trajectory. A path from 2 cm above the superior temporal line at the orbital rim to the posterior tract was clear in 98% and is the preferred surgical vector. Posterior trajectories were more often unobstructed than anterior trajectories (70 vs. 48%, p < 0.0001). Rates of obstruction did not differ by age, sex, or BMI. Orbital bone was the most frequent obstruction. The average olfactory tract length was 28 mm bilaterally. The SOKC may be the preferred surgical approach for an olfactory implant. All patients had at least one route with an unobstructed view of either the anterior or posterior olfactory tract.

Research productivity has become an increasingly important factor in Otolaryngology-Head and Neck Surgery (OHNS) residency selection, particularly following the transition of USMLE Step 1 to pass/fail scoring. In response, the Electronic Residency Application Service (ERAS) will introduce a redesigned “scholarly works” section beginning in the 2027 application cycle that emphasizes peer-reviewed scholarship, consolidates related research outputs, and highlights meaningful contributions. These changes may encourage greater focus on research quality rather than publication volume and improve opportunities for applicants from less research-intensive institutions. However, persistent competitive pressures may limit their impact, as applicants are likely to continue prioritizing activities most valued during the selection process. Additional measures may be needed to reduce emphasis on research quantity and better align incentives with substantive scholarly achievement. Continued evaluation of application trends will be necessary to determine whether these reforms achieve their intended goals.

Purpose: The aim of this study was to evaluate the accuracy of self-reported hearing asymmetry in predicting objectively defined asymmetric hearing loss (AHL) and identify patient factors associated with over- or underestimation of individual ear hearing loss severity. Method: A cross-sectional survey analysis of consecutive adult patients undergoing audiometric evaluation was conducted at the audiology and otology/neurotology clinics of a single tertiary referral center from 2020 to 2025. Fifty patients reporting hearing asymmetry who had not undergone prior audiometric testing within 5 years were included. A survey was administered to quantify subjective individual ear hearing loss severity before audiometric evaluation to determine the accuracy of self-reported AHL (≥ 15 dB interaural difference) and subjective severity estimation for each ear. Results: Seventy percent of patients incorrectly identified AHL based on audiometric testing. Misclassification did not differ significantly according to age, sex, or race. Patients with lower (< 25 dB) or moderate (25–50 dB) binaural pure-tone averages were more likely to misclassify AHL than those with higher thresholds (> 50 dB). Sixty-two percent of patients misclassified the worse hearing ear, with a strong bias toward overestimation (94%). In contrast, 48% misclassified the better hearing ear, with a modest skew toward underestimation (58%). Across subgroups, worse hearing ears were significantly overestimated compared with better hearing ears. Patients with better binaural hearing and narrower interaural differences were more prone to worse hearing ear overestimation. Conclusions: It is likely that patients do not reliably estimate AHL corresponding to a 15-dB interaural difference. Better binaural hearing and lower interaural asymmetry were associated with poorer estimation of the worse hearing ear, underscoring the importance of audiometric confirmation in patients with preserved hearing.

This scientific briefing reports preliminary 5‐year recovery outcomes from COVID‐19‐associated smell loss in a nationwide cohort. Adults with confirmed COVID‐19 infection and self‐reported smell loss since January 2020 were surveyed through a longitudinal web‐based questionnaire, and a follow‐up survey was distributed to participants who had completed a prior 2‐year study. Among 419 respondents (mean age 45.7 ± 13.7 years; 79.0% female; 84.5% white), 44.2% reported complete smell recovery, 48.4% partial recovery, and 7.4% no recovery or worsening smell. Complete recovery was significantly higher in participants younger than 40 years ( P < .001) but did not differ by gender ( P = .51). Compared with 2‐year outcomes, the rate of complete recovery increased from 38.4% to 44.3%. These findings indicate that while modest additional recovery occurs beyond 2 years, olfactory dysfunction persists in more than half of patients 5 years after COVID‐19‐associated smell loss. While a much larger analysis is currently in progress, this report represents the longest‐term results published to date.

Background: Pulsatile tinnitus (PT), a challenging condition for patients and clinicians alike, is often linked to vascular, neoplastic, and systemic disorders. The most common cause is idiopathic intracranial hypertension (IIH). However, physicians must recognize that not all intracranial hypertension (IH) is idiopathic and can be due to secondary causes, including cerebral venous anomalies, medications, and systemic medical conditions. Objective: To highlight the importance of this entity, we report a case of drug-induced IH (DIIH), caused by isotretinoin (ISO), that presented with persistent unilateral PT. Methods: Informed consent for the publication of clinical information was obtained from the patient. Results: A 30-year-old female developed unilateral PT and blurred vision shortly after initiating ISO for acne. She was diagnosed with IH, and despite ISO cessation, acetazolamide escalation, and multiple therapeutic lumbar punctures, her PT persists 1 year later. Neuroimaging revealed a high-riding jugular bulb with diverticulum and possible sigmoid sinus dehiscence, likely contributing to the persistence of her symptoms following resolution of her headaches and visual changes. Conclusion: While DIIH typically resolves after discontinuation of the offending agent, this case demonstrates a unique presentation of ISO-associated DIIH manifesting as unilateral PT that persisted despite medical therapy and drug cessation. This highlights the importance of recognizing DIIH as a potential cause of PT, as well as evaluating coexisting anatomic variants and medical comorbidities, which are crucial for timely diagnosis and treatment.

To identify major themes of interest posted by users of the foremost Facebook cochlear implant (CI) support group, understand how these users engage in online support communities, and identify educational gaps in CI care. We conducted a retrospective thematic content analysis approach rooted in framework analysis. 536 Facebook posts were gathered over a two-week period in July 2024 from the Cochlear Implant Experiences Facebook group. Posts were analyzed for author, tone, content, and engagement metrics. Posts were inductively coded into more specific themes and subthemes by two coders with any disagreements resolved by consensus discussion. Majority of posts were authored by patients (81.6%), followed by unknown authors (11.8%), family members (6.2%), companies/vendors (0.2%), and providers (0.2%). The average number of reactions and comments was 22 and 20, respectively. Most posts had a neutral tone (49.6%), followed by a negative tone (28.3%), and positive tone (22.1%). Majority of posts were questions (69%), followed by experience-sharing (21%), and information-sharing posts (10%). Eight major themes were identified from the analysis. Patients utilize this social media community for various reasons but overwhelmingly utilize it to ask questions related to management of the CI device and related equipment. These findings demonstrate trust among patients to gain information from each other and seek support, providing valuable information for providers and companies to fill educational gaps in CI care.

Despite well‐known associations between nutrition and chemosensory dysfunction, very little is known regarding the nutritional impact of COVID‐19‐related chemosensory dysfunction. A retrospective cohort study using the National COVID Cohort Collaborative (N3C) Database was performed to evaluate the risk of malnutrition in individuals with COVID‐19‐induced anosmia. Statistical analysis among groups was performed by odds ratio (OR) calculations (95% confidence interval [CI]). 19,384 (0.05%) COVID‐19‐positive adults without preexisting malnutrition were identified with a new diagnosis of anosmia. Within this subgroup, there were significant odds of developing overnutrition (OR 1.36, 95% CI [1.26, 1.46], P < .0001) and any malnutrition diagnosis (OR 1.34, 95% CI [1.25, 1.44], P < .0001), but not undernutrition (OR 0.88, 95% CI [0.66, 1.16], P = .35). These large database findings indicate that chemosensory losses in COVID‐19 patients may increase the risk of subsequent overnutrition on a broad, national scale. Level of Evidence. Level 3.