Weiss, Natalie

Introduction: Laryngopharyngeal symptoms (LPS) refer to aerodigestive complaints that may result from the retrograde flow of gastric contents into the upper aerodigestive tract. These symptoms may be under-recognised in populations exposed to mechanical or environmental stressors. Divers may be at increased risk due to factors such as pressure changes and body positioning. This study characterised the prevalence and severity of LPS among divers and identified associated risk factors. Methods: A cross-sectional, anonymous survey was distributed to members of the Divers Alert Network (DAN). Collected data included demographics, diving-related behaviours, medical history, and LPS burden measured using the Reflux Symptom Index (RSI). Results: Of the 309 survey responses analysed, 47.2% were male with a median age of 50.0 years (IQR: 40.0−60.0). Among 291 divers with complete RSI data, 26.1% (95% CI, 21.4–31.5%) had abnormal RSI scores, representing a +16.0 percentage-point increase (95% CI, 11.3%−21.4%) over non-diving population estimates (P < 0.001). In multivariable analysis, female sex (adjusted prevalence rate [aPR] 1.59, 95% CI 1.07–2.37) and gastroesophageal reflux disease (GERD) history (aPR 1.75, 95% CI 1.16–2.65) were independent predictors. Recreational divers had a lower risk (aPR 0.59, 95% CI 0.39–0.90). Approximately 5% of respondents described their symptoms as life-threatening. Conclusions: Divers may represent an under-recognised population at elevated risk for LPS. Female sex and GERD history were associated with greater symptom burden, while recreational diving appeared less provocative compared to technical diving. These findings may have implications for risk stratification and symptom management in the diving community.

Abstract Objective To evaluate the connection between symptom burden and sexual quality of life in women with idiopathic subglottic stenosis (iSGS). iSGS is a rare fibroinflammatory disorder involving progressive airway narrowing and respiratory distress. While the impact on physical functioning is well‐established, the influence of iSGS on sexual health, a key component of quality of life, remains unexplored. Study Design Anonymized cross‐sectional survey using validated questionnaires. Setting Online international iSGS support group (Living with Idiopathic Subglottic Stenosis). Methods The Dyspnea Index (DI), the Female Sexual Quality of Life (SQOL‐F) questionnaire, and the Medical Outcomes Health Survey (SF‐36) were distributed to an iSGS support group. Only complete responses were analyzed. Associations between DI and sexual quality of life were evaluated using correlation and linear regression. Median‐based symptom burden groupings were used for secondary descriptive comparisons. Results 682 completed all items in the assigned questionnaires and met inclusion criteria. DI scores were inversely correlated with SQOL‐F (Rho = −0.305, P < .001). SQOL‐F was consistently lower among those with high symptom burden across nearly all items; only partner communication showed no difference. Each one‐point increase in DI predicted a 0.61‐point decrease in SQOL‐F ( B = −0.609, P < .001). High‐burden patients also reported significantly lower SF‐36 Physical (PCS) and Mental (MCS) Component Scores. Conclusions Greater airway symptom burden in iSGS is associated with significantly diminished sexual and general health‐related quality of life. These findings reinforce a need for patient‐centered care that considers both physical and psychosocial well‐being.

Objectives: Despite advantages of titanium mesh, hardware exposure affects up to 25% of cases reported in the literature. We aim to identify risk factors associated with titanium mesh exposure following cranioplasty and characterize early wound changes that may signal impending hardware exposure. Methods: A review of 34 patients who underwent titanium mesh cranioplasty between 2015 and 2025 was performed. Seventeen patients with hardware exposure were matched 1:1 with 17 controls. Data on demographics, comorbidities, operative details, and postoperative complications were collected. Statistical analysis included Fisher exact test and t tests, with significance set at P <0.05. Results: Significant risk factors for titanium hardware exposure included a history of metal allergy and reconstruction with advancement flaps. Significant protective factors included patients undergoing postoperative radiation therapy and reconstruction with rotational flaps. Conclusions: Titanium mesh exposure risk increases with metal allergy history, postoperative radiotherapy, and use of advancement flaps for reconstruction. Recognition of early wound changes is crucial for timely intervention. These findings support individualized surgical planning and highlight the need for close postoperative monitoring to reduce complications and improve reconstructive outcomes.

Subglottic stenosis (SGS) may arise from both mechanical and inflammatory airway injury. Patients with mast cell activation syndrome (MCAS) are uniquely vulnerable, due to both direct effects of systemic inflammation and indirect effects of repeated intubation for anaphylaxis that can converge to cause life-threatening airway compromise. We describe a sentinel case of a 34-year-old female with MCAS and multiple prior intubations who presented with progressive dyspnea. Flexible laryngoscopy revealed grade III SGS. She underwent urgent endoscopic intervention, including balloon dilation, carbon dioxide (CO 2 ) laser radial incisions, and steroid injection. Airway patency was restored, and postoperative care focused on optimizing systemic mast cell control with cromolyn, fexofenadine, montelukast, and omalizumab. Literature review supports a mechanistic role for mast cell mediators in airway fibrosis and impaired wound healing, compounding the effects of mechanical trauma in MCAS. This sentinel case highlights clinically significant risk of SGS in patients with MCAS. By integrating case findings with mechanistic insights, this report underscores the urgent need for interdisciplinary awareness, proactive airway evaluation, and research into surveillance and prevention strategies in MCAS and related disorders. Level of Evidence: Level V/Case Report and Narrative Review.

ABSTRACT Objectives To critically evaluate clinical and voice‐related outcomes of in‐office serial intralesional steroid injection (SILSI) in adults diagnosed with idiopathic subglottic stenosis (iSGS). Data Sources MEDLINE, Embase, CINAHL Ultimate, CENTRAL, ClinicalTrials.gov . Review Methods A systematic search of databases was conducted from inception through April 5, 2025. Studies eligible for inclusion must have reported on adult SILSI recipients undergoing management of iSGS. Articles were independently screened and reviewed by two authors for treatment variables including steroid protocol, clinical outcomes, respiratory function, vocal outcomes, and complications. Results Of 383 studies identified, 14 met inclusion criteria ( n = 371). Triamcinolone was the most commonly used agent in 10 studies. Steroid dosage, number of treatment sessions, and injection interval varied widely across studies. Improvements in surgery‐free interval, peak expiratory flow, dyspnea index, degree of stenosis, and voice‐related outcomes were observed in several studies. No major complications were reported in the included studies. Conclusion Current evidence suggests SILSI represents a promising adjunctive therapy in the treatment of iSGS, with improvement noted across several measures. However, significant variability in steroid treatment regimens and inconsistent reporting of outcomes complicate interpretations of efficacy.

Abstract Synchronous squamous cell carcinoma (SCC) and chronic lymphocytic leukemia (CLL) in the parotid gland is rare, with limited evidence on personalized treatment. We report a 75-year-old male with prior cutaneous SCC who presented with a hypermetabolic parotid mass and cervical lymphadenopathy; fine needle aspiration confirmed SCC. Surgery revealed poorly differentiated SCC and CLL in multiple lymph nodes. He underwent radiotherapy but developed regional SCC relapse without systemic CLL symptoms. Recurrence in the ear required extensive surgical resection and reconstruction. Genetic profiling showed high tumor mutational burden (&gt;50 mutations/Mb) and mutations in ARID1B, CDKN2A, MSH2, PMS2, and TP53. He received six cycles of cemiplimab followed by cetuximab-based targeted therapy, based on rising circulating DNA levels. This case emphasizes the value of genetic profiling and tools like TMB, FISH, and immunohistochemistry for risk stratification and personalized treatment in managing advanced or complex parotid malignancies, including synchronous SCC and CLL, to optimize patient outcomes.

ABSTRACTObjectivesThyroglossal duct cyst (TGDC) associated carcinoma is rare, accounting for less than 2% of TGDC cases. The majority of cases are classified as papillary thyroid carcinoma (PTC). Standard treatment for TGDC‐PTC involves a Sistrunk procedure and prophylactic total thyroidectomy (TT). However, the necessity of these extensive surgical interventions remains debated. This report aims to explore whether individualized surgical approaches may reduce morbidity while maintaining favorable oncological outcomes.MethodsRetrospective case series of three patients with TGDC‐PTC.ResultsThe age range at presentation for our patients with TGDC‐PTC was 26 to 50. Case 1 involved a 38‐year‐old patient with a cystic mass near the hyoid bone and submental lymphadenopathy who underwent cyst excision with level Ia lymph node clearance. Case 2 is of a 50‐year‐old patient with a history of TGDC‐PTC who presented with a recurrent neck mass 9 years after the initial surgery and underwent a revision Sistrunk procedure. Case 3 presents a 26‐year‐old patient with a large TGDC and a benign thyroid nodule who underwent a Sistrunk procedure. All three patients had PTC confirmed by final pathology. All had no evidence of recurrent disease at follow‐up evaluations ranging from 1 to 12 years.ConclusionThis case series demonstrates the feasibility and safety of individualized surgical management for TGDC‐PTC. Risk stratification allowed for tailored interventions and avoided overly aggressive approaches. Further studies are needed to establish definitive guidelines for managing TGDC‐PTC, particularly in low‐risk patients.Level of Evidence4.

AbstractIntroductionCastleman disease (CD) refers to a heterogeneous group of lymphoproliferative disorders, which rarely involves the larynx. Our goal in this study is to elucidate the clinical presentation, diagnostic techniques, and treatment methods of laryngeal CD through a scoping review and the addition of a new case.MethodsDue to limited existing literature, we employed a mixed methodology for review. First, we searched Google Scholar using terms related to laryngeal CD. Subsequently, we screened abstracts using Covidence, drawing from databases such as PubMed, Science Direct, ProQuest, and EMBASE. We shortlisted studies for data extraction, focusing on clinical presentations, diagnostics, and treatment methodologies. Finally, we described our additional case.ResultsScoping review revealed five qualifying laryngeal CD articles. Presenting symptoms included dysphagia, hoarseness, and dyspnea. Diagnosis was always established through histopathologic analysis. Management included local excision or radiotherapy. In our additional case, a 71‐year‐old male with known CD presented with neck swelling, dysphagia, and dysphonia. Exam revealed lymphoid laryngeal and supraglottic hyperplasia and edema. Laryngeal symptoms improved with medical management of CD.DiscussionGiven the rarity of laryngeal CD, its identification and management can be a challenge. Practitioners should be aware of characteristic points in a CD patient's history, physical exam, imaging, and biopsies. Local excision of obstructive lymphoid tissue and radiation are the best‐supported therapies. This study aims to build toward improvements in accurate diagnosis and appropriate treatment for laryngeal CD.