Annals of Otology,Rhinology & Laryngology

To examine the relationship between the National Residency Matching Program (NRMP) rank list position and otolaryngology residency performance.

Five consecutive graduating classes at a single institution’s otolaryngology residency training program (2021-2025) were evaluated (n = 18) using their complete 5-year data. Correlation coefficients were calculated to assess the relationship between NRMP rank and in-service exam scores, research productivity, total case logs, milestone evaluations, selection as Administrative Chief Resident, receipt of teaching awards, and post residency position. Milestone evaluations were based on faculty ratings across all 7 core competencies on a 1- to 7-point scale, with an average score calculated for each resident. Spearman’s rho was used to evaluate correlations between NRMP rank and both in-service scores and milestone evaluations. Chi-square tests were conducted to assess associations between NRMP rank and categorical outcomes, including selection as Administrative Chief Resident, receipt of the teaching award, and post residency position.

The average NRMP rank of the residents was 8.778 (range: 1-26). There was a significant correlation between higher NRMP rank and higher milestone evaluations (ρ = −.544, P = .020). However, no significant correlations between NRMP rank and in-service exam scores, research productivity, total case logs, selection as Administrative Chief Resident, receipt of the teaching award, or post residency position were found.

Our results suggest that better-ranked residents receive higher milestone evaluation scores. However, NRMP rank alone may not reliably predict performance on in-service exam scores, chief resident selection, receipt of teaching awards, or position after residency training.

Vocal cord cysts are common benign lesions causing dysphonia, while sulcus vocalis, a groove on the vocal fold, can coexist with cysts and complicate treatment. This study compares clinical characteristics and voice outcomes in patients with vocal cord cysts, with and without sulcus vocalis.

This retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, from 2012 to 2023. Patients with vocal cord cysts who underwent microlaryngeal surgery were included. Sulcus vocalis was suspected preoperatively using videostroboscopic examination and confirmed intraoperatively during microlaryngoscopy with visual inspection and palpation. They were divided into 2 groups: with and without coexisting sulcus vocalis. Voice outcomes were assessed using pre- and postoperative Voice Handicap Index-10 (VHI-10) scores.

A total of 54 patients with vocal cord cysts were included, with 31 (57.4%) having coexisting sulcus vocalis and 23 (42.6%) without. Patients with sulcus vocalis were significantly older (median age 30 vs 22 years, P = .008) and had lower smoking rates (6.45% vs 52.17%, P < .001). They also exhibited worse voice outcomes, with higher preoperative (30 vs 22, P = .002) and postoperative VHI-10 scores (20 vs 10, P < .001) and smaller median VHI-10 improvements (8 vs 12 points, P = .047). Mucosal bridges were more common in the sulcus group (19.35% vs 0%, P = .032), but no significant differences in cyst type (epidermoid or mucus retention), recurrence rates, or follow-up duration were observed between the 2 groups.

Sulcus vocalis worsens voice outcomes in patients with vocal cord cysts, highlighting the need for comprehensive preoperative evaluation. Future research should explore combined surgical treatments for both conditions.

Airway reconstruction triggers a surgery-induced stress (SIS) response, but its effect on cartilage regeneration remains elusive. SOX9 regulates cartilage regeneration by promoting type II collagen production and may aid in repair; however, the role of SOX9 in response to SIS is unclear. We utilized a mouse model to validate SOX9 nuclear expression in tracheal chondrocytes and assess its localization after segmental tracheal replacement.

Tracheas from C57BL/6J mice were digested using Dispase-Collagenase-Trypsin, then collagenase II to isolate chondrocytes for primary culture. Syngeneic tracheal grafts were harvested from donor animals, and a 3 to 4 mm tracheal graft was implanted orthotopically to assess chondrocyte function in vivo. At 1 month, graft, anastomosis, and adjacent host tissues were harvested. Samples were stained for SOX9 and COL2A1, and their localization was analyzed with ImageJ.

Primary tracheal chondrocytes showed strong nuclear SOX9 and cytoplasmic COL2A1 expression. One month after orthotopic tracheal replacement, SOX9 nuclear colocalization increased in the host and anastomosis regions (P = .0269 and P = .0262, respectively), but not in the graft (P = .5958). COL2A1 intensity in the cartilage matrix was significantly higher in graft, host, and anastomosis compared to native cartilage (all P < .01), with no morphological differences.

After tracheal reconstruction, increased SOX9 and COL2A1 intensities indicate a potential chondrocyte response to SIS. SOX9 nuclear localization may be involved in regulating COL2A1 in tracheal chondrocytes during cartilage injury and repair. This supports a possible role for SOX9 in maintaining cartilage function and its potential as a therapeutic target to improve graft integration and airway stability.

While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity on management of vestibular schwannoma (VS). The objective of this study was to determine whether race and ethnicity impacted treatment choice and postoperative management of VS.

Retrospective review of patients diagnosed with VS (ICD9 225.1, ICD10 D33.3, and ICD 10 H93.3) who presented to a tertiary care center between January 1, 2018 and October 31, 2023 was completed (IRB H-45412). Primary outcomes, including treatment choice, time to treatment, and postoperative management, were compared among different racial and ethnic groups.

Of the 78 patients diagnosed with VS, 46 (59.0%) patients were observed with serial imaging, 12 (15.4%) underwent radiation, and 14 (18.0%) pursued surgery initially. Treatment choice (P = .3917), time to treatment (P = .3310), and loss to follow up (P = .0579) were not significantly different between different races/ethnicities. In patients who pursued surgery, the duration of admission (P = .9300), need for rehabilitation (P = .6271), postoperative facial nerve paresis (P = .8233), and hospital readmission (P = .5680) did not differ significantly. The proportion of patients who qualified for hearing rehabilitation did not differ significantly (P = .3545). However, a significantly higher proportion of White patients chose to pursue hearing rehabilitation compared to the other groups ( P = .0096).

Race and ethnicity did not significantly impact choice of treatment, management patterns, or postoperative course for patients with VS.

To assess for longitudinal changes in the prevalence, duration, and self-perceived impact of persistent tinnitus amongst young adults (ages 18-24) in the United States.

The adult National Health Interview Surveys (NHIS) for calendar years 2008 and 2023 were investigated for specific tinnitus related symptoms among young adults (ages 18-24). The prevalence of tinnitus in the past 12 months and the overall duration of tinnitus symptoms were determined and compared between the 2 survey years.

In 2023, an estimated 2.30 million young adults reported tinnitus in the prior 12 months, risk for which was increased with very loud sound exposure (odds ratio [95% confidence interval], 2.6 [1.7-3.9]). Tinnitus was reported to be a moderate or big problem in 8.7% and 3.1% of respondents, respectively, and only 10.1% saw a medical specialist for their tinnitus. The prevalence of tinnitus increased from 5.8% in 2008 to 7.8% in 2023 (P = .030). From 2008 to 2023 there was also an increase in duration of tinnitus (P < .001).

Nationally representative data indicate a concerning increasing prevalence and duration of tinnitus among young adults with a significant self-perceived impact. This increasing prevalence of tinnitus may reflect underlying issues of noise exposure and merits further ongoing surveillance.

IV.

The prevalence of sleep-disordered breathing, including obstructive sleep apnea, has driven the rapid growth of sleep surgery as a subspecialty. Medicare reimbursement plays a pivotal role in the economic viability of sleep surgery, but trends remain understudied. This study analyzes reimbursement trends for commonly performed sleep surgery procedures from 2000 to 2024, assessing inflation-adjusted changes in facility-based professional reimbursement.

The 11 most frequently billed sleep surgery procedures at a single institution in 2024 were identified. Medicare data on facility-based professional reimbursement were extracted from 2000 to 2024 using the CMS Physician Fee Schedule. Inflation adjustments were applied using the CPI Inflation Calculator. Year-to-year percentage changes and linear regression analyses were performed.

Among the analyzed CPT codes, a consistent decline in inflation-adjusted facility prices was observed, with an average aggregate decrease of 39.8%. The most pronounced decline was in CPT 42975 (Drug-Induced Sleep Endoscopy), which decreased by 72.1% (R² = .88). Other procedures, such as CPT 30140 (Submucous Resection of Inferior Turbinate) and CPT 31231 (Diagnostic Nasal Endoscopy), experienced aggregate declines exceeding 58%. Procedures like CPT 30130 (Excision of Inferior Turbinate) showed relatively stable pricing with a 2.6% aggregate reduction.

The substantial decline in inflation-adjusted facility prices for sleep surgery procedures underscores challenges in sustaining the financial and operational viability of this growing subspecialty. Reduced reimbursement may hinder innovation, training, and resource allocation, with potential downstream impacts on patient access and care. Policymakers should consider these findings to ensure equitable and sustainable support within the healthcare system.

4.

This study evaluated the efficacy of perioperative intraoral sucralfate in reducing postoperative pain following tonsillectomy through a systematic review and meta-analysis.

A comprehensive search of PubMed, SCOPUS, Embase, Web of Science, and Cochrane up to September 2025 identified 13 studies comparing perioperative intraoral sucralfate with placebo or no treatment. Outcomes included throat pain, otalgia, swallowing pain, analgesic consumption, and perioperative morbidities.

Sucralfate increased the proportion of patients reporting no or mild throat pain and otalgia, improved mucosal healing at 5 to 7 days, and reduced throat pain, swallowing pain, otalgia, analgesic use, and time to resume >50% of a regular diet. No significant differences were observed in postoperative bleeding or nausea/vomiting.

Perioperative intraoral sucralfate may be an effective adjuvant therapy that improves postoperative pain control, enhances wound healing, reduces analgesic requirements, and facilitates earlier dietary resumption after tonsillectomy.

Evaluate the utility of the large language model (LLM), ChatGPT, for the analysis of operative notes and the generation of Current Procedural Terminology (CPT) codes in comparison to human clinical coders.

CPT billing codes assigned by ChatGPT were compared to existing billing data. Otology practice within a tertiary academic center.

About 191 operative notes from a single surgeon (9/2022-10/2023) were analyzed. ChatGPT-3.5 and 4 models were prompted for CPT codes based on operative notes. Assessment included determining exact and partial match rates, sensitivity and specificity for targeted procedures, and work Relative Value Units (wRVU) differences between ChatGPT-generated and human-assigned codes.

ChatGPT-3.5 achieved exact matches in 22% of cases and partial matches in 32%, while ChatGPT-4 achieved 14% exact and 33% partial matches. When cochlear implantation (CI) was excluded, performance dropped significantly. For CI, ChatGPT-3.5 demonstrated a sensitivity of 94% and specificity of 90%, while ChatGPT-4 showed a sensitivity of 96% and specificity of 92%. In contrast, performance on cartilage grafting was poor, with sensitivities of 4.2% for ChatGPT-3.5 and 0% for ChatGPT-4. ChatGPT-3.5 and 4 showed moderate CPT code matching accuracy among themselves, with slight agreement to human coders. Both models tended to underbill for wRVUs compared to human coders, with significant differences in the values generated.

This study assessed ChatGPT’s effectiveness in automating CPT code assignment for otologic surgeries. While the models achieved high sensitivity values for assigning codes related to cochlear implantation, both models struggled with complex cases, failed to apply modifiers, and often assigned fewer wRVUs. The findings highlight ChatGPT’s potential in medical billing but indicate a need for further refinement.

Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various surgical options, optimal management remains unclear, and restenosis is a common complication. Steroid-eluting stents, such as the Propel™, have shown promise in sinus applications but are underreported in airway stenosis and reconstruction.

We present a case of a 2-year-old female with transverse myelitis and neuromuscular respiratory failure with bilateral vocal cord paresis, which led to multiple intubations and subsequent PGS. She ultimately underwent tracheostomy due to recurrent respiratory failure with viral infections and associated failure to thrive. Once stable, preparations for decannulation began. The patient underwent endoscopic division of posterior glottic scar tissue, followed by placement of a Propel™ steroid-eluting stent to the interarytenoid and arytenoid mucosa.

At 2-week follow-up, laryngoscopy revealed significant reduction in scar tissue without restenosis, with progressive resolution of granulation tissue and edema. Despite persistent vocal cord paresis, airway patency was maintained. At 3-month follow-up, there was marked improvement of stenosis sufficient to allow tracheostomy capping.

This case highlights the off-label use of a steroid-eluting stent as adjunctive therapy in a pediatric patient with PGS. Outcomes demonstrated reduced scar tissue and improved airway patency, allowing progression toward decannulation. Further studies are needed to evaluate the role of steroid-eluting stents in the management of complex laryngeal disorders.

Management of deep cervical lipomas (DCLs) is described only in case reports and series in the literature. We aim to present a scoping review of this literature and the largest case series of surgically resected DCLs to describe presentation, workup, and efficacy of transcervical resection for DCLs.

A systematic search for surgically resected solitary DCLs was conducted in PubMed, Embase (Elsevier), Scopus, and Cochrane library on 12/19/2025 using PRISMA methodology. Study protocol was registered in PROSPERO (CRD420251052065) and articles were screened independently by 2 authors, with conflicts resolved by a third reviewer. All solitary DCLs resected via a transcervical approach at a tertiary center from 2014 to 2025 were reviewed.

From a total of 1459 articles, 144 studies met criteria, and 163 cases (median age 45 years, 25.2% pediatric, 67.5% male) were included. The most common presenting symptom was swelling (81.6%), and 63.2% were enlarging. A total of 232 imaging studies, most commonly CT (n = 102), were conducted amongst 90.8% of patients for an average of 1.4 imaging studies per patient. Biopsy was performed in 27.6% of patients, with 43.4% of biopsies being inconclusive or inconsistent with benign fatty tumor. Postoperative complaints were noted for 9.8% of patients, with only 3.1% (n = 5) having persistent complaints. Two recurrences were noted. The institutional cohort of 10 patients (median age 55 years, 10% pediatric, 90% male, 90% non-Hispanic White) mirrored the literature, with the most common presenting symptom being palpable neck mass (80%), at least one imaging study per patient on average, no persistent complaints, and one recurrence.

DCLs are less common than subcutaneous lipomas but follow a similar clinical course. Presentation most commonly occurs as a palpable mass, most of which are enlarging. Imaging without biopsy is often sufficient for workup. Transcervical resection is diagnostic and therapeutic with minimal morbidity.

To investigate whether current tonsillectomy (TE) guidelines for adults with recurrent acute tonsillitis (RT) are too restrictive, potentially excluding patients who would benefit from surgery, and to explore predictive factors of improved postoperative Throat-Related Quality of Life (TR-QoL).

In this prospective cohort study, patients undergoing TE were stratified into 3 groups based on increasingly stringent criteria: G1 (not meeting the Danish National Guidelines (DNG) or the Scottish Intercollegiate Guidelines Network [SIGN]/Paradise criteria), G2 (meeting only DNG), and G3 (meeting both DNG and SIGN/Paradise criteria). The effects of TE were assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) and the Glasgow Benefit Inventory (GBI). TOI-14 scores, GBI scores, patient satisfaction and postoperative sore throat episodes were evaluated after 12, 24 and 36 months. Predictive factors of improved TR-QOL were identified using multiple linear regression.

At baseline, 65 patients (G1: n = 21, G2: n = 33, G3: n = 11) were analyzed. Response rates ranged from 65% to 86% at follow-ups. All groups demonstrated significant, sustained improvements in TOI-14 and GBI scores. TOI-14 total scores improved from 45.0 at baseline to 8.1-10.2 at follow-ups, GBI total scores ranged from 34.9-40.1, satisfaction rates were high (96%-98%), and sore throat episodes were infrequent postoperatively. Group differences were minimal. The preoperative TOI-14 score was the strongest predictor of improved TR-QOL (adjusted R² = 0.723).

TE provided sustained benefits and significantly improved TR-QoL across a broad range of RT patients, including those who did not meet current guideline criteria, suggesting that guidelines may be too restrictive. The preoperative TOI-14 score was the strongest predictor of TR-QoL improvement. Integrating such a patient-centered tool to select patients for TE may enhance RT patient management.

To characterize contemporary workforce trends among physician assistants in otolaryngology–head & neck surgery in the United States.

Longitudinal analysis of annual survey of the Society of Physician Assistants in Otorhinolaryngology–Head & Neck Surgery (SPAO-HNS) data, collected 2015 to 2024. The survey captured self-reported practice patterns, compensation models, and clinical responsibilities. Statistical analyses included linear and logistic regressions to evaluate temporal trends and differences by practice setting.

A total of 1227 survey responses were analyzed. Most respondents were physician assistants (93.7%), predominantly working in private stand-alone otolaryngology practice environments (66.8%). Majority of respondents reported working an average of 40 hours per week with salary-based compensation (71.8%), though productivity-based bonuses rose over the study period (P =< .001). Common procedures performed independently included cerumen removal, foreign body extraction, and nasal endoscopy or flexible fiberoptic laryngoscopy. Practice setting influenced patient volume and scope of responsibilities, with stand-alone practices reporting higher outpatient volumes. The proportion of respondents planning to leave otolaryngology within 5 years nearly doubled from 17% in 2015 to 29% in 2024.

This 10-year longitudinal analysis highlights the integral and evolving contributions of physician assistants and nurse practitioners to otolaryngology care across diverse practice settings. The findings document an expanding role in enhancing access to care and performing office procedures independently. However, the rising proportion of respondents intending to leave the field signals emerging workforce sustainability challenges. Proactive strategies to support recruitment, retention, and professional development are needed to ensure a stable and effective otolaryngology workforce capable of meeting growing patient needs.

To (1) report on the long-term recurrence rate of surgically managed pleomorphic adenoma (PA) and (2) assess long-term surgical outcomes after parotidectomy

Cross-sectional survey of all patients with a pathologic diagnosis of PA who underwent surgical management in a tertiary care center from 01/1997 to 12/2023 and had access to an electronic patient portal. Surveys were delivered via electronic patient portal or phone call with 6 questions to assess recurrence and long-term surgical outcomes. Time to first recurrence and recurrence free survival were analyzed using a Kaplan-Meier curve.

Seven hundred-forty-five patients met inclusion criteria and received the survey, with a 56% response rate (n = 420). The clinical median follow-up length was 51 days, which extended to a median length of 6.2 years following the survey. The median change in follow-up length was 5.37 years (P < .001). The recurrence rate was 1% at 5 years, with a median time to first recurrence of 7.54 years. 13% and 9% of responders reported facial asymmetry and incisional cosmetic concerns, respectively. 33% of patients reported experiencing Frey syndrome, which increased from 5.2% of survey responders with documented Frey syndrome at their original post-operative assessment.

Long-term assessment of PA outcomes confirms low recurrence rates, suggesting regular surveillance of recurrence is likely unnecessary. Complaints of Frey syndrome increased in frequency with longer term follow-up, which should be considered during patient counseling.

3

To assess the efficacy of adjuvant MMC in the endoscopic treatment of airway stenoses.

PubMed/MEDLINE, Cochrane Library, Scopus, Embase, and Google Scholar databases.

A literature search was conducted following PRISMA guidelines. The PICOS tool was used to determine the eligibility criteria for this study. A single arm meta-analysis was performed for stenosis resolution, the rate of patients requiring multiple endoscopic procedures, and the rate of patients requiring other surgical treatments.

A total number of 358 patients (median age: 48.0 years; 95% CI 44.8-50.8) were included. The median follow-up was 25.2 months (n = 244/358; 95% CI 15.4-38.3). Overall, the cumulative stenosis resolution rate was 76.37% (n = 187/254; 95% CI 59.72-89.64), the rate of patients requiring multiple endoscopic procedures was 52.33% (n = 131/260; 95% CI 32.03-72.25), and the rate of patients requiring other surgical treatments was 4.08% (n = 26/310; 95% CI 0.37-11.48). The median intervention-free interval was 366 days (n = 155/358; 95% CI 270-696).

Current evidence does not allow definitive conclusions regarding the efficacy of adjuvant MMC in reducing recurrence or prolonging intervention-free intervals in airway stenosis. Further well-designed prospective studies are needed to clarify the role of MMC and to inform evidence-based guidelines for patient selection and treatment use.

NA.

The purpose of this study was to develop and implement a novel 3D printed simulator to be used to educate patients about home drain removal prior to discharge and to highlight its benefits to the patient and healthcare systems.

A deidentified CT scan was used to create an anatomically accurate 3D printed mold of a neck. Additional conduits and inserts were added to the simulator during the silicone molding process. Simulators were produced and utilized on inpatient floors of a head and neck service at one comprehensive cancer center to assist with patient education for an existing home drain removal program.

Three novel simulators were produced and used in the patient discharge training program for patient-directed home drain removal. 3D anatomic models have been shown to improve patient understanding and assist with acquisition of procedural skills, so the incorporation of a drain removal simulator into a home drain removal program sought to improve patient comfort with drain removal and expand the number of eligible patients for this program. Home drain removal is associated with reduced unnecessary clinic visits, lower healthcare costs, and optimized resource utilization.

A 3D printed drain removal simulator has the potential to enhance patient education for home-based surgical neck drain removal and expand enrollment in self-directed drain removal. Greater enrollment in home drain removal has the potential to benefit patients and healthcare systems through improved time efficiency and financial savings.

To compare the intraoperative and postoperative outcomes of using oxidized regenerated cellulose (Surgicel^®) versus absorbable gelatin sponge (Spongostan^®) for supporting graft material in endoscopic tympanoplasty.

We retrospectively analyzed 92 patients who underwent endoscopic type 1 tympanoplasty between 2020 and 2024. Patients were divided into 2 groups based on the supporting graft material used: 47 received Surgicel^® and 45 received Spongostan^®. Primary outcome measures included intraoperative hemostasis quality, duration of graft placement, postoperative graft success, graft lateralization, and hearing outcomes at 6 and 12 months.

Hemostasis during graft placement was better in the Surgicel^® group (P = .017), and shorter graft placement duration was observed (P = .047). At ≥ 6 months, graft success rates were comparable between the groups (89.4% for Surgicel^® vs 82.2% for Spongostan^®; P = .380). However, graft lateralization was significantly less frequent in the Surgicel^® group (2.1%) compared to the Spongostan^® group (15.6%; P = .029). While the Spongostan^® group showed significantly better hearing results at 6 months (mean ABG 16.9 dB vs 28.6 dB; P < .001), hearing outcomes were similar by 12 months.

Both Spongostan^® and Surgicel^® are effective supporting graft materials in endoscopic tympanoplasty. However, Surgicel^® was associated with certain intraoperative advantages, including superior hemostasis and shorter operative time, along with a significantly lower risk of postoperative graft lateralization. These benefits suggest Surgicel^® may be a preferable option for enhancing surgical efficiency and optimizing outcomes in endoscopic ear surgery.

Endotracheal intubation can cause laryngeal injury, with clinical presentation ranging from transient hoarseness to persistent vocal cord immobility. This study examines the incidence, clinical features, and outcomes of post-intubation laryngeal injuries following procedures traditionally considered low risk for such complications.

We conducted a retrospective review of adult patients who underwent tracheal intubation for surgical procedures between May 1, 2018, and December 31, 2024, and subsequently presented with postoperative laryngeal injury–related symptoms. Patients who underwent cardiothoracic, thyroid, parathyroid, or anterior cervical spine procedures were excluded. We reviewed patient demographics, airway and intubation characteristics, treatments, and clinical outcomes.

Among 267 824 patients undergoing 454 924 general anesthetics, 30 developed postoperative laryngeal injury (6.6/100 000; 95% CI 4.5–9.4) which did not resolve spontaneously and required laryngology evaluation. Of these 22 (67%) had well defined movement abnormalities: unilateral (n = 15) and bilateral vocal cord immobility (n = 1), unilateral hypomobility (n = 4), bilateral hypomobility (n = 1), combined unilateral vocal cord immobility with contralateral hypomobility (n = 1), and 11 (33%) had no movement abnormality. Twenty-one (64%) were intubated via video laryngoscopy. Follow-up was available for 21 patients (70%) with a median [IQR] duration of 12 [9-35] months; 15 (72%) showed partial improvement without complete resolution, while 6 showed no improvement.

Laryngeal injury following general anesthesia with tracheal intubation is a uncommon complication. In our series, approximately two-thirds of patients had identifiable injuries, while one-third exhibited no structural abnormality. While 75% of patients demonstrated partial symptomatic improvement, however, complete resolution was not observed in any of the patients who received follow-up in our institution, underscoring the severity of this complication.

To explore the surgical effect for patients with different types of tympanosclerosis under total otoendoscopy.

A retrospective analysis was performed on the clinical data of 86 patients who were diagnosed with tympanosclerosis and underwent total endoscopic ear surgery. According to the Wielinga classification, the patients were categorized into type II group (n = 34) and type IV group (n = 52). Hearing outcomes were recorded and analyzed at the preoperative, short-term postoperative (≤6 months), and long-term postoperative (≥1 year) periods.

Significant differences in average air-bone gap (ABG) were observed among preoperative, short-term, and long-term postoperative periods in type II and IV tympanosclerosis. No difference was found between type II and IV in short-term ABG, whereas a significant difference appeared in long-term outcomes (P < .05). The duration of illness was strongly correlated with tympanosclerosis type and preoperative ABG.

The short-term surgical benefits of type II and type IV are similar, while the long-term hearing recovery of type II is better. The bone conduction recovery of type IV is better. The longer the disease course, the more severe the hearing loss.