Laryngology Brief, July 2026, Issue 2
Laryngology Brief, July 2026, Issue 2Welcome to the second issue of Laryngology Brief, Every month I scan the laryngology literature across 11 core journals, this time 139 articles published between June 1 and July 1, 2026, and select the handful that I believe deserve a working clinician's attention. Each featured paper comes with a short summary of its design and numbers, followed by my own reading: why it matters at the bedside or in the office, where the data is solid, and where I would hold back. This issue leans toward questions we face weekly: choosing between angiolytic lasers, sequencing medialization in vocal fold paralysis, what to offer the refractory neurogenic cough patient, and how honestly to counsel a subglottic stenosis patient on endoscopic versus open surgery. My aim is not to replace your own reading but to save you time and give you a starting argument. Comments and disagreements are welcome; they make the next issue better and increase my motivation to continue! Featured Papers in This Issue
⭐ Highlight of This IssueLin RJ, Zeng PYF, MacInnis P, Horton G, Anderson J. Awake Blue Light vs. KTP Laser Treatment for Vocal Fold Lesions: A Randomized Controlled Trial. Laryngoscope. 2026. DOI A prospective, open-label, randomized pilot trial comparing an office-based 445 nm blue light laser with the established 532 nm KTP laser for benign vocal fold lesions (98 patients, 49 per arm). VHI-10 improved by about 12.4 points in both groups at day 90 (p<0.001), with the between-group difference at -1.16 (95% CI -5.44 to +3.13, p=0.60), that is, no difference in voice, pain, or stroboscopic closure (complete closure 91.2% vs 85.7%, p=0.74). Why it matters: First of all our field needs more randomized controlled trials! Thanks Lin and her team. Office-based angiolytic laser is now the workhorse of many practices; the contribution here is that the blue light laser gives results equivalent to KTP. This matters as device economics: the full text points to KTP console discontinuation, so a portable blue light laser giving equal results is a real alternative for a center without KTP. Where I add a note: the study is open-label with unblinded stroboscopy and only 90 days, and equivalence was framed as "no difference found" rather than a formal noninferiority design. It does not answer lesion recurrence, and the preclinical claim that blue light scars less is not tested over this short window. Still, reassuring for the clinician choosing between the two devices. NeurolaryngologyCabral J, et al. Superior Laryngeal Nerve Block for Neurogenic Cough: A Systematic Review and Meta-Analysis. Otolaryngology, Head and Neck Surgery. 2026. DOI A single-arm meta-analysis (8 retrospective studies, 552 patients) of the superior laryngeal nerve block for neurogenic cough. Pooled subjective improvement was 74% (95% CI 68.6 to 78.8), with low heterogeneity for that outcome (I squared 13.6%). Why it matters: Neurogenic cough is one of those pictures where our hands feel relatively tied; neuromodulators do not work for everyone, and the patient wanders for years. Having the block supported by a pooled 74% response, consistent across studies, moves it into "a viable office procedure to try." Two full-text nuances matter. First, a dose-response signal: the Cough Severity Index dropped significantly only in the three-or-more injections subgroup (mean difference -10.57), not with one or two, so this is a repeated program, not a single shot. Personally I consult that we will perform at least 3 injection and if we had around 50% reduction I will continue doing a few more. Second, patients already on neuromodulators responded less (52% vs 89% in one study). The honest limits: all studies retrospective, single-arm, no control, so effect versus placebo is unproven, and the CSI heterogeneity is high (I squared 81%). Safety is reassuring, serious adverse events about 2%. I would offer it to the refractory patient with that frank framing. Yun JH, Lee JM, Jung SY, Kim HS. Endoscopic Laser Thyroarytenoid Myoneurectomy in Botulinum Toxin-Refractory Adductor Spasmodic Dysphonia: A Case Series. Journal of Voice. 2026. DOI Endoscopic laser thyroarytenoid myoneurectomy was performed in 28 patients with adductor spasmodic dysphonia refractory to botulinum toxin or poorly compliant with repeated injections. Mean VHI fell from 92.6 to 58.3, jitter and shimmer roughly halved, the connected-speech CSID score dropped from 89.4 to 19.5, and videostroboscopy showed resolution of ventricular hyperadduction and anteroposterior compression in every patient, with no permanent paralysis. In the body of the paper, 11 of 14 patients (78.6%) reported at least 50% improvement and 4 (28.6%) at least 90%. Six-month follow-up was available in 14 patients. Why it matters: In spasmodic dysphonia, botox is still the standard, but being dependent on an injection every three months is not sustainable for a subset of patients. Offering a permanent surgical option with an acceptable safety profile is a real door for them. The critical caveat from the full text is that vocal tremor did not improve, so this technique targets adductor spasm, not tremor, and tremor-dominant patients should be excluded. We should thank to Domingos Hiroshi Tsuji for this surgical technique. And I would read their[ long term results paper ](- 10.1002/lary.31904) or Ton Langeveld's Myoneurectomy for AdSD Monday meeting of ELS. PhonosurgeryAbdelshafy A, et al. Steroid Injection for Benign Vocal Fold Lesions: A Systematic Review and Meta-Analysis. Journal of Voice. 2026. DOI A meta-analysis (14 studies, 694 patients) evaluating steroid injection for benign vocal fold lesions. Pooled lesion resolution was 77.9% (95% CI 71.2 to 83.4) with a mean VHI-10 improvement of -14.6. Why it matters: Steroid injection is an intermediate step that keeps some patients out of the operating room, and the full text turns my "benign lesion is a broad umbrella" hunch into numbers. Response follows lesion type: inflammatory lesions 84%, mixed 71%, scar or fibrotic only 48%, with the VHI-10 gain tracking the same gradient (inflammatory -15.8, scar -9.1). So this is a real escape from the operating room in early, inflammatory lesions and a low-expectation option in fibrotic ones. The honest caveat, which the authors state, is high heterogeneity (I squared over 90%) and significant publication bias (Egger p=0.0028), so the pooled effect may be modestly overestimated, and post-treatment VHI-10 still sits around 19. For a selected inflammatory or early lesion, valuable as a first office move. Graves J, Hawkshaw M, Syamal M, Rutt A, ..., Sataloff RT. Staged Interventions for Vocal Fold Paresis and Paralysis: A Proposed Decision Paradigm for Type 1 Thyroplasty. Journal of Voice. 2026. DOI From a single-center screen of roughly 1,000 patients, 72 with paresis or paralysis who underwent type 1 thyroplasty between 1990 and 2024 were analyzed. Patients were split into a "thyroplasty first" group (45) and an "other intervention first," mostly injection, group (27). The thyroplasty-first patients were older, and their time to a second medialization procedure was a median of 3.6 years, that is, 3.3 times longer. Meanwhile, no significant difference was found between groups in glottic closure, glottic gap measurement, or voice quality outcomes. But in this study, the limitaion is that the non-thyroplasty group includes non-medialization procedures like subglottic stenosis surgery or KTP ablation for varices. It's not fair to compare these two groups, and the comparison is not scientifically showing thyroplasty versus other because other has everything in it. Why it matters: By "staged intervention" here we mean the order in which we medialize a permanent paralysis: a temporary injection laryngoplasty first, or straight to a type 1 thyroplasty. This is a decision we make constantly, and most of us default to "let's try an injection first, and move to thyroplasty if it turns out to be permanent." What is interesting in this paper is that while voice outcomes are similar on both paths, patients who had thyroplasty first needed revision much later. In other words, sequencing looks less like a determinant of the result and more like a lever for durability. But I would not take it at face value. This is a retrospective series, the cases of a single senior surgeon, and the selection bias is obvious: the thyroplasty-first group was already older, so these were likely patients whose permanence was anticipated from the start. Laryngeal RejuvenationSzymanowski A, et al. Voice Therapy versus Injection Augmentation for Presbyphonia: A Systematic Review and Meta-Analysis. Journal of Voice. 2026. DOI A meta-analysis (24 studies, 432 patients over 60) comparing voice therapy with injection augmentation for presbyphonia. Overall VHI-10 improved (-1.20, p<0.001) but the maximum phonation time effect was not significant (+1.53 s, p=0.09), and voice therapy versus augmentation showed no difference (VHI-10 -1.26 vs -1.15, p=0.80). Why it matters: The aging voice will come to us more and more, and the patient often asks "injection or therapy?" Read against the full text, this is a state-of-the-field paper, not a verdict: only VHI-10 and MPT were reported consistently enough to pool, and neither showed superiority of one approach. So I read it as "both are reasonable, and therapy, being harmless, is a defensible first step," not "therapy is superior." The MPT heterogeneity is near-total (I squared 99%) driven by one outlier, so that endpoint is fragile. The real unanswered questions, which the authors flag, are the combined approach (therapy plus augmentation) and individualizing by frailty; that is where I would look next. Imaging and Artificial IntelligenceHuang JL, ..., Ni XG. Multiview Laryngoscopic Image Fusion for Patient-Level Stratification of Vocal Fold Lesions. Journal of Voice. 2026. DOI A deep learning model that fuses, at the patient level, multiple laryngoscopic images taken at different distances and angles, in a multicenter cohort of 628 patients. In the external cohort, for benign versus malignant/high-risk discrimination, it achieved an AUC of 0.89 and a specificity of 0.975 but a sensitivity of 0.64. Why it matters: What this study gets conceptually right is that it looks not at a single frame but, as we actually do, at multiple views; an architecture closer to clinical reasoning, and it is multicenter with external validation, which sets it apart from most single-center AI work. But the numbers must be read honestly: specificity 0.975 with sensitivity only 0.643 means the model cannot say "not malignant," only "pay attention to this one." The full text is explicit that at the current operating point it should not be a standalone screening or rule-out tool, only an adjunct for endoscopic triage before biopsy; I respect that honesty. Also, patient-level fusion gave the best AUC point estimate but was not statistically better than the other fusion strategies, so "fusion is essential" is premature. Using AI as a supporting mind, not a replacement for the decision, is exactly where I draw the line. SwallowingYoon H, et al. High- versus Low-Intensity Expiratory Muscle Strength Training in Parkinsonism: A Randomized Controlled Trial. Dysphagia. 2026. DOI A single-blind RCT (30 patients) comparing high-intensity (75% of maximum expiratory pressure) with low-intensity (50%) EMST over 6 weeks in degenerative parkinsonism. Both arms improved swallowing safety and vallecular residue, but only the high-intensity arm improved respiratory outcomes: maximum expiratory pressure (59.7 to 72.7, p=0.047) and peak cough flow (272 to 326, p=0.016). Why it matters: Most of us apply EMST but are not clear on its "dose." The full text draws a clean line: low intensity is not useless, it still improved penetration-aspiration and residue, but only high intensity added respiratory and cough-clearance gains, and cough flow is exactly the airway-protection reserve that matters in neurogenic dysphagia. Honest limits: no sham arm, small sample, short duration, and the only between-group significant difference was vallecular residue, so "high is definitively superior" overstates it. My read: prefer high intensity in the patient who tolerates it, keep low intensity as a reasonable option when tolerance or adherence is limited. The dose is a real variable, not a detail. AirwayTurayeva A, et al. Endoscopic and Open Surgical Therapeutic Outcomes of Subglottic Stenosis: A Systematic Review. Journal of Voice. 2026. DOI A systematic review (21 studies, 153 children and 2714 adults, 85% idiopathic) with descriptive synthesis of crude pooled proportions, not a meta-analysis. Endoscopic procedures (n=1508): 36% revision (95% CI 33 to 38) and 36% decannulation success. Open airway resection (n=416): 13% revision (95% CI 10 to 16) and 85% decannulation success. Why it matters: This puts numbers on the trade-off we set up when counseling patients: endoscopy is less invasive but more recurrent (revision 36% vs 13%), open resection more durable (decannulation 85% vs 36%). But the crucial full-text caveat, which the authors stress, is confounding by indication: severe stenoses (Cotton-Meyer III to IV) were preferentially sent to open surgery, so a large part of the apparent gap reflects patient selection, not the intrinsic superiority of open surgery. They deliberately avoided a pooled meta-analytic model because of this and the heterogeneity. Etiology also matters: endoscopic revision was lower in acquired post-intubation cases (21%) than idiopathic (40%). So I use this as a counseling reference, framed as "severity and etiology drive the choice," not as evidence that open surgery is simply better. Yılmaz T. The Effect of Preoperative Body Mass Index on Dyspnea After Endoscopic Total and Partial Arytenoidectomy for Bilateral Vocal Fold Paralysis. Journal of Voice. 2026. DOI A retrospective single-center review (Hacettepe University, Ankara) of 105 patients with bilateral vocal fold paralysis, mostly after thyroidectomy, who underwent endoscopic total (27) or partial (78) arytenoidectomy, relating preoperative BMI to the validated Dyspnea Index (DI) before and one year after surgery. Glottal area and anterior commissure angle roughly tripled and DI fell from a mean of 27 to 10 after surgery in both arytenoidectomy types, but on multiple regression, BMI, postoperative glottal area, and postoperative anterior commissure angle independently predicted the postoperative DI (adjusted R squared 0.667), with BMI the single strongest factor: each one-point rise in BMI corresponded to a 0.43 standardized-beta increase in postoperative dyspnea score. Why it matters: The Dyspnea Index is a validated ten-item patient-reported measure of upper-airway dyspnea, and glottal area and anterior commissure angle are the two objective endoscopic surrogates we actually have for airway caliber after arytenoidectomy; this paper ties all three to BMI in one regression. Arytenoidectomy counseling has always centered on the airway-versus-voice trade-off in my head, and BMI is not something I had weighed as an independent variable, yet here it comes out as the strongest single predictor of how short of breath the patient still feels after a technically successful, objectively enlarged airway. The practical shift is straightforward: weight belongs in the preoperative conversation, not as an afterthought, and a high-BMI patient should be told plainly that surgery alone may not fully resolve the dyspnea. What this study cannot answer is causation, since it is a retrospective correlation and postoperative BMI was never remeasured, so we know that heavier patients report more dyspnea before and after surgery, not that losing weight afterward would lower the score. It also does not define a BMI target, does not exclude smokers, which blurs the signal further, and it does not test counseled weight loss prospectively. What makes me trust the association more than I otherwise would is that the effect size lines up closely with the one prior study on this exact question, Elsamna et al., who found nearly the same 0.43-point rise in DI per BMI point; two independent cohorts landing on the same number is a real signal, not a coincidence I would wave away. ▪️ In Brief
Necati Enver, MD Istanbul Voice Center |
Doç. Dr. Necati Enver - Ses Yutma ve Nefes Hastalıkları
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