{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:33:31Z","timestamp":1787762011662,"version":"build-2784847793"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["OTO Open"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of limited English proficiency (LEP) on the presentation, diagnosis, and management of vestibular schwannoma (VS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective matched cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single tertiary academic center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of patients diagnosed with VS at a tertiary academic center from 2018 to 2023 identified 29 LEP and 1350 non\u2010LEP patients. LEP patients were matched 1:1 to non\u2010LEP patients using propensity scores based on age, sex, insurance, and zip code\u2013based income. Clinical variables included audiometric data, tumor characteristics, time to diagnosis and treatment, and management outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant differences were found in presenting symptoms, tumor characteristics, or treatment recommendations. LEP patients were significantly less likely to undergo word recognition testing (41% vs 97%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Among those tested, bilingual LEP patients performed worse than non\u2010LEP counterparts in word recognition testing (44.5% vs 61.9%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.1). LEP patients trended toward larger tumor volumes at diagnosis (6072.5\u2009mm\u00b3 vs 2114\u2009mm\u00b3,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.059) and longer delays from symptom onset to diagnosis (4949 vs 2609 days), even after outlier removal. LEP patients also had higher loss to follow\u2010up rates (34% vs 14%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.123).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Though not statistically significant, several trends suggest LEP patients may face potential barriers to timely diagnosis and follow\u2010up for VS. The relative underrepresentation of LEP patients may also reflect underlying disparities. These findings underscore the need for targeted efforts to improve access and outcomes for LEP patients in neurotologic care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/oto2.70222","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T16:40:42Z","timestamp":1775493642000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Limited English Proficiency on the Presentation and Management of Vestibular Schwannomas"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-2641","authenticated-orcid":false,"given":"Christian","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly Y.","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Arts and Sciences University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keshav V.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Perelman School of Medicine University of Pennsylvania\u2014Perelman Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Bigelow","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Ruckenstein","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Peng\u2010Hwa","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12105-020-01155-x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2023.02.018"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2018.1399795"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29325"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998221077197"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40136-023-00459-0"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.1338"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30997"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25771"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002397"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.10.126"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31871"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12030364"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31661"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-022-07477-6"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.23055"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/00034894231180009"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3171\/2013.1.JNS121370"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.25892"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2017.03.018"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000003883"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v042.i08"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.4103\/2152-7806.78516"},{"key":"e_1_2_8_25_1","unstructured":"WilsonJ.Investing in English Skills: The Limited English Proficient Workforce in U.S. Metropolitan Areas. 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