About

Jeremiah Alt, MD, PhD, FACS, FARS, is a Professor and serves as Division Chief for Rhinology within the Department of Otolaryngology-Head and Neck Surgery at University of Utah Health. His clinical practice is focused on sinus and nasal diseases, including the management of acute and chronic sinusitis, polyps, allergy, septal deviation, growths and tumors of the sinuses and skull base, and cerebrospinal fluid leaks. Dr. Alt works with a multidisciplinary team that includes neurosurgeons, neuroradiologists, head and neck pathologists, and specialized ENT cancer surgeons to ensure optimal treatment outcomes. In addition to his clinical work, he is actively involved in research, serving as a co-investigator on a multi-institutional NIH grant studying treatment outcomes for sinus disease. His research interests include examining the relationship between immune system inflammatory markers and disease severity in chronic sinusitis, aiming to elucidate how microscopic disease aspects relate to clinical measures. He is also a faculty member in Head and Neck Surgery and the Associate Director of the Rhinology-Sinus and Skull Base Surgery Program at the University of Utah.

Research topics

• Medicine
• Surgery
• Internal medicine
• Immunology
• Pathology
• Biology
• Dermatology
• Intensive care medicine
• Family medicine
• Anesthesia
• Virology
• Physical therapy
• Biotechnology
• Microbiology
• Biomedical engineering
• Law

Selected publications

• Determining the Minimal Clinically Important Difference of the 40‐Item Smell Identification Test in People With Cystic Fibrosis

  International Forum of Allergy & Rhinology · 2026-03-13

  articleOpen access

  BACKGROUND: Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are highly prevalent among people with cystic fibrosis (PwCF) and negatively impact quality of life. The 40-item Smell Identification Test (SIT) is widely used to assess psychophysical olfaction, but a CF-specific minimal clinically important difference (MCID) has not been established. This study aimed to determine the SIT MCID in PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) and/or endoscopic sinus surgery (ESS). METHODS: Data from three prospective, multi-institutional observational studies were pooled. Participants were ≥12 years old with confirmed CF and CRS who completed SIT at baseline and ≥1 follow-up (3, 6, 9, 12, or 24 months). Distribution-based MCIDs were calculated using four methods: standard error of measurement (SEM), minimal detectable change (MDC = 1.96 × SEM), 0.5 × baseline standard deviation (SD), and 0.5 × SD of change scores (ΔSD). RESULTS: A total of 122 participants were enrolled (mean age 32.9 years, 54% female). Of these, 99 contributed follow-up SIT scores (79 ETI, 20 ESS). SIT scores remained stable with ETI, with a small but statistically significant decline at 6 months (-1.4, p = 0.02). ESS was associated with mean gains of 3.1-4.5 points at early follow-up, though these did not reach significance. Pooled distribution-based MCID estimates ranged from 2 to 4 points, with an overall threshold of 3.1 (95% CI: 2.1-4.1). CONCLUSIONS: This CF-specific SIT threshold provides a clinically interpretable cut-off for assessing olfaction. These findings establish a foundation for future work and highlight the importance of developing disease-specific MCIDs to guide clinical care and research.

  PublisherDOI

• Intraoperative Indocyanine Green Fluorescence Enables Primary Tumor Localization and Treatment De‐Escalation in <scp>SCCUP</scp> : A Case Report

  Head & Neck · 2026-03-26

  articleOpen access

  BACKGROUND: Unknown primary cancer in the head and neck presents a difficult surgical treatment dilemma. Patients with squamous cell carcinoma of unknown primary (SCCUP) typically present with an enlarging neck mass found on biopsy but with no indication of primary site on diagnostic exams such as flexible laryngoscopy, CT, MRI, and/or PET/CT. Failure to identify primary sites eliminates surgical treatment as an option, pushing patients toward definitive chemoradiation with associated side effects. METHODS: Indocyanine green (ICG) has been used to identify primary carcinoma in known oropharyngeal squamous cell carcinoma while using transoral robotic surgery (TORS). In this case, we injected ICG intraoperatively in a patient with SCCUP to help with the real-time localization of ICG in the tumor. RESULTS: ICG fluorescence successfully identified a previously undetected primary lesion within the oropharynx during TORS, which enabled precise surgical excision of the tumor. CONCLUSIONS: This case demonstrates the potential of ICG-guided TORS to localize primary tumors in SCCUP patients, offering a pathway to surgical treatment and potentially reducing reliance on chemoradiation.

  PublisherDOI

• Utilizing a publicly accessible automated machine learning platform to enable diagnosis before tumor surgery

  Communications Medicine · 2025-10-08

  articleOpen access

  In benign tumors with potential for malignant transformation, sampling error during pre-operative biopsy can significantly change patient counseling and surgical planning. Sinonasal inverted papilloma (IP) is the most common benign soft tissue tumor of the sinuses, yet it can undergo malignant transformation to squamous cell carcinoma (IP-SCC), for which the planned surgery could be drastically different. Artificial intelligence (AI) could potentially help with this diagnostic challenge. CT images from 19 institutions were used to train the Google Cloud Vertex AI platform to distinguish between IP and IP-SCC. The model was evaluated on a holdout test dataset of images from patients whose data were not used for training or validation. Performance metrics of area under the curve (AUC), sensitivity, specificity, accuracy, and F1 were used to assess the model. Here we show CT image data from 958 patients and 41099 individual images that were labeled to train and validate the deep learning image classification model. The model demonstrated a 95.8 % sensitivity in correctly identifying IP-SCC cases from IP, while specificity was robust at 99.7 %. Overall, the model achieved an accuracy of 99.1%. A deep automated machine learning model, created from a publicly available artificial intelligence tool, using pre-operative CT imaging alone, identified malignant transformation of inverted papilloma with excellent accuracy. Planning for surgery to remove a tumor, and the preoperative counseling a surgeon gives to the patient, can be very different, depending on if that tumor is cancerous or non-cancerous. Unfortunately, it can be difficult to always know which it is before actually getting to the operating room. Here we show the utilization of a publicly available platform, Google Vertex AI, and pre-operative computed tomography (CT) imaging of patients from nineteen separate institutions, to identify cancerous transformation of a non-cancerous tumor with excellent accuracy in a specific tumor type. An automated machine learning (AutoML) model, created from a publicly available artificial intelligence tool, by physicians with little coding background, was able to differentiate between these types of tumors with better accuracy than previously published rates from experts. This tool could serve to better inform surgical planning for tumors. Hosseinzadeh et al. demonstrate use of a publicly accessible automated machine learning platform to differentiate between a common benign tumor and malignant transformation of it within the paranasal sinuses. This AI algorithm beat prior human prediction, and showed that physicians with no coding background can effectively utilize this tool.

  PublisherOA PDFDOI

• EPS6.04Abridging the 22-item Sino-Nasal Outcome Test (SNOT-22) in people with cystic fibrosis to limit survey burden

  Journal of Cystic Fibrosis · 2025-06-01

  article
  PublisherDOI

• Characterizing air pollution exposure methodologies in rhinology: a scoping review

  International Journal of Environmental Health Research · 2025-03-13 · 1 citations

  reviewOpen access

  ABST RACTCharacterization of air pollution assessment methodologies in rhinologic disease research is lacking. A scoping review was thus conducted to survey exposure methods in studies examining common rhinologic conditions: allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Several medical databases were queried for variables relating to (1) adults with a diagnosis of CRS or AR and (2) air pollution exposure. Data was extracted for pollutants assessed, method of quantifying exposure, assessment of residential stability, inclusion of authors with expertise in environmental exposure assessment, and disease-related outcomes. Thirty-four articles were included for analysis - 16 for AR and 18 for CRS. Fifteen studies originated from East Asia, 10 from North America, and 6 from Europe. The most common pollutant studied was PM2.5 (28 studies), with most studies investigating multiple pollutants. Twenty-one studies used a nearby air monitor to quantify exposure, 9 studies reported whether subjects had residential stability for the period assessed, and 17 studies included authors with climate science background. Timeframes included both acute and chronic exposure. Current methods to quantify air pollution exposure in rhinology vary considerably and inconsistently employ expertise from environmental scientists. Future investigations may benefit from multidisciplinary collaboration, reporting of residential stability, and standardized reporting metrics.

  PublisherOA PDFDOI

• Abridging the 22‐Item Sino‐Nasal Outcome Test (SNOT‐22) in People With Cystic Fibrosis: Limiting Survey Burden

  International Forum of Allergy & Rhinology · 2025-05-15

  articleOpen access

  Chronic rhinosinusitis (CRS) affects quality-of-life (QoL) in people with cystic fibrosis (PwCF), despite the reduction in symptoms and symptom severity associated with cystic fibrosis transmembrane conductance regulator (CFTR) modulators [1]. To precisely assess sinus symptoms and treatment needs in the post-modulator period, patient-related QOL instruments should be revisited. The 22-item SinoNasal Outcome Test (SNOT-22) measures CRS burden and QoL. Abbreviated surveys can lessen respondent fatigue. Item response theory (IRT) can help refine surveys by identifying the most informative survey items while maintaining reliability [2-4]. IRT assesses item discrimination (ɑ), the ability to differentiate trait levels, and difficulty (β), which defines thresholds for response categories [2-4]. Liu et al. refined the SNOT-22 using IRT with strong reliability and validity [5]. Given PwCF's unique CRS burden, this study used IRT to create abbreviated SNOT-22 versions by selecting the most informative items. A secondary aim explored SNOT-22 differences by modulator therapy history. This cross-sectional study, approved by local Institutional Review Boards, analyzed 185 adults (age 18 and over) with cystic fibrosis (CF) and CRS from 12 academic centers between 2018 and 2023, primarily from an ongoing trial (NCT04469439). Baseline SNOT-22 scores were analyzed, with full information maximum likelihood used to handle missingness in the graded response IRT models assessing item discrimination and difficulty. Demographic and clinical data were collected. Shortened surveys were developed by first retaining items contributing above-average information within subdomains (nasal, otologic/facial pain, sleep, emotional), whereupon we applied a stricter rule ensuring at least 30% of the test information was retained from each subdomain to produce a further shortened survey, as implemented by Feng et al. [6]. Internal consistency (Cronbach's α > 0.7) and convergent validity (Pearson's r >0.8) confirmed reliability and efficacy of shortened surveys. Statistical analyses were conducted using R with the “mirt” and “psych” packages [7, 8]. The study included 185 PwCF with CRS, predominantly male (60%), with history of modulator therapy use (77%), and with F508del variants (59%) (Table 1). The mean total SNOT-22 score was 39.3 [±19.8]. Subdomain mean scores were 13.0 [±8.3] for nasal, 4.8 [±3.8] for otologic/facial pain, 13.0 [±9.7] for sleep, and 1.5 [±2.0] for emotional. Responses ranged from 0 (“No problem”) to 5 (“Severe problem”) across most subdomains, except for the emotional subdomain, which lacked the most extreme responses. Initial IRT analysis for all PwCF retained above-average information items across subdomains, preserving 55%–63% of subdomain information and yielding an 11-item survey. A stricter 30% threshold retained six items, covering 34%–54% of information in each subdomain (Figure 1). Despite shortening, difficulty thresholds remained consistent, capturing the full range of symptom severity. Of 142 PwCF with history of modulator therapy, IRT analysis produced nine-item and seven-item surveys. Compared to the total PwCF cohort, the nine-item survey excluded “reduced concentration” and “reduced productivity,” while the seven-item survey retained “dizziness.” All other items were consistent between groups (Figure 1). Notably, PwCF with history of modulator therapy had lower average scores for “thick nasal discharge” (2.0) and “post nasal discharge” (1.7) than those not on therapy (2.4 and 2.2, respectively). Item contributions are detailed in Table S1. Correlation analysis showed strong agreement between shortened and original SNOT-22 scales, with Pearson's coefficients of r = 0.97 (11-item) and r = 0.94 (6-item) for the total PwCF cohort, and r = 0.96 (9-item) and r = 0.95 (7-item) for the modulator therapy subgroup. The original SNOT-22 had a Cronbach's α of 0.93, while shortened versions maintained strong internal consistency (0.90–0.84), ensuring reliable CRS-specific QoL assessment in PwCF. The SNOT-22 is a validated CRS assessment tool for PwCF [5]. Using IRT in a multi-institutional cohort, we retained high-information items and created reliable abbreviated versions of the questionnaire specifically relevant for PwCF. PwCF retained different SNOT-22 items using IRT than other populations [5], indicating distinct symptom distributions and QoL impacts. The 11-item version kept “dizziness,” “facial pain/pressure,” and “embarrassed,” while omitting “ear pain/pressure,” “nasal blockage,” and “sad.” The six-item version showed greater divergence, retaining “waking up tired” and “fatigue.” These differences underscore the need for further study on CRS symptom distribution across populations. When IRT analysis was applied only to PwCF on modulator therapy, it generated largely similar abbreviated surveys to across the entire sample. PwCF on modulators, however, omitted “reduced concentration” and “reduced productivity” from the 11-item SNOT-22 creating a nine-item version. Using the 30% threshold, they retained the six-item SNOT-22 with the addition of “dizziness.” These variations may reflect differences in symptom perception post-therapy and warrant further study. Respondent fatigue, a decline in data quality due to survey length and complexity, may be mitigated by abbreviated surveys [9]. PwCF experience significant fatigue, with severe cases affecting up to 26% [10]. While respondent fatigue in PwCF remains unstudied, abbreviated surveys could enhance participation and data quality. Our findings support shortening the SNOT-22 to reduce fatigue while retaining key information, emphasizing the need for tailored CRS patient reported outcome measures and validation for PwCF. Limitations of this study include modest sample size, limited sociodemographic data, skewed beta parameters, and SNOT-22 midpoint clustering, which may underrepresent CRS severity. Key symptoms such as nasal blockage and dysosmia were excluded in IRT-based shortening, raising concerns about capturing CRS impact. Additional psychometric validation of the shortened scales is required. Despite this, the study supports IRT-based SNOT-22 shortening for PwCF while preserving key information. This work was supported by the Cystic Fibrosis Foundation (BESWIC20A0 and BESWIC22Y5). This foundation provided support for the planning and execution of this work but did not have specific involvement in the study design, data collection, analysis, or interpretation, or decision to submit the article for publication. Research reported in this publication was supported by the National Center for Advancing Translational Science (NCATS) of the National Institutes of Health under the UCLA Clinical and Translational Science Institute grant number UL1TR001881. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. DGE-2034835. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. Daniel M. Beswick: In the last 36 months. Daniel M. Beswick has received grant support from NIH/NHLBI, CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity). Jeremiah A. Alt: Consultant for OptiNose and Medtronic. Speaker panel GSK. GlycoMira board and equity holder. Kristine A. Smith: In the last 24 months, served as consultant for SanofiGenzyme. Zachary M. Soler: Consultant for OptiNose, Regeneron, and Lyra; Medical Directory for Healthy Humming. Rodney J. Schlosser: Consultant for OptiNose, Medtronic, Stryker, Cyrano; Medical Directory for Healthy Humming. Jennifer L. Taylor-Cousar: In the last 36 months, JLT-C has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants for her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; received fees from Vertex Pharmaceuticals Incorporated related to consultation on clinical research design, participation on advisory boards, and speaking engagements; and served on advisory boards and/or provided clinical trial design consultation for Insmed, 4DMT, and AbbVie. She serves on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation's Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN's Sexual Health, Reproduction and Gender Research Working Group, on the scientific advisory board for Emily's Entourage, and on the ATS Respiratory Health Awards, Scientific Grant Review and Clinical Problems Assembly Programming Committees. All other authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

  PublisherOA PDFDOI

• Sleep in disease: inflammation and chronic rhinosinusitis

  Neurobiology of Sleep and Circadian Rhythms · 2025-04-26 · 3 citations

  articleOpen accessSenior authorCorresponding

  Chronic rhinosinusitis (CRS) is a common inflammatory disorder that is associated with significant quality of life (QOL) impairment, including sleep dysfunction. There are multiple factors that have been independently associated with poor sleep among this population including alterations in inflammatory mediators, rhinologic symptom interference such as nasal discharge, obstruction, and facial pain, and co-morbid conditions including asthma. While there is a high prevalence of sleep dysfunction among this population, treatment with both medical and surgical options may lead to sustained improvements in sleep. This review aims to highlight the burden of sleep dysfunction, discuss common theories regarding the etiology, and evaluate strategies that may facilitate improvement in sleep dysfunction among patients with CRS. • Sleep dysfunction is highly prevalent among patients with chronic rhinosinusitis. • Numerous factors may impact sleep in this population, including immune mediators. • Both medical and surgical treatments may improve sleep quality in these patients.

  PublisherDOI

• Corticosteroid responsive olfactory dysfunction in chronic rhinosinusitis: what does it mean?

  Rhinology Journal · 2025-01-09

  article

  BACKGROUND: In the setting of chronic rhinosinusitis (CRS), olfactory improvement with corticosteroids suggests reversibility and preserved function. While self-rated olfactory function does not replace psychophysical measures of olfactory function, our goal is to investigate if self-reported pre-operative corticosteroid-responsive olfactory dysfunction (CROD) is a predictor of post-operative olfactory improvement in patients with CRS undergoing sinus surgery. METHODOLOGY: We performed a prospective, observational study of patients with refractory CRS with and without nasal polyposis and pre-operative olfactory dysfunction undergoing sinus surgery. Patients were characterized into corticosteroid-responsive and non-corticosteroid-responsive based on a survey response. Patient outcome measures for Sniffin Sticks, Olfactory Cleft Endoscopy Score (OCES), Questionnaire of Olfactory Disorders (QOD-NS), and Sino-nasal Outcomes Test (SNOT-22) were recorded pre- and post-operatively. RESULTS: A total of 253 participants were included. Patients with CROD were more likely to have comorbid nasal polyposis, asthma, and aspirin sensitivity. Patients with CROD had significantly better post-operative improvement in OCES total scores and QOD-NS total scores compared to patients without CROD. CONCLUSIONS: In conclusion, patients with CRS and CROD are more likely to have a greater improvement in olfactory dysfunction post-operatively by several measures of olfactory outcomes. This suggests that corticosteroid responsiveness is a clinical predictor of preserved function and reversibility and can be used as a simple clinical prognostic factor.

  PublisherDOI

• Socioeconomic and geographic factors influencing pituitary tumor care in Utah

  Academia oncology. · 2025-10-31

  articleOpen access

  Social determinants of health (SDOHs) include non-medical factors impacting health outcomes. The prognostic role of SDOHs, such as rurality or access to healthcare, among patients with pituitary neuroendocrine tumors (pitNETs) is under-reported in the literature. We evaluated the impact of rurality and socioeconomic factors on pitNET care and management. Using data from the Utah Cancer Registry Database (2010–2019), we conducted a retrospective review, delineating patients into frontier (&lt;6 people/sq mi), rural (6–99 people/sq mi), and urban (&gt;100 people/sq mi) populations by their county of residence. Frontier (n = 24), rural (n = 251), and urban (n = 1135) patients traveled 106.5 (±93.9), 31.9 (±52.0), and 10.0 (±11.9) miles, respectively, to receive treatment (p &lt; 0.001). No significant differences were observed in microadenoma resections (p = 0.822), macroadenoma resections (p = 0.149), treatment delays (p = 0.785), or follow-up length (p = 0.582). Frontier patients were more likely to be uninsured (p &lt; 0.001) and from lower-income regions (p &lt; 0.001). Uninsured patients were more likely to present with macroadenomas (54.7% vs. 45%, p &lt; 0.001), undergo surgery (51.6% vs. 40.9%, p &lt; 0.001), face longer delays from diagnosis to surgery (1.7 vs. 1.4 months, p = 0.001), and have a shorter follow-up (64.8 vs. 68.8 months, p &lt; 0.001). While frontier patients lived farther from care facilities, no differences in decisions for surgery or delays in treatment were observed. Uninsured patients did experience larger tumors, longer delays from diagnosis to surgery, and a shorter follow-up. These results suggest that despite delays in the treatment of pitNETs, the high rates of treatment in frontier and rural populations may reflect avenues of care using available tertiary-care facilities. These results may warrant additional study to better understand improvement in rural patients’ access to care.

  PublisherDOI

• Evaluating Methodology for Increasing Diversity in US Residency Training Programs: A Scoping Review

  Journal of Graduate Medical Education · 2025-10-01 · 1 citations

  reviewOpen accessSenior author

  ABSTRACT Background There remains limited understanding of effective strategies to increase diversity, equity, and inclusion within residency programs—highlighting the need for a comprehensive review of current interventions. Objective To synthesize literature regarding interventions to increase the representation of populations underrepresented in medicine (URiM) within US residency programs. Methods A scoping review of studies published from January 2000 to July 2023 was conducted. Data were extracted from PubMed, Embase, Cochrane Library, and Scopus. URiM was defined by race, ethnicity, and gender. Studies were included if an intervention was implemented by a graduate medical education residency program but were excluded if they did not describe a defined intervention or if they were published outside of the United States. Study interventions were categorized into 5 areas: applicant factors, selection measures, application screening, interviews, and post-interview communication. Results Initial search captured 2683 titles and abstracts; 257 full-text articles were reviewed, with 27 eligible articles meeting inclusion criteria. Eligible articles were categorized as: applicant–12 (44%), selection–8 (30%), screening–17 (63%), interview–8 (30%), and post-interview–4 (15%). Many articles addressed multiple interventions that positively impacted URiM composition, making it difficult to isolate the effect of individual interventions. Common, effective interventions included holistic reviews, clerkships, and standardized interviews. Conclusions This review demonstrates that interventions aimed at increasing diversity in residency programs vary in their approaches, but consistent evaluation and evidence of effectiveness are lacking from the current literature.

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Recent grants

• A Novel Glycosaminoglycan-Based Therapeutic for Chronic Rhinosinusitis

  NIH · $4.4M · 2016–2024

• A Novel Glycosaminoglycan-Based Therapeutic for Chronic Rhinosinusitis

  NIH · $298k · 2016–2018

Frequent coauthors

• Timothy L. Smith

  Oregon Health & Science University

  81 shared

• Jess C. Mace

  Oregon Health & Science University

  65 shared

• Richard R. Orlandi

  University of Utah

  53 shared

• Rodney J. Schlosser

  Oregon Health & Science University

  49 shared

• Zachary M. Soler

  Medical University of South Carolina

  47 shared

• Amarbir S. Gill

  University of Michigan–Ann Arbor

  40 shared

• Kristine A. Smith

  University of Utah

  35 shared

• Daniel M. Beswick

  34 shared

Education

• M.D.

  University of Utah

• Ph.D.

  University of Utah