About

Karen Bracha Zur, MD, is a Professor of Otorhinolaryngology: Head and Neck Surgery at the Children's Hospital of Philadelphia. She holds the E. Mortimer Newlin Endowed Chair in Pediatric Otolaryngology and Human Communication and the William Potsic Endowed Chair in Pediatric Otolaryngology and Childhood Communication at the same institution. Her clinical expertise includes management of pediatric voice disorders, pediatric airway reconstruction, laryngotracheal reconstruction, pediatric swallowing disorders, and management of larygotracheal papillomatosis. Her research focuses on pediatric voice disorders, laryngotracheal reconstruction, and general pediatric otolaryngology, with specific interests in pediatric airway management and communication. Dr. Zur is actively involved in clinical care and research aimed at improving outcomes for children with complex ENT conditions.

Research topics

• Medicine
• Intensive care medicine
• Surgery
• Internal medicine
• Medical physics
• Anatomy
• Emergency medicine
• Anesthesia
• Pediatrics

Selected publications

• Tonsillar expression quantitative trait loci verify and expand genetic contributors to childhood atopic diseases

  bioRxiv (Cold Spring Harbor Laboratory) · 2026-03-17

  articleOpen access

  Abstract The spectrum of causal variants, mechanisms, and immunologic gene networks that influence pediatric atopic traits are not completely understood. Human genetic variation associated with transcript abundance (eQTLs) can help to advance our understanding, yet prior work has focused on profiling immune cell populations collected from peripheral blood primarily in adult populations, leaving uncharacterized tissue-resident lymphocytes collected from children. Here, we paired genotyping with gene expression profiling across four populations of tonsil-derived immune cell types – including previously uncharacterized germinal center B cells – collected from 103 children across development (ages 1-18). Using these data, we report cell-type specific gene networks and identify 13,393 eGenes (1,793 eGenes not previously reported in similar datasets) influenced by 27,603 eQTLs (5,199 not previously reported). We link discovered eQTLs to associations identified in pediatric and adult asthma and atopy traits, nominating 78 eGenes like TRAF3 , ZBTB10 and JAZF1 in disease relevant cell types. Our resource is freely available and exemplifies the importance of discovery in native tissues and across human development.

  PublisherDOI

• Dysphonic Children: Performers vs. Non-Performers

  Journal of Voice · 2026-02-01

  articleSenior author
  PublisherDOI

• Inhibition of the MRTF-A/SRF signaling axis alleviates vocal fold scarring

  Matrix Biology · 2025-02-14 · 5 citations

  articleOpen access
  PublisherOA PDFDOI

• Surgical Treatments for Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome: Systematic Review and Network Meta‐analysis

  Otolaryngology · 2025-07-31

  reviewSenior author

  Abstract Objective To compare surgical versus medical treatment approaches for periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome. Data Sources PubMed, Embase, Web of Science, and Cochrane. Review Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta‐analyses‐Network Meta‐analyses checklist. Two authors independently reviewed the studies. Inclusion criteria comprised randomized controlled trials and cohort studies. Non‐English studies, along with case series and review articles, were excluded. The primary outcome was the incidence of persistent symptoms following surgery, compared to medical treatment. Secondary outcomes included complications. Results The search identified 693 publications. After applying the inclusion and exclusion criteria, nine studies were included (three randomized controlled trials and six cohort studies), comprising a total of 691 patients (256 [37%] females, mean age: 2.97 years, and interquartile range: 2.3‐3.3). Patients were treated with either tonsillectomy (n = 201), intracapsular tonsillectomy (IT, n = 24), or medical treatment (n = 466). Surgery was associated with a higher likelihood of symptom resolution compared to medical treatment (odds ratio [OR]: 11.7, 95% CI: 2.14‐63.94). However, heterogeneity was observed across studies ( I 2 = 80.8%, P < .01). A sensitivity analysis was performed, including randomized controlled trials. Both tonsillectomy (OR: 34.15, 95% CI: 3.77‐308.95) and IT (OR: 21, 95% CI: 1.5‐293.25) were associated with a greater likelihood of symptom resolution. The pooled complication rate was 6.6%, with a higher incidence in patients who underwent tonsillectomy versus IT (46/201 vs 0/24, P = .008). The pooled rate of symptom recurrence was 13.6% in patients following tonsillectomy and 37.5% in IT. Conclusion Surgical management of PFAPA with tonsillectomy was superior to medical treatment. Tonsillectomy resulted in a lower recurrence rate of symptoms compared to IT, with a comparable incidence of complications to existing literature. However, given the limited number of patients in the IT group, these findings should be interpreted with caution, and further randomized studies are warranted.

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• Primary vs. secondary closure of tracheocutaneous fistulas: A prospective cohort study

  International Journal of Pediatric Otorhinolaryngology · 2025-02-26 · 1 citations

  article
  PublisherDOI

• Controlled decorin delivery from injectable microgels promotes scarless vocal fold repair

  bioRxiv (Cold Spring Harbor Laboratory) · 2025-06-28 · 1 citations

  preprintOpen access

  Vocal fold (VF) scarring is a leading cause of poor voice, yet no therapies exist to prevent its progression. Current treatments, such as intracordal steroid injections, offer limited efficacy and carry significant off-target toxicities. To identify targeted anti-scarring strategies, we performed transcriptomics of human VF myofibroblasts, the cellular drivers of VF scarring, and identified the proteoglycan decorin (DCN) as downregulated in activated myofibroblasts. We also show a time-dependent decrease in DCN during fibrotic wound healing in a preclinical rat model of VF scarring. Administration of DCN suppressed VF myofibroblast activation by reducing pro-fibrotic gene expression, α-smooth muscle actin (α-SMA) levels, and cell contractility. DCN was encapsulated in hyaluronic acid microgels for sustained protein release for 3-4 weeks. In a rat model of VF scarring, DCN-loaded microgels prevented hallmark features of scarring, including collagen deposition and myofibroblast activation. These findings highlight DCN as a promising therapeutic and provide a sustained delivery platform with translational potential against VF scarring.

  PublisherOA PDFDOI

• A Consensus Statement on the Administration of Systemic Bevacizumab in Patients with Recurrent Respiratory Papillomatosis

  The Laryngoscope · 2024-08-03 · 14 citations

  articleOpen accessSenior author

  OBJECTIVE: To provide detailed guidance on the administration of systemic bevacizumab in patients with recurrent respiratory papillomatosis (RRP) based on a detailed review of the scientific literature and a consensus of experts with real-world clinical experience. METHODS: A bevacizumab consensus working group (N = 10) was composed of adult and pediatric otolaryngologists, adult and pediatric oncologists, and a representative from the RRP Foundation (RRPF), all with experience administering systemic bevacizumab in patients with RRP. After extensive review of the medical literature, a modified Delphi method-based survey series was utilized to establish consensus on the following key areas: clinical and patient characteristics ideal for treatment candidacy, patient perspective in treatment decisions, treatment access, initial dosing, monitoring, guidelines for tapering and discontinuation, and reintensifying therapy. RESULTS: Seventy-nine statements were identified across nine critical domains, and 45 reached consensus [clinical benefits of bevacizumab (3), patient and disease characteristics for treatment consideration (7), contraindications for treatment (3), shared decision-making (incorporating the patient perspective) (5), treatment access (3), initial dosing and administration (8), monitoring (7), tapering and discontinuation (6), and reintensification (3)]. CONCLUSION: This consensus statement provides the necessary guidance for clinicians to initiate systemic administration of bevacizumab and represents a potential paradigm shift toward nonsurgical treatment options for patients with RRP. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:5041-5046, 2024.

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• Exposures and coexisting conditions in pediatric nodular tracheobronchitis

  Pediatric Pulmonology · 2024-06-21

  article

  BACKGROUND: The aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy. METHODS: We conducted a single-center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023. RESULTS: Common coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%). Bronchoalveolar lavage (BAL) demonstrated cellular inflammation with elevated proportions of neutrophils in 63%, and lymphocytes in 24%. Among 88 patients in whom bacterial cultures were performed, 52% were positive, with Moraxella, Haemophilus, Streptococcal and Pseudomonas species predominating. Among 30 patients who underwent viral testing, 57% were positive, with rhinovirus (82%) and adenovirus (29%) predominating. Patients with neutrophilic inflammation were more likely to have a positive respiratory bacterial culture and/or viral polymerase chain reaction (p = 0.003, 0.005). Evaluation of the gastrointestinal tract included 79 patients with a history of esophagogastroduodenoscopy, 45 patients with a videofluoroscopic swallow study (VFSS), and 45 patients with multi-channel intraluminal impedance and pH testing. The majority of VFSS were abnormal (60%) demonstrating either laryngeal penetration (33%) or intratracheal aspiration (27%). Median pH reflux and impedance proximal reflux indices were 3.8% and 0.5% respectively. CONCLUSION: Potential contributing factors in the pathophysiology of nodular tracheobronchitis include bacterial and viral infections, GERD, dysphagia/aspiration, and EOE. When nodular tracheobronchitis is observed during bronchoscopy, further evaluation to assess for these conditions should be considered.

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• Age-related remodeling of the vocal fold extracellular matrix composition, structure, and biomechanics during tissue maturation

  Connective Tissue Research · 2024-11-01 · 6 citations

  articleOpen access

  PURPOSE: The vocal folds (VFs) are among the most mechanically active connective tissues, vibrating between 80 and 250 hz during speech. Overall VF function is determined by the composition and structure of their extracellular matrix (ECM). During tissue maturation, the VFs remodel from a monolayer of collagen fibers to a tri-layered structure, affecting tissue biomechanics. However, age-related VF ECM remodeling remains poorly understood since few studies have explored the proteins governing collagen fibrillogenesis or the non-collagenous ECM components critical for VF elasticity. MATERIALS AND METHODS: VFs from immature, sexually mature, and skeletally mature rats were evaluated by endoscopy, histology, and electron microscopy for cellular and biochemical composition, ECM organization, and proteoglycan distribution. Nanoindentation modulus was determined by atomic force microscopy. RESULTS: Collagen fiber abundance, maturity, and alignment are low in immature rats but show an age-dependent increase during tissue maturation. Lumican and fibromodulin, which regulate early-stage collagen fibril formation, are distributed throughout the VFs, and their abundance decreases with age. Decorin, involved in collagen organization, is concentrated just beneath the epithelium and increases with age. Elastin levels increase during tissue maturation, but hyaluronic acid abundance and distribution remain consistent with age. VF nanoindentation modulus trends toward a decrease with age. CONCLUSION: This work identifies changes in VF ECM composition and organization during tissue maturation, focusing on proteins that regulate collagen fibrillogenesis, fiber assembly, and VF biomechanics. These findings may inform the development of pro-reparative therapies designed to influence collagen network structure and overall ECM dysregulation in a number of laryngeal pathologies.

  PublisherDOI

• Benjamin Defect: Children with Posterior Glottic Defects and Vocal Fold Immobility

  Journal of Voice · 2024-07-01

  letterSenior author
  PublisherDOI

Frequent coauthors

• Ian N. Jacobs

  Children's Hospital of Philadelphia

  37 shared

• Karthik Balakrishnan

  Stanford Health Care

  30 shared

• Catherine K. Hart

  Cincinnati Children's Hospital Medical Center

  26 shared

• Luv Javia

  University of Pennsylvania

  25 shared

• Michael J. Rutter

  University of Cincinnati

  24 shared

• Stephen R. Chorney

  Children's Medical Center

  24 shared

• Douglas R. Sidell

  Stanford University

  23 shared

• Diego Preciado

  Children's National

  23 shared

Education

• BS

  Yale University

• MD

  Albert Einstein College of Medicine

  1998

Awards & honors

• E. Mortimer Newlin Endowed Chair in Pediatric Otolaryngology…
• William Potsic Endowed Chair in Pediatric Otolaryngology and…