PURPOSE: The Sniffin' Sticks test is among the most commonly used methods of olfactory assessment and has been successfully adapted across various countries. However, to date, no study has examined cultural changes over...PURPOSE: The Sniffin' Sticks test is among the most commonly used methods of olfactory assessment and has been successfully adapted across various countries. However, to date, no study has examined cultural changes over time, within the same country. The present research is the first to explore the adaptation of odor labels to contemporary contexts. METHODS: A total of 83 normosmic participants (57 women) aged 18 to 75 years (y) (M = 35.2 y, SD = 13.7) were enrolled in four studies in which we replaced the unfamiliar odor labels with more familiar ones and balanced the frequency of labels used in the entire set of odor labels. Lastly, forty additional healthy participants (28 women) aged from 18 to 61 y (M = 32.8 y, SD = 11.4) were recruited to assess the test-retest reliability of the newly developed version of SS-OIT labeling within a period ranging from 1 to 57 days (M = 14.8 days, SD = 13.2). RESULTS: We aimed to increase the number of labels that are known by the present population, and hence, we modified 31% of the odor labels. The correlation coefficient of the new SS-OIT test-retest was moderate (R = .66 which changed to R = .71 after excluding an outlier, p < .001), which is typical for 16-item olfactory tests when tried in a normosmic population. CONCLUSION: This study introduces a fresh approach to SS-OIT labeling via a careful refinement and validation of an existing test that aligns more closely with evolving cultural trends. We also confirm the suitability of the new SS-OIT for clinical and research assessment.
PURPOSE: Revision microsurgery for vestibular schwannoma (VS) after failure of prior microsurgery and/or stereotactic irradiation represents a technically demanding scenario with uncertain functional outcomes. We aimed t...PURPOSE: Revision microsurgery for vestibular schwannoma (VS) after failure of prior microsurgery and/or stereotactic irradiation represents a technically demanding scenario with uncertain functional outcomes. We aimed to evaluate operative strategy, extent of resection, tumor control, and functional results-primarily facial nerve outcomes-in patients undergoing revision VS surgery in a high-volume tertiary center. METHODS: A retrospective single-center cohort study included consecutive patients who underwent revision VS microsurgery between 1998 and 2025. Demographic, radiological, surgical, and audiological data were analyzed. Primary endpoint was long-term facial nerve function assessed by House-Brackmann (HB) grading. Secondary endpoints included extent of resection, tumor control on follow-up MRI, hearing outcome, and perioperative morbidity. RESULTS: Nineteen patients (2.6% of 741 treated VS cases) underwent revision surgery. Most tumors were advanced (Koos grade 4, 74%). Gross total resection was achieved in 79%. Immediate postoperative HB VI occurred in 58%, improving over time to 11% at last follow-up. Favorable long-term facial function (HB I-III) was observed in 68%. Hearing preservation was not achieved. Perioperative complications occurred in 42%, most commonly cerebrospinal fluid pseudocyst. Radiological tumor control reached 95% during a mean follow-up of 136 months. CONCLUSION: Revision VS microsurgery provides high rates of tumor control with acceptable facial nerve outcomes but limited hearing preservation. It should be reserved for carefully selected patients and performed in experienced centers with cranial nerve reconstruction expertise.
BACKGROUND: The main aim of this study was to determine whether hereditary factors and exposures during childhood are associated with chronic rhinosinusitis (CRS) in adulthood. METHODOLOGY/PRINCIPLE: The Respiratory Heal...BACKGROUND: The main aim of this study was to determine whether hereditary factors and exposures during childhood are associated with chronic rhinosinusitis (CRS) in adulthood. METHODOLOGY/PRINCIPLE: The Respiratory Health In Northern Europe (RHINE) study is a random population sample collected from seven centres in five countries during the period of 1990-1994. Data on CRS from the third follow-up in 2020 (RHINE 4) were examined in relation to previously reported hereditary factors and exposures during childhood. RESULTS: In total, 7,686 subjects were included, with a mean age of 51.5 ± 7.1 years. The following items were associated with a significantly higher adjusted odds ratios (OR) for adult CRS: Serious respiratory infection at < 5 years of age (1.86, 95% CI 1.31-2.65); parental asthma (5.22, 95% CI 2.26-12.09); parental chronic obstructive pulmonary disease (COPD) (1.92, 95% CI 1.49-2.48); and living in the inner city compared with living on a farm as a child (1.50, 95% CI 1.05-2.15). Four or more members living in the household at 5 years of age (0.79, 95% CI 0.59-1.06), Childhood asthma (1.28, 95% CI 0.80-2.05), childhood furry pet (1.05, 95% CI 0.84-1.32), eating fish almost every day vs never (1.95, 95% CI 0.62-6.16), recurrent ear infections (1.14, 95% CI 0.89-1.47), and parental smoking (father smoker: 0.97, 95% CI 0.74-1.27; mother smoker; 0.90, 95% CI 0.62-1.32) were not significantly associated with adult CRS. CONCLUSIONS: Serious respiratory infection before the age of 5 years, parental asthma or COPD, and living in the inner city increases the risk for having CRS in adulthood. These factors should be taken into consideration when assessing airway vulnerability in children and their risk for chronic rhinosinusitis later in life.
PURPOSE: To calibrate nylon epidural catheters against glass capillaries for obtaining reliable volume yields and present the development and implementation of a translatable human perilymph sampling methodology which mi...PURPOSE: To calibrate nylon epidural catheters against glass capillaries for obtaining reliable volume yields and present the development and implementation of a translatable human perilymph sampling methodology which minimally impacts cochlear function. METHODS: Two gauges of nylon epidural catheters were calibrated against glass capillary tubes to establish the minimum fluid column height to yield a desired sample volume. We also report development of a proposed surgical methodology for in vivo sampling, and implementation in a clinical cohort study of cochlear implant recipients. We assessed the impact of sampling on hearing in a subset of hearing preservation candidates. RESULTS: Correlation equations for both 18G and 16G catheters yielding a desired sample volume 'x' with a fluid column height 'y'. The equations for 18G and 16G catheters respectively are y = 6.538x + 1.0894 and 3.8008x + 0.6754. A sampling apparatus consisting of an epidural catheter passed through a house suction tip attached to a 1 mL syringe provides optimal ergonomics and manoeuvrability. Extracochlear ECochG amplitudes and thresholds are unaffected by collection of perilymph using this technique, as were 3-month hearing preservation outcomes. CONCLUSION: These results describe a safe, accurate and transferrable alternative to using glass capillaries to sample directly from the human inner ear during surgery.
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has long been considered a predominantly male disorder; however, increasing evidence suggests substantial sex-related differences in clinical presentation and disease p...BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has long been considered a predominantly male disorder; however, increasing evidence suggests substantial sex-related differences in clinical presentation and disease progression. METHODS: This retrospective study included adult patients diagnosed with OSAS by polysomnography between January 2020 and January 2026. Demographic characteristics, polysomnographic findings, laboratory parameters, and echocardiographic measurements were analyzed. Systemic inflammation was assessed using the monocyte-to-HDL ratio, monocyte-to-LDL ratio, systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV). RESULTS: A total of 230 patients were included (68.3% male, 31.7% female). Female patients were older and had higher body mass index at diagnosis (p < 0.001). Mean and minimum oxygen saturation levels were significantly lower in women (p < 0.01), who also exhibited higher pulmonary artery pressure and lower ejection fraction (p < 0.001). In contrast, monocyte-based inflammatory indices (MON/HDL, MON/LDL, and SII) were significantly higher in men. No significant sex-related differences were observed for SIRI or PIV. CONCLUSION: OSAS demonstrates distinct sex-specific clinical and inflammatory phenotypes. While women tend to present at a later stage with more pronounced cardiopulmonary involvement, men exhibit a greater systemic inflammatory burden. These findings support the importance of incorporating sex-based considerations into diagnostic and therapeutic strategies for OSAS.
BACKGROUND: Anterior commissure exposure is the primary challenge in Wendler glottoplasty, often hindering successful suturing in narrow or prominent larynges. METHOD: We describe a "scarless" hybrid technique for diffic...BACKGROUND: Anterior commissure exposure is the primary challenge in Wendler glottoplasty, often hindering successful suturing in narrow or prominent larynges. METHOD: We describe a "scarless" hybrid technique for difficult cases. Following fiber-laser de-epithelialization, two 18-gauge trocars are inserted percutaneously through the thyroid cartilage. A suture is passed through the trocars, retrieved endoscopically, and tied externally over a Silastic sheet, bypassing endolaryngeal space constraints. Hyaluronic acid is injected to reduce suture tension. CONCLUSION: This combined approach salvages the procedure when endoscopic exposure is inadequate, ensuring a tight synechia without visible cervical scarring, optimizing outcomes for transgender patients.
BACKGROUND: Reliable national assessments of hearing loss are essential for evaluating their burden and developing public health policies. However, a comprehensive analysis specific to China has been lacking. Therefore,...BACKGROUND: Reliable national assessments of hearing loss are essential for evaluating their burden and developing public health policies. However, a comprehensive analysis specific to China has been lacking. Therefore, to estimate the burden of hearing loss in China, we described the national hearing loss burden by severity, cause, gender, and age in 2019. METHODS: This study conducted a secondary analysis using data from the Global Burden of Disease Study 2019. We provided national prevalence and years lived with disability (YLDs) counts by gender and age group, as well as the prevalence, crude rates, and age-standardized rates (ASRs) per 100,000 people for hearing loss of various severities and cause-specific hearing loss, with 95% uncertainty intervals (UIs). FINDINGS: In 2019, the prevalence of hearing loss in China was 426.5 million, and YLDs were 11.1 million. The total ASRs and total YLDs for all types of hearing loss per 100,000 people were 22,612 cases and 617.9, respectively. The burden of mild hearing loss was the most significant, followed by moderate, moderately severe, severe, and profound hearing loss. Age-related and other hearing loss were the primary causes of hearing loss, while otitis media was the secondary cause for mild and moderate hearing loss, and congenital defects were the secondary cause for more severe hearing loss. Individuals over 50 years of age experienced the highest prevalence of hearing loss, with peak prevalence in the 65-69 age group. CONCLUSION: Hearing loss presents a significant public health challenge in China. Although the causes of hearing loss are correlated with the severity of hearing impairment, age-related hearing loss can be mitigated through early prevention. Coordinated efforts are necessary at various levels to address this public health challenge.
OBJECTIVE: Otologic surgery requires detailed anatomical knowledge and advanced technical skills, making laboratory training relevant. The limited availability of human temporal bones has encouraged the development of al...OBJECTIVE: Otologic surgery requires detailed anatomical knowledge and advanced technical skills, making laboratory training relevant. The limited availability of human temporal bones has encouraged the development of alternative anatomical models. This systematic review evaluates the anatomical features, surgical access routes, and applicability of ovine temporal bone models for otologic surgical training. DESIGN: The authors conducted a systematic review across PubMed, SciELO, and Google Scholar databases. Eligible studies described anatomical findings based on microscopic or endoscopic dissection of ovine temporal bones and/or assessed their use for surgical training. Data on anatomy, surgical approaches, performed procedures, preservation methods, and participant profiles were extracted. The review followed PRISMA guidelines, and the protocol was registered in PROSPERO. RESULTS: Twenty-six studies met the inclusion criteria. Sheep middle- and inner-ear anatomy showed close correspondence with human structures. Retroauricular, transcanal, and retrosigmoid approaches were consistently described. A wide range of procedures including tympanoplasty, ossicular chain reconstruction, stapedotomy, facial nerve decompression, and cochlear implantation were reported using microscopic and endoscopic techniques. Studies reported reductions in operative time, improved technical accuracy, and increased participant confidence. The model was consistently described as low cost, generally available, and ethically acceptable when sourced from the food industry, although some anatomical differences from the human temporal bone have been reported. CONCLUSIONS: The ovine temporal bone is a feasible and ethically acceptable model for otologic surgical training. Its anatomical realism supports a wide range of procedures, although anatomical differences should be considered when translating findings to human surgery. These findings support the incorporation of ovine temporal bone dissection into structured otologic surgical training programs.
OBJECTIVES: To evaluate the impact of extraesophageal acidic reflux and proton pump inhibitor (PPI) therapy on the dwell time of Provox voice prostheses. METHODS: This is a retrospective review of prospectively recruited...OBJECTIVES: To evaluate the impact of extraesophageal acidic reflux and proton pump inhibitor (PPI) therapy on the dwell time of Provox voice prostheses. METHODS: This is a retrospective review of prospectively recruited patients with total laryngectomy/ laryngopharyngectomy and rehabilitation with Provox voice prosthesis who underwent 24 h pH monitoring study. Associations between multiple acid exposure metrics (percentage of time at pH < 6.5, < 6.0, < 5.5, < 5.0, and Ryan score), clincal history and mean dwell time of the last three voice prostheses were assessed using linear regression analysis. RESULTS: Twenty-two patients were included. Regression analysis showed an inverse relationship between acid exposure and the average dwell time in days of the voice prostheses (β = -1.85, 95% CI: -2.90 to -0.80, p = 0.0014, R2 = 0.40 for pH < 6.5 resp. β = -1.74, 95% CI: -2.95 to -0.52, p = 0.0071, R2 = 0.30 for pH < 6.0). Twelve patients were on regular PPI treatment, 10 patients were off PPI. Patients with PPI usage did not show a significantly different acid exposure in the neopharynx. No difference in the dwell time between the patients with and without regular PPI therapy was observed. CONCLUSION: In our cohort, acid reflux exposure is inversely correlated with the dwell time of Provox voice prostheses. PPI treatment was not associated with a reduced acid exposure and prolonged dwell time of the voice prostheses, indicating insufficient effect or other mechanisms involved. Further studies are needed to identify effective therapeutic strategies in prolonging voice prostheses dwell times.
PURPOSE: While the application of tuning fork Weber (TFW) test in adult is well-documented, its accuracy in the paediatric population remains uncertain although conductive hearing loss is frequently identified in childre...PURPOSE: While the application of tuning fork Weber (TFW) test in adult is well-documented, its accuracy in the paediatric population remains uncertain although conductive hearing loss is frequently identified in children. Similarly, the effectiveness of the audiometric Weber (AW) test is ambiguous. Given evidence suggesting that age influences lateralization accuracy and understanding of instructions, this research specifically targets school-aged children to evaluate these diagnostic tools effectively. This study aims to explore the lateralization accuracy of TFW and AW tests in detecting conductive hearing loss in children and the agreement of these tests with the predicted lateralization responses based on audiogram. METHODS: This study involved 75 children with conductive hearing loss aged between seven to twelve years old. Each subject underwent TFW (256 Hz and 512 Hz) and AW (250 Hz and 500 Hz) tests. RESULTS: All subjects achieved high accuracy (> 80%) in both TFW and AW tests. McNemar's test revealed there was no significant difference between the TFW and AW tests for both frequencies (p > 0.05). Using Cohen's Kappa, the lateralization responses in both tests demonstrate substantial to almost perfect agreement (k = 0.78-0.92). with the predicted lateralization responses for both frequencies. Large air-bone gap group also demonstrated higher accuracy for both tests compared to the small air-bone gap group, although the difference was not statistically significant (p > 0.05). CONCLUSION: Both the TFW and AW tests showed high lateralization accuracy in either unilateral or bilateral CHL supported by substantial to almost perfect agreement with the respective PTA in school-aged children with conductive hearing loss.
PURPOSE: The Canalith Repositioning Maneuver (CRM) is the gold-standard treatment for Benign Paroxysmal Positional Vertigo (BPPV), but its success relies heavily on strict angular precision. Clinical estimation of head a...PURPOSE: The Canalith Repositioning Maneuver (CRM) is the gold-standard treatment for Benign Paroxysmal Positional Vertigo (BPPV), but its success relies heavily on strict angular precision. Clinical estimation of head angles introduces substantial execution variability, leading to maneuver failure. Extended Reality (XR) and wearable sensors offer a promising solution by providing real-time biomechanical guidance. This scoping review systematically maps the emerging evidence on XR technologies for sensor-guided precision control during CRMs. METHODS: Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, Cochrane CENTRAL, and IEEE Xplore for studies published between January 2010 and December 2025. Eligible studies evaluated Head-Mounted Displays (HMDs) or comparable wearable devices integrated with motion-tracking technologies for CRM execution. Data were synthesized using a convergent narrative approach. RESULTS: Six studies met the inclusion criteria, comprising clinical feasibility trials (n = 3) and computational simulation studies (n = 3). Hardware predominantly included smartphone-based Virtual Reality (VR) and custom head-mounted Inertial Measurement Units (IMUs) utilizing visual or auditory feedback. Clinical evidence demonstrated that sensor-guided feedback significantly minimized angular positional errors compared to standard unguided maneuvers. Concurrently, advanced 3D simulations successfully mapped inner ear biomechanics and validated optimized maneuver pathways. CONCLUSION: XR and motion-tracking technologies effectively standardize CRM angular precision. By reducing execution variability, these systems can ensure consistent, expert-level care among clinicians and ultimately democratize execution to enable safe, highly effective self-treatment for patients at home. Future research must prioritize large-scale comparative effectiveness trials and evaluate Mixed Reality (MR) systems to mitigate visual occlusion and fall risks.
OBJECTIVE: Efficient targeting of the olfactory cleft remains a key barrier to olfactory-targeted intranasal therapy and emerging nose-to-brain (N2B) delivery strategies. However, the upstream aerodynamic mechanisms gove...OBJECTIVE: Efficient targeting of the olfactory cleft remains a key barrier to olfactory-targeted intranasal therapy and emerging nose-to-brain (N2B) delivery strategies. However, the upstream aerodynamic mechanisms governing aerosol access to the olfactory cleft during natural inhalation remain insufficiently characterized. METHODS: A standardized representative sinonasal model reconstructed from high-resolution CT data of 32 healthy adults was used to evaluate the effects of administration plane, aerosol particle size, and administration angle on olfactory cleft deposition. Airflow and particle transport were simulated using a lattice Boltzmann-discrete particle method (LBM-DPM) framework across 108 parameterized conditions under natural inhalation. A geometry-consistent 3D-printed nasal model combined with radiotracer-based SPECT/CT imaging was used to experimentally validate deposition trends across administration planes. RESULTS: Under nebulized delivery during natural inhalation, administration plane and aerosol particle size were the primary determinants of olfactory deposition efficiency, whereas administration angle exerted minimal influence. Shallow insertion facilitated upstream aerosol transport toward the olfactory cleft, with particles of approximately 7 μm achieving the highest and stable deposition efficiency across conditions. A modest interaction between insertion depth and particle size was observed without altering the optimal delivery configuration. In vitro radiotracer experiments demonstrated consistent deposition trends across administration planes compared with numerical simulations, supporting the model predictions. CONCLUSION: Under physiological inhalation, shallow nozzle positioning combined with intermediate-sized aerosol particles represents an optimal parameter configuration for olfactory-targeted intranasal aerosol delivery. These findings provide quantitative guidance for optimizing intranasal administration parameters and may support the development of nebulized delivery systems for olfactory-targeted therapies.
PURPOSE: Reconstruction of nasal defects involving the alar region, nasal tip, and lateral nasal wall remains challenging because restoration of contour continuity, structural support, and airway patency must be achieved...PURPOSE: Reconstruction of nasal defects involving the alar region, nasal tip, and lateral nasal wall remains challenging because restoration of contour continuity, structural support, and airway patency must be achieved simultaneously. This study evaluated the clinical outcomes of a two-stage delayed and prelaminated nasolabial flap designed to improve vascular reliability and long-term contour stability in nasal reconstruction. METHODS: A total of 22 patients underwent nasal reconstruction following excision of basal cell carcinoma or squamous cell carcinoma. Defects included both full-thickness and complex partial-thickness nasal defects. The surgical technique combined flap delay, dermo-subcutaneous prelamination with conchal cartilage, and flap transfer through a prepared skin canal to preserve the natural alar groove and reduce pedicle compression. Postoperative complications and aesthetic outcomes were evaluated. RESULTS: All flaps survived without total loss. Partial distal necrosis occurred in two patients and was successfully managed with skin grafting and secondary revision. Postoperative venous congestion developed in two patients and was treated with leech therapy. Trapdoor deformity occurred in four patients and improved with conservative management. Revision procedures were required in six patients, including flap thinning in four cases and secondary revision after partial necrosis in two cases. Defects measuring up to 6 cm were successfully reconstructed with satisfactory contour, color match, and preservation of nasal airway patency at a follow-up of 9-12 months. CONCLUSION: The two-stage delayed and prelaminated nasolabial flap is a reliable and versatile option for selected nasal defects, including full-thickness and complex partial-thickness reconstructions, providing durable structural support with minimal donor-site morbidity.
BACKGROUND: Tracheoesophageal puncture (TEP) is a widely used method of voice rehabilitation following total laryngectomy; however, it is associated with complications, including persistent leakage and tracheoesophageal...BACKGROUND: Tracheoesophageal puncture (TEP) is a widely used method of voice rehabilitation following total laryngectomy; however, it is associated with complications, including persistent leakage and tracheoesophageal fistula (TEF). Management of recurrent TEF can be challenging, especially in patients with prior radiotherapy and impaired wound healing. CASE PRESENTATION: This paper reports a case of a 44-year-old male with advanced glottic squamous cell carcinoma who underwent total laryngectomy with flap reconstruction and adjuvant radiotherapy, followed by TEP for voice rehabilitation. The patient developed a persistent tracheoesophageal fistula refractory to conservative management, prosthesis removal, endoscopic closure, and open surgical repair with muscle flap interposition. Definitive revision surgery was performed using a composite right inguinal graft, consisting of a dermal-fascial layer to create a double-layer seal between the trachea and esophagus and an external full-thickness skin graft to reinforce the stoma. Postoperative imaging confirmed fistula closure, and the patient ultimately resumed full oral intake without aspiration. CONCLUSION: This case demonstrates that a multilayered repair using a full-thickness skin graft combined with a dermal-fascial interposition can achieve successful closure of a recurrent tracheoesophageal fistula. This approach may represent an effective and less invasive alternative prior to consideration of free flap reconstruction in selected patients.
PURPOSE: Oral tongue squamous cell carcinoma (OTSCC) is characterized by aggressive local invasion and a high risk of cervical nodal metastasis and mortality. Earlier detection of recurrent OTSCC is associated with impro...PURPOSE: Oral tongue squamous cell carcinoma (OTSCC) is characterized by aggressive local invasion and a high risk of cervical nodal metastasis and mortality. Earlier detection of recurrent OTSCC is associated with improved survival. This systematic review with quantitative synthesis aimed to evaluate the performance of machine learning (ML) models in predicting recurrence in OTSCC. METHODS: This review was conducted in accordance with the PRISMA 2020 guidelines. Studies published between August 2019 and July 2025 that used ML models to predict recurrence in OTSCC were included. Five eligible retrospective cohort and registry-based studies using various ML models were identified. Extracted performance metrics included the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. RESULTS: ML-based models showed generally favorable predictive performance for OTSCC recurrence. Reported AUCs ranged from 0.69 to 0.97 in exploratory quantitative synthesis. Model accuracies ranged from 68% to 95%, sensitivities from 47% to 94%, and specificities from 79% to 96%. Multimodal models that integrated whole-slide imaging (WSI) features with clinicopathological variables, particularly depth of invasion, achieved the highest reported performance across the included studies. CONCLUSION: ML models show promising predictive performance for recurrence in OTSCC, particularly in early-stage disease. Multimodal models that combine WSI with clinicopathological data appear to improve predictive accuracy. Although ML models are not a substitute for clinical expertise, they are rapidly evolving into valuable adjunctive tools for recurrence risk stratification. Prospective validation and external testing across diverse populations are warranted before routine clinical implementation.