European Archives Of Oto-rhino-laryngology[JOURNAL]
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200 papers
Association between dietary inflammatory index and Bell's palsy: a retrospective case-control study.
Celik B, Yalciner B
Eur Arch Otorhinolaryngol · 2026 May · PMID 42165875 · Publisher ↗
OBJECTIVES: Bell's palsy (BP) is an acute facial nerve disorder characterized by rapid-onset unilateral paralysis, in which inflammatory and immune-mediated processes are implicated. The Dietary Inflammatory Index (DII)...
OBJECTIVES: Bell's palsy (BP) is an acute facial nerve disorder characterized by rapid-onset unilateral paralysis, in which inflammatory and immune-mediated processes are implicated. The Dietary Inflammatory Index (DII) quantifies the inflammatory potential of the diet and reflects systemic inflammatory burden. However, its association with BP has not been previously investigated. METHODS: This retrospective case-control study included 30 patients with newly diagnosed BP and 30 age- and sex-matched controls without a history of facial paralysis. Dietary intake was assessed using a validated food frequency questionnaire, and DII scores were calculated using standardized methodology. Group differences were analyzed using appropriate statistical tests. Multivariable logistic regression evaluated the association between DII and BP after adjustment for age, sex, and body mass index. Receiver operating characteristic (ROC) analysis assessed discriminatory performance. RESULTS: Patients with BP had significantly higher DII scores than controls (2.54 ± 1.86 vs. 1.18 ± 1.33; p = 0.002). The BP group also exhibited higher intakes carbohydrates, total fat, saturated fat, monounsaturated fat, and sodium (all p < 0.01). Each 1-unit increase in DII score was independently associated with BP (adjusted OR = 1.70; 95% CI: 1.18-2.47; p = 0.005). ROC analysis demonstrated moderate discriminatory ability (AUC = 0.753; 95% CI: 0.626-0.879). CONCLUSION: Higher dietary inflammatory potential is associated with Bell's palsy, indicating a more pro-inflammatory dietary profile; however, causality cannot be inferred.
Siglec expression in sentinel lymph nodes in patients with oral squamous cell carcinoma.
Cardell LO, Cardenas EI, Piersiala K … +1 more , Kumlien Georén S
Eur Arch Otorhinolaryngol · 2026 May · PMID 42165874 · Publisher ↗
PURPOSE: Siglecs (sialic acid-binding immunoglobulin-like lectins) are immune receptors that modulate leukocyte signaling and influence tumor immunosurveillance. Tumor cells exploit Siglec-sialic acid interactions via hy...
PURPOSE: Siglecs (sialic acid-binding immunoglobulin-like lectins) are immune receptors that modulate leukocyte signaling and influence tumor immunosurveillance. Tumor cells exploit Siglec-sialic acid interactions via hypersialylation to dampen anti-tumor immunity. Sentinel lymph nodes (SLNs) can be conditioned by tumors to form immunosuppressive environments supporting metastasis. This study analyzes Siglec receptor expression in SLN- associated T cells from OSCC patients and evaluates correlations with tumor stage (T stage) and nodal metastasis (N stage). METHODS: Sentinel lymph nodes (SLNs) were collected from OSCC patients undergoing SLN mapping/biopsy as part of standard care. Healthy lymph nodes (HLNs) were collected from non-cancer controls undergoing surgery for benign conditions. Immune cells were isolated and Siglec expression on CD4⁺ and CD8⁺ T cells were quantified using flow cytometry. Within the OSCC cohort, SLNs were classified as metastasis-negative (M⁻) or metastasis-positive (M⁺) based on histopathological assessment. Expression levels were compared between lymph node types and correlated with clinical staging parameters. RESULTS: Distinct patterns of Siglec expression were observed between CD4 + and CD8 + T-cell subsets. Siglec-3 expression on SLN T cells was decreased in metastasis-positive (M⁺) SLNs compared with metastasis-negative (M⁻) SLNs.s. Similarly, Siglec-5 expression on T cells was decreased in SLNs from patients with higher primary tumor stage (T stage) and more extensive nodal metastasis (N stage). CONCLUSION: SLN immune cells exhibit distinctive Siglec expression changes associated with tumor progression. Downregulation of Siglec-3 and Siglec-5 on T cells in metastatic or advanced-stage disease, suggests that Siglec-mediated immune regulation contributes to the immunosuppressive pre-metastatic niche. These findings provide first-time evidence of altered Siglec pathways in SLNs, highlighting their potential utility as immune biomarkers and therapeutic targets in solid malignancies.
Predictors of thyroid cancer in paediatric patients with thyroid nodules: A systematic review and meta-analysis.
Shah S, Walters B, Balasubramanian SP … +1 more , Edafe O
Eur Arch Otorhinolaryngol · 2026 May · PMID 42162290 · Publisher ↗
PURPOSE: Thyroid nodules are rare in children but have a higher malignancy rate compared to adults. Risk factors and predictors of thyroid cancer in children with thyroid nodules are not well-characterised. This systemat...
PURPOSE: Thyroid nodules are rare in children but have a higher malignancy rate compared to adults. Risk factors and predictors of thyroid cancer in children with thyroid nodules are not well-characterised. This systematic review aims to evaluate risk factors and predictors of malignancy in paediatric thyroid nodules. METHODS: PubMed, Embase and Cochrane databases were searched up to 6th April 2026. A quality assessment of the included articles was performed, along with a meta-analysis using the random-effects model. RESULTS: Sixteen studies met the inclusion criteria, comprising 2,634 patients (794 malignant and 1,840 benign cases). Papillary thyroid cancer represented the majority of cancers (84.5%). Variables that were significantly associated with thyroid cancer in the meta-analysis were as follows: previous radiation exposure, odds ratio (OR) 1.96 [95% CI 1.15, 3.34]; palpable lymphadenopathy, OR 7.73 [95% CI 3.03, 19.75]; intranodal calcifications, OR 10.33 [95% CI 3.20, 33.37]; increased vascularity, OR 3.21 [95% CI 1.95, 5.28]; and elevated thyroid stimulating hormone levels, mean difference + 0.92 mIU/L [95% CI 0.50, 1.35]. Quality assessment using the Newcastle-Ottawa Scale, with a majority of studies scoring ≥ 7 stars. CONCLUSION: The identification of predictors of thyroid cancer in children with thyroid nodules will inform the development and evaluation of models with a view to improving preoperative diagnosis.
Response to comment on: "Predicting recovery in Bell's palsy: the impact of early rehabilitation and prognostic indicators".
Lucidi D, Dallari V, Fernandez IJ
Eur Arch Otorhinolaryngol · 2026 May · PMID 42162289 · Publisher ↗
Abstract loading — click title to view on PubMed.
Benefits of bilateral cochlear implantation in children: a systematic review and meta-analysis.
Zhuchkova A, Remacha J, Sandoval M … +3 more , Codina A, Larrosa F, Bernal-Sprekelsen M
Eur Arch Otorhinolaryngol · 2026 May · PMID 42162288 · Publisher ↗
OBJECTIVE: To systematically evaluate the benefits and risks of bilateral cochlear implantation (BiCI) in children compared with unilateral cochlear implantation (UniCI), with a focus on auditory outcomes, language devel...
OBJECTIVE: To systematically evaluate the benefits and risks of bilateral cochlear implantation (BiCI) in children compared with unilateral cochlear implantation (UniCI), with a focus on auditory outcomes, language development, and potential complications. METHODS: A systematic review and meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO (1128982). Searches were performed in PubMed, ScienceDirect, Scopus, and the Cochrane Library for studies published between 2015 and June 2025, with selective inclusion of earlier high-quality pediatric studies. Eligible studies included children with congenital or early-onset bilateral deafness who received BiCI or UniCI. Primary outcomes were speech perception (especially in noise), sound localisation, and spoken language development. Secondary outcomes included quality of life and adverse effects. Random-effects meta-analyses were performed using standardised mean differences (SMD). RESULTS: Fifty studies were included in the qualitative synthesis and 20 in the meta-analyses. BiCI provided significantly better outcomes in speech perception in noise (SMD = + 0.70, p < 0.001) and sound localisation (SMD = + 0.74, p < 0.001), with consistent benefits across study designs and populations. Language development also favoured BiCI (SMD = + 0.65 for receptive vocabulary). Earlier implantation and shorter inter-implant intervals were associated with larger benefits. Surgical and vestibular complications were infrequent and did not exceed those reported for UniCI. Quality-of-life ratings were consistently higher in BiCI users. CONCLUSION: Bilateral cochlear implantation offers a significant but variable advantage over unilateral implantation in children, particularly in noisy environments, spatial hearing, and language acquisition. While language outcomes generally favour BiCI, results show greater heterogeneity compared to auditory measures. Benefits are most robust with early and simultaneous implantation. Although BiCI is a safe and effective intervention, the observed methodological and clinical heterogeneity underscores the need for standardized longitudinal assessments.
Blood biomarker-based risk factors and predictive model for middle ear cholesterol granuloma.
Wang Z, Zheng Q, Xia R … +5 more , Zhu Q, Ji C, Zhang X, Li S, Fu T
Eur Arch Otorhinolaryngol · 2026 May · PMID 42156542 · Publisher ↗
BACKGROUND: Middle ear cholesterol granuloma (CG) is an uncommon inflammatory lesion often arising in patients with persistent otitis media with effusion (OME). Although local pathological mechanisms have been well descr...
BACKGROUND: Middle ear cholesterol granuloma (CG) is an uncommon inflammatory lesion often arising in patients with persistent otitis media with effusion (OME). Although local pathological mechanisms have been well described, the contribution of systemic factors has not been clearly defined. OBJECTIVES: To investigate blood-derived risk indicators for middle ear CG and to establish a predictive model capable of early risk assessment in OME patients. METHODS: This retrospective case-control study included 31 patients with surgically and histologically verified CG and 60 patients with uncomplicated OME. Demographic characteristics, comorbidities, and laboratory parameters were compared. Logistic regression analyses were applied to identify independent predictors. A multivariable prediction model was generated, and its diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Hypertension (OR = 22.77, 95% CI: 2.82-183.85; P = 0.003), higher total cholesterol levels (OR = 1.87, 95% CI: 1.15-3.03; P = 0.011), and increased serum albumin (OR = 1.25, 95% CI: 1.03-1.50; P = 0.022) were identified as independent risk factors for CG. Eosinophil count demonstrated a negative association (OR = 0.90, 95% CI: 0.83-0.99; P = 0.025). While single blood indicators showed modest performance (AUCs < 0.65), the combined model yielded stronger discrimination with an AUC of 0.801 (95% CI: 0.699-0.904; P < 0.001). CONCLUSION: This study highlights systemic metabolic and inflammatory contributors-including hypertension and dyslipidemia-to the development of middle ear CG. The composite model offers a practical tool for identifying high-risk OME patients and may support earlier surveillance and clinical intervention.
Fiberoptic endoscopic evaluation of swallowing in neurogenic oropharyngeal dysphagia in adults: Part 1 of a scoping review.
Alves TC, Furkim AM, Schindler A … +3 more , Pizzorni N, Onofri SMM, da Silva RG
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120577 · Publisher ↗
PURPOSE: The main objective of this scoping review was to describe the characteristics found in the FEES protocols in adults with neurogenic oropharyngeal dysphagia. METHODS: Following the Joanna Briggs Institute and PRI...
PURPOSE: The main objective of this scoping review was to describe the characteristics found in the FEES protocols in adults with neurogenic oropharyngeal dysphagia. METHODS: Following the Joanna Briggs Institute and PRISMA-ScR guidelines, an extensive search was conducted in six databases: Wiley Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, and LILACS. The search was carried out without restriction of study design, publication date, or language. Two blind independent raters were appointed to select, review, and extract all content according to a priori exclusion criteria. A third rater was also appointed to resolve the disagreement. Data extraction included study characteristics, professional expertise, and FEES performance details. RESULTS: A total of 6,033 abstracts were screened, leading to the inclusion of 115 publications. Most studies were conducted in the United States, Germany, Japan, Brazil, and Italy. Speech-language pathologists and otorhinolaryngologists were the most frequently cited professionals performing FEES. Information about the FEES protocol and its performance varied. The description of food consistencies, initial consistency trials, use of dye, and volume was more frequently reported but lacked consensus. CONCLUSION: The FEES protocol applied to the adult population with oropharyngeal dysphagia does not have a uniform description and performance.
Impact of Neck Dissection on Infrahyoid and Suprahyoid Muscle Dimensions in Head and Neck Cancer.
Alsleibi S, Remer E, Yogev D … +5 more , Parmet Y, Greenberg G, Dobriyan A, Gluck I, Alon E
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120576 · Publisher ↗
OBJECTIVE: To quantitatively assess changes in the dimensions of infrahyoid and suprahyoid muscles following neck dissection (ND) in head and neck cancer patients. METHODS: This study retrospectively analyzed 61 head and...
OBJECTIVE: To quantitatively assess changes in the dimensions of infrahyoid and suprahyoid muscles following neck dissection (ND) in head and neck cancer patients. METHODS: This study retrospectively analyzed 61 head and neck cancer patients who underwent selective or therapeutic neck dissection at a tertiary medical center between June 2010 and April 2022. The study protocol was approved by the institutional Helsinki Committee. Eligible participants had no procedures directly impacting strap muscles (e.g., thyroidectomy, tracheostomy). Preoperative and postoperative PET-CT scans were analyzed to measure dimensions of digastric, mylohyoid, and infrahyoid muscles, with measurements of the rectus capitis posterior major muscle serving as a control. Statistical analysis was conducted using a two-way ANOVA within a linear mixed-effects model framework to assess changes in muscle dimensions pre- and post-operation. RESULTS: Postoperative reductions in the dimensions of infrahyoid and suprahyoid muscles on the operated side were significant (p < 0.001), while the rectus capitis posterior major muscle remained unchanged (p > 0.05). No significant changes were observed on the non-operated side. The mylohyoid muscle exhibited greater susceptibility to radiation and modified neck dissection (p = 0.0049, p = 0.0225, respectively). Tumor size and chemotherapy did not significantly influence muscle atrophy. CONCLUSION: The findings indicate that neck dissection leads to significant postoperative atrophy of infrahyoid and suprahyoid muscles, likely due to surgical trauma, denervation, and postoperative fibrosis. This atrophy may have important implications for postoperative recovery and functional outcomes in head and neck cancer patients, highlighting the need for further research on its impact on quality of life. LEVEL OF EVIDENCE: Level III.
Tissue expansion ear reconstruction in bilateral microtia patients with bonebridge implantation.
Feng J, Jiang M, Zhi J … +4 more , Zhang Y, Wu J, Wang D, Wang B
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120575 · Publisher ↗
OBJECTIVE: To evaluate the efficacy and safety of modified three-stage tissue expansion ear reconstruction in patients with bilateral congenital microtia and Bonebridge implantation. METHODS: A retrospective analysis was...
OBJECTIVE: To evaluate the efficacy and safety of modified three-stage tissue expansion ear reconstruction in patients with bilateral congenital microtia and Bonebridge implantation. METHODS: A retrospective analysis was conducted on 18 patients with bilateral congenital microtia treated between January 2021 and December 2024. All patients underwent bilateral ear reconstruction, with one side having prior Bonebridge implantation. Modified three-stage tissue expansion ear reconstruction was performed. Surgical outcomes were assessed through objective measurements and patient satisfaction scores, while monitoring Bonebridge device function. RESULTS: Mean follow-up was 12.94 ± 3.87 months. No significant differences were found between the reconstructed ear and contralateral reconstructed ear in circumference, width, length, or auriculocephalic angle (p > 0.05). Overall patient satisfaction reached 88.9%, with VAS scores improving from 0.67 ± 0.59 preoperatively to 8.22 ± 1.18 (p < 0.001). Four patients (22.2%) experienced mild complications, all successfully managed. Audiological evaluation showed no significant difference in unaided bone conduction thresholds pre- and postoperatively (28.3 ± 5.6 dB HL vs. 27.9 ± 5.8 dB HL, p = 0.82), indicating preservation of inner ear function. Aided speech recognition scores remained stable (92.4 ± 4.3% vs. 91.8 ± 4.7%, p = 0.68), and all patients demonstrated normal Bonebridge electronic function and coupling test results. CONCLUSIONS: Modified three-stage tissue expansion ear reconstruction is a safe and effective treatment for bilateral microtia patients with Bonebridge implantation. Through precise preoperative localization, compartmentalized dissection strategy, individualized expansion protocol, and meticulous framework implantation technique, satisfactory aesthetic outcomes can be achieved while protecting Bonebridge device function and preserving residual hearing.
Clinical-pathological T-stage discrepancy in OPHL: impact on oncologic outcomes.
Liberale C, Librio S, Serafini E … +9 more , Strangio R, Roncadi L, Bassani S, Querzoli G, Mattioli F, Marchioni D, Presutti L, Molteni G, Fermi M
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120574 · Publisher ↗
BACKGROUND: Clinical-pathological discordance in T staging is common in laryngeal squamous cell carcinoma (LSCC) and may affect treatment planning and prognosis. Its impact in patients treated with open partial horizonta...
BACKGROUND: Clinical-pathological discordance in T staging is common in laryngeal squamous cell carcinoma (LSCC) and may affect treatment planning and prognosis. Its impact in patients treated with open partial horizontal laryngectomy (OPHL) remains unclear. METHODS: A retrospective multicenter study was conducted on 106 patients with glottic or supraglottic LSCC treated with OPHL. Discrepancies between clinical (cT) and pathological (pT) staging were analyzed. Associations with preoperative factors, adjuvant therapy, disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) were evaluated. RESULTS: T-stage discordance was observed in 37.7% of patients, with 19.8% upstaged and 17.9% downstaged. No preoperative factor was significantly associated with discordance. T-stage discrepancy was not significantly associated with DFS, DSS, OS, or the need for adjuvant therapy. CONCLUSION: In patients undergoing OPHL, clinical-pathological T-stage discordance does not appear to significantly affect oncologic outcomes, likely due to the modular and adaptable nature of the surgical procedure.
Comparison of tuboplasty and tympanotomy tube, alone or in combination for the treatment of chronic otitis media with effusion: randomized controlled trial.
Lou Z, Lou Z, Yu Y … +6 more , Ji J, Wang J, Zhang B, Hu Y, Zhang Y, Chen Z
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120573 · Publisher ↗
OBJECTIVE: The objective of this study was to compare the tympanotomy tube (TT) retention success rates, the chronic otitis media with effusion (COME) recurrence rates, and the complications of radiofrequency tuboplasty...
OBJECTIVE: The objective of this study was to compare the tympanotomy tube (TT) retention success rates, the chronic otitis media with effusion (COME) recurrence rates, and the complications of radiofrequency tuboplasty only (RT-only), tympanotomy tube insertion (TTI) + RT, and TTI-only, used to treat unilateral chronic otitis media with effusion (COME) in adult associated with hypertrophy of the nasopharyngeal orifice of the Eustachian tube. MATERIALS AND METHODS: Patients with COME and hypertrophy of the nasopharyngeal orifice were randomly allocated to either an RT-only group or a TTI + RT group or a TTI-only group. The successful treatment rates, TT retention rates, OME recurrence rates, postoperative Eustachian tube (ET) orifice mucosal inflammation (ETI) grades, and complications were evaluated 18 months after surgery. RESULTS: A total of 156 COME patients were included. The successful treatment rates differed significantly among the three groups (P < 0.01). The TT retention success rate in the TTI + RT group was significantly higher than in the TTI-only group (96.2% vs. 82.7%, P < 0.05). The total TT premature extrusion rates at 6-12 months differed significantly between the TTI + RT and TTI-only groups (P < 0.05). Similarly, the total OME recurrence rates differed significantly among the three groups (P < 0.001). At both 6-12 and 12-18 months, the differences were significant between the TTI-only, and the RT-only and TTI + RT groups (P < 0.05). In the RT-only and TTI + RT groups, the OME recurrence rates of patients with preoperative grade 3 ETI were significantly higher than those of patients with preoperative grade 4 ETI. No RT-related severe adverse event was observed in the RT-only or TTI + RT group. Only three patients developed small red granulomas in the posterior cushion. CONCLUSIONS: The TTI + RT group exhibited the highest treatment success rate and the most durable outcomes of selected COME patients with hyperplastic ET nasopharyngeal orifices. However, given the small sample size, the short follow-up time, and the co-interventions, future studies with larger cohorts are required to validate the findings. In addition, it is important to explore further whether RT more effectively treats hypertrophic mucosa than hypertrophic cartilage at the nasopharyngeal orifice.
Diagnostic accuracy and citation integrity of four large language models on otolaryngology vignettes.
Pennington-FitzGerald W, Warrier A, Durant S … +5 more , Sharaf I, Carlino F, Pamula SD, Eloy JA, Levi J
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120572 · Publisher ↗
OBJECTIVES: This study aimed to compare the diagnostic accuracy and citation integrity of four large language models (LLMs) including one general (ChatGPT-4) and three intended for clinical and research use (OpenEvidence...
OBJECTIVES: This study aimed to compare the diagnostic accuracy and citation integrity of four large language models (LLMs) including one general (ChatGPT-4) and three intended for clinical and research use (OpenEvidence, Perplexity, and Pathway), using standardized otolaryngology clinical vignettes. METHODS: One hundred validated otolaryngology clinical vignettes were presented to each LLM with a prompt requesting both a diagnosis and supporting citations. Diagnostic accuracy was determined against reference answers, and errors were categorized as logical, informational, or explicit. Citation number, source type, hallucination rate, and journal CiteScores were also compared. RESULTS: All models demonstrated high diagnostic accuracy (82.0%-91.0%), with ChatGPT-4 achieving the highest numerical accuracy (91.0%), though differences between models were not statistically significant (p = 0.057). Logical errors were most frequent across all models. OpenEvidence and Perplexity generated the most citations per response, while ChatGPT-4 produced the fewest and had the highest hallucination rate (23.0%). Source preferences varied, with OpenEvidence and Pathway favoring narrative reviews and Perplexity favoring government/public health websites. OpenEvidence had the highest mean CiteScore for journal citations. CONCLUSION: This is the first study to assess both diagnostic accuracy and citation integrity of LLMs in otolaryngology. While ChatGPT-4 was most accurate, it had the highest rate of citation hallucinations, suggesting a trade-off between accuracy and source reliability. OpenEvidence, though slightly less accurate, provided more consistent and verifiable references, demonstrating the ability to prioritize citation integrity alongside diagnostic performance for clinical integration.
Pathophysiologic phenotyping of idiopathic sudden sensorineural hearing loss: toward precision management.
Ibrahim I, Rashidy RE, Sweet R … +1 more , Talib H
Eur Arch Otorhinolaryngol · 2026 May · PMID 42120571 · Publisher ↗
PURPOSE: Idiopathic sudden sensorineural hearing loss (ISSNHL) is traditionally managed as a uniform clinical emergency using empirical corticosteroid protocols, yet outcomes vary widely, suggesting underlying etiologic...
PURPOSE: Idiopathic sudden sensorineural hearing loss (ISSNHL) is traditionally managed as a uniform clinical emergency using empirical corticosteroid protocols, yet outcomes vary widely, suggesting underlying etiologic heterogeneity. This review aims to propose a precision medicine framework for ISSNHL by re-examining the condition through specific pathophysiologic determinants, including structural third window syndromes, microvascular compromise, and metabolic factors. METHODS: A narrative synthesis of emerging evidence regarding 3D-FLAIR MRI, high-resolution CT (HRCT), and metabolic profiling is presented. Illustrative cases of Enlarged Vestibular Aqueduct (EVA) and Superior Semicircular Canal Dehiscence (SSCD) are utilized to highlight the limitations of traditional steroid therapy in structural phenotypes. RESULTS: A significant proportion of "idiopathic" cases can be stratified into distinct pathophysiologic phenotypes. Structural anomalies (TWS) often exhibit limited steroid responsiveness but benefit from early biomechanical identification. Furthermore, advanced imaging like 3D-FLAIR MRI reveals blood-labyrinth barrier (BLB) disruption as a prognostic marker for vascular-driven hearing loss. Metabolic factors, such as Vitamin D and B12 deficiencies, further modulate cochlear resilience and recovery potential. CONCLUSION: SSNHL should be managed as a heterogeneous syndrome. We propose a stratified management algorithm that integrates high-resolution imaging and metabolic screening into early decision-making. Shifting toward pathophysiology-guided care allows for personalized adjuvant strategies (e.g., HBOT, metabolic correction) and more accurate prognostic counseling, ultimately improving individualized patient outcomes.
Methodological considerations in a randomized trial comparing cold and hot haemostasis in tonsillectomy.
Shakeel N, Khan RU
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115426 · Publisher ↗
Abstract loading — click title to view on PubMed.
Vestibular function in patients diagnosed with obstructive sleep apnea.
Sloth PB, Krogsgaard E, Hougaard DD
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115425 · Publisher ↗
PURPOSE: The primary endpoint was to determine the prevalence of vestibular hypofunction in patients suffering from obstructive sleep apnea (OSA). Secondary and tertiary objectives were to determine any correlation betwe...
PURPOSE: The primary endpoint was to determine the prevalence of vestibular hypofunction in patients suffering from obstructive sleep apnea (OSA). Secondary and tertiary objectives were to determine any correlation between vestibular hypofunction and the degree of sleep apnea and/or the Dizziness Handicap Inventory (DHI) scores, and the presence of comorbidities, respectively. METHODS: A cross-sectional prospective cohort design in which 175 adult subjects diagnosed with either probable, mild, moderate, or severe OSA were recruited. Subjects underwent complete video head impulse (vHIT) testing and a self-reported fulfilment of the DHI questionnaire. A standardized approach was applied for the interpretation and classification of the vHIT results. RESULTS: The prevalence of vestibular hypofunction was found to be 6.9%. No significant differences in apnea-hypopnea-index (AHI) score (p = 0.26) or within AHI groups (p = 0.45) were found. Consistently, no significant differences in total DHI score (p = 0.14) or within DHI subcategories (p = 0.21) were found. OSA and an accompanying heart condition was significantly correlated to having vestibular hypofunction (p = 0.00). Subjects with vestibular hypofunction had a significantly higher number of comorbidities (p = 0.03). Furthermore, the probability of having vestibular hypofunction significantly increased with increasing numbers of accompanying comorbidities (p = 0.03). CONCLUSION: Twelve subjects (6.9%) in a population of adult OSA patients had vestibular hypofunction. No correlation between the prevalence of vestibular hypofunction and the degree of OSA was found. Consistently, no correlation to the total- or subcategory mean DHI scores was found. A significant correlation was found between vestibular hypofunction and the presence of a heart condition as well as an increased number of comorbidities, respectively.
Estimation of the indirect costs associated with chronic rhinosinusitis with nasal polyposis in Spain: an analysis from a societal perspective.
Maza-Solano J, San-Gil G, Cuvillo-Bernal A … +6 more , Calvo-Henriquez C, Domínguez-Sosa S, Dávila I, González-Pérez R, Villacampa-Aubá JM, Alobid I
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115424 · Publisher ↗
PURPOSE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition associated with functional impairment and a relevant socioeconomic burden. While direct healthcare costs have been partially...
PURPOSE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition associated with functional impairment and a relevant socioeconomic burden. While direct healthcare costs have been partially described in Spain, indirect costs related to loss of work productivity remain insufficiently characterized. This study aimed to estimate the indirect costs associated with CRSwNP in Spain from a societal perspective, focusing on productivity losses due to absenteeism and presenteeism. METHODS: A cost-of-illness analysis with a one-year time horizon and a societal perspective was conducted in working-age adults (18-64 years) with CRSwNP in Spain. Disease prevalence (0.8%) was derived from national epidemiological studies. Productivity loss was estimated using published data on absenteeism and presenteeism, assuming a mean of 49.8 equivalent lost productivity days per patient per year. Economic valuation followed the human capital approach, applying average total labor costs and adjusting for labor market participation. Deterministic sensitivity analyses explored parameter uncertainty. RESULTS: An estimated 242,582 working-age adults were affected by CRSwNP, of whom 169,808 were effectively employed. The mean annual indirect cost per employed patient was €8,178.65, with presenteeism accounting for 60% and absenteeism for 40%. Extrapolation to the national level resulted in an estimated annual productivity loss of €1.39 billion, ranging from approximately €0.9 billion to nearly €2.0 billion in sensitivity analyses. CONCLUSIONS: CRSwNP is associated with substantial productivity losses in Spain, leading to a considerable indirect economic burden predominantly driven by presenteeism. These findings support the inclusion of indirect costs in assessments of disease burden and healthcare decision-making.
Patterns of multiple primary malignancies in patients with head and neck cancer: a 20-year single-institution cohort study.
Jang HB, Lee DH
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115423 · Publisher ↗
OBJECTIVE: Head and neck cancer (HNC) has achieved improved locoregional control; however, long-term survival remains compromised by the development of multiple primary malignancies (MPM). This study aimed to investigate...
OBJECTIVE: Head and neck cancer (HNC) has achieved improved locoregional control; however, long-term survival remains compromised by the development of multiple primary malignancies (MPM). This study aimed to investigate the clinical patterns of multiple primary malignancies involving HNC in a 20-year single-institution cohort from East Asia. PATIENTS AND METHODS: We retrospectively reviewed 86 patients diagnosed with multiple primary malignancies, including HNC, between 2004 and 2024. To assess subsite-specific associations, 104 cancer pairs were analyzed by matching each HNC with each non-HNC on a one-to-one basis. This approach accounted for 12 patients with three primary malignancies and two patients with four primary malignancies. RESULTS: Lung (24.0%), colorectal (15.3%), and gastric cancers (13.4%) were the most frequently associated malignancies. Thyroid cancer was the most common HNC subsite (24.0%); however, hypopharyngeal cancer demonstrated the highest normalized prevalence of multiple primary malignancies (3.5%) and showed significant associations with gastroesophageal tumors. Additionally, a significant association was observed between oral cavity cancer and hematologic malignancies, with the hematologic malignancy preceding the oral cavity cancer in all five cases. Metachronous tumors were more prevalent than synchronous tumors, with a mean interval of 46.9 months following the diagnosis of the index cancer. Synchronous malignancies occurred more frequently when HNC was the index tumor (p = 0.0068). CONCLUSION: Significant subsite-specific associations are observed between hypopharyngeal and gastroesophageal cancers, as well as between oral cavity and hematologic malignancies. Metachronous tumors predominate over synchronous tumors, occurring at a mean interval of 46.9 months following the diagnosis of the index cancer.
Clinical outcomes of fibular and scapular free osseous flaps in head and neck reconstruction: a retrospective comparative study.
Favero V, Sala G, Mazzarella F … +7 more , Bissolotti G, Ruaro A, Taboni S, Gaudioso P, Nicolai P, Ferrari M, Tiengo C
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115422 · Publisher ↗
PURPOSE: Osseous microvascular reconstruction of the head and neck following oncologic or osteoradionecrotic resection remains surgically challenging. The fibular free flap is the gold standard for mandibular reconstruct...
PURPOSE: Osseous microvascular reconstruction of the head and neck following oncologic or osteoradionecrotic resection remains surgically challenging. The fibular free flap is the gold standard for mandibular reconstruction, whereas the scapular free flap has emerged as a viable alternative in selected scenarios. METHODS: A retrospective comparative analysis was performed on 69 adults undergoing cervicofacial reconstruction with fibular (n = 37) or scapular (n = 32) osseous free flaps (2015-2025). Surgical, functional, and patient-reported outcomes (DASH, EFAS, SHI, MDADI, EORTC QLQ-H&N35, FACE-Q) were assessed. RESULTS: Demographics and clinical profiles were similar, though scapular recipients were older. Fibular flaps predominate in mandibular, scapular in maxillary reconstructions. Fibular reconstructions used more custom plates and had longer follow-up but exhibited higher donor-site complication (24.3%) and elective revision (62.2%) rates. PROMs were comparable; extensive scapular flaps caused mild upper limb function decline. CONCLUSION: Scapular flaps demonstrated lower donor-site complication rates and comparable functional and patient-reported outcomes in this cohort. These findings suggest that the scapular flap represents a valuable reconstructive alternative, particularly in patients in whom fibular harvest may be less suitable.
Acquired Eustachian tube atresia following turbinoplasty: multimodal surgical reconstruction, clinical outcomes, case series, and literature review.
Sanad SA, Almutairi HM, Alamry S
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42115421 · Publisher ↗
BACKGROUND: Acquired atresia of the Eustachian tube (ET) is an uncommon but debilitating condition that can significantly impair middle ear ventilation and drainage, leading to chronic otitis media, conductive hearing lo...
BACKGROUND: Acquired atresia of the Eustachian tube (ET) is an uncommon but debilitating condition that can significantly impair middle ear ventilation and drainage, leading to chronic otitis media, conductive hearing loss, and aural fullness. Despite its impact, diagnosis and management remain challenging, with limited literature on standardized approaches. OBJECTIVE: This case series aims to describe the clinical presentation, imaging findings, surgical management, and outcomes of three adult patients with acquired ET atresia treated using multimodal surgical interventions, including balloon dilation, laser-assisted dissection, and microdebrider techniques. METHOD: We retrospectively reviewed three adult cases presenting with persistent otologic symptoms refractory to conventional medical and ventilation tube therapy. Diagnosis was confirmed through endoscopic evaluation and imaging. Surgical intervention targeted restoration of ET patency using endoscopic and microscopic techniques tailored to the anatomical findings of each case. RESULTS: All patients demonstrated symptomatic improvement postoperatively, with reduced otorrhea, otalgia, and improved middle ear aeration, and improvement in ETDQ-7 average score. Use of adjunctive techniques such as balloon dilation and short-term stenting helped maintain patency and enhance outcomes. No major complications were noted. CONCLUSION: A multimodal, individualized approach to acquired ET atresia can provide significant clinical benefit. Adjunctive use of balloon dilation, laser, and microdebrider techniques enhances surgical success. Further research is needed to determine long-term outcomes and optimal treatment protocols.
Vocal folds irregular mucosal changes: a multimodal evaluation for diagnosis and genetic risk stratification.
Aref EEM, AbdelAal AH, Ewida RM … +1 more , Ibrahim RAW
Eur Arch Otorhinolaryngol · 2026 May · PMID 42115420 · Publisher ↗
PURPOSE: Irregular vocal fold mucosal changes pose diagnostic challenges and may range from benign to malignant. Emerging research highlights Sex-determining Region Y-box 2 (SOX2) gene amplification as a potential early...
PURPOSE: Irregular vocal fold mucosal changes pose diagnostic challenges and may range from benign to malignant. Emerging research highlights Sex-determining Region Y-box 2 (SOX2) gene amplification as a potential early marker in head and neck tumorigenesis. This work aimed to evaluate vocal fold irregular mucosal lesions for the early detection of high-risk lesions (high-grade dysplasia, carcinoma in situ, and squamous cell carcinoma (SCC)) and to explored the potential role of SOX2 gene in early laryngeal carcinogenesis. METHODS: This is a prospective observational cross-sectional study with a follow-up up to 2 years; 40 male patients with vocal fold irregularities were examined by laryngo-stroboscopy, then classified into two groups based on histopathological diagnosis: (A) Low-risk group (benign lesions, low-grade dysplasia), (B) High-risk group (high-grade dysplasia, carcinoma insitu and SCC. Real-time polymerase chain reaction PCR was performed to detect SOX2 gene expression. RESULTS: Significant differences were observed in vocal fold stroboscopic features (mucosal wave and amplitude), and SOX2 gene expression across lesion groups, with higher SOX2 expression noted in the high-risk group (P < 0.05). A strong positive correlation was observed between histopathological severity and each of stroboscopic impairment in mucosal wave and amplitude, and Log SOX2 gene expression. The regression analysis showed a significant independent predictive effect of SOX2 gene expression on the progression to high-risk lesions. CONCLUSIONS: This study integrated established diagnostic standards, laryngostroboscopy for clinical assessment, and histopathology as the gold standard for grading, while the analysis of SOX2 gene expression showed a promising predictive molecular marker for tumorigenesis.
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