European Archives Of Oto-rhino-laryngology[JOURNAL]
Sun
200 papers
P-glycoprotein expression in sinonasal inverted papillomas and polyps: Marker or bystander?
Altan E, Küçüktağ Z, Arslankoz S … +2 more , Yetişgin E, Tatar EÇ
Eur Arch Otorhinolaryngol · 2026 May · PMID 42086988 · Publisher ↗
OBJECTIVE: Sinonasal inverted papillomas (IPs) and nasal polyps (NPs) represent distinct benign lesions with different biological behaviors. P-glycoprotein (P-gp), a multidrug resistance transporter, has been implicated...
OBJECTIVE: Sinonasal inverted papillomas (IPs) and nasal polyps (NPs) represent distinct benign lesions with different biological behaviors. P-glycoprotein (P-gp), a multidrug resistance transporter, has been implicated in inflammatory and neoplastic processes, but its expression in IPs has not been previously investigated. This study aimed to evaluate and compare the immunohistochemical expression of P-gp in IPs and NPs. METHODS: In this retrospective cohort study, 89 patients who underwent primary functional endoscopic sinus surgery between 2018 and 2022 were included: 56 with IP and 33 with NP. None of the patients had prior sinonasal surgery. Representative tissue samples were histopathologically examined, and P-gp expression was assessed by quantitative fluorescent immunohistochemistry. Expression was categorized as negative (0), weak (1), moderate (2), or strong (≥3). Statistical comparisons between groups were performed using t-test and chi-square analysis. RESULTS: The mean age was significantly higher in the IP group compared to the NP group (49.0 ± 16.2 vs. 40.6 ± 14.1 years; p = 0.012). Sex distribution did not differ significantly between groups (p = 1.000). P-gp expression showed distinct patterns: in the NP group, 3.0% were negative, 60.6% weak, and 36.4% moderate; in the IP group, 12.5% were negative, 35.7% weak, and 51.8% moderate. Strong expression was not observed in either group. A statistically significant difference in the distribution of expression categories was found between the groups (χ² = 6.01, p = 0.049), with moderate expression being more frequent in IPs. CONCLUSION: This study demonstrates, for the first time, P-gp expression in sinonasal inverted papillomas. While mean expression levels did not differ significantly, moderate P-gp expression was significantly more prevalent in IPs compared to NPs. These findings suggest that P-gp may contribute to the distinct inflammatory and proliferative profile of IPs and could represent a potential therapeutic target in sinonasal tumors.
Comment on "Clinicopathological characteristics, incidence trends, and prognostic factors of salivary gland secretory carcinoma: a SEER database analysis (2011-2021)".
Tu L, Han T
Eur Arch Otorhinolaryngol · 2026 May · PMID 42084772 · Publisher ↗
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Analysis of clinical efficacy of repetitive transcranial magnetic stimulation in the treatment of residual dizziness after reduction of benign paroxysmal positional vertigo.
Luan F, Wang XY, Xing JJ … +2 more , Zhang Y, Zhang ZC
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42062570 · Publisher ↗
PURPOSE: To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for residual dizziness (RD) after benign paroxysmal positional vertigo (BPPV) repositioning. METHODS: This retrospective...
PURPOSE: To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for residual dizziness (RD) after benign paroxysmal positional vertigo (BPPV) repositioning. METHODS: This retrospective study included 170 patients with RD after BPPV repositioning, allocated to ginkgo biloba extract (GBE, n = 63), vestibular rehabilitation therapy(VRT, n = 65, VRT + GBE), or rTMS (n = 42, rTMS + GBE) groups, according to the treatment received. Dizziness Handicap Inventory (DHI) and Visual Analog Scale (VAS) scores were assessed at multiple time points. Psychological status, quality of life, clinical efficacy, recurrence, and safety were also evaluated. RESULTS: DHI and VAS scores reductions were greater in rTMS and VRT groups than GBE alone at all time points (P < 0.05), with rTMS showing greater short-term DHI improvement and better SDS reduction than VRT (P < 0.05). SF-36 scores improved more in rTMS and VRT groups. Efficacy rates were 97.62% (rTMS), 100% (VRT), and 96.83% (GBE) (P < 0.05). CONCLUSION: rTMS combined with GBE was associated with short-term symptom and depressive improvement in RD patients. Due to non-randomized design, findings require confirmation in prospective trials.
Tinnitus severity and hearing loss: mechanistic insights and future directions.
Liu X, Guo Y
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050142 · Publisher ↗
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Correction: Evolution of midface microvascular reconstruction: three decades of experience from a single institution.
Uglesic V, Amin K, Blivajs I … +1 more , Kosutic D
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050141 · Publisher ↗
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Effects of auditory pathway maturation on hearing loss diagnosis.
Savioli S, Mancini P, De Seta D … +3 more , Turchetta R, Frisina A, Russo FY
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050140 · Publisher ↗
PURPOSE: The maturation of auditory pathways in newborns, particularly in pre-terms, is a crucial process influencing the accuracy and timeliness of early audiological diagnosis. The aim of this study was to investigate...
PURPOSE: The maturation of auditory pathways in newborns, particularly in pre-terms, is a crucial process influencing the accuracy and timeliness of early audiological diagnosis. The aim of this study was to investigate the effect of postnatal auditory pathway maturation on hearing loss diagnosis by comparing early and later ABR assessments in pre-term and full-term newborns. METHODS: Seventy-eight newborns (156 ears) were enrolled and divided by gestational age. All underwent initial screening, clinical Auditory Brainstem Response (ABR), tympanometry, and evaluation of diagnostic timing. Statistical analyses were performed with Jamovi (v.2.3.28). RESULTS: In full-term newborns, the initial screening significantly predicted ABR outcomes, whereas no such correlation emerged in pre-terms. However, pre-terms showed a significant improvement in ABR thresholds over time, consistent with postnatal maturational effects on auditory pathway function. Additionally, pathological tympanograms (type B) were associated with a delayed diagnosis. CONCLUSIONS: These findings stress the need for tailored protocols and extended follow-up in pre-term newborns, as well as early detection of middle ear conditions to minimize both under- and over-diagnosis.
The Double-C cartilaginous scaffold: a novel technique for transcanal repair of large anterior-predominant tympanic membrane perforations.
Reda M, Gaber M
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050139 · Publisher ↗
PURPOSE: To evaluate the efficacy of the Double-C cartilaginous scaffold technique in the transcanal repair of large anterior-predominant tympanic membrane perforations. METHODS: This single-arm prospective study include...
PURPOSE: To evaluate the efficacy of the Double-C cartilaginous scaffold technique in the transcanal repair of large anterior-predominant tympanic membrane perforations. METHODS: This single-arm prospective study included 37 patients with large anterior-predominant tympanic membrane perforations, an intact ossicular chain, and no cholesteatoma, who underwent transcanal microscopic myringoplasty using a standardized double-layered, C-shaped tragal cartilage scaffold with an underlay perichondrial layer. Postoperative outcomes assessed were graft uptake, air–bone gap (ABG) closure, and complications over a minimum follow-up of six months. RESULTS: Graft uptake was achieved in 34 patients (91.9%), with no blunting, lateralization, cartilage extrusion, or canal stenosis observed. The mean preoperative ABG was 33.1 ± 3.3 dB, which improved significantly to 13.2 ± 4.5 dB at 6 months postoperatively (p < 0.001), with a mean hearing gain of 19.9 ± 4.4 dB. No major complications occurred. CONCLUSION: The Double-C cartilaginous scaffold technique effectively addresses the challenge of inadequate anterior graft support, providing reliable anatomical closure and significant functional hearing improvement in patients with large anterior-predominant tympanic membrane perforations.
Orbital clock concept: A novel anatomical zoning system for endoscopic vs. external orbital approaches.
Fayed MT, Elkady M, Elbakary M … +3 more , Ibrahim AA, Saafan ME, Tomoum MO
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050138 · Full text
PURPOSE: To present a road map and an algorithm that illustrate the rhinologist’s perspective in orbital surgery, guiding surgeons in selecting the most appropriate approach to orbital pathology. METHODS: We conducted a...
PURPOSE: To present a road map and an algorithm that illustrate the rhinologist’s perspective in orbital surgery, guiding surgeons in selecting the most appropriate approach to orbital pathology. METHODS: We conducted a prospective case series of one hundred consecutive patients undergoing orbital or transorbital endoscopic procedures from January 2023 to January 2025 at the Departments of Otorhinolaryngology and Ophthalmology, Tanta and Alexandria University Hospitals. RESULTS: Using the right orbit as a clock, the endoscopic endonasal approaches provide access to the medial orbital compartment and orbital apex from 1 to 7 o'clock; the precaruncular approach allows access to the anterior medial compartment from 1 to 6 o'clock. The lower eyelid preseptal approach gives access to the inferior orbital compartment from 4 to 8 o'clock. The lateral retrocanthal or microorbitotomy approach offers access to the lateral orbital compartment from 7 to 11 o'clock. The Superior eyelid crease approach provides access to the superior compartment from 9 to 3 o'clock. CONCLUSION: The rhinologist’s perspective in orbital surgery has expanded from solely performing medial orbital and optic nerve decompression to bypass the periorbita to medial intraconal lesions and 360-degree access to the orbit by adding transorbital approaches.
Multi-scale transcriptomic integration reveals epithelial state heterogeneity and remodeling-associated transcriptomic clusters in chronic rhinosinusitis with nasal polyps.
Liu F, Ye F, Gu X … +1 more , Yin X
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050137 · Publisher ↗
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) involves persistent mucosal inflammation and epithelial remodeling, yet the molecular mechanisms driving epithelial dysfunction remain unclear. METHODS: Singl...
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) involves persistent mucosal inflammation and epithelial remodeling, yet the molecular mechanisms driving epithelial dysfunction remain unclear. METHODS: Single-cell and bulk RNA sequencing data were integrated to characterize the cellular composition, gene expression patterns, and pathway activities in CRSwNP. Single-cell clustering, pseudotime analysis, and cell annotation were performed to define epithelial cell subsets. Bulk transcriptomic data underwent differential expression, enrichment, and pathway analysis. Gene set variation analysis (GSVA) and LASSO regression were applied to construct a pathway-based signature score, followed by consensus clustering for transcriptomic cluster identification. RESULTS: Epithelial cells exhibited clear heterogeneity, with basal, secretory, and ciliated subsets forming a continuous differentiation trajectory. Upregulated pathways included extracellular matrix organization, PI3K-Akt signaling, and epithelial-mesenchymal transition, while interferon and NF-κB signaling were suppressed. Pathway-based modeling identified two internally consistent transcriptomic clusters: one dominated by epithelial barrier and ciliary activity, and another characterized by extracellular remodeling and IL-13/TGF-β signaling. CONCLUSIONS: This multi-scale transcriptomic analysis highlights epithelial state heterogeneity and extracellular remodeling as potential molecular features of CRSwNP and proposes an exploratory transcriptomic stratification that warrants further validation in independent cohorts.
Effect of intranasal vitamin A nanoparticles on persistent olfactory dysfunction: a randomized clinical trial.
Algarni MA, Alsulami FT, Alzarea AI … +6 more , Alruqayb WS, Alharbi A, Alsenani F, Altemani AH, Abdelazim AH, Abdelazim MH
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050136 · Publisher ↗
PURPOSE: Persistent olfactory dysfunction severely impacts quality of life. Although Vitamin A aids tissue regeneration, poor mucosal bioavailability limits clinical efficacy. This study evaluated the effectiveness of in...
PURPOSE: Persistent olfactory dysfunction severely impacts quality of life. Although Vitamin A aids tissue regeneration, poor mucosal bioavailability limits clinical efficacy. This study evaluated the effectiveness of intranasal Vitamin A nanoparticles compared to conventional Vitamin A for treating persistent olfactory loss, aiming to overcome absorption barriers. METHODS: In this randomized, double-blind trial, 60 patients with post-infectious olfactory dysfunction received either Vitamin A nanoparticles or conventional Vitamin A for six months. Nanoparticles were synthesized via nanoprecipitation and verified by electron microscopy. Monthly olfactory function was measured using Sniffin’ Sticks TDI scores. Data were analyzed using a two-way mixed-model ANOVA to assess Group × Time interactions, followed by post-hoc pairwise comparisons based on Estimated Marginal (EM) Means with Bonferroni correction to compare efficacy between the two delivery methods. RESULTS: A significant Group × Time interaction was observed across all olfactory domains (p < 0.001$), confirming a superior therapeutic trajectory for the nanoparticle group. By month 6, the nanoparticle group demonstrated significantly greater improvements in threshold (Δ1.30 ± 0.18), discrimination (Δ1.30 ± 0.11), and identification (Δ1.40 ± 0.20) scores compared to the conventional group (p < 0.05). Post-hoc analysis revealed that significant between-group divergence emerged starting from month 3. The mean TDI increase was 4.00 points in the nanoparticle group compared to 2.40 points in the conventional group. CONCLUSION: Intranasal Vitamin A nanoparticles significantly outperformed conventional Vitamin A as evidenced by the mixed-model ANOVA results; however, total improvements fell short of the Minimal Clinically Important Difference (MCID). Although nanoparticle delivery enhances biological activity and absorption, the clinical impact remains modest within a 6-month window. Future research should investigate whether optimized dosing or combination therapies can achieve clinically meaningful results. CLINICAL TRIAL REGISTRATION: DFM-IRB 00012367-25-07-011.
Electromyographic findings of the orbicularis oculi muscle in recurrent endonasal dacryocystorhinostomy failure : Orbicularis Oculi Function In Endonasal Dacryocystorhinostomy Failure.
Agayarov OY, Arslan IB, Taskin AC … +5 more , Boluk E, Bilgin S, Karakurt SE, Sener U, Cukurova I
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050135 · Publisher ↗
PURPOSE: To evaluate orbicularis oculi muscle function using electromyography in patients who developed recurrent epiphora and membranous neo-ostium obstruction after endonasal dacryocystorhinostomy (END-DCR) with docume...
PURPOSE: To evaluate orbicularis oculi muscle function using electromyography in patients who developed recurrent epiphora and membranous neo-ostium obstruction after endonasal dacryocystorhinostomy (END-DCR) with documented initial patency and symptom improvement. METHODS: Nineteen patients who underwent at least two END-DCR procedures on the same eye and later developed recurrent epiphora were included. Orbicularis oculi muscle activity was assessed using quantitative electromyography. Electrophysiological findings of the operated side were compared with the asymptomatic contralateral side and with healthy controls. RESULTS: Motor unit potential (MUP) duration and amplitude were significantly increased on the operated side compared with both the asymptomatic side and the control group, consistent with neurogenic changes. No significant differences were observed between the asymptomatic side and controls. CONCLUSION: Despite the limited number of patients, the rarity and homogeneity of this clinical subgroup allowed detection of consistent and statistically robust electrophysiological differences. These findings provide preliminary evidence that orbicularis oculi dysfunction may contribute to recurrent failure after END-DCR with documented initial neo-ostium patency.
Machine learning for predicting muscle loss after radiotherapy using clinical and toxicity data in oral cavity cancer.
Weng NH, Lin JB, Jan YT … +5 more , Lin YH, Leu YS, Chen YJ, Wu KP, Lee J
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050134 · Publisher ↗
PURPOSE: Muscle loss after radiotherapy is associated with poor overall survival in patients with oral cavity cancer. In this study, we aimed to develop a machine learning model for predicting muscle loss after radiother...
PURPOSE: Muscle loss after radiotherapy is associated with poor overall survival in patients with oral cavity cancer. In this study, we aimed to develop a machine learning model for predicting muscle loss after radiotherapy. METHODS: This study included patients with oral cavity cancer who underwent surgery and post-operative radiotherapy at two tertiary centers between 2010 and 2020. Muscle loss was determined by comparing pre- and post-radiotherapy computed tomography scans. The Random Forest (RF), eXtreme Gradient Boosting (XGBoost), and Categorical Boosting (CatBoost) models were trained to predict muscle loss using clinical and toxicity features. Model performance was evaluated using the area under the curve (AUC). The SHapley Additive exPlanations (SHAP) method was used to interpret the model. RESULTS: Of 903 eligible patients (median age: 55 years), 572 and 331 were in the derivation and external validation cohorts, with 144 (25.2%) and 81 (24.5%) patients experiencing muscle loss after radiotherapy, respectively. The CatBoost model achieved the highest AUC compared to the RF and XGBoost models in the external validation cohort (AUC: 0.993, 0.991, and 0.989, respectively). Mini Nutritional Assessment score, anorexia, and dysphagia were identified as the top three contributing features for muscle loss prediction. The SHAP force plot provided a personalized model prediction interpretation for each patient. CONCLUSIONS: A machine learning model based on clinical and toxicity data could predict muscle loss after radiotherapy for oral cavity cancer. Personalized predictions could assist clinicians in guiding interventions for muscle mass preservation.
Pilot study of intratonsillar immunotherapy for timothy grass pollen.
Steinsvåg SK, Moe SE, Lønnerød AC … +3 more , Berget KT, Florvaag E, Aarstad HJ
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050133 · Full text
BACKGROUND: Allergen-specific immunotherapy (AIT) is a treatment for upper airway allergy that is resistant to optimal symptomatic management. Traditionally, it is administered via repeated subcutaneous injections (subcu...
BACKGROUND: Allergen-specific immunotherapy (AIT) is a treatment for upper airway allergy that is resistant to optimal symptomatic management. Traditionally, it is administered via repeated subcutaneous injections (subcutaneous immunotherapy, SCIT) or daily sublingual tablets/drops (sublingual immunotherapy, SLIT) for 3–5 years. Direct allergen exposure has also been attempted through intralymphatic immunotherapy (ILIT) via injections into inguinal lymph nodes. OBJECTIVE: To evaluate the clinical and immunological effects of intratonsillar allergen immunotherapy for timothy grass pollen allergy. METHODS: This uncontrolled, prospective, cross-sectional, pilot study included 12 patients with allergic rhinoconjunctivitis to timothy grass pollen, refractory to symptomatic treatment. Each patient received a dose of 1 mL 10,000 SQ-U standardized, aluminum hydroxide-adsorbed depot grass pollen extract (Alutard, ALK-Abelló, Denmark) for SCIT at four-week intervals. Follow-up was conducted 18 months after the final injection. RESULTS: During the first two injections, 7 out of 12 patients developed systemic adverse reactions within minutes, including generalized itching, edema with rashes, tiredness, and mild dyspnea, all resolving spontaneously within two hours without epinephrine administration. Patients reported significant symptom improvement, including reduced nasal congestion, rhinorrhea, sneezing, mouth breathing, and ocular itching. Immunologically, the antibody responses to timothy pollen (IgE and IgG4) showed similarities to patterns previously described for SLIT, SCIT and ILIT. CONCLUSIONS: Intratonsillar depot grass pollen extract injections improved symptoms of timothy-induced allergic rhinoconjunctivitis. It also induced immunological alterations characteristic for allergen-specific immunotherapy. To our knowledge, this is the first study to report the intratonsillar administration of AIT for grass pollen allergy.
Gans repositioning maneuver in treating posterior canal benign paroxysmal positional vertigo: A systematic review.
Alashram AR
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050132 · Publisher ↗
PURPOSE: To examine the impact of the Gans repositioning maneuver (GRM) on patients with posterior canal BPPV (PC-BPPV) and to determine the quality of the studies. METHODS: “PubMed, CINAHL, Scopus, PEDro, REHABDATA, Web...
PURPOSE: To examine the impact of the Gans repositioning maneuver (GRM) on patients with posterior canal BPPV (PC-BPPV) and to determine the quality of the studies. METHODS: “PubMed, CINAHL, Scopus, PEDro, REHABDATA, Web of Science, and EMBASE” were systematically searched from inception to November 2025. Experimental studies involving patients with PC-BPPV who were administered the GRM, compared with active, passive, or no treatment, and examined PC-BPPV symptoms, were included in this review. The quality of the included studies was assessed using the “Physiotherapy Evidence Database (PEDro).” RESULTS: A total of eleven studies met the inclusion criteria. A total of 1183 patients with PC-BPPV (mean age: 54.9 years; females: 59%) were included in this review. The results showed that GRM is effective for patients with PC-BPPV. The quality of the included studies ranged from 3 to 8, with a median score of 6. CONCLUSIONS: The initial findings suggest that GRM appears effective and comparable to the Epley Repositioning Maneuver (ERM) and Semont Repositioning Maneuver (SRM) in patients with PC-BPPV. However, it was not superior to either maneuver. The overall certainty of evidence is moderate due to methodological limitations and heterogeneity among the included studies. Thus, additional high-quality randomized controlled trials with standardized treatment protocols and long-term follow-ups are warranted to confirm the clinical effects of the maneuver.
Circulating tumor HPV DNA versus PET-CT for surveillance in oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis.
Aouf MM, Tamás L, A El-Shirbeny H … +2 more , Abdel-Maboud M, Dános K
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050131 · Publisher ↗
PURPOSE: To evaluate the diagnostic performance of circulating tumor HPVDNA (ctHPVDNA) for detecting residual or recurrent disease in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinom...
PURPOSE: To evaluate the diagnostic performance of circulating tumor HPVDNA (ctHPVDNA) for detecting residual or recurrent disease in patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) compared with positron emission tomography–computed tomography (PET-CT). METHODS: Data sources, including MEDLINE, Embase, CENTRAL, and Scopus, were searched from 2015 to May 2025 for studies evaluating the detection of circulating tumor DNA after treatment for HPV-positive OPSCC, using PET-CT as the reference standard. A systematic review and meta-analysis were conducted and registered with PROSPERO (CRD420251037973). Two reviewers independently extracted data according to the PRISMA guidelines and assessed quality using the QUADAS-2 tool. A hierarchical random-effects model was used to estimate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios (DORs). RESULTS: Ten studies comprising 596 patients met the inclusion criteria. Pooled sensitivity for ctHPVDNA was 0.86 (95% CI, 0.68–0.95), specificity was 0.96 (95% CI, 0.88–0.99), and DOR was 153.0 (95% CI, 45.3–516.1). Subgroup analyses revealed the highest performance in studies using droplet digital polymerase chain reaction (ddPCR) and in those with sampling times greater than 12 weeks after treatment. PET-CT showed sensitivity of 0.89 (95% CI, 0.81–0.94) and specificity of 0.83 (95% CI, 0.30–0.98), with greater heterogeneity driven by threshold effects. CONCLUSIONS: ctHPV DNA demonstrates high specificity and good sensitivity for detecting post-treatment recurrence in HPV-positive OPSCC, outperforming PET-CT in specificity and complementing its role in surveillance.
Silent obstruction: The hidden role of aberrant internal carotid artery in middle ear pathology.
Rana MS, Satpute SS
Eur Arch Otorhinolaryngol · 2026 Jun · PMID 42050130 · Publisher ↗
PURPOSE: Aberrant Internal carotid artery (ICA) within the middle ear is a rare congenital vascular anomaly, occurring in approximately 1% of the population [1]. It often remains clinically silent or presents with nonspe...
PURPOSE: Aberrant Internal carotid artery (ICA) within the middle ear is a rare congenital vascular anomaly, occurring in approximately 1% of the population [1]. It often remains clinically silent or presents with nonspecific otological symptoms, making preoperative diagnosis challenging. This study aims to highlight the importance of early identification and safe management of aberrant ICA through a clinical case and literature review. METHODS: We report a case of 36 year old female presenting with bilateral chronic ear discharge and tympanic membrane retraction. Detailed otoscopic examination and radiological imaging were performed. A focused literature review was conducted to contextualize clinical presentation, diagnostic strategies and management. RESULTS: Imaging revealed an aberrant ICA coursing through the middle ear. The patients presentation was non specific, and the diagnosis was established only after radiological evaluation. Recognition of this anomaly preoperatively prevented inadvertent vascular injury. Literature suggests that such cases are frequently diagnosed incidentally, with intraoperative hemorrhage being the most severe complication when missed. CONCLUSION: Preoperative identification of aberrant ICA is critical in patients with atypical middle ear findings. Routine consideration of vascular anomalies and appropriate imaging can avert life threatening complications and guide safe surgical planning.
Diagnostic work-up strategies impact on head and neck Squamous Cell Carcinoma (SCC) of unknown primary survival: a national multicentric retrospective analysis.
Chiesa Estomba CM, Droppelman-Alvarez P, Brunet A … +11 more , Virós-Porcuna D, Roldan-Fidalgo A, Corriols-Noval P, Sánchez JL, García-Velasco F, Sistiaga-Suarez JA, Pollán-Guisasola C, Martínez-Camerano A, García-Foraster X, López-Álvarez F, Rovira A
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050129 · Publisher ↗
OBJECTIVE: Head and neck squamous cell carcinoma of unknown primary (HNSCC-CUP) represents a clinical challenge due to its heterogeneity and lack of consensus in diagnostic and therapeutic management. This study analyses...
OBJECTIVE: Head and neck squamous cell carcinoma of unknown primary (HNSCC-CUP) represents a clinical challenge due to its heterogeneity and lack of consensus in diagnostic and therapeutic management. This study analyses the impact of HPV, diagnostic and therapeutic strategies, as well as the outcomes in CUP patients in Spain. METHODS: A retrospective multicenter study (2018–2021) was conducted across eight tertiary care hospitals in Spain, including patients HNSCC-CUP undergoing different diagnostic and therapeutic strategies. Variables analysed included demographic data, clinical features, diagnostic techniques, therapeutic modalities, and clinical outcomes. Statistical analyses involved Kaplan-Meier curves, log-rank tests, and Cox regression. RESULTS: A total of 112 patients were identified. HPV positivity (p16 and/or HPV DNA) was observed in 30.4% of cases. The primary tumor was identified in 26.7% of cases, predominantly in the ipsilateral tonsil and tongue base and more frequently among the HPV positive cohort (61.7%). Three-year overall survival (OS) was 69.6%, with better OS observed in multimodal treatments (p = 0.020). Extracapsular extension and unimodal treatments were associated with worse prognosis (p < 0.05). The identification of the micro primary tumour during the diagnostic surgery was associated with a better overall and recurrence-free survival. CONCLUSIONS: HNSCC-CUP remains a diagnostic and therapeutic challenge. Diagnostic surgery and multimodal treatment improve OS, especially in patients with advanced disease. This study highlights the importance of molecular diagnosis and multidisciplinary management in HNSCC-CUP and underscores epidemiological differences related to HPV status. Prospective studies are needed to validate these findings.
The efficacy of local tranexamic acid injection in reducing intraoperative bleeding and improving surgical field quality in septoplasty: a randomized controlled trial.
Alkheder A, Yousfan A
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050128 · Publisher ↗
INTRODUCTION: Intraoperative bleeding during septoplasty impairs surgical field visualization and increases operative risks. While tranexamic acid (TXA) has demonstrated systemic efficacy, concerns regarding thromboembol...
INTRODUCTION: Intraoperative bleeding during septoplasty impairs surgical field visualization and increases operative risks. While tranexamic acid (TXA) has demonstrated systemic efficacy, concerns regarding thromboembolic events persist. This study evaluated the efficacy and safety of locally injected TXA in reducing bleeding and improving surgical conditions during septoplasty. METHODS: A double-blind, randomized controlled trial was conducted at a single university hospital. 108 patients of physical status Class I according to the American Society of Anesthesiologists (ASA) classification system undergoing elective septoplasty were randomized to receive a standard local anesthetic solution (lidocaine 2% with epinephrine) either with (n = 54) or without (n = 54) 100 mg of added TXA. Primary outcomes were intraoperative blood loss, surgical field quality (Boezaart scale), and surgeon satisfaction (5-point Likert scale). Secondary outcomes included complications, operative duration, and adverse events. RESULTS: The TXA group demonstrated a statistically significant reduction in mean intraoperative blood loss compared to controls (101.39 mL vs. 211.11 mL; p < 0.001). Surgical field quality was superior in the TXA group (mean Boezaart score 1.85 vs. 2.67; p < 0.001), as was surgeon satisfaction (mean Likert score 4.48 vs. 3.72; p < 0.001). The incidence and severity of mucosal lacerations requiring suturing were significantly lower in the intervention group (p = 0.004). Hemodynamic stability was maintained, with no significant difference in adverse events between groups. CONCLUSION: Local injection of 100 mg TXA significantly reduces intraoperative bleeding, improves surgical field quality, and increases surgeon satisfaction in septoplasty, without increasing complications. This targeted approach represents a safe and effective adjunct for optimizing surgical conditions in this common procedure.
Smartphone-based tinnitus retraining therapy in Ménière's disease patients following vestibular ablation: a feasibility study.
Gunay G, Surmeli M, Surmeli R … +2 more , Onder SS, Yilmaz AAS
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050127 · Publisher ↗
PURPOSE: To evaluate the feasibility and preliminary outcomes of smartphone-delivered Tinnitus Retraining Therapy (TRT) in Ménière's disease patients with persistent tinnitus following intratympanic gentamicin ablation....
PURPOSE: To evaluate the feasibility and preliminary outcomes of smartphone-delivered Tinnitus Retraining Therapy (TRT) in Ménière's disease patients with persistent tinnitus following intratympanic gentamicin ablation. METHODS: This prospective exploratory clinical study enrolled 23 patients with unilateral Ménière's disease who had undergone intratympanic gentamicin ablation ≥ 6 months prior and experienced chronic tinnitus. Patients underwent a 6-month TRT program combining smartphone-based broadband noise therapy (6 h daily) with directive counselling. Primary outcomes were Tinnitus Handicap Inventory (THI) and Beck Depression Inventory (BDI) scores assessed at baseline, 1, 3, and 6 months. Secondary measures included psychoacoustic parameters (tinnitus pitch, loudness, minimum masking level). Fifteen patients (65.2%) completed the protocol. RESULTS: Among completers (n = 15), median THI scores decreased from 38.00 (IQR: 28.00–56.00) at baseline to 20.00 (IQR: 8.00–40.00) at 6 months (mean reduction 15.74 points; p = 0.03). Improvements were evident by 3 months and sustained through 6 months. BDI scores remained stable (baseline median: 10.00, IQR: 6.00–15.00; 6-month median: 9.00, IQR: 4.00–13.00; p = 0.23). Psychoacoustic parameters showed no significant changes (all p > 0.05). Baseline analysis revealed positive correlations between tinnitus loudness and hearing threshold (rₛ = 0.56, p = 0.01), age and tinnitus loudness (rₛ = 0.44, p = 0.03), and THI and BDI scores (rₛ = 0.50, p = 0.01). Eight participants (34.8%) discontinued treatment primarily due to sound intolerance. CONCLUSIONS: This feasibility study suggests that smartphone-delivered TRT is a feasible approach that may be associated with reductions in tinnitus handicap scores in post-gentamicin Ménière's patients, without measurable changes in acoustic characteristics. The observed THI reduction (15.74 points) is comparable to published conventional TRT outcomes, though the absence of a control group precludes causal inference. The 34.8% attrition rate, primarily due to sound intolerance, highlights the need for improved patient selection and adherence strategies. These preliminary findings warrant confirmation in larger controlled trials. This accessible approach addresses an important therapeutic gap, though attrition rates suggest need for improved adherence strategies.
Benchmarking next-generation large language models in otorhinolaryngology: a prospective, guideline-anchored, blinded evaluation of ChatGPT-5, Gemini-3, Grok-2, Llama-4, and DeepSeek-4 across case scenarios.
Günsoy B, Tümüklü K
Eur Arch Otorhinolaryngol · 2026 Apr · PMID 42050126 · Publisher ↗
PURPOSE: Large language models (LLMs) are increasingly utilized in medicine; however, their reliability in surgical and diagnostic specialties requiring guideline-anchored reasoning remains underexplored. The study syste...
PURPOSE: Large language models (LLMs) are increasingly utilized in medicine; however, their reliability in surgical and diagnostic specialties requiring guideline-anchored reasoning remains underexplored. The study systematically evaluated the performance of five contemporary LLMs in otorhinolaryngology (ENT). METHODS: A prospective, two-phase, cross-sectional analysis compared ChatGPT-5 (OpenAI), Gemini-3 (Google), Grok 2 (xAI), Llama 4 (Meta), and DeepSeek-4 (DeepSeek) using 100 standardized ENT clinical scenarios derived from AAO-HNS, ERS, and IFOS guidelines. Each model answered 900 questions (4 open-ended and 5 multiple-choice questions per case), and the process was repeated one month later to assess temporal stability. Two board-certified otorhinolaryngologists, blinded to the study, rated all 9,000 responses for accuracy, comprehensiveness, and adherence to guidelines on a 6-point scale. Statistical analyses included Kruskal–Wallis, Dunn’s post-hoc, Wilcoxon, and ICC reliability testing. RESULTS: Inter-rater reliability was excellent (ICC = 0.91; Cronbach’s α = 0.89). Significant inter-model differences were found across all domains (p < 0.001). ChatGPT-5 achieved the highest composite score (5.58 ± 0.24), outperforming Gemini-3 (5.42 ± 0.28; p < 0.01) and other models within a narrow, clinically credible band (5.05–5.30). Accuracy was higher for multiple-choice than open-ended items (p = 0.027), with ChatGPT-5 showing the smallest format gap. All models demonstrated strong alignment with international ENT guidelines and adhered to clinical safety standards. Temporal stability was greatest in ChatGPT-5 and Gemini-3, with minimal drift between test phases (Δ < 0.1). CONCLUSION: All evaluated LLMs delivered high factual and guideline-based reasoning in otolaryngology, with ChatGPT-5 exhibiting superior precision, completeness, and longitudinal stability. These findings support the supervised integration of LLMs as adjunctive tools for clinical education and decision support in ENT.
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