BACKGROUND: The distinction between frailty and ageing is becoming increasingly recognised, however, the clinical implication of this in head and neck cancers has not been fully explored. In this review we evaluate the p...BACKGROUND: The distinction between frailty and ageing is becoming increasingly recognised, however, the clinical implication of this in head and neck cancers has not been fully explored. In this review we evaluate the prognostic value of frailty, assessed through established screening tools, in predicting the long-term survival outcomes among patients with head and neck cancer. METHODS: We performed a systematic review in accordance with the PRISMA guidelines. The search was conducted in Ovid MEDLINE, Ovid Embase, PubMed, Cochrane library and ClinicalTrials.gov databases. RESULTS: Five studies met the inclusion criteria for this review, encompassing 1131 patients. Of these four studies employed a retrospective design, while one was prospective. Three of the five studies demonstrated a significant correlation between frailty and long-term survival outcomes. In contrast, two of the five studies specifically examined long-term disease free survival (DFS), but neither found a significant association between frailty and long-term DFS. CONCLUSION: Frailty is prevalent amongst patients with head and neck cancer and its assessment using validated screening tools may hold significant prognostic value. Currently, frailty assessment is most valuable as a guide in patient/treatment selection and enabling shared decision making. However, further research is needed to determine the most effective frailty screening tool and to clarify its specific role in this patient population.
Huber P, Braunschweig T, Frankenberger H
… +4 more, Stihl C, Gröger M, Gellrich D, Lasch M
Eur Arch Otorhinolaryngol
· 2026 Jun · PMID 42050124
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BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly driven by type 2 inflammation and frequently persists despite standard therapy. Dupilumab has proven efficacy, yet robust predictors of long-...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is predominantly driven by type 2 inflammation and frequently persists despite standard therapy. Dupilumab has proven efficacy, yet robust predictors of long-term response remain insufficiently defined. METHODS: In this monocentric, retrospective analysis, 163 adults with CRSwNP treated with dupilumab for ≥ 24 months were assessed at a tertiary referral center. Outcome parameters included nasal polyp score (NPS), sinonasal quality of life (SNOT-22), and olfactory function (SSIT). Treatment response was classified according to EUFOREA 2023 criteria. Archived polyp tissue from 72 patients obtained prior to Dupilumab treatment underwent histological reassessment, with eosinophilic infiltration quantified using absolute thresholds (Lee et al.: ≤10, 11–69, ≥ 70 eosinophils/HPF) and relative thresholds (Yang et al.: >20%). RESULTS: Dupilumab led to marked and sustained clinical improvements across the cohort (NPS − 4.6 ± 2.1; SNOT-22 − 44.1 ± 18.5; SSIT + 4.3 ± 2.9 at 24 months). Outcomes were independent of demographic factors, asthma, NERD, allergen sensitization, serum IgE, or blood eosinophils. In contrast, higher tissue eosinophilia correlated with enhanced short-term responses. Patients with > 20% eosinophils showed significantly greater SNOT-22 reduction at 12 months (p < 0.05). Stratification by ≥ 70 eosinophils/HPF and Yang’s classification (0–10, 11–69, ≥ 70) consistently showed superior trajectories in high-grade eosinophilia. EUFOREA response rates were highest in these subgroups, with no non-responders observed. CONCLUSION: Dupilumab achieved durable benefit across all patient subgroups, while elevated tissue eosinophilia predicted faster and more pronounced short-term improvements. Systematic eosinophil quantification may refine patient stratification and optimize biologic therapy allocation in CRSwNP.
STUDY DESIGN: Cadaveric comparative study. OBJECTIVE: To assess the additional superior reach achievable using the pedicled pectoralis major (PM) flap with subclavicular tunnelling and clavicle osteotomy compared with th...STUDY DESIGN: Cadaveric comparative study. OBJECTIVE: To assess the additional superior reach achievable using the pedicled pectoralis major (PM) flap with subclavicular tunnelling and clavicle osteotomy compared with the standard supraclavicular route. METHODS: Ten hemi-thoraces from fresh-frozen cadavers without prior clavipectoral surgery were dissected. Each PM flap was passed sequentially through three routes: supraclavicular, subclavicular, and mid-shaft clavicle osteotomy. Maximum superior reach from the clavicle midpoint to the ipsilateral preauricular-temporal region was measured under a standardised manual traction technique. Two observers recorded distances, and their mean value was used for analysis. Comparisons between the three routes were performed using the Friedman test and Wilcoxon signed-rank tests with Bonferroni adjustment. RESULTS: In this cadaveric series, mean ± SD reach was 166.6 ± 42.3 mm (supraclavicular), 195.6 ± 37.6 mm (subclavicular), and 215.4 ± 28.5 mm (clavicular osteotomy). The corresponding mean gains were + 29 mm (p = 0.006) from supraclavicular to subclavicular, + 20 mm (p = 0.004) from subclavicular to osteotomy, and + 49 mm (p = 0.002) from supraclavicular to osteotomy. Each step gave a measurable improvement in reach, all of which proved statistically significant. CONCLUSIONS: Subclavicular tunnelling and clavicle osteotomy significantly increased PM flap reach by 20–50 mm. While these gains are modest, they may be clinically useful in salvage situations where free tissue transfer is not feasible.
Wierzbicka M, Zabrodsky M, Al Yaghchi C
… +10 more, Arens C, Desuter G, Enver N, Geneid A, Kopczyk R, Lopez IG, Mattei A, Sjögren E, Tedla M, Piazza C
Eur Arch Otorhinolaryngol
· 2026 Jun · PMID 42050122
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PURPOSE: To describe European legal foundations, governance structures, and quality assurance mechanisms for bioethics committee approvals in multicenter laryngology research, and present a consensus framework to harmoni...PURPOSE: To describe European legal foundations, governance structures, and quality assurance mechanisms for bioethics committee approvals in multicenter laryngology research, and present a consensus framework to harmonize practice across Europe. METHODS: An expert panel used the Nominal Group Technique to define scope, review supranational and national regulations (including Regulation (EU) 536/2014 and GDPR considerations), and identify practical barriers in multicenter/multinational laryngology research. Consensus rounds prioritized reproducibility, feasibility, and harmonization of ethics review processes across jurisdictions. RESULTS: Regulatory context combines EU Regulation 536/2014 and GDPR with substantial national heterogeneity in REC/IRB structure and procedures. Core challenges include: (i) heterogeneity of documentation and approvals; (ii) ambiguity about single vs. multiple REC approvals in multicenter studies; (iii) limited guidance for registry-based and real-world data designs; and (iv) variable integration of data protection and ethics review. Key recommendations: clarify when single-country versus cross-border REC approvals are required; standardize documentation templates and timelines; align consent and data-handling with ethics review; provide governance for emerging study designs and biobanking; and promote EUlevel coordination to harmonize practices. CONCLUSIONS: National variation challenges multicenter laryngology research in Europe. The European Laryngological Society provides a consensus framework to guide legal bases and quality assurance of REC approvals, aiming to improve efficiency, consistency, and ethical compliance.
PURPOSE: Evaluate whether vestibular schwannoma (VS) size, volume, and fundal involvement of the internal auditory canal (IAC) are independent predictors of hearing outcomes at diagnosis. METHODS: Retrospective, single-c...PURPOSE: Evaluate whether vestibular schwannoma (VS) size, volume, and fundal involvement of the internal auditory canal (IAC) are independent predictors of hearing outcomes at diagnosis. METHODS: Retrospective, single-center observational study (2001–2020) in a Tertiary academic French medical center for adult patients with sporadic unilateral VS who underwent clinicoradiological monitoring. Tumor size and volume were measured with Horos/ITK-SNAP. Fundus involvement was defined by the presence/absence of a T2 hyperintensity on MRI. Hearing was evaluated by interaural PTA differences and by serviceable/non-serviceable hearing according to WRS. RESULTS: One hundred and seventy patients were included. Unlike tumor volume, fundus involvement and tumor size were independent risk factors for hearing loss, increasing the PTA interaural threshold by + 9.07dBHL (p = 0.022) and + 1.35dBHL (p = 0.005), respectively. Fundus involvement affected mid-to-high frequencies, whereas tumor size impacted all frequencies. Based on WRS classification, fundus involvement was associated with increased risk of non-serviceable hearing (OR = 2.82, 95% CI [1.12–7.50]). In sensitivity analyses with multiple imputation, the association remained in the same direction but was not significant. Tumor size showed a non-linear association with non-serviceable hearing (classes C/D): a 13 mm tumor carried a 7.16-fold higher risk versus 5 mm (OR = 7.16, 95% CI [1.73–29.63]). No significant association was observed for tumors > 13 mm. CONCLUSION: Tumor size and IAC fundus involvement are each independent risk factors associated with increased interaural PTA difference at diagnosis. Tumor size showed a non-linear association with WRS-defined non-serviceable hearing, while fundus involvement was significant in complete-case analysis but not after multiple imputation. Tumor volume was not predictive.
OBJECTIVE: The objective of this study was to evaluate the graft success rate, hearing outcomes, and complications associated with three-layer graft myringoplasty for repairing subtotal and total perforations. MATERIALS...OBJECTIVE: The objective of this study was to evaluate the graft success rate, hearing outcomes, and complications associated with three-layer graft myringoplasty for repairing subtotal and total perforations. MATERIALS AND METHODS: Forty-two patients with subtotal and total perforations underwent endoscopic perichondrium-cartilage three-layer graft myringoplasty. Graft success, hearing improvement, and complications were assessed 6 months postoperatively. RESULTS: Among the 42 patients, 59.52% presented with subtotal perforation and 40.48% with total perforation. Preoperative air-bone gap (ABG) ≤ 40 dB was observed in 92.86% of patients, whereas ABG > 40 dB was found in 7.14% of patients with ossicular chain fixation or interruption. The mean operative time was 36.6 ± 2.8 min (range, 32–41 min). The graft success rate at postoperative 6 months was 97.62%. Audiological testing was completed in 39 (92.9%) patients with a normal ossicular chain at 6 months. Postoperative air-conduction pure-tone average (PTA) improved from 36.60 ± 12.14 dB to 26.53 ± 11.70 dB, with a mean change of − 10.07 dB (95% confidence interval [CI]: −15.39 to − 4.75; P = 0.000464). Bone-conduction PTA demonstrated no significant change (15.08 ± 7.49 dB vs. 13.82 ± 8.52 dB; mean change − 1.26 dB, 95% CI: −5.05 to 2.53; P = 0.506). The ABG significantly improved from 21.52 ± 6.38 dB to 12.71 ± 4.58 dB, corresponding to a mean reduction of − 8.81 dB (95% CI: −11.17 to − 6.45; P = 4.35 × 10⁻⁹). No graft-related complications (e.g., graft lateralization, significant blunting, or graft medialization) were identified during the follow-up period. CONCLUSIONS: The endoscopic three-layer graft technique without raising the tympanomeatal flap appears feasible and associated with favorable short-term outcomes. However, future prospective controlled studies with larger sample sizes and longer-term endoscopic or radiologic follow-up are needed to validate these findings and provide more comprehensive insights.
PURPOSE: Obstructive sleep apnoea (OSA) is a growing health concern with significant personal and public health costs. This is the first study to evaluate the efficacy of “Down Under” barbed reposition pharyngoplasty (DU...PURPOSE: Obstructive sleep apnoea (OSA) is a growing health concern with significant personal and public health costs. This is the first study to evaluate the efficacy of “Down Under” barbed reposition pharyngoplasty (DU-BRP) and coblation tongue channelling (CCT) in adults with OSA, particularly those with unfavourable anatomical phenotypes. METHODS: A prospective, two-centre cohort trial was conducted with 105 patients undergoing DU-BRP and CCT. Outcomes included Apnoea-Hypopnoea Index (AHI), Oxygen Desaturation Index (ODI4%), Epworth Sleepiness Scale (ESS), and changes in upper airway anatomy, measured pre- and 3–6 months post-operatively. RESULTS: Of the 105 patients, 92 attended all postoperative appointments and 75 completed postoperative polysomnography and were included in the objective outcome analysis. The cohort (68/92 male, mean age 40.6 ± 12.7 years) showed significant improvement across all measures. Median (IQR) AHI decreased from 27 (33.4) to 7.1 (11.6) events/hr (p < 0.001), ESS from 12.5 (8) to 4 (4) points (p < 0.001), and ODI4% from 25.4 (37) to 7 (17) (p < 0.001). Surgical success (AHI < 20 with > 50% reduction) was achieved in 75% of patients, with 43% considered complete responders (AHI < 5). Among patients with challenging anatomy, success rates were 76% for those with Friedman stage 3 anatomy, 62.5% for those with complete circumferential velum collapse, and 73% for those with complete base of tongue collapse. CONCLUSION: DU-BRP combined with CCT was associated with significant improvements in objective and patient-reported OSA outcomes at six months, including in patients with unfavourable anatomical phenotypes. Future research should refine staging systems incorporating physiologic phenotypes to enhance the predictability of outcomes of these surgical techniques.
Eur Arch Otorhinolaryngol
· 2026 Jun · PMID 42026301
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PURPOSE: More than 60% of seasonal allergic rhinitis (SAR) patients still remain inadequately control even after receiving standard-of-care (SoC). Recently, Stapokibart (CM310), has demonstrated efficacy in randomized co...PURPOSE: More than 60% of seasonal allergic rhinitis (SAR) patients still remain inadequately control even after receiving standard-of-care (SoC). Recently, Stapokibart (CM310), has demonstrated efficacy in randomized controlled trials, but real-world evidence for SoC-refractory SAR is still insufficient. METHODS: This prospective real-world study enrolled 127 patients with moderate-to-severe SAR. All participants received Stapokibart treatment (600 mg subcutaneous loading dose, followed by 300 mg at week 2). Efficacy outcomes included the reflective total nasal /ocular symptom score (rTNSS/rTOSS), visual analogue scale (VAS), and rhinoconjunctivitis quality of Life questionnaire (RQLQ) change at weeks 2 and 12. Statistical analyses used Wilcoxon signed-rank test (Bonferroni-corrected) and generalized estimating equations (GEE). RESULTS: All outcomes improved significantly at Weeks 2 and 12 vs. baseline (all P < .001). Median rTNSS decreased from 8.00 (IQR:7.00–10.00) to 4.00 (2.00–5.00) at Week 2 and remained stable; rTOSS fell to 0.00 (0.00–1.75) at Week 12. VAS and RQLQ showed progressive improvements. Only 8 (6.3%) patients reported mild, transient injection-site adverse events; no severe events occurred. CONCLUSION: Stapokibart is clinically effective and well-tolerated in SoC-refractory SAR, with sustained benefits up to 12 weeks. It is a valuable treatment for heterogeneous patients, supporting its routine clinical use.
PURPOSE: Cochlear nerve (CN) atrophy has been reported as a secondary change in acquired sensorineural hearing loss (ASNHL). However, the findings remained inconsistent across studies. A systematic review and meta-analys...PURPOSE: Cochlear nerve (CN) atrophy has been reported as a secondary change in acquired sensorineural hearing loss (ASNHL). However, the findings remained inconsistent across studies. A systematic review and meta-analysis was conducted to compare CN size between affected ears and normal-hearing controls. METHODS: Embase, PubMed, Web of Science and Scopus databases were searched before August, 2025. A random-effect meta-analysis was used to estimate the standardized mean difference (SMD) and 95% confidence interval to quantify the difference of CN size between groups. Cross-sectional area (CSA) was set as the outcome for CN measurement. Modified Newcastle–Ottawa scale was used for methodological quality. RESULTS: Ten articles comprising 665 subjects (728 ears) in study group and 504 subjects (663 ears) in control group were included. A significant reduction in the CSA of CN in ASNHL ears compared to normal-hearing controls (SMD=-0.67, 95%CI: -1.03~-0.31; P < 0.001) was found, albeit with substantial heterogeneity (I²=83.7%). Subgroup analysis stratified by hearing loss duration and measured location demonstrated a significantly smaller CSA of CN at mid-point of the internal auditory canal (IAC) in patients with long-term ASNHL (SMD=-0.63, 95%CI: -0.95~-0.32; P < 0.001), with low heterogeneity (I²=0%), but not in sudden ASNHL or in measurements at the IAC fundus. The robustness of these primary findings was tested by sensitivity analysis. CONCLUSION: CN atrophy was pronounced in long-term ASNHL ears when measured at mid-point of IAC, highlighting possible degenerative neural changes from hearing deprivation. The recommended measurement and target population for CN atrophy were proposed in ASNHL for future studies.
INTRODUCTION: Surgical simulation has evolved significantly, transitioning from basic models to advanced virtual reality (VR) platforms, addressing the limitations of cadaveric training such as cost, availability, and et...INTRODUCTION: Surgical simulation has evolved significantly, transitioning from basic models to advanced virtual reality (VR) platforms, addressing the limitations of cadaveric training such as cost, availability, and ethical concerns. VR offers a risk-free, immersive environment for trainees to practice complex procedures, providing real-time feedback and objective performance metrics. Despite its potential, VR applications in Otolaryngology (ENT), particularly temporal bone surgery, remain underexplored due to anatomical complexity and specialty size. The primary hypothesis of this pilot trial was that VR simulation would achieve comparable technical performance to cadaveric dissection, while enhancing self-perceived competency. As a pilot study, no pre-specified non-inferiority margin was established; statistical non-significance was interpreted as potential equivalence requiring validation in a powered trial. This study presents the development and pilot evaluation of a VR-based temporal bone dissection simulator, comparing its efficacy against traditional cadaveric training. METHODS: A single-centre crossover trial involving 14 ENT residents was conducted, with participants randomized into two arms: one starting with VR simulation (VRS) and the other with cadaveric dissection (CD). The VR platform, developed in collaboration with I3 Simulations, incorporated haptic feedback, real-time performance tracking, and scaffolded learning modules. Outcomes were assessed using pre- and post-simulation questionnaires, System Usability Scale (SUS), Technology Acceptance Model (TAM), and Zirkle grading for procedural accuracy. RESULTS: Results demonstrated a 26.7% increase in self-perceived competency post-VR (p < 0.001), with no significant difference in technical performance between VRS and CD (p = 0.623). SUS scores indicated moderate usability (score = 65.9 ± 14.2), while TAM scores reflected high acceptability (69.2% ± 12.1%). Qualitative feedback revealed strong trainee endorsement, with 85.7% reporting skill improvement and 78.6% willing to reuse the simulator. CONCLUSIONS: The study supports VR as a viable adjunct or alternative to cadaveric training, offering comparable educational outcomes with added scalability and accessibility. Limitations include small sample size and potential evaluator bias, warranting larger multi-institutional studies. These findings underscore VR’s transformative potential in ENT surgical education, advocating for further refinement and integration into training curricula.
OBJECTIVE: To investigate the potential interaction between the vestibular and olfactory systems by evaluating olfactory identification performance in patients with BPPV. METHODS: Fifty-two patients with BPPV and 50 age-...OBJECTIVE: To investigate the potential interaction between the vestibular and olfactory systems by evaluating olfactory identification performance in patients with BPPV. METHODS: Fifty-two patients with BPPV and 50 age-matched healthy controls were evaluated using the 16-item Sniffin’ Sticks identification test Hummel et al. (Chem Senses. 22(1):39-52, 1997). The control group was derived from a standardized institutional database with specific age-matching protocols to ensure transparency across departmental research Kar et al. (Eur Arch Otorhinolaryngol, 2026). RESULTS: The Mean Total Olfactory Score was lower in the BPPV group (10.92 ± 2.13) compared to controls (11.66 ± 2.01); however, this difference did not reach statistical significance (p = 0.0805). Significant differences were observed for specific odors, notably “Orange” (p = 0.016). CONCLUSION: BPPV appears to have a marginal, sub-clinical impact on olfactory identification. The transient nature of paroxysmal vestibular stimulation may be insufficient to cause the robust sensory reorganization seen in chronic vestibular pathologies.
PURPOSE: 3D exoscopes have been increasingly adopted in otorhinolaryngology. However, conventional passive-polarized 3D displays (PPD) have limitations in vertical viewing angle, which can impair 3D visualization at nonf...PURPOSE: 3D exoscopes have been increasingly adopted in otorhinolaryngology. However, conventional passive-polarized 3D displays (PPD) have limitations in vertical viewing angle, which can impair 3D visualization at nonfrontal angles, particularly for surgical assistants. Active-polarized 3D displays (APD) can overcome these limitations. This study aimed to compare the usability and performance of a conventional PPD and a prototype APD using the ORBEYE 4 K 3D exoscope system under viewing conditions unfavorable to the PPD. METHODS: Twenty-four otorhinolaryngologists participated in the study. A prototype APD and a commercially available PPD were connected in parallel to the ORBEYE. The participants performed a procedural task simulating stapes surgery with the viewing position set 20° above the display center. The task performance was evaluated based on the number of successfully completed procedural tasks. A target-tracking test was performed before and after the procedural task to evaluate ocular fatigue by calculating the slope of the saccadic main sequence. The usability was assessed using a questionnaire. RESULTS: The APD scored higher than the PPD for all questionnaire items. The number of successful procedural tasks was significantly higher in the APD group. With the APD, there was no change in perceived ocular fatigue before and after the procedural task, whereas with the PPD, there was a tendency toward increased fatigue. CONCLUSION: The APD demonstrated superior usability and task performance compared to a conventional PPD, particularly under vertically displaced viewing conditions. APD may be particularly beneficial for assistants and surgeons working at various levels of the eye.