In recent years, the role of the medical specialist has undergone a substantial evolution, increasingly intersecting with the fields of healthcare management and economics. Many clinicians are now gaining skills in areas...In recent years, the role of the medical specialist has undergone a substantial evolution, increasingly intersecting with the fields of healthcare management and economics. Many clinicians are now gaining skills in areas such as cost-effectiveness analysis, health policy, and service organization. While such competencies can enhance awareness of the broader healthcare context, it is critical to reaffirm that the primary duty of a specialist â€" particularly in the field of otorhinolaryngology â€" is to ensure clinical appropriateness based on current evidence and guidelines, not to account for economic variables.
I read with great interest the recent consensus document on olfactory implants. This excellent and comprehensive work represents a significant milestone in the translational pathway towards sensory neuroprostheses for pa...I read with great interest the recent consensus document on olfactory implants. This excellent and comprehensive work represents a significant milestone in the translational pathway towards sensory neuroprostheses for patients with persistent olfactory dysfunction (OD).
We read with great interest the recent study by Fieux et al. (1), which developed an evaluation model based on clinical practices, public health insurance, and private insurance systems in France. Through rigorous cost-e...We read with great interest the recent study by Fieux et al. (1), which developed an evaluation model based on clinical practices, public health insurance, and private insurance systems in France. Through rigorous cost-effectiveness analysis, the authors concluded that initiating biologic therapy in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) without previous endoscopic sinus surgery (ESS) imposes excessive economic burdens. This finding aligns with the current guideline regarding the indications for biological treatment in CRSwNP, which reserves biologics primarily for patients with prior ESS history.
BACKGROUND: Non-keratinizing nasopharyngeal carcinoma (NPC) is closely related to Epstein-Barr virus (EBV) infection. Patients with NPC often exhibit diverse treatment responses due to tumor heterogeneity. Thus, identify...BACKGROUND: Non-keratinizing nasopharyngeal carcinoma (NPC) is closely related to Epstein-Barr virus (EBV) infection. Patients with NPC often exhibit diverse treatment responses due to tumor heterogeneity. Thus, identifying molecular subgroups based on EBV involvement holds promise for refining personalized treatment strategies and improving treatment outcomes in NPC patients. METHODS: 193 treatment-naive NPC specimens with comprehensive clinical and pathological data were procured from Fujian Cancer Hospital. RNA sequencing was employed to acquire the gene expression profiles, followed by the re-annotation of 100 EBV-associated genes leveraging the EBV sequence. Molecular subtypes were conducted via consensus clustering, with an external NPC cohort serving as a validation dataset. Scissor method was applied to identify survival-associated cell subpopulations from single-cell data, following comprehensive bioinformatic analyses. RESULTS: Three molecular subtypes of NPC-CoriLyt, Cneg, and CEB1-were identified, each with specific clinical profiles. The CEB1 subtype is distinguished by its heightened metabolic activity and immunosuppressive environment. A hub-gene-based risk model for these subtypes strongly predicted disease-free survival, with replicated results in the validated cohort. The model's predictive accuracy was high, with areas under the curve for 1, 3, and 5-year survival rates at 0.79, 0.86, and 0.88, respectively. M2-type macrophages exhibit a high-risk score profile and play a critical role in EBV infection, with prominent activation of the TNF-II and TGF-B signaling pathways. CONCLUSIONS: This study introduced a new EBV-related transcriptomics-based classification system for NPC that showed great promise in predicting patient survival outcomes.
BACKGROUND: The anatomy of the sphenoethmoidal recess is of clinical importance, however, the literature focuses on the superior turbinate and the sphenoid ostium. We analyzed the entire junction of the posterior ethmoid...BACKGROUND: The anatomy of the sphenoethmoidal recess is of clinical importance, however, the literature focuses on the superior turbinate and the sphenoid ostium. We analyzed the entire junction of the posterior ethmoidal region and the sphenoid sinus (SEJ) to define possible regularities. METHODS: We analyzed the junction between the posterior ethmoidal region and the sphenoid sinus on CT scans of 100 paranasal sinuses from 50 individuals using the 3D Slicer software. RESULTS: The SEJ had two components: medially the sphenoethmoidal recess, laterally the wall between these aeriated regions, the latter built by the basal lamella of the superior turbinate (4BL) in 92.0%. The 4BL was a constant structure (100.0%), its most frequent phenotype was a frontally oriented pentangular wall without dehiscences (44.0%). There were no bony walls between the 3BL and the anterior wall of the sphenoid sinus in 49.0% and there was one wall in 42.0%. The 4BL had three complicating factors: firstly, it shifted to anterior, if the supreme turbinate was present (43.0%). Secondly, the pneumatization of the 4BL and the superior turbinate (25.0%) was related to an incomplete-dehiscent anterior 4BL wall. Thirdly, sphenoethmoidal cells (36.0%) led to a bony contact of the optic canal and the 4BL (33.0%). CONCLUSIONS: The 4BL is an important landmark for endoscopic sinus and skull base surgery with highly constant morphology and a typical phenotype. Surgeons should be aware that after dissection of the 3BL the next wall is likely the 4BL which mostly merges to the ASW. This study can help surgeons to detect anatomical variations and improve their intraoperative orientation.
BACKGROUND: Chronic rhinosinusitis (CRS) is a common cause of olfactory dysfunction (OD), and eosinophilic CRS is one of the subtypes characterized by eosinophilic infiltration. Animal models of olfactory dysfunction in...BACKGROUND: Chronic rhinosinusitis (CRS) is a common cause of olfactory dysfunction (OD), and eosinophilic CRS is one of the subtypes characterized by eosinophilic infiltration. Animal models of olfactory dysfunction in eosinophilic CRS are necessary for exploring potential therapeutic strategies. Glucocorticoids are therapeutic for eosinophilic CRS-OD and the mechanism of action requires further exploration. METHODOLOGY: The eosinophilic CRS-OD rat model was induced by intranasal administration of ovalbumin (OVA) and Aspergillus oryzae protease (AP) for 8 weeks, followed by intraperitoneal injection of dexamethasone. Olfactory function was assessed behaviorally, neuronal activity electrophysiologically, and neurotransmitter/inflammatory factor levels via high-performance liquid chromatography (HPLC). Histological analyses of nasal tissue and the olfactory bulb were performed. RESULTS: All OVA/AP-induced eosinophilic CRS-OD rats developed chronic nasal inflammation and olfactory dysfunction. Reduced olfactory bulb (OB) volume was accompanied by thinning of the olfactory neuron layer (ONL) and the glomerular layer (GL). The OB exhibited increased microglia and elevated inflammatory cytokine expression. Further analysis revealed decreased glutamate (Glu), increased γ-aminobutyric acid (GABA), and a significant reduction in the spontaneous firing rate (SFR) of mitral/tufted cells (M/Ts) within the OB. Dexamethasone treatment significantly ameliorated olfactory impairment in this model, decreasing OB microglia numbers and inflammatory cytokine levels, and significantly increasing M/T SFR. CONCLUSIONS: Microglia-mediated neuroinflammation contributes to abnormal neural activity in the olfactory bulb, which may be one mechanism for the development of eosinophilic CRS-OD. The neuroprotective effect of dexamethasone, mediated through microglial inhibition, highlights microglia as an important therapeutic target for eosinophilic CRS-OD.
BACKGROUND: Many Post-Acute COVID-19 Syndrome (PACS) patients continue to experience persistent dysosmia up to two years post-pandemic. Cognitive and semantic memory functions, along with olfactory associative areas, may...BACKGROUND: Many Post-Acute COVID-19 Syndrome (PACS) patients continue to experience persistent dysosmia up to two years post-pandemic. Cognitive and semantic memory functions, along with olfactory associative areas, may be affected in PACS without olfactory recovery. Visual-olfactory bimodal olfactory training may stimulate these areas. This study evaluates the olfactory recovery using a new bi-modal training kit, MaMadeleine assisted by a web application. METHODOLOGY: A prospective randomised study (Nov 2021-June 2022) included PACS patients aged >=14 with post-infectious olfactory dysfunction. Patients were randomized for two months of simple (A) or semantic (B) visual-olfactory training. Evaluations included clinical assessments, Sniffin' Sticks Tests, and quality-of-life questionnaires. Adherence to treatment was monitored via the web application. RESULTS: We included 83 patients, on average 13+-5.6 months after COVID-19. Olfactory training using MaMadeleine led to subjective orthoand retro-nasal olfactory improvement in 79.4% (n=58) and 58.9% (n=43) of patients, respectively, with Sniffin' Sticks Test scores increasing from 26.5+-7.5 to 29.1+-7.4. Both groups saw a 20% decrease in parosmia and phantosmia. No significant differences in recovery were observed between groups, although exploratory findings in a small subgroup (n=10) with semantic memory impairment suggest a possible benefit of bimodal training, warranting further investigation. Quality of life improved significantly in both groups. Adherence was better in group B than in group A. CONCLUSIONS: MaMadeleine training improves subjective olfactory function, psychophysical test results, and quality of life in PACS patients with olfactory dysfunction. Multimodal training enhances adherence. Further studies are needed in semantic memory-impaired patients.
BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizum...BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) often leads to poor sleep quality and fatigue. Many patients with CRSwNP are also at risk for obstructive sleep apnea (OSA). This study examined how mepolizumab and/or endoscopic sinus surgery (FESS) affect sleep quality and OSA in patients with severe uncontrolled CRSwNP. METHODS: In a randomised trial with 58 patients, participants received mepolizumab alone or combined with FESS. Sleep quality was measured using FOSQ-10 and ESS, and OSA severity via AHI from home sleep apnea tests. RESULTS: At baseline, 70% of participants had OSA (AHI ≥5), with 34.6% having moderate-to-severe OSA. After six months, there were significant improvements in sleep quality (SNOT-22, FOSQ-10, ESS) in both groups but no significant change in objective OSA measures (AHI, ODI). Patients with OSA showed a reduction in severity, however non-significant. There were no severe adverse events (SAE) during the follow-up. CONCLUSIONS: Mepolizumab, with or without FESS, improved subjective sleep quality and reduced fatigue but did not significantly affect OSA severity. This suggests that while treatment eases sleep-related symptoms, it may not resolve underlying OSA, particularly in more severe cases.
We would like to sincerely thank Zhong et al. for their thoughtful and well-articulated letter in response to our recent systematic review (1). Their commentary offers interesting perspectives on the landscape of traditi...We would like to sincerely thank Zhong et al. for their thoughtful and well-articulated letter in response to our recent systematic review (1). Their commentary offers interesting perspectives on the landscape of traditional herbal medicine research and the role of Chinese-language databases.
INTRODUCTION: The autonomic nervous system (ANS) regulates respiratory mucosal inflammation and is linked to various airway diseases. However, the relationship between ANS dysfunction and chronic rhinosinusitis (CRS) has...INTRODUCTION: The autonomic nervous system (ANS) regulates respiratory mucosal inflammation and is linked to various airway diseases. However, the relationship between ANS dysfunction and chronic rhinosinusitis (CRS) has not been fully investigated. This study aimed to explore the association between ANS and CRS using a battery of quantitative autonomic function tests. METHODS: Patients with CRS undergoing surgery were prospectively enrolled. Subjective evaluation of disease severity was assessed using the sino-nasal outcome test-22 questionnaires for CRS and the 31-item composite autonomic symptom score questionnaires for ANS dysfunction, while computed tomography and endoscopic scores represented objective severity. A battery of autonomic function tests was conducted, and the results were used to generate the modified composite autonomic scoring scale (mCASS) to provide a quantitative evaluation of ANS function. RESULTS: A total of 49 patients were enrolled. The most common dysautonomic symptoms were dry mouth (73.5%), dizziness (71.4%), and dry eyes (55.1%). Twenty-six patients (53.1%) had a positive mCASS score, indicating abnormal autonomic function. Within the subdomains, most abnormalities were observed in the sudomotor score (28.6%). The mCASS score showed a positive correlation with the endoscopic score, with marginal significance. Notably, the sudomotor subdomain score was significantly correlated with the endoscopic score. CONCLUSION: A significant correlation was found between objective autonomic nervous system function and severity of chronic rhinosinusitis, particularly in the sudomotor subdomain, suggesting a link between peripheral cholinergic activity and sinonasal inflammation. Further research is needed to clarify the underlying mechanisms.
We read with great interest the systematic review by Choulakis et al. Traditional herbal medicine in the treatment of acute and chronic rhinosinusitis. This comprehensive analysis provides valuable insights into evidence...We read with great interest the systematic review by Choulakis et al. Traditional herbal medicine in the treatment of acute and chronic rhinosinusitis. This comprehensive analysis provides valuable insights into evidence-supported herbal interventions for rhinosinusitis, particularly highlighting preparations like BNO-1016 for acute rhinosinusitis (ARS) and Xiangju for chronic rhinosinusitis (CRS). The rigorous methodology, including risk-of-bias assessments, strengthens the review’s credibility.
BACKGROUND: In the setting of chronic rhinosinusitis (CRS), olfactory improvement with corticosteroids suggests reversibility and preserved function. While self-rated olfactory function does not replace psychophysical me...BACKGROUND: In the setting of chronic rhinosinusitis (CRS), olfactory improvement with corticosteroids suggests reversibility and preserved function. While self-rated olfactory function does not replace psychophysical measures of olfactory function, our goal is to investigate if self-reported pre-operative corticosteroid-responsive olfactory dysfunction (CROD) is a predictor of post-operative olfactory improvement in patients with CRS undergoing sinus surgery. METHODOLOGY: We performed a prospective, observational study of patients with refractory CRS with and without nasal polyposis and pre-operative olfactory dysfunction undergoing sinus surgery. Patients were characterized into corticosteroid-responsive and non-corticosteroid-responsive based on a survey response. Patient outcome measures for Sniffin Sticks, Olfactory Cleft Endoscopy Score (OCES), Questionnaire of Olfactory Disorders (QOD-NS), and Sino-nasal Outcomes Test (SNOT-22) were recorded pre- and post-operatively. RESULTS: A total of 253 participants were included. Patients with CROD were more likely to have comorbid nasal polyposis, asthma, and aspirin sensitivity. Patients with CROD had significantly better post-operative improvement in OCES total scores and QOD-NS total scores compared to patients without CROD. CONCLUSIONS: In conclusion, patients with CRS and CROD are more likely to have a greater improvement in olfactory dysfunction post-operatively by several measures of olfactory outcomes. This suggests that corticosteroid responsiveness is a clinical predictor of preserved function and reversibility and can be used as a simple clinical prognostic factor.
Skull base reconstruction is a critical component of endoscopic endonasal skull base surgery (EESBS). Bed rest remains an indispensable element of post-operative care, which should be carefully considered for reducing th...Skull base reconstruction is a critical component of endoscopic endonasal skull base surgery (EESBS). Bed rest remains an indispensable element of post-operative care, which should be carefully considered for reducing the risk of cerebrospinal fluid (CSF) leaks and enhancing surgical outcomes (1, 2). However, the necessity of bed rest continues to be controversial as indicated by the expert consensus on perioperative management of skull base reconstruction, due to a lack of high-quality evidence to support its effectiveness (1-4). This study focuses exclusively on anterior skull base reconstruction, which is frequently employed in EESBS but has not been sufficiently investigated. In this study, we retrospectively collected patient data from three skull base centres to analyse the impact of bed rest on the occurrence of post-operative CSF leakage.
Mortuaire G, Seys SF, de Kinderen J
… +20 more, Bettio G, Cavaliere C, Reitsma S, Schneider S, Andrianakis A, Tomazic PV, Wagenmann M, Ciofalo A, Diamant Z, Eckl-Dorna J, Fokkens WJ, de Vincentiis M, Holzmeister C, Marin G, Masieri S, Otten JJ, Scheckenbach K, Tu A, Bachert C, I Alobid P W Hellings C Hopkins V Hox A Kjeldsen V J Lund A Laulajainen-Hongisto L Van Gerven CC
BACKGROUND: Criteria for biologic treatment of uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) differ across international recommendations and prescription of biologics depends on national reimburse...BACKGROUND: Criteria for biologic treatment of uncontrolled severe chronic rhinosinusitis with nasal polyps (CRSwNP) differ across international recommendations and prescription of biologics depends on national reimbursement criteria. CHRINOSOR offers an opportunity to analyse biologic indications in the real-world setting according to international recommendations. METHODS: CRSwNP patients who received dupilumab treatment in the ENT clinic of 6 tertiary centres (5 countries) were included. Baseline demographic and lifestyle factors, NP score, SinoNasal Outcome Test-22 score, visual analogue scale for sinus symptoms, and Asthma Control Test score were retrieved from the medical records. Indication criteria for biologic treatment according to EUFOREA 2021, and EPOS/EUFOREA 2023 recommendations was applied. Dupilumab effectiveness was assessed at baseline, 24 and 52 weeks in relation to these criteria. RESULTS: 61.8% and 79.8% of patients met respectively the EUFOREA 2021 or the EPOS/EUFOREA 2023 indication criteria for biologic treatment. Dupilumab was effective in patients who met or did not meet international criteria for biologic indication. However, patients who met the indication criteria showed overall a more pronounced effect on most of the outcome parameters than patients who did not meet the criteria. CONCLUSIONS: Real-world management of CRSwNP with biologics does not strictly follow the indication criteria established by international recommendations but depends on management criteria established by local authorities. These vary significantly and are either more or less stringent from one country to another. Dupilumab effectiveness in CRSwNP, whether these criteria are met or not, suggests that a broader CRSwNP population may benefit from dupilumab.
BACKGROUND: This study aimed to evaluate the presence of Serpentine Signs on computed tomography (CT) images and its impact on the clinical symptoms in patients with empty nose syndrome (ENS). METHODS: A retrospective st...BACKGROUND: This study aimed to evaluate the presence of Serpentine Signs on computed tomography (CT) images and its impact on the clinical symptoms in patients with empty nose syndrome (ENS). METHODS: A retrospective study analysed patients with ENS enrolled in previous studies. The clinical characteristics and results of ENS-specific questionnaire evaluations were reviewed. The ratio of the maximal to minimal thickness (M/m ratio) of the septal mucosa was also calculated to demonstrate the degree of swelling. Mucosal swelling was defined as a thickness greater than twice that of the surrounding mucosa. A Serpentine Sign was identified by the presence of two or more mucosal swellings on one side of the central nasal septum. RESULTS: Seventy-one (74.0%) of the 96 enrolled patients with ENS exhibited Serpentine Signs on CT images. Patients with the Serpentine Sign had significantly lower symptom scores on the ENS 6-item Questionnaire (ENS6Q) and 25-Item Sino-Nasal Outcome Test (SNOT-25). Regression analysis revealed that the ENS6Q, SNOT-25, sleep, psychological, and empty nose symptom domains were significantly associated with the Serpentine Sign. The M/m ratio of the nasal septal mucosa significantly decreased in 39 participants with available postoperative CT images 6 months after nasal reconstruction surgery, along with an improvement in ENS6Q and SNOT-25 scores. CONCLUSION: The Serpentine Sign was associated with fewer ENS symptoms in patients with ENS. The severity of septal mucosal swelling decreased after surgical reconstruction. These results imply a significant impact of airflow alteration due to over-reduction of the inferior turbinate on the nasal mucosa.
BACKGROUND: Smell tests in children need to be standardized and validated, include odors familiar to children, and be defined by age-dependent standards. This study aimed to adapt the Sniffin Kids Test (SKT) for Polish c...BACKGROUND: Smell tests in children need to be standardized and validated, include odors familiar to children, and be defined by age-dependent standards. This study aimed to adapt the Sniffin Kids Test (SKT) for Polish children and conduct validation and evaluation of the Sniffin Kids Poland Test (). METHODOLOGY: The study included 382 children (4-14 years old) recruited in Poland, who were allocated into healthy (n=343) and sick (with subjective olfactory disorders, n=39), divided into 3 age subgroups, but also 13 anosmic children with Kallmann syndrome (KS) and olfactory bulb aplasia. Firstly, the smell testing was performed in 382 children using SKT, and subsequently, SKPOL was created using odors identified by at least 75% of healthy individuals. The 10th percentile of SKPOL results in healthy children was adopted as a cutoff point between norm and pathology. SKPOL validation and reliability were assessed using the KS group results. RESULTS: Odor identification score in SKT of Polish children in healthy 6-14-year-olds did not meet the criteria for a test adapted for population studies. An odor identification rate was obtained for 5 odors in 4-7 years old, 7 odors in 8-10 years old, and 9 odors in 11-14 years old. SKPOL was created using these odors. Age-dependent norms for SKPOL were 26.5+-7.5 to 29.1+-7.4, respectively. All KS children had SKPOL results below the 10th percentile. CONCLUSIONS: Validation and evaluation of SKPOL confirmed good adaptation and high reproducibility of the test for Polish children aged 4-14 years.
This issue of our journal starts with an extremely interesting systematic review on the impact of CRS on cognition measured with objective global cognitive function tests like the Montreal Cognitive Assessment (MoCA) or...This issue of our journal starts with an extremely interesting systematic review on the impact of CRS on cognition measured with objective global cognitive function tests like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE).
BACKGROUND: Two primary surgical approaches, the transcranial approach (TCA) and the endoscopic endonasal approach (EEA), offer distinct advantages and disadvantages, but studies have yet to compare their outcomes for tr...BACKGROUND: Two primary surgical approaches, the transcranial approach (TCA) and the endoscopic endonasal approach (EEA), offer distinct advantages and disadvantages, but studies have yet to compare their outcomes for trigeminal schwannoma (TS) resection systematically. METHODOLOGY: A retrospective review of TSs between 2013 and 2023 was performed, with clinical characteristics, surgical outcomes, and follow-up data collected and analyzed. The patients were divided into two surgical groups, and tumours within each group were further classified according to the Samii system into middle fossa (type A), dumbbell-shaped involving middle and posterior fossae (type C), and extracranial with intracranial extension (type D), excluding posterior fossa (type B). RESULTS: A total of 101 patients (44 via EEA, 57 via TCA) were included. The two groups exhibited comparable baseline characteristics, except for the prevalence of dizziness in the pooled data (types A, C, and D). In pooled data and type A tumours, the EEA was associated with a statistically significant differences in higher gross total resection rate, shorter operative time, lower intracranial infection rate, and greater improvement in facial numbness. EEA was also significantly associated with a lower neurological deficits and higher Karnofsky Performance Scale scores in pooled data. Both approaches resulted in similar outcomes for type C tumours. EEA was advantageous for type D tumours in the infratemporal fossa, pterygopalatine fossa, and medial orbital regions, and no neurological deficits were observed. CONCLUSIONS: The optimal outcome of the surgical approach and minimization of morbidity for these complicated lesions depend on the meticulous selection of cases.
INTRODUCTION: There is no data in the literature regarding the appropriate management of patients with an incidental finding of paranasal sinus fungal ball (FB) or its natural history. This study examined the long-term o...INTRODUCTION: There is no data in the literature regarding the appropriate management of patients with an incidental finding of paranasal sinus fungal ball (FB) or its natural history. This study examined the long-term outcomes of a cohort of patients with FB, pooled from a large imaging database. METHODS: A retrospective screening of 108,369 head imaging studies for phrases indicative of FB in a tertiary referral center, during 2012-2023. RESULTS: A total of 1,716 patients were identified according to the search criteria and their imaging studies were evaluated by the authors. 83 (4.83%) patients were noted to have findings compatible with FB. Mean age was 78.3+-11.8 years and median follow-up (FU) time was 59.2 (10.2-178.8) months. The most involved sinuses were maxillary (50.6%) and sphenoid (43.4%). Intra-sinus calcifications and sinus opacification were observed in all patients. Additionally, sinus wall bony sclerosis, and erosion were observed in 44.5% and 2.4%, respectively. 5 (6.0%) patients underwent surgery during follow-up. 4 (4.8%) patients had FB-associated symptoms, and 1 patient (1.2%) had posterior sphenoid sinus wall erosion. No morbidity or complications were reported for the remaining 78 (94%) patients who did not receive treatment. During a median interval of 50 months, 34/49 (69.4%) patients with >=2 consecutive imaging studies showed no worsening of radiographic findings. CONCLUSION: During an average FU of 5 years of patients with incidental FB findings, the vast majority remained asymptomatic and without complications. Thus, upfront surgical intervention for asymptomatic FB in elderly fragile patients may not be mandatory and a clinical and imaging FU can be a reasonable treatment plan.
BACKGROUND: Nasopharyngeal carcinoma (NPC) is notable not only for its distinct geographic and ethnic distribution but also for its metabolic alterations. A key feature of NPC is its reliance on aerobic glycolysis for en...BACKGROUND: Nasopharyngeal carcinoma (NPC) is notable not only for its distinct geographic and ethnic distribution but also for its metabolic alterations. A key feature of NPC is its reliance on aerobic glycolysis for energy production. This shift from oxidative phosphorylation to glycolysis provides cancer cells with a metabolic advantage, supporting rapid growth and survival. Targeting aerobic glycolysis has therefore emerged as a promising therapeutic strategy. METHODS: RT-qPCR, Western blot, IHC, and IF staining were used to examine gene and protein expression levels. Cell viability, proliferation, migration, and invasion were measured using the CCK-8 assay, colony formation assay, and transwell assay, respectively. Interactions among NPM1, PKM2, NSUN2, and YBX1 were examined using RIP, Co-IP, MeRIP, RNA pulldown, and dual-luciferase reporter assays. Aerobic glycolysis and oxidative phosphorylation (OXPHOS) levels were analyzed using the XF96 metabolic analyzer. Additionally, an in vivo mouse model of NPC was established for further validation. RESULTS: NPM1 was abnormally elevated in NPC tissues and cells. Silencing of NPM1 inhibited aerobic glycolysis, suppressed NPC progression and metastasis, and reduced PKM2 nuclear translocation. Mechanistically, NPM1 physically interacted with PKM2 to promote its nuclear localization, while the NSUN2/YBX1 axis upregulated NPM1 expression through m5C modification, stabilizing NPM1 mRNA. CONCLUSION: The NSUN2-YBX1 axis induces m5C modification of NPM1, leading to increased NPM1 stability and its expression. This upregulation facilitates the nuclear translocation of PKM2, which promotes aerobic glycolysis and drives the proliferation and metastasis of NPC. These findings highlight the potential of targeting NPM1 as a novel therapeutic approach for NPC.