The objective of this study was to compare the tympanotomy tube (TT) retention success rates, the chronic otitis media with effusion (COME) recurrence rates, and the complications of radiofrequency tuboplasty only (RT-only), tympanotomy tube insertion (TTI) + RT, and TTI-only, used to treat unilateral chronic otitis media with effusion (COME) in adult associated with hypertrophy of the nasopharyngeal orifice of the Eustachian tube. Patients with COME and hypertrophy of the nasopharyngeal orifice were randomly allocated to either an RT-only group or a TTI + RT group or a TTI-only group. The successful treatment rates, TT retention rates, OME recurrence rates, postoperative Eustachian tube (ET) orifice mucosal inflammation (ETI) grades, and complications were evaluated 18 months after surgery. A total of 156 COME patients were included. The successful treatment rates differed significantly among the three groups (P < 0.01). The TT retention success rate in the TTI + RT group was significantly higher than in the TTI-only group (96.2% vs. 82.7%, P < 0.05). The total TT premature extrusion rates at 6-12 months differed significantly between the TTI + RT and TTI-only groups (P < 0.05). Similarly, the total OME recurrence rates differed significantly among the three groups (P < 0.001). At both 6-12 and 12-18 months, the differences were significant between the TTI-only, and the RT-only and TTI + RT groups (P < 0.05). In the RT-only and TTI + RT groups, the OME recurrence rates of patients with preoperative grade 3 ETI were significantly higher than those of patients with preoperative grade 4 ETI. No RT-related severe adverse event was observed in the RT-only or TTI + RT group. Only three patients developed small red granulomas in the posterior cushion. The TTI + RT group exhibited the highest treatment success rate and the most durable outcomes of selected COME patients with hyperplastic ET nasopharyngeal orifices. However, given the small sample size, the short follow-up time, and the co-interventions, future studies with larger cohorts are required to validate the findings. In addition, it is important to explore further whether RT more effectively treats hypertrophic mucosa than hypertrophic cartilage at the nasopharyngeal orifice.

To quantitatively assess changes in the dimensions of infrahyoid and suprahyoid muscles following neck dissection (ND) in head and neck cancer patients. This study retrospectively analyzed 61 head and neck cancer patients who underwent selective or therapeutic neck dissection at a tertiary medical center between June 2010 and April 2022. The study protocol was approved by the institutional Helsinki Committee. Eligible participants had no procedures directly impacting strap muscles (e.g., thyroidectomy, tracheostomy). Preoperative and postoperative PET-CT scans were analyzed to measure dimensions of digastric, mylohyoid, and infrahyoid muscles, with measurements of the rectus capitis posterior major muscle serving as a control. Statistical analysis was conducted using a two-way ANOVA within a linear mixed-effects model framework to assess changes in muscle dimensions pre- and post-operation. Postoperative reductions in the dimensions of infrahyoid and suprahyoid muscles on the operated side were significant (p < 0.001), while the rectus capitis posterior major muscle remained unchanged (p > 0.05). No significant changes were observed on the non-operated side. The mylohyoid muscle exhibited greater susceptibility to radiation and modified neck dissection (p = 0.0049, p = 0.0225, respectively). Tumor size and chemotherapy did not significantly influence muscle atrophy. The findings indicate that neck dissection leads to significant postoperative atrophy of infrahyoid and suprahyoid muscles, likely due to surgical trauma, denervation, and postoperative fibrosis. This atrophy may have important implications for postoperative recovery and functional outcomes in head and neck cancer patients, highlighting the need for further research on its impact on quality of life. Level III.

This study aimed to compare the diagnostic accuracy and citation integrity of four large language models (LLMs) including one general (ChatGPT-4) and three intended for clinical and research use (OpenEvidence, Perplexity, and Pathway), using standardized otolaryngology clinical vignettes. One hundred validated otolaryngology clinical vignettes were presented to each LLM with a prompt requesting both a diagnosis and supporting citations. Diagnostic accuracy was determined against reference answers, and errors were categorized as logical, informational, or explicit. Citation number, source type, hallucination rate, and journal CiteScores were also compared. All models demonstrated high diagnostic accuracy (82.0%-91.0%), with ChatGPT-4 achieving the highest numerical accuracy (91.0%), though differences between models were not statistically significant (p = 0.057). Logical errors were most frequent across all models. OpenEvidence and Perplexity generated the most citations per response, while ChatGPT-4 produced the fewest and had the highest hallucination rate (23.0%). Source preferences varied, with OpenEvidence and Pathway favoring narrative reviews and Perplexity favoring government/public health websites. OpenEvidence had the highest mean CiteScore for journal citations. This is the first study to assess both diagnostic accuracy and citation integrity of LLMs in otolaryngology. While ChatGPT-4 was most accurate, it had the highest rate of citation hallucinations, suggesting a trade-off between accuracy and source reliability. OpenEvidence, though slightly less accurate, provided more consistent and verifiable references, demonstrating the ability to prioritize citation integrity alongside diagnostic performance for clinical integration.

Clinical-pathological discordance in T staging is common in laryngeal squamous cell carcinoma (LSCC) and may affect treatment planning and prognosis. Its impact in patients treated with open partial horizontal laryngectomy (OPHL) remains unclear. A retrospective multicenter study was conducted on 106 patients with glottic or supraglottic LSCC treated with OPHL. Discrepancies between clinical (cT) and pathological (pT) staging were analyzed. Associations with preoperative factors, adjuvant therapy, disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) were evaluated. T-stage discordance was observed in 37.7% of patients, with 19.8% upstaged and 17.9% downstaged. No preoperative factor was significantly associated with discordance. T-stage discrepancy was not significantly associated with DFS, DSS, OS, or the need for adjuvant therapy. In patients undergoing OPHL, clinical-pathological T-stage discordance does not appear to significantly affect oncologic outcomes, likely due to the modular and adaptable nature of the surgical procedure.

To evaluate the efficacy and safety of modified three-stage tissue expansion ear reconstruction in patients with bilateral congenital microtia and Bonebridge implantation. A retrospective analysis was conducted on 18 patients with bilateral congenital microtia treated between January 2021 and December 2024. All patients underwent bilateral ear reconstruction, with one side having prior Bonebridge implantation. Modified three-stage tissue expansion ear reconstruction was performed. Surgical outcomes were assessed through objective measurements and patient satisfaction scores, while monitoring Bonebridge device function. Mean follow-up was 12.94 ± 3.87 months. No significant differences were found between the reconstructed ear and contralateral reconstructed ear in circumference, width, length, or auriculocephalic angle (p > 0.05). Overall patient satisfaction reached 88.9%, with VAS scores improving from 0.67 ± 0.59 preoperatively to 8.22 ± 1.18 (p < 0.001). Four patients (22.2%) experienced mild complications, all successfully managed. Audiological evaluation showed no significant difference in unaided bone conduction thresholds pre- and postoperatively (28.3 ± 5.6 dB HL vs. 27.9 ± 5.8 dB HL, p = 0.82), indicating preservation of inner ear function. Aided speech recognition scores remained stable (92.4 ± 4.3% vs. 91.8 ± 4.7%, p = 0.68), and all patients demonstrated normal Bonebridge electronic function and coupling test results. Modified three-stage tissue expansion ear reconstruction is a safe and effective treatment for bilateral microtia patients with Bonebridge implantation. Through precise preoperative localization, compartmentalized dissection strategy, individualized expansion protocol, and meticulous framework implantation technique, satisfactory aesthetic outcomes can be achieved while protecting Bonebridge device function and preserving residual hearing.

The main objective of this scoping review was to describe the characteristics found in the FEES protocols in adults with neurogenic oropharyngeal dysphagia. Following the Joanna Briggs Institute and PRISMA-ScR guidelines, an extensive search was conducted in six databases: Wiley Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, and LILACS. The search was carried out without restriction of study design, publication date, or language. Two blind independent raters were appointed to select, review, and extract all content according to a priori exclusion criteria. A third rater was also appointed to resolve the disagreement. Data extraction included study characteristics, professional expertise, and FEES performance details. A total of 6,033 abstracts were screened, leading to the inclusion of 115 publications. Most studies were conducted in the United States, Germany, Japan, Brazil, and Italy. Speech-language pathologists and otorhinolaryngologists were the most frequently cited professionals performing FEES. Information about the FEES protocol and its performance varied. The description of food consistencies, initial consistency trials, use of dye, and volume was more frequently reported but lacked consensus. The FEES protocol applied to the adult population with oropharyngeal dysphagia does not have a uniform description and performance.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is traditionally managed as a uniform clinical emergency using empirical corticosteroid protocols, yet outcomes vary widely, suggesting underlying etiologic heterogeneity. This review aims to propose a precision medicine framework for ISSNHL by re-examining the condition through specific pathophysiologic determinants, including structural third window syndromes, microvascular compromise, and metabolic factors. A narrative synthesis of emerging evidence regarding 3D-FLAIR MRI, high-resolution CT (HRCT), and metabolic profiling is presented. Illustrative cases of Enlarged Vestibular Aqueduct (EVA) and Superior Semicircular Canal Dehiscence (SSCD) are utilized to highlight the limitations of traditional steroid therapy in structural phenotypes. A significant proportion of "idiopathic" cases can be stratified into distinct pathophysiologic phenotypes. Structural anomalies (TWS) often exhibit limited steroid responsiveness but benefit from early biomechanical identification. Furthermore, advanced imaging like 3D-FLAIR MRI reveals blood-labyrinth barrier (BLB) disruption as a prognostic marker for vascular-driven hearing loss. Metabolic factors, such as Vitamin D and B12 deficiencies, further modulate cochlear resilience and recovery potential. SSNHL should be managed as a heterogeneous syndrome. We propose a stratified management algorithm that integrates high-resolution imaging and metabolic screening into early decision-making. Shifting toward pathophysiology-guided care allows for personalized adjuvant strategies (e.g., HBOT, metabolic correction) and more accurate prognostic counseling, ultimately improving individualized patient outcomes.

The primary endpoint was to determine the prevalence of vestibular hypofunction in patients suffering from obstructive sleep apnea (OSA). Secondary and tertiary objectives were to determine any correlation between vestibular hypofunction and the degree of sleep apnea and/or the Dizziness Handicap Inventory (DHI) scores, and the presence of comorbidities, respectively. A cross-sectional prospective cohort design in which 175 adult subjects diagnosed with either probable, mild, moderate, or severe OSA were recruited. Subjects underwent complete video head impulse (vHIT) testing and a self-reported fulfilment of the DHI questionnaire. A standardized approach was applied for the interpretation and classification of the vHIT results. The prevalence of vestibular hypofunction was found to be 6.9%. No significant differences in apnea-hypopnea-index (AHI) score (p = 0.26) or within AHI groups (p = 0.45) were found. Consistently, no significant differences in total DHI score (p = 0.14) or within DHI subcategories (p = 0.21) were found. OSA and an accompanying heart condition was significantly correlated to having vestibular hypofunction (p = 0.00). Subjects with vestibular hypofunction had a significantly higher number of comorbidities (p = 0.03). Furthermore, the probability of having vestibular hypofunction significantly increased with increasing numbers of accompanying comorbidities (p = 0.03). Twelve subjects (6.9%) in a population of adult OSA patients had vestibular hypofunction. No correlation between the prevalence of vestibular hypofunction and the degree of OSA was found. Consistently, no correlation to the total- or subcategory mean DHI scores was found. A significant correlation was found between vestibular hypofunction and the presence of a heart condition as well as an increased number of comorbidities, respectively.

Acquired atresia of the Eustachian tube (ET) is an uncommon but debilitating condition that can significantly impair middle ear ventilation and drainage, leading to chronic otitis media, conductive hearing loss, and aural fullness. Despite its impact, diagnosis and management remain challenging, with limited literature on standardized approaches. This case series aims to describe the clinical presentation, imaging findings, surgical management, and outcomes of three adult patients with acquired ET atresia treated using multimodal surgical interventions, including balloon dilation, laser-assisted dissection, and microdebrider techniques. We retrospectively reviewed three adult cases presenting with persistent otologic symptoms refractory to conventional medical and ventilation tube therapy. Diagnosis was confirmed through endoscopic evaluation and imaging. Surgical intervention targeted restoration of ET patency using endoscopic and microscopic techniques tailored to the anatomical findings of each case. All patients demonstrated symptomatic improvement postoperatively, with reduced otorrhea, otalgia, and improved middle ear aeration, and improvement in ETDQ-7 average score. Use of adjunctive techniques such as balloon dilation and short-term stenting helped maintain patency and enhance outcomes. No major complications were noted. A multimodal, individualized approach to acquired ET atresia can provide significant clinical benefit. Adjunctive use of balloon dilation, laser, and microdebrider techniques enhances surgical success. Further research is needed to determine long-term outcomes and optimal treatment protocols.

Irregular vocal fold mucosal changes pose diagnostic challenges and may range from benign to malignant. Emerging research highlights Sex-determining Region Y-box 2 (SOX2) gene amplification as a potential early marker in head and neck tumorigenesis. This work aimed to evaluate vocal fold irregular mucosal lesions for the early detection of high-risk lesions (high-grade dysplasia, carcinoma in situ, and squamous cell carcinoma (SCC)) and to explored the potential role of SOX2 gene in early laryngeal carcinogenesis. This is a prospective observational cross-sectional study with a follow-up up to 2 years; 40 male patients with vocal fold irregularities were examined by laryngo-stroboscopy, then classified into two groups based on histopathological diagnosis: (A) Low-risk group (benign lesions, low-grade dysplasia), (B) High-risk group (high-grade dysplasia, carcinoma insitu and SCC. Real-time polymerase chain reaction PCR was performed to detect SOX2 gene expression. Significant differences were observed in vocal fold stroboscopic features (mucosal wave and amplitude), and SOX2 gene expression across lesion groups, with higher SOX2 expression noted in the high-risk group (P < 0.05). A strong positive correlation was observed between histopathological severity and each of stroboscopic impairment in mucosal wave and amplitude, and Log SOX2 gene expression. The regression analysis showed a significant independent predictive effect of SOX2 gene expression on the progression to high-risk lesions. This study integrated established diagnostic standards, laryngostroboscopy for clinical assessment, and histopathology as the gold standard for grading, while the analysis of SOX2 gene expression showed a promising predictive molecular marker for tumorigenesis.