Otolaryngology Head Research Articles

Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma

ObjectivesThe lymph node status is crucial for guiding the surgical approach for patients with laryngeal and hypopharyngeal carcinoma (LHC). Nonetheless, occult lymph node metastasis presents challenges to assessment and treatment planning. This study seeks to develop and validate a diagnostic model for evaluating cervical lymph node status in LHC patients.Materials and methodsThis study retrospectively analyzed a total of 285 LHC patients who were treated at the Department of Otolaryngology Head and Neck Surgery, Daping Hospital, Army Medical University, from January 2015 to December 2020. Univariate and multivariate logistic regression analyses were employed to construct the predictive model. Discrimination and calibration were used to assess the predictive performance of the model. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the model, and validation was conducted using 10-fold cross-validation, Leave-One-Out Cross Validation, and bootstrap methods.ResultsThis study identified significant predictors of lymph node metastasis in LHC. A diagnostic predictive model was developed and visualized using a nomogram. The model demonstrated excellent discrimination, with a C-index of 0.887 (95% CI: 0.835-0.933). DCA analysis indicated its practical applicability, and multiple validation methods confirmed its fitting and generalization ability.ConclusionThis study successfully established and validated a diagnostic predictive model for cervical lymph node metastasis in LHC. The visualized nomogram provides a convenient tool for personalized prediction of cervical lymph node status in patients, particularly in the context of occult cervical lymph node metastasis, offering valuable guidance for clinical treatment decisions.

Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training

BackgroundIn otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training.MethodsA cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology–head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback.ResultsA transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools.ConclusionsThe 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.

The Usefulness of YouTube Videos Related to Endoscopic Sinus Surgery for Surgical Residents

Abstract Objective The use of online teaching modalities to supplement surgical learning has increased recently, demonstrating promising results. Previous studies have analyzed the value and usefulness of YouTube as an educational source to learners, including teaching surgical skills to Otolaryngology–Head and Neck Surgery (OHNS) trainees. YouTube videos on endoscopic sinus surgery (ESS) still need to be explored as ESS remains a common, yet challenging surgery that OHNS residents encounter regularly. This study aimed to objectively evaluate the usefulness of YouTube videos on ESS for surgical education. Design YouTube was searched using the following keywords: “uncinectomy,” “maxillary antrostomy,” “anterior ethmoidectomy,” and “ethmoid bulla resection.” These represent the initial ESS steps residents learn. Each video was assessed for eligibility by two independent reviewers. Outcome Measures The LAParoscopic surgery Video Educational Guidelines (LAP-VEGaS) and ESS-specific criteria were used to assess educational quality. Video popularity index (VPI) was used to calculate video popularity. Results Of the 38 videos that met inclusion criteria, the average LAP-VEGaS score was 6.59 (± ) 3.23 standard deviation. Most videos were designated low quality. There was a weak positive correlation between whether a video included ESS-specific criteria and LAP-VEGaS score (r = 0.269, p = 0.102). There was a significant positive correlation between VPI and LAP-VEGaS scores (r = 0.497, p = 0.003). Conclusions Overall, the quality of included videos was poor. OHNS residents should not rely solely or primarily on YouTube videos to learn surgical skills relevant to ESS. To maximize potential of online teaching, high-quality videos should be used to compliment other methods of teaching.

Not so simple: evaluating consequences validity evidence for a workplace-based assessment in surgery

PurposeWorkplace-based assessments (WBAs) of trainee operative skills are widely used in surgical education as formative assessments to facilitate feedback for learning, but the evidence to support this purpose is mixed. Further evaluation of the consequences of assessment use and score interpretation is needed to understand if there is alignment between the intended and actual impacts of assessment. This study examines consequences validity evidence for an operative WBA, exploring whether WBA use is consistent with the goals of formative assessment for learning.MethodsEight residents and 9 faculty within the Department of Otolaryngology—Head and Neck Surgery at a tertiary institution completed semi-structured interviews after participating in a pilot of a surgical WBA, the System for Improving and Measuring Procedural Learning in the OR (SIMPL OR). Residents received feedback from attendings via both scores (performance and autonomy ratings) and recorded dictations. Interview questions explored faculty and resident perceptions of feedback behaviors and perceived impacts on their teaching or learning practices. Three researchers analyzed transcripts using directed qualitative content analysis to generate themes and evaluated how the perceived impacts aligned with formative purposes for assessment and score use.ResultsBoth faculty and residents identified intended impacts of formative assessment, including (1) greater emphasis on feedback, (2) support for a postoperative feedback routine, and (3) facilitation of case-specific reflection. Residents also used score and verbal feedback for (1) calibrating case perceptions and (2) benchmarking performance to an external standard. The recorded dictations supported feedback by (1) providing context for ratings, (2) facilitating review of dictated feedback, and (3) prompting faculty for deliberate feedback. Unintended impacts included: (1) emotional discomfort during the assessment process, (2) increased feedback frequency but not diversity or quality, (3) inadequate support for feedback conversations, and (4) limited next steps for teaching or learning. Assessment usage declined over the pilot period.ConclusionsThe validity evidence gathered in this study suggests an operative WBA can be used for formative purposes to improve perceptions of feedback, but unintended consequences and implementation challenges limited ultimate impacts on teaching and learning. User perspectives can add important elements to consequences validity evidence and should be further evaluated in different implementation settings to better understand how WBAs can achieve their formative goals.

Female leadership representation within otolaryngology specialty societies

ObjectivesDetermine if women have continued parity in leadership in otolaryngology specialty societies as compared to a paper by Choi and Miller in 2012. Additionally, we wanted insight into obstacles female leaders faced by surveying them directly to better understand their experiences with gender bias. MethodsChi-squared test evaluation was done using the American Academy of Otolaryngology Head and Neck Surgery (AAOHNS) 2020 membership data and directly from various otolaryngology specialty societies. An anonymous survey to assess different experiences of leaders in various Otolaryngology specialty societies was sent to current and past leaders of specialty societies via email. Survey data was assessed using descriptive statistics and multivariate logistical analyses. Study Design: Cross-sectional study and survey study. ResultsFemale members comprised 19.3 % of practicing AAOHNS otolaryngologists. All societies had proportionate female leadership representation except for AAOA, which had greater representation. Compared to data from 10 years ago, female representation in all the societies' leadership has not changed significantly. Survey results demonstrated 64.9 % of respondents felt gender bias exists in Otolaryngology. 45.6 % of respondents personally experienced gender bias during their careers. Survey results showed males are less likely to experience gender bias. ConclusionThere is stability in the proportion of women in otolaryngology leadership positions compared to a decade ago largely due to efforts of leaders in the field. However, women leaders note experiencing gender bias and time away from clinical duties are prospective areas where support can be given. Level of evidence3.

Validated mobile applications in otolaryngology head and neck surgery for patient and physicians: A systematic literature review

ImportanceMobile apps in the field of ORL-HNS, are widely used by patients and physicians, but neither necessarily developed in collaboration with healthcare professionals nor subjected to regulations by the United States Food and Drug Administration guidelines, with a resultant potential of risk for its users. ObjectiveTo provide the ORL-HNS physician with an updated list of scientific peer review literature- validated mobile apps for safe use for both the clinician and the patients, for screening, diagnosis, therapy and follow up for various ORL-HNS pathologies. Evidence reviewA comprehensive systematic review of the scientific literature was conducted in “PubMed,” “EMBASE,” and “Web of Science” without limitation of publication date up to January 1st, 2023. The included papers validated mobile apps in the ORL-HNS discipline. Each study was evaluated using the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) tool. FindingsFrom the thousands of unregulated ORL-HNS mobile apps available for download and use in the various app stores, only 17 apps were validated for safe use by the clinician and/or patient. Their information is listed. Conclusions and relevanceThe limited number of validated mobile apps highlights the importance to use validated apps in clinical practice, to improve evidence-based medicine and patient safety. Physician are encouraged to use and recommend their patients to use validated mobile apps only, like any other tool in clinical practice in the evidence-based era.

[Analysis of inducement of benign paroxysmal positional vertigo].

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People's Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.

[Preliminary application of indocyanine green fluorescence imaging technology in nasal endoscopic tumor surgery].

Objective:To preliminarily study the practical value of Indocyanine green（ICG） molecular fluorescence imaging technology in nasal endoscopic tumor surgery. Methods:Five patients with tumors related to nasal sinuses, orbital wall and skull base in the Department of Otolaryngology head and Neck Surgery, General Hospital of Xinjiang Military Command from December 2022 to April 2023 were enrolled. Among them, 3 were benign tumors and 2 were malignant tumors. All patients underwent surgery under the guidance of ICG molecular fluorescence imaging. ICG was administered intravenously through cubital vein at a dose of 0.5 mg/kg 12 to 24 h before surgery. Tumors were labeled by fluorescence imaging during the operation. surgeons cleared the tumor tissue strictly according to the labeled range and depth, malignant tumors were further expanded and cleaned according to pathology results. Results:All 5 patients achieved accurate tumor localization with the aid of fluorescence imaging technology. Resections were performed with reference to fluorescent labeling boundaries, all patients achieved complete tumor cleanup or negative margins. Conclusion:For tumor-related surgery under nasal endoscopy, ICG molecular fluorescence imaging technology can not only achieve accurate real-time positioning, but also provide evidence for surgeons to judge tumor boundaries. Therefore, we believe that the technology should have certain practical value in nasal endoscopic tumor surgery.

[Efficacy analysis of 23 cases of parapharyngeal space tumors removed by oral approach assisted by plasma and high-definition endoscopic system].

Objective:To explore the selection, efficacy and application of indications for parapharyngeal space tumor resection assisted by plasma and HD endoscopic system through oral approach. Methods:The clinical data of 23 patients with parapharyngeal space tumor resection assisted by plasma and HD endoscopic system were retrospectively analyzed in Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical University from January 2013 to June 2023. All cases were examined by high-resolution CT and MRI before operation, and some cases were examined by CTA or DSA. During the operation, the high definition nasal endoscopic recording system was assisted, and low temperature plasma knife was used in some cases. The follow-up time was from 3 to 115 months, and the median follow-up time was 45 months. Results:There were no deaths in this group. All patients had complete tumor resection. The maximum tumor diameter was as follows: （5.20±1.00） cm, the operation time was（128.70±46.67） min, and the average blood loss was（80.87±32.74） mL. One case of vascular smooth muscle tumor had more bleeding during the operation and was assisted by tracheotomy after operation. One case of nourishing vascular bleeding after operation of giant Schwannoma was investigated and hemostasis + external carotid artery ligation. Bleeding in the remaining cases was below 120 mL. Postoperative pathologies were all benign tumors, including 11 pleomorphic adenoma, 4 schwannoma, 2 base cell adenoma, 1 epidermoid cyst, 1 lymphatic cyst with infection, 1 angiomyoma, 1 solitary fibroma, 1 salivary gland cyst, and 1 tendon giant cell tumor. All patients were followed up. One patient originating from vagal schwannoma had 2-month vocal cord paralysis and 1 recurrence（recurrence of the skull base of schwannoma）. Conclusion:Oral approach assisted by plasma and high-definition endoscopic system is suitable for partial selective resection of benign tumors in parapharyngeal space, which has the advantages of less trauma and rapid recovery. When the tumor is blood-rich, suspected to be malignant, the top of the tumor is deep into the cranial base nerve canal,located outside the internal carotid artery, and larger than 6.0 cm considering pleomorphic adenoma, it is recommended to conduct an external open or auxiliary cervical small incision approach.

[Clinical study of ear keloids with surgical excision and intraoperative low-energy X-ray irradiation therapy].

Objective:To explore the clinical efficacy of surgical excision combined with low-energy X-ray irradiation in the treatment of ear keloids. Methods:Clinical data of 32 cases of ear keloid lesions that received surgical treatment alone or surgery combined with radiotherapy from March 2019 to November 2022 in the Department of Otorhinolaryngology Head and Neck Surgery of the Tianjin First Central Hospital were retrospectively analyzed. Among them, 10 cases received radiotherapy and 22 cases did not receive radiotherapy. The radiotherapy group received irradiation with a large divided dose of 50 kV low-energy X-rays. The mode of fractionation radiotherapy was as follows: the first was 10 Gy of intraoperative radiation therapy and the second was 8 Gy on the 3rd postoperative day for a total of 18 Gy. The local efficacy and skin radiation reaction were observed at a follow-up of 8-52 months. Results:The median follow-up was 26 months, and as of the date of the last follow-up, 9 cases were cured and 1 case was ineffective in the radiotherapy group, with an effective rate of 90.0%, while 9 cases were cured and 13 cases were ineffective in the no-radiotherapy group, with an effective rate of 40.9%. The recurrence of ear keloids was not related to the side, site, or etiology of the patient's onset（P>0.05）. Recurrence was related to whether or not the patients received radiotherapy（χ²=4.885, P<0.05）, and the recurrence rate in the radiotherapy group（10.0%） was significantly lower than that in the non-radiotherapy group（59.1%）. Conclusion:Surgical excision combined with low-energy X-ray irradiation therapy is an effective method of treating keloids in the ear, especially with intraoperative radiation therapy can achieve more satisfactory results.

Burnout in Australian Otorhinolaryngology Head and Neck Surgery consultants during the coronavirus disease 2019 (COVID-19) pandemic

Burnout in Australian Otorhinolaryngology Head and Neck Surgery consultants during the coronavirus disease 2019 (COVID-19) pandemic

The role of virtual endoscopy in surgical practice of otolaryngology head and neck surgery: a review article

Virtual endoscopy involves the acquisition of data to generate a three-dimensional view of hollow anatomical structures. This interface would allow for the realistic integration of anatomical structures in complex cavities involving sinuses, larynx, and ears. Current literature lacks updated review on the role virtual endoscopy in otolaryngological practice. This paper serves to highlight the use of virtual endoscopy in amongst three main domains: otology, rhinology and laryngology. Review of literature were conducted using various databases including, Pubmed, Scopus, Embase, Web of Science, google scholar. Only papers in full text, English language, and relevant to our objectives were included. A critical descriptive review of the papers were performed to illustrate the strength and weakness on the utilization of virtual endoscopy as a surgical planning tool in otorhinolaryngology practice. The advantages of applying VE in our practice serves two folds; as an educational tool for novice trainees mainly for surgical skill acquisition and as a pre-op planning to understand complex anatomical narrow operative fields. Our paper is the first to demonstrate the most updated commentary review article of the application of virtual endoscopy in sinus surgery, laryngeal airway evaluation and the assessment of ear surgery.  

JAMA Otolaryngology–Head & Neck Surgery—The Year in Review, 2023

JAMA Otolaryngology–Head & Neck Surgery—The Year in Review, 2023

Creating an Undergraduate Research Program in Otolaryngology—Head and Neck Surgery (Oto-HNS) for Students Underrepresented in Medicine

Creating an Undergraduate Research Program in Otolaryngology—Head and Neck Surgery (Oto-HNS) for Students Underrepresented in Medicine

[Effects of nasal valve on subjective nasal patency and nasal resistance: a correlation study on numerical simulation of nasal airflow].

Objective: To investigate the correlations between subjective nasal patency, nasal valve area size and aerodynamic parameters in normal nasal cavity by means of numerical simulation, and to explore the effect of nasal valve on nasal subjective sensation and nasal airflow regulation. Methods: A total of 52 healthy participants (31 males and 21 females) with the average age of 37.8 years, were recruited from the outpatient Department of Otorhinolaryngology Head and Neck Surgery, the Ninth People's Hospital Affiliated to the Medical College of Shanghai Jiao Tong University between January and August 2023. Visual Analog Scale (VAS) scores for unilateral nasal subjective sensation were obtained from all participants. Additionally, the aerodynamic characteristics of inspiratory airflow were simulated. A correlation matrix analysis was conducted to identify the correlation strength between these subjective and objective parameters. Results: VAS scores showed negative correlations with unilateral nasal valve cross-sectional area (r=-0.85, P<0.01) and unilateral intranasal airflow (r=-0.57, P<0.01), and was a positive correlation with unilateral nasal resistance (NR) at the front-end of inferior turbinate (r=0.61, P<0.01). The average cross-sectional area of unilateral nasal valve was (0.85±0.35) cm2. The cross-sectional area of unilateral nasal valve was negatively correlated with unilateral NR (r=-0.50, P<0.01), and positively correlated with unilateral nasal airflow (r=0.61, P<0.01). The NR at the nasal valve area accounted for (40.41±23.54)% of the total unilateral NR. Nearly half of the unilateral NR [(46.74±21.38)%] and air warming [(49.96±10.02)%] occurring before the front end of inferior turbinate were achieved. Conclusions: The nasal valve area plays a crucial role in influencing nasal NR, unilateral nasal airflow, and changes in nasal airflow temperature. Moreover, it is associated with subjective perception of nasal patency.

Performance of Chat GPT on Equilibrium Field of the Otorhinolaryngology Head and Neck Surgery Specialty Certificate Examinations

Performance of Chat GPT on Equilibrium Field of the Otorhinolaryngology Head and Neck Surgery Specialty Certificate Examinations

[Perioperative experience in a case of human laryngotracheal allotransplantation].

Loss of laryngeal function is a primary problem faced by patients after total laryngectomy. Although the voice function of the larynx can be partially compensated by some methods(such as implanting a voice prosthesis, using an electrolarynx and so on), and swallowing dysfunction can be improved by postoperative rehabilitation training, patients still need to breathe through the tracheostoma for life. Laryngeal transplantation, as the only therapeutic measure that has the potential to completely restore laryngeal function, has been the focus of attention in the field of otorhinolaryngology head and neck surgery both at home and abroad. In this article, we review a case of human laryngotracheal allotransplantation that was successfully completed in West China Hospital of Sichuan University, including case presentation, preoperative evaluation and preparation, surgical procedure, and postoperative management, which will provide a reference for the future development of clinical laryngeal transplantation.

[The application of endoscope and microscope in the stapes surgeries].

Objective:To compare the application of endoscope and microscope in all kinds of stapes surgeries. Methods:Fifty-nine stapes surgeries have been collected from April 2020 to May 2023 in Senior Department of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School. Hearing level, hospital stay post-operation, times of hospital visit post-operation, etc. have been compared between the endoscopic group and microscopic group. Patients who were failed to place the stapes prosthesis because of the poor exposure of the oval window have been analyzed. Results:Otosclerosis was the most common diagnosis in both groups. There was 1（1/23） middle ear malformation in the endoscopic group and 5（5/36） middle ear malformations in the microscopic group. There were 2 Van Der Hover syndromes and 4 Treacher Collins syndromes in the microscopic group. In the endoscopic group ABG of 10 ears（43.5%） ≤ 10 dB, and ABG of 21 ears（91.3%） ≤20 dB.In the microscopic group ABG of 13 ears（41.9%） ≤ 10 dB, and ABG of 28 ears（90.3%） ≤ 20 dB. There was no statistic difference between 2 groups. Times of hospital visit post-operation in the endoscopic group was less than in the microscopic group（P<0.01）. There was no facial palsy, tympanic perforation or profound sensorineural hearing loss in both groups. Conclusion:Endoscope is more suitable for patients who are evaluated with no severe stapes malformation, or less manipulation of drilling the bone. It could also reduce the hospital visit post-operation. Patients with narrow ear canal or severe middle ear malformation are recommended to perform the surgery with microscope, because it provides the chance of manipulation with 2-hands of surgeons.

[Adipose-derived stem cell-derived exosomes regulate Th2/Treg balance in peripheral blood of AR patients through the mTOR pathway].

Objective:To investigate the mechanism of adipose derived stem cell exosomes（ADSC-exos） regulating Th2/Treg balance in peripheral blood of patients with allergic rhinitis（AR）. Methods:Thirty patients with AR who were treated in Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University from March 2022 to October 2022 were selected, and 30 patients with simple deviation of nasal septum who were treated in our department during the same period were selected as the control group. 10 mL peripheral venous blood was collected from all patients. The levels of IL-4 and TGF-β in plasma were analyzed by ELISA. PBMCs were isolated by density gradient centrifugation. Then, protein and RNA were further extracted, and the expression levels of IL-4, TGF-β, GATA3 and Foxp3 genes were detected by qRT-PCR. Western Blotting detected p-PI3K（P85）, p-AKT（Ser473） in PBMCs of AR patients and healthy controls. Protein expression levels of p-mTOR（Ser2448）, p-p70S6K（Thr389）, and the proportion of Th2 and Treg cells were analyzed by flow cytometry. PBMCs of AR patients were stimulated to differentiate and co-cultured with exosomes of adipose stem cells. p-PI3K（P85）, p-AKT（Ser473）, p-mTOR（Ser2448） were detected in exosome treated group and untreated group by Western Blotting. The expression level of p-p70S6K（Thr389） protein, the proportion of Th2 and Treg cells were analyzed by flow cytometry, and the levels of IL-4 and TGF-β in the supernatant of cell culture were detected by ELISA. Results:Compared with the control group, the mTOR pathway in peripheral blood of AR group was significantly activated, the level of IL-4 in plasma was increased, and the level of TGF-β was decreased（P<0.05）. Compared with the control group, the proportion of Th2 cells in peripheral blood was increased, and the proportion of Treg cells was decreased（P<0.01）. Compared with the untreated group, the expression level of mTOR pathway protein decreased, the level of IL-4 decreased, and the level of TGF-β increased. The proportion of Th2 cells decreased, and the proportion of Treg cells increased（P<0.01）. Conclusion:There is an imbalance of Th2 and Treg cells in peripheral blood mononuclear cells of AR patients; the PI3K/AKT/mTOR/p70S6K pathway is activated in peripheral blood mononuclear cells of AR patients Exosomes derived from adipose mesenchymal stem cells may regulate Th2/Treg balance in AR patients through the PI3K/AKT/mTOR/p70S6K pathway.

Management of nasal vestibule carcinomas: recommendations by the Oncological Committee of the Italian Society of Otorhinolaryngology - Head and Neck Surgery.

Squamous cell carcinoma of the nasal vestibule (NV SCC) is a head and neck malignancy for which there is no established consensus on most aspects of clinical management. The purpose of this document is to give updated recommendations that incorporate recent evidence on its clinical characteristics and the high efficacy of brachytherapy as primary treatment modality. A working group consisting of the members of the Scientific Committee for Oncology and Reconstructive Surgery of the Italian Society of Otorhinolaryngology Head and Neck Surgery and radiation oncologists expert in brachytherapy was formed to achieve a consensus. Consensus was reached on a set of recommendations, proposing a refined anatomical definition of the nasal vestibule, a novel T staging system of the NV SCC, and brachytherapy as standard of care, with a new method for catheter implantation. The Committee emphasises the critical role of an accurate classification in clinical practice and encourages further research to validate the novel staging system and further improve treatment strategies. Where appropriate, it is recommended that patients be referred to centres with specific experience in brachytherapy for NV SCC.