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Abstract Objective To evaluate the clinical significance of WAI as a predictive marker for MD and LVAS among adults. Methods Participants included 110 ears with MD, 18 ears with LVAS, and 92 normal ears (control group) recruited from clinical audiology settings. The outcome measures included Wideband Energy Absorbance (WBA), Resonance Frequency (RF), admittance Magnitude (YM), and phase Angle (YA). Propensity Score Matching (PSM) was conducted to treat the group imbalance. Results Compared with the control group, The MD group exhibited significantly lower WBA between 1587 and 4000 Hz (p < 0.05), while the LVAS group showed lower WBA between 1000 and 2520 Hz (p < 0.05). The MD and LVAS groups had lower RF (p < 0.05), while they had higher YM at low frequencies (226 and 678 Hz for MD, and 1000 Hz for LVAS, p < 0.05). Conclusions This study showed that LVAS has a lower WBA at middle frequencies, whereas MD has a lower WBA at middle and high frequencies. These findings suggest that WAI may serve as a predictive marker for MD and LVAS. However, further studies are needed to explore its diagnostic utility in Third Mobile Window Abnormalities (TMWA). Level of evidence: IV: Retrospective cohort study.

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Abstract Objective Gut microbiome dysbiosis is associated with various diseases. Causal association between Chronic Rhinosinusitis (CRS) and gut microbiome is yet unknown. This study aimed to investigate the potential causal relationship between CRS and gut microbiome dysbiosis. Methods We used Genome-Wide Association Study (GWAS) data from FinnGen database for CRS. The Dutch Microbiome Project study provided data on gut microbiota species. A total of 334,182 individuals were included. Two-sample bidirectional Mendelian Randomization (MR) analysis was used to investigate causal relationship between CRS and gut microbiome. The main methods of evaluation were Inverse Variance Weighting (IVW), weighted median, weighted mode, and MR-Egger regression. Sensitivity analyses were performed to assess heterogeneity and pleiotropy. Results Forward MR analysis indicated CRS is potentially linked to decreased risk of Haemophilus parainfluenzae (OR = 0.79, 95% CI 0.66‒0.94, p = 0.009) and increased risk of Bilophila’s (OR = 1.14, 95% CI 1.02–1.27, p = 0.023) within the gut. Reduced risks in gut microbiota-related pathways like UDP-N-acetyl-D-glucosamine biosynthesis I (OR = 0.85, 95% CI 0.77‒0.94, p = 0.002) and increased risk in pathway NAD biosynthesis I from aspartate (OR = 1.14, 95% CI 1.03–1.27, p = 0.010) were also linked to CRS. Reverse MR analyses, we obtained no positive results (p > 0.05/412). Conclusion This study reveals CRS exerts a causal impact on shifts within the composition of the gut microbiome and also links to the changes of gut microbiota-related metabolic pathways. The risk of changes in gut microbiota should be of greater concern in patients with CRS than in the general population. Level of evidence: Mendelian Randomized (MR) studies are second only to randomized controlled trials in terms of the level of evidence.

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Abstract Objective This study aims to assess the relationship between Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections and Head and Neck (H&N) lymphoma in a region where HBV and HCV are highly prevalent. Methods Patients diagnosed with H&N lymphoma between 2013 and 2022 at our institution were eligible for the study, with exclusion criteria applied to patients with a history of recurrence, other cancers, HIV infections, organ transplantation, and those below 18-years of age. The first and the second control group comprised outpatients and patients diagnosed with Head and Neck Squamous Cell Carcinoma (HNSCC) who were gender and age-matched at the same hospital. Logistic regression analysis, which was adjusted for sex, age, smoking, alcohol consumption, Rheumatoid Arthritis (RA), and Systemic Lupus Erythematosus (SLE), was utilized to estimate the Odds Ratio (OR) and 95% Confidence Interval (95% CI) for HBV and HCV infection status. Results From 2013 to 2022, 304 patients with H&N lymphoma were identified. After excluding those with a history of other cancers or recurrences, 262 patients remained. The first control group included 1048 matched outpatients. Additionally, 262 patients diagnosed with HNSCC during the same period were selected as the second control group. Of the 242 Non-Hodgkin Lymphoma (NHL) patients, 102 had Extranodal Lymphoma (ENL). Of these ENL patients, 49 tested positive for HBV and 17 for HCV. After controlling for the confounding factors, NHL patients with HBsAg positivity had a significantly higher prevalence rate than healthy controls, particularly among B-cell Lymphoma and Diffuse Large B-Cell Lymphoma (DLBCL) patients. Furthermore, there were no significant differences in HCV infections between the three groups. Conclusions In conclusion, the study found a significant link between HBV infection and H&N NHL, particularly DLBCL in Taiwan. However, no significant link was discovered between HCV infection and H&N lymphoma. These findings suggest a potential role for HBV in the development of H&N NHL and DLBCL. Level of evidence: 4.

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Abstract Objective The levels of vitamin D in the human body are primarily measured through serum 25-hydroxyvitamin D (25(OH)D) levels. Observational studies suggest a potential association between the incidence of laryngeal cancer and vitamin D levels, but the causality remains unclear. This study aims to investigate the potential causal relationship between vitamin D levels and laryngeal cancer. Methods This Mendelian Randomization (MR) study is based on large-scale GWAS (Genome-Wide Association Study) summary datasets. We selected two different datasets of 25(OH)D and conducted two two-sample univariable Mendelian Randomization (MR) analyses. Four different MR methods were applied, and a series of sensitivity analyses were performed. In addition, a two-sample Mendelian randomization was conducted to account for the confounding effect of smoking. Furthermore, we performed GO enrichment analyses on the SNPs used as instrumental variables. Results The combined findings from both univariable MR analyses support a potential causal relationship between serum 25(OH)D levels and laryngeal cancer, suggesting that higher levels of vitamin D may have a protective effect against laryngeal cancer. Multivariable MR analysis showed that even after accounting for smoking as a confounding factor, the impact of 25(OH)D on laryngeal cancer remained significant. Enrichment analysis further indicated that 25(OH)D may inhibit the occurrence and progression of laryngeal cancer by regulating the metabolism of exogenous substances, lipid metabolism, and cellular responses to environmental stimuli. Conclusion Higher serum 25-hydroxyvitamin D levels serve as a protective factor against laryngeal cancer, suggesting that increasing vitamin D levels may reduce the risk of laryngeal cancer. Level of evidence: This was a Mendelian randomized study with a level of evidence second only to clinical randomized trials, and higher than cohort and case-control studies.

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Abstract Objective Compare the risk of developing Vestibular schwannoma in patients prescribed Hormone Therapy (HT). Methods We performed a systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA), the search was conducted in English, and we included all the studies that met the following criteria: (a) Participants who presented with VS; (b) Patients prescribed Hormone Replacement Therapy (HRT); (c) Prospective, retrospective or case-control study. Results Of the 146 articles, four met the inclusion criteria and were included in the systematic review and meta-analysis. Two studies documented an increased relative risk of Vestibular schwannoma in patients that had ever used hormone replacement therapy, another study found an incidence rate 2.2 times higher than the expected incidence rate and the other study indicated a 10% increased odds of the Vestibular Schwannoma in patients who have ever used hormone replacement therapy. Conclusion The use of hormone replacement therapy was associated with an increased relative risk of Vestibular Schwannoma but also demonstrated a lack of a definitive association. Level of evidence: Level 1.

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Abstract Objective Cochlear size, shape and the anatomy vary a lot among the human population. Cochlear size is a clinically useful parameter to determine the suitable cochlear implant electrode length. Objective is to assess the cochlear size and shape variation among the Argentine population. Methods Computer Tomography (CT) scans of 247 ears were assessed for the cochlear parameters including basal turn diameter (A-value) and width (B-value) and the cochlear height in the mid-modiolar section (H-value) using OTOPLAN® version 4.0. Shape of cochlear basal turn was determined by the ratio between B- and A-values. Cochlear Duct Length (CDL) was estimated from the A-, and B-values. Results The A-value was found to vary between 6.7 mm and 10.1 mm with a mean value of 8.7 ± 0.61 mm and the B-value was found to vary between 4.5 mm and 8.1 mm with a mean value of 6.4 ± 0.57 mm. The cochlear height as measured in the axial view from the mid-modiolar section was 3.78 ± 0.57 mm. Shape of the cochlear basal turn as determined by the ratio between B- and A-values showed 41 out of 248 ears (16.5%) have more of a round shaped basal turn with the ratio of ≥0.75 leaving the remaining 207 ears (83.5%) with more of an elliptical shaped basal turn. CDL was found to vary between 24.5 mm and 41.2 mm with a median value of 33.6 mm. Conclusion Argentine population appears to have slightly smaller cochlear size compared to population from other countries as reported in literature. Level of evidence: 3.

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Abstract Objective To investigate the plane and related mechanisms of tongue-originated obstruction in Obstructive Sleep Apnea Syndrome (OSAS) patients with macroglossia, utilizing pharyngeal Magnetic Resonance Imaging (MRI) in combination with Upper Airway Pressure Monitoring (UAPM). Methods Nineteen OSAS patients with macroglossia and 19 healthy controls were enrolled in this study. Every case was examined by pharyngeal MRI and Polysomnogram (PSG). The minimum Retropalatal Space (RP), the minimum Retrolingual Space (RL), soft palate thickness and the minimum space from the dorsal tongue to the soft palate (TP) were measured on a midsagittal plane. UAPM was measured only in the OSAS group. The differences of results between groups were statistically analyzed. Results Both UAPM and pharyngeal MRI indicated that the obstruction plane was present in patients with OSAS along the velopharyngeal plane. The mean values of both RP and RP/RL of patients with OSAS in this study were significantly smaller than control group values (p < 0.05). There was no significant difference in RL and soft palate thickness across the two groups (p > 0.05). The value of TP in both groups was close to 0, showing no significant difference between groups (p > 0.05). Conclusions The velopharyngeal plane was the most common site demonstrating obstructive etiology in OSAS patients with macroglossia. The related mechanism is suspected to include the backward movement of the soft palate caused by the high arch and the fall of the middle segment of the hypertrophic tongue. These findings may inform tongue-related surgical site decision-making for OSAS patients with macroglossia. Level of evidence: IV: Retrospective cohort study.

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Abstract Objectives To standardize the necessary competencies for Head and Neck Surgery residents related to the specialty. Methods The Delphi process was employed in its sequential phases: the selection of an expert panel; a structured questionnaire containing a preliminary list of potential competencies; the electronic distribution of the questionnaire to the experts, with options to “maintain”, “remove”, or “modify” the competencies and to suggest the inclusion of new competencies; a second round indicating “agree” or “disagree” for each reformulated or new competency; and the final consensus. Results Forty-six competencies were established for Head and Neck Surgery residents in the specialty. Conclusion Head and Neck Surgery residents and fellows should be trained in depth for the competency framework encompassing both routine and complex surgical interventions. Level of evidence: 5.

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Abstract Objective To investigate the causal associations between Gut Microbiota (GM) and Chronic Sinusitis (CRS) using Mendelian Randomization (MR). Methods Genome-Wide Association Study (GWAS) summary statistics for 473 GM taxa were obtained from MiBioGen consortium. CRS data (22,099 cases vs. 371,520 controls) were sourced from the FinnGen R12 cohort. Causal effects were estimated via Inverse Variance-Weighted (IVW), MR-Egger, weighted median, and Bayesian-weighted MR methods. Sensitivity analyses (heterogeneity and horizontal pleiotropy tests) were performed to validate robustness. Results IVW analysis identified 20 GM taxa significantly associated with CRS risk (p < 0.05). Of these, 7 taxa (e.g., Francisellales, Roseibacillus, Merdibacter massiliensis) exhibited risk-increasing effects, while 13 taxa (e.g., Firmicutes I, Succinivibrionaceae) showed protective effects. Sensitivity analyses confirmed the absence of significant heterogeneity (Cochran’s Q p > 0.05) or pleiotropy (MR-Egger intercept p > 0.05). Bayesian-weighted MR validated 18 causal relationships (posterior probability > 95%), except for RUG420 sp900317985 and UBA7703 (non-significant). Conclusions This MR study provides genetic evidence supporting causal roles of specific GM taxa in CRS pathogenesis. These findings highlight the gut-sinus axis as a potential therapeutic target and underscore the utility of large-scale biobanks (e.g., FinnGen) in advancing precision medicine. Level of evidence: Level 5. Mendelian Randomized (MR) studies are second only to randomized controlled trials in terms of the level of evidence.

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Abstract Objective This study aimed to test at an experimental level the contributions of traditional treatments with Platelet Rich Plasma (PRP) to the recovery of hearing in hearing loss due to acoustic trauma. Methods Thirty healthy adult rats were used in the study. Otoacoustic Emission (OAE) measurements were performed before the study. All rats with OAE measurements were exposed to 95 dB pure tone sound at a frequency of 4 kHz for 60-minutes. OAEs of the experimental animals were measured again at the 24th hour and it was determined that acoustic trauma had occurred. The rats were divided into 3 groups of 10, the first group was the control group, the 2nd group was determined as the group in which approximately 0.5 mL of intratympanic PRP was injected for 5 doses with 2 days intervals, and the 3rd group was determined as the group in which approximately 0.5 mL of intratympanic steroid was injected with 2 days intervals. OAE measurements made after 7 and 21 days were evaluated, and the treatments given were compared to the group without treatment. Results The results obtained from day-by-day and frequency-by-frequency measurements of DPOAE were statistically compared to check whether significant results were obtained. It was determined that better results were obtained in rats with acoustic trauma treated with PRP and prednol compared with acoustic trauma who received no treatment, and close treatment efficacy results were found between PRP and prednol groups. Conclusion When DPOAE measurements of these three groups at 4 kHz frequency on various days were compared with Group 1, a significant statistical difference was observed in Groups 2 and 3, but no significant difference was found between Groups 2 and 3. It was concluded that PRP is as effective as steroids in the improvement of hearing.

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Abstract Objective To perform a thorough evaluation of body balance in Turner Syndrome, adding evidence to the already scarce data in literature regarding labyrinth impairment in these patients. Methods Adolescent and adult patients and a control group of healthy women were subject to otolaryngological, audiological, and vestibular evaluations. The latter included electronystagmography with caloric and rotational testing, cervical vestibular-evoked myogenic potential and static posturography with dynamic tests. Results Twenty-seven patients aged 15–33 years (mean: 21.9-years) were evaluated. Karyotype was 45,X in 13/27 cases. Dizziness was reported in eight patients and progressive hearing loss in ten. Audiometry was abnormal in 13/27 cases, six of them sensorineural, six conductive, and one with a mixed pattern. A balance abnormality was found in 21/27 patients (78%). Nineteen patients had vestibular lesion, [12 peripheral (57%), four combined (19%), three central (11%)] and two had only somatosensorial deficit. Non-vestibular abnormalities were found in 6 (22%) patients, five with somatosensorial deficit and one with visual dependence. Balance abnormalities were neither associated with karyotype (45,X vs. other karyotypes) nor with hearing impairment. Control group comprised 20 healthy women aged 27–35 years (mean: 30.5 years); 4/20 (25%) had a balance abnormality, two peripheral and two central causes, a frequency significantly lower than that of TS patients (p < 0.001). Conclusion Despite the low frequency of self-reported vestibular and auditory symptoms, this study reveals a high rate of inner ear involvement among women with TS, in which both auditory and vestibular pathways are frequently affected, often in a subclinical or compensated manner. These findings reinforce the importance of comprehensive screening protocols and indicate that appropriate interventions, including vestibular rehabilitation, should be considered as components of clinical follow-up in this population. Level of evidence: 4.

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Abstract Objective To translate, culturally adapt and validate the Cuestionário de Expectativas (CEA) for the Brazilian context, with focus on assessing the expectations of patients during pre-surgical stage. Methods An analytical and descriptive study was carried out, including translation, back-translation, adaptation and validation of the CEA. The process involved 119 participants who answered the questionnaire, allowing the analysis of understanding of the items using the Content Validity Index (CVI) and Exploratory Factor Analysis (EFA). Reliability was assessed with Cronbach's Alpha, McDonald's Omega and Composite Reliability coefficients, using Item Response Theory (IRT). Results The questionnaire had a total CVI of 0.974, indicating good comprehension by the participants, as well as high values for three internal consistency coefficients (⍺ = 0.828; ω = 0.854; CC = 0.900). The instrument showed great consistency indices and validity measures to be applied on a large scale. Conclusion The validity and reliability of the instrument were confirmed. Therefore, the instrument was translated, adapted and validated for Brazilian Portuguese. Levels of evidence: Step 2.

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Abstract Objectives In this research, nomograms were constructed from clinical variables in patients with postoperative Follicular Thyroid Cancer (FTC) to predict the survival of FTC patients. Methods Adult patients surgically treated for FTC from 2004 to 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Significant clinical variables were screened using univariate analysis and further screened with multivariate Cox regression analysis, which were used to construct nomogram models for Overall Survival (OS) and Cancer-Specific Survival (CSS). Results Age, sex, marital status, tumor size, glandular invasion status, N stage and M stage were identified as the clinical variables affecting the OS in FTC patients. Additionally, all variables, except sex, were found to have an impact on the CSS in FTC patients. The c-index shows agreement between the predicted results and the actual observed results, and the calibration curve of the probability of survival also shows agreement between the predicted plot and the actual observations. Conclusions Our study successfully built a nomogram of OS and CSS for FTC patients who had undergone surgery. Level of evidence: IV: Retrospective cohort study.

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Abstract Objective Previous observational studies have indicated an association between various immune cells and allergic rhinitis; however, the causal relationship remains uncertain. This study seeks to further investigate the causal link between immune cells and allergic rhinitis through bidirectional two-sample Mendelian randomization analysis. Methods Allergic rhinitis related data were obtained from the MRC-IEU database, while data for 731 immune cells were sourced from the GWAS catalog. The causal association between immune cells and allergic rhinitis was assessed using inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode methods. Stability and reliability of the findings were evaluated through Cochran's Q test, MR-Egger intercept p-value, and leave-one-out analysis. Results Primarily based on IVW methods, 38 distinct immunocyte phenotypes were identified as potentially influencing allergic rhinitis (p < 0.05), while allergic rhinitis was found to potentially impact 20 different immunocyte phenotypes (p < 0.05). The results for heterogeneity, horizontal pleiotropy, and sensitivity analyses demonstrated stability. Conclusion This study establishes a strong genetic correlation between immune cells and allergic rhinitis, enhances current knowledge regarding the role of immune cells in AR, and offers potential targets for the development of novel immune-based therapeutic strategies. Level of evidence: Level 5.

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Abstract Objective To explore the propensity matching score to compare the clinical efficacy of infection localized and inflammatory quiescent stage I surgery in the treatment of congenital preauricular fistula. Methods 120 patients with congenital preauricular fistula treated in our hospital from January 2022 to August 2023 were selected. The patients were divided into infection limited group (n = 63) and inflammation rest group (n = 57) according to the mode of operation. The two groups were matched at 1:1 with Propensity Score Matching (PSM) method, and finally included in infection limitation group and inflammation rest group (n = 50). Patients in both groups were treated with stage I operation. Results Before PSM, there were significant differences between the two groups in terms of gender, age, BMI, and the number of patients with previous infection requiring incision and drainage (p < 0.05). After PSM, there were no statistically significant differences in general information between the two groups (p > 0.05). There was no significant difference in healing, incidence of postoperative complications and recurrence rate between the two groups (p > 0.05). Conclusion There is no significant difference in the clinical efficacy comparison of surgical treatment for congenital preauricular fistula between the infection-localized phase and inflammation-quiescent stage I surgery with PSM. Level of evidence: Level 3.

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Abstract Objective Is to compare two tomographic measurements that can be used to predict the visibility of the round window: the angle formed by the junction of the line that goes from the round window Membrane Center Point (MJR) to the Facial Nerve surface (FN) with the Coronal Plane (CP) traced over this surface (RWM-FN-CP Angle) and the vertical distance between the midpoint of the RWM and this Coronal Plane (RWM-CP Vertical Distance); in adults and children, in order to verify if there are significant differences between the groups, which would justify the greater surgical difficulty caused by the lower visibility of the RW in children. Methods In this retrospective study, the RWM-FN-CP angle and the RWM-CP vertical distance were measured in Computerized Tomography Scans (CT) of patients who underwent CI surgeries. Results 32 individuals who underwent CT in the period 2015–2018, 16 adults aged 27–73 years, and 16 children, with a mean age of 3.4 (±2.7) years were evaluated. The mean of the RWM-FN-CP angle in children was significantly lower, than the mean in adults. The mean RWM-CP vertical distance in children was significantly lower than the mean in adults (p = 0.0001). Conclusion In children, the RWM-FN-CP angle is more acute, and the measured MJR-PC vertical distance is smaller when compared to adults. The anatomical differences observed in the tomographies justify the lower visibility of the RW during the surgical act of cochlear implantation in children. Level of evidence: 3.

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Abstract Objective The present study’s goal was to estimate the inferior laryngeal nerves monitoring impact on patient’s vocal quality after thyroidectomy in head and neck surgery training program. Methods Eighty-five patients were evaluated, mean age 48,19 yrs., with no thyroid hormone dysfunctions. They were randomly distributed into two groups. Forty patients were operated on without nerve monitor (Group A) and other 45 with nerve monitor (Group B). The groups were controlled by gender, age, tobacco use, thyroid volume, surgery extent, post-op hypoparathyroidism, malignancy and laryngeal trauma. The patients went through perceptive evaluation and acoustic vocal analysis, before and after surgery (1st and 4th week). The same group of head and neck resident surgeons operated on all patients. Results In perceptive evaluation, only breathiness (4th week), showed significant difference between the groups (25% in Group A vs. 6.7% in Group B, p = 0.041). However, when the patients were compared with themselves, evaluating the status before versus after surgery, none of the parameters, not even breathiness, showed any significant difference. In vocal acoustic analysis, no significant difference was observed. Fundamental frequency (Hz) in women was 202.62 (before surgery), 198.19 (1st-week) and 191.90 (4th-week) in Group A, and 193.48 (before surgery), 190.63 (1st week) and 186.81 (4th week) in Group B. Conclusion At the present study, there was no impact, neither improvement nor worsening, in vocal quality of patients submitted to thyroidectomies with inferior laryngeal nerves monitoring. Level of evidence: Level 1.

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Abstract Objective To compare the postugraphic outcomes of two different methods in four basic postural conditions. Methods The individuals with vestibular disorders were divided into two subgroups according to their age: more than 60-years old and aged between 18 and 60. All the participants underwent to computerized dynamic posturography (EquiTest System®) and a mobile posturography (Vertiguard System®) in four test conditions: (1) Eyes open and stable surface, (2) Eyes closed and stable surface, (4) Eyes open and unstable surface, (5) Eyes closed and unstable surface. Results The elderly group presented worse overall outcomes in computerized dynamic posturography compared to controls. These outcomes were not different between groups when mobile posturography was used. For both methods, the results were not different between groups when the Conditions 1, 2 and 5 were evaluated separately. A significantly higher proportion of elderly subjects exhibited alterations in C4 during mobile posturography. Conclusion Computerized dynamic posturography was overall more sensitive at detecting abnormal postural sway in elderly individuals with vestibular disorders. In mobile posturography, Condition 4 also seemed particularly sensitive at detecting postural instability. Level of evidence: 2.

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Abstract Objective This study evaluates the prognostic significance of systemic inflammatory markers ‒ NLR, LMR, PLR, and SII ‒ in patients with SSNHL. Methods This retrospective study included 120 patients diagnosed with SSNHL at the Otolaryngology Department of Hospital. Medical records from both SSNHL and healthy control groups were reviewed to collect demographic data, pure tone audiometry results, and routine blood parameters. Hearing recovery was assessed at baseline and after two months using Siegel's criteria, and patients were categorized as either recovered (complete, partial, or slight recovery) or unrecovered. Results Compared to controls, SSNHL patients showed significantly elevated neutrophil counts, platelet levels, NLR, PLR, and SII values. Statistically significant differences were observed between recovered and unrecovered groups in neutrophil count (p = 0.021), lymphocyte count (p = 0.001), PDW (p = 0.042), NLR (p = 0.001), PLR (p = 0.001), LMR (p = 0.001), and SII (p = 0.001). Logistic regression analysis identified low LMR as a significant independent predictor of poor prognosis (R² = 0.271). Conclusion Elevated NLR, PLR, and SII values may reflect inflammatory processes and microvascular dysfunction in SSNHL. Among these, LMR emerged as a novel and potentially valuable prognostic biomarker for predicting treatment outcomes. Level of evidence: 3.

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Abstract Objective Sudden Sensorineural Hearing Loss (SSNHL) is routinely encountered in otolaryngology clinics. The prognosis of SSNHL varies dramatically and depends on multiple influence factors. This study aimed to develop an explainable Machine Learning (ML) model with easily accessible features to predict the prognosis of SSNHL. Methods This bi-center retrospective study included 534 patients with SSNHL. We randomly split the data into training and validation sets. Univariate analysis and Least Absolute Shrinkage and Selection Operator (LASSO) regression were employed to select predominant features, including demographic, disease-specific characteristics, and laboratory items. We evaluated the performance of five ML models constructed with six crucial variables using the Area Under the receiver operating characteristic Curve (AUC), accuracy, specificity, sensitivity, and F1 scores. These models were further calibrated by calibration curve and Brier score. Clinical utility was evaluated by Decision Curve Analysis (DCA). The Shapley Additive Explanations (SHAP) method was applied to interpret feature contribution and explain the ML models. Results The Random Forest (RF) model reached the highest AUC of 0.998. Its accuracy, sensitivity, specificity, and F1 score were 0.981, 0.963, 0.989, and 0.967, respectively. DCA curve analysis revealed a comparable net benefit of the models. The SHAP method revealed that the primary features were degree of hearing loss, audiogram type, age, Mean Corpuscular Volume (MCV), onset to treatment, and serum Albumin (ALB) accordingly. Conclusions The explainable ML model was superb in predicting hearing outcome and providing information on feature contributions. Clinicians can better understand the contributors to hearing recovery and guide aural rehabilitation using the SHAP method. Level of evidence Level 3.

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Abstract Objective The prevalence of Nasopharyngeal Carcinoma (NPC) is increasing, and the mortality of patients with cisplatin resistance is high. In this study, we aimed to elucidate several potential mechanisms of miR-199a-5p in regulating the progression and cisplatin resistance of NPC. Methods Relevant datasets were downloaded from the Gene Expression Omnibus (GEO) database to verify miR-199a-5p expression in NPC. The miR-199a-5p level was evaluated by RT-qPCR, and the prognostic significance was analyzed by K-M curve. Cell proliferation, migration, invasion and apoptosis were detected in vitro. The contents of Epithelial-Mesenchymal Transition (EMT) protein, apoptosis protein and SLC1A5 protein were detected by Western immunoblotting. DLR assay elucidated that miR-199a-5p targets SLC1A5. The effect of miR-199a-5p on subcutaneous tumor in nude mice was detected in vivo. Results We found that miR-199a-5p was differentially expressed in nasopharyngeal carcinoma, and patients with high expression showed good prognosis. It was also found to be associated with cisplatin resistance and showed low expression in HNE1/DDP cells. The up-regulation of miR-199a-5p can inhibit the proliferation, migration and invasion of NPC cells, and enhance cell apoptosis. The mechanism may be achieved by targeting SLC1A5. Conclusion The high expression of miR-199a-5p can inhibit SLC1A5 and thus the progression of NPC. At the same time, the high expression of miR-199a-5p can increase the sensitivity of NPC to cisplatin. Level of evidence Level 5.

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Abstract Objectives Human Papillomavirus (HPV) may be a predictive biomarker predictor for clinical outcome and influence treatment decisions in patients with Head and Neck Squamous Cell Carcinoma (HNSCC). Methods We evaluated 253 patients with HNSCC from state of São Paulo, Brazil. The influence of p16INK4a expression was analyzed with epidemiological and clinical variables. Results In total, 32.4% of tumors studied had positive (+) p16INK4a protein expression, and 67.6% had negative. The variables were similar in both groups being the mostly with age under 64-years, male, white race, functional illiterate, smokers and alcoholics. The most affected primary site was oral cavity with T3/T4 tumoral stage, N1/N2/N3 nodals, M0 metastasis and III/IV clinical stage. Patients with oropharyngeal primary site and (+) p16INK4a, clinical staging III and chemotherapy treatment had worse survival. The median time of distant metastasis-free was 38.3-months in oropharyngeal (+) p16INK4a and 15.1-months in negative (−) p16INK4a. Conclusion In the present study, the epidemiological variables are similar in both groups (Positive and negative p16INK4a expression): age under 64-years, male, white, functionally illiterate, smokers and alcoholics. There is no association of p16INK4a expression with primary site, however, the (−) p16INK4a shows better overall survival, higher frequencies in distant metastasis and less free time of the disease. Although the literature shows a greater survival in oropharynx (+) p16INK4a, our results are contradictory. It is suggested that future studies in different regions and with a larger sample size should be carried out to confirm these findings, because the patients who participated in the present study are only from a specific region of Brazil. Level of evidence 2B.

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Abstract Objective The combined endoscopic and open frontolateral laryngectomy technique has been proposed to balance oncologic safety with functional preservation in the management of glottic tumors involving the Anterior Commissure (AC). This study aims to describe this technique in detail, its indications, and to present our institution’s case series. Methods A retrospective review was conducted of all patients undergoing surgery for glottic lesions suspected of malignancy between 2017 and 2024 at a single institution. Patients treated with the combined endoscopic and open frontolateral laryngectomy approach were included. Surgical technique, indications, contraindications, and perioperative management were documented. Outcomes assessed included oncologic control, tracheostomy status, and laryngeal function. Results Among 138 patients treated surgically for suspected malignant glottic lesions, four patients underwent the combined approach. Tumor stages included T1b (n = 2), T2 (n = 1), and T3 (n = 1). All patients were male, with a mean age of 71.5-years. Local disease control was achieved in three patients (75%), while one T3 patient experienced recurrence requiring salvage radiotherapy, achieving subsequent disease control. All patients retained laryngeal function, with no need for permanent tracheostomy or reports of dysphagia. Postoperative dysphonia was characterized by roughness, breathiness, and high-pitched but functional voices. Conclusion The combined approach offers a feasible alternative for managing AC-involving glottic tumors, providing oncologic safety while preserving function. It enables precise tumor resection with limited sacrifice of normal tissue and the potential for phonation-preserving reconstruction. Given the small sample size, further studies are needed to validate its efficacy and long-term benefits. Level of evidence 4.

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Abstract Objective To assess the discriminative validity and diagnostic accuracy of posturographic parameters from the Horus® in individuals with and without vestibulopathy. Methods This is a methodological study of discriminative validity and diagnostic accuracy. 153 individuals aged 40-79, of both sexes, were included and divided into Group 1 (with vestibular dysfunction) and Group 2 (without vestibular dysfunction). Instruments on clinical characterization, cognition, physical activity level, and posturography were applied. Discriminative validity was assessed with nonparametric multivariate analyses, the Mann-Whitney test, controlled with Holm adjustment and rank-biserial correlation to estimate effect size. Sensitivity, specificity, area under the curve, and cutoff points were calculated using ROC curves. Results The final sample included 78 individuals in Group 1 and 75 in Group 2, with mean ages of 59.36 and 56.48 years, respectively. Significant differences were found between the groups for all dependent variables related to confidence ellipse/limit of stability and mediolateral velocity (p < 0.001), with moderate to large differences (ES > 0.28) and in most of the anteroposterior velocity and sensory analysis (p < 0.005), with small to moderate differences (ES: >0.11 and <0.43). The ROC curve analysis revealed that confidence ellipse/limit of stability and mediolateral velocity exhibited high specificity (84% and 80%) and moderate sensitivity (52.6% and 53.85%). The Vestibular Function parameter demonstrated good sensitivity (70%) and moderate specificity (60.8%), while the Composite Balance Index showed a sensitivity of 79.5% and specificity of 64%. Conclusion Horus® posturographic parameters demonstrated moderate to good discriminative ability to differentiate individuals with and without vestibular dysfunction, with high sensitivity for vestibular function and the Composite Balance Index. Level of evidence 3 (cross-sectional study).

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Abstract Objectives This study aimed to use Mendelian Randomization (MR) method to explore the potential causal association of triglyceride and cholesterol on the risk of vestibular vertigo and potential mediating factors. Methods We extracted genetic variants associated with triglyceride and cholesterol from the genome-wide association study. Univariable two-sample MR were performed to evaluate the effects of triglyceride and cholesterol on the vestibular vertigo. Besides, Multivariate MR (MVMR) was used to estimate direct effects of triglyceride and cholesterol on the vestibular vertigo after adjusting for potential mediating factors. We also performed that a two-step mediation MR framework to elucidate potential mediators and to estimate the proportion of the association mediated. Results Genetically predicted triglyceride and cholesterol were positively associated with the risk of vestibular vertigo. In the MVMR analysis, causal associations between triglyceride and cholesterol with vestibular vertigo remained stable and robust after adjusting for body mass index, hypertension, and type 2 diabetes, whereas the association between triglyceride and cholesterol and the risk of vestibular vertigo became nonsignificant after adjusting for vitamin D. In the mediation analysis, we found that the causal effect of cholesterol on vestibular vertigo might partly mediated by vitamin D. Conclusion The present study provides robust evidence that genetically predicted triglyceride and cholesterol are independently causally associated with the risk of vestibular vertigo. Vitamin D also was found to mediate the causal pathways between cholesterol and vestibular vertigo. Level of evidence Level III.

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Abstract Objective To propose a protocol for image-guided implant placement estimation, combining 3D reconstruction of preoperative Computed Tomography (CT) images and a guide-marker, for individuals undergoing percutaneous Bone Conduction Hearing Devices (BCHD). Methods Fifty-one subjects aged 6- to 75-years undergoing percutaneous BCHD surgery were included. Three optional implant points were estimated and marked using a guide-marker, and compared with preoperative CT images to define optimal placement. A peer validation was conducted by two independent reviewers to assess the replicability of the protocol in clinical practice. Results Bilateral CT images were obtained from all 51 subjects, and a total of 54 BCHD surgeries were performed. Relevant findings, including mastoid cells (19.6%), cranial suture lines (27.5%), perforating vessels (13.7%), bone surface irregularities (1.9%), venous lakes (9.8%), and fixation plates (3.9%) were identified in 52.9% of subjects, and they affected the implant placement in 37.3% of cases. There was moderate agreement between the reviewers regarding implant placement in both right and left ears, and in relation to the actual implant placement performed during the surgical procedure. Conclusion The image-guided implant placement estimation, combining 3D reconstruction of preoperative Computed Tomography (CT) images and a guide-marker, has proven reliable and effective for estimating optimal implant placement in subjects undergoing percutaneous BCHD surgery, thereby constituting a valuable tool for clinical practice. Level of evidence 2.

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Abstract Objectives To develop and evaluate the anatomical accuracy and haptic fidelity of an affordable kit consisting of a silicone head, a foam support, and a 3D-printed biomodel of the paranasal sinuses for surgical training. Methods This single-center, technological, and interventional study detailed the development of a human sinus biomodel. Its anatomical and haptic evaluation was conducted by ten senior rhinologists, who performed 37 standard surgical tasks. Participants rated similarity to fresh cadaveric dissection on a 5-point Likert scale. Computed tomographic images were converted into a standard tessellation file through a combination of automatic and manual segmentation. This file was then used in a 3D printer to create the biomodel, which was customized with a red silicone coating to emulate mucosa, as well as silicone-insulated wire and acrylic yarn to simulate arteries and nerves. The model was mounted onto a silicone head and foam support, with a total production cost of US$ 43.37. Results The similarity of anatomic landmarks scored a mean above 4.0 ± SD on both sides. The lacrimal bone drilling/debulking procedure was somewhat suboptimal for exposing the lacrimal sac, scoring a mean of 3.1 ± 1.04 on the left side but 4.3 ± 0.64 on the right. Likewise, uncinectomy was rated 3.4 ± 1.02 on the left and 3.7 ± 0.90 on the right, while the periorbit incision received scores of 3.5 ± 0.92 on the left and 4.5 ± 0.50 on the right. All other steps received ratings above 4.0 ± SD. Conclusion This study presents a fully reproducible and cost-effective method for constructing a 3D sinus biomodel. The model demonstrated high anatomical and haptic fidelity, as validated by senior rhinologists, making it a valuable tool for surgical training in sinonasal procedures. Level of evidence This study provides Level 2 evidence.

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Abstract Objective To develop and evaluate a predictive model for cognitive impairment, assessed by a brief cognitive test, among middle-aged and older adults with self-reported hearing loss, aiming to facilitate early identification and targeted intervention in high-risk populations. Methods This study utilized data from the 2011-2018 waves of the China Health and Retirement Longitudinal Study, including 1,093 individuals aged 45 and above with self-reported hearing impairment but normal cognition at baseline. The average follow-up duration was 5.2-years. Cognitive impairment was defined as a total cognitive score at least one standard deviation below the mean for the corresponding age group. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors, and a nomogram was constructed based on significant variables. Model performance was assessed using calibration curves, time-dependent Concordance indices (C-index), and the Area Under the receiver operating Characteristic Curve (AUC). Risk stratification analysis was conducted across various sociodemographic subgroups. Results During follow-up, 152 individuals (13.9%) developed cognitive impairment. Higher education level, urban residence, and participation in leisure social activities (e.g., playing mahjong) were independently associated with lower risk of cognitive impairment. The nomogram demonstrated good discriminative performance, with AUCs of 0.728, 0.762, and 0.768, and corresponding time-dependent C-indices of 0.719, 0.761, and 0.767 at 3-, 5-, and 6-year follow-up points, respectively. Calibration plots indicated good agreement between predicted and observed risks. Risk scores varied significantly across subgroups defined by sex, age, education level, and residential location. Kaplan-Meier analyses confirmed the model’s effective risk stratification capability. Conclusion This study presents the first predictive model tailored to cognitive risk heterogeneity among older adults with self-reported hearing loss. By incorporating a brief cognitive test, the nomogram demonstrated reliable performance and holds potential for use in risk stratification, population screening, and personalized preventive interventions. Level of evidence 2 ‒ Prospective cohort study based on the longitudinal CHARLS data.

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Abstract Objectives PIK3CA-Related Overgrowth Spectrum (PROS) is a highly heterogeneous disease. Facial Infiltrating Lipomatosis (FIL) is a rare PROS subset, and its atypical phenotypes, such as macrotia, present diagnostic and therapeutic challenges due to limited data. This study aims to detail the diagnostic and long-term management procedures for an extremely rare case of Macrotia associated with PROS/FIL. Methods To confirm the underlying etiology, Whole Exome Sequencing (WES) was performed, complementing routine clinical and pathological examinations. Otoplasty was used as the intervention to reduce ear size. Long-term follow-up was conducted to monitor surgical outcome, stability, and potential recurrence. Results WES identified a PIK3CA pathogenic variant (p.H1047R). Combined with pathological findings, the patient was definitively diagnosed with PROS manifesting as the FIL phenotype. The reductive otoplasty surgery achieved significant improvement in the affected ear's morphology, reducing the deformity to a minimal, aesthetically pleasing level. Crucially, the 1-year follow-up showed remarkable stability in the near-normal ear contour, without any signs of recurrence or overgrowth. The successful aesthetic restoration significantly alleviated the patient's psychological distress. Conclusions This case demonstrates that WES is essential for accurate molecular diagnosis of PROS/FIL in patients presenting with atypical phenotypes like Macrotia. Furthermore, otoplasty is an effective and reliable reconstructive strategy for restoring ear aesthetics in these patients, providing excellent and stable long-term results and improving patient quality of life. Level of evidence Level 4.

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Abstract Objective To evaluate the clinical efficacy of Chinese Herbal Medicine (CHM) in treating Allergic Rhinitis (AR) through meta-analysis. Methods A meta-analysis was conducted using a random effects model to explore the impact of CHM on response rates, nasal symptom scores, quality of life, blood Immunoglobulin E (IgE) levels, and adverse reactions. Results A total of 1,326 articles were retrieved, of which 12 studies were included. The meta-analysis showed that the response rate in the experimental group was higher than in the control group (p < 0.001). The adverse reaction rate was lower in the experimental group compared with the control group (p = 0.003). Subgroup analysis by publication year indicated that studies published in 2024 and 2023 showed lower nasal congestion scores in the experimental group compared with the control group (p < 0.0001); nasal itching scores were lower in the experimental group than in the control group (p < 0.0001). Subgroup analysis by age revealed that the 30+ and 40+ age groups had lower nasal itching scores, sneezing scores and rhinorrhea scores in the experimental group compared with the control group (p < 0.0001). Blood IgE levels were also lower in the experimental group compared with the control group (p = 0.002). Scores for the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were lower in the experimental group (p < 0.0001). Conclusion The current evidence suggests that CHM can enhance the efficacy of AR treatment, improve patients’ quality of life, and result in a lower rate of adverse reactions. Level of evidence I.

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Abstract Objective Benign Paroxysmal Positional Vertigo (BPPV) is transient vertigo and paroxysmal nystagmus induced by changes in head position. This study was conducted to investigate the differential expression of serum proteins in patients with refractory BPPV and to screen for diagnostic biomarkers. Methods Serum samples were collected from patients with BPPV; tandem mass tag-based quantitative proteomics technology was used to detect and quantify the serum proteins of 30 individuals with refractory BPPV and 30 control volunteers. Bioinformatics analysis of differentially expressed proteins was performed using hierarchical clustering, gene ontology annotation, Kyoto Encyclopedia of Genes and Genomes analysis, and protein-protein interaction network analysis. Results A total of 769 proteins were identified, and 57 differentially expressed proteins were screened between the two groups; 15 proteins were upregulated, whereas 42 were downregulated. Five differentially expressed proteins were chosen for parallel reaction monitoring analysis to confirm the results. Apolipoprotein A-I, apolipoprotein A-II, apolipoprotein C-III, fibrinogen gamma chain, and fructose-bisphosphate aldolase B were the five potential candidate biomarker proteins. Conclusions This is the first quantitative proteomic study to reveal diagnostic biomarkers in patients with BPPV using tandem mass tag labeling technology. The identified differential proteins may improve the understanding of the pathogenesis and molecular mechanism of BPPV. Level of evidence Level 4.

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Abstract Objective Emerging evidence suggests inflammation contributes to Meniere’s Disease (MD), a chronic vestibular disorder characterized by vertigo, hearing loss, and tinnitus. However, the causal role of Inflammatory Factors (IFs) and the mediating effects of Plasma Metabolites (PMs) in MD remain unclear. This study investigated bidirectional causality between IFs and MD and evaluated PMs as potential mediators. Methods Using Genome-Wide Association Study (GWAS) summary data, we performed bidirectional Mendelian Randomization (MR) analyses to assess causal links between 91 IFs, 1,400 PMs, and MD. Single Nucleotide Polymorphisms (SNPs) genome-wide significant for IFs, PMs, and MD served as instrumental variables. Inverse Variance Weighting (IVW), MR-Egger, and weighted median methods were applied. Mediation analysis quantified PMs’ role in IF-MD associations. Sensitivity analyses (MR-PRESSO, leave-one-out) tested robustness. Results Genetically predicted higher CCL23 levels reduced MD risk (IVW OR = 0.5757 per SD decrease; 95% CI 0.3679-0.9007; p = 0.0156). No reverse causality from MD to IFs was observed (IVW OR = 0.9919; 95% CI 0.9812-1.0028; p = 0.1448). Mediation analysis revealed PMs accounted for 14.6% of the protective effect of IFs on MD. Elevated IF levels correlated with increased PMs (IVW OR = 1.0788; 95% CI 1.0125-1.1494; p = 0.0192), while higher PMs reduced MD risk (IVW OR = 0.5444; 95% CI 0.3006-0.9859; p = 0.0448). Sensitivity analyses confirmed result consistency, with no significant pleiotropy. Conclusion This study identifies CCL23 as a protective factor against MD, partially mediated by PMs. Findings underscore inflammation and metabolic pathways as potential therapeutic targets. Further validation in diverse populations and exploration of biological mechanisms are needed to advance MD treatment strategies. Level of evidence 5.

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Abstract Objectives Hearing loss significantly impacts auditory function and quality of life in children. Assessing Health-Related Quality of Life (HRQoL) using utility measures provides valuable insight into the effectiveness of interventions such as Cochlear Implants (CI) and Hearing Aids (HA). To compare HRQoL using multiple utility measures (HUI-3, EQ-5D-5 L, VAS) and functional auditory performance (PEACH, TEACH) in children with cochlear implants, hearing aids, and unaided severe to profound hearing loss. Methods Ninety children aged 7-10 years were divided into three groups (n = 30 each): CI users, HA users, and children with unaided severe to profound hearing loss. Utility measures and auditory performance scales were administered. Statistical analysis involved ANOVA and Pearson’s correlation. Results CI users exhibited the highest utility scores (HUI-3 = 0.68964; EQ-5D = 0.88446) and auditory performance scores (PEACH = 37; TEACH = 25.83). Strong correlations were found between utility scores and auditory performance. HUI-3 showed greater sensitivity in detecting hearing-specific QOL improvements. Conclusion Cochlear implantation results in superior HRQoL and auditory performance compared to hearing aids. Use of sensitive, hearing-specific tools like HUI-3 is recommended. Level 3 Non-randomized controlled cohort/follow-up study.

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Abstract Objective To establish consensus-based recommendations for the indication, surgical technique, and perioperative care in glottoplasty for transgender women seeking vocal feminization. Methods Ten otolaryngologists from distinct Brazilian academic institutions, all experienced in transgender voice surgery, contributed to this position paper. A modified Delphi method was applied, supported by a narrative literature review. Recommendations were classified using Oxford Centre for Evidence-Based Medicine levels. Results Glottoplasty is indicated for transgender women experiencing vocal gender incongruence, regardless of their baseline fundamental frequency. Absolute and relative contraindications were defined, as well as recommended preoperative assessments such as videolaryngoscopy, acoustic voice analysis, and validated quality-of-life questionnaires. Perioperative management includes voice rest, individualized medication protocols, and post-operative voice therapy. Most recommendations are based on level IV and V evidence, reflecting the current paucity of prospective studies. Conclusion This is the first Brazilian consensus on glottoplasty for transgender women, providing structured clinical guidance for indication, technical execution, and follow-up. Higher-level evidence is needed to strengthen future recommendations.

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Abstract Objective Determine odds of incident cognitive impairment among patients with severe to profound hearing loss and co-existing multisensory impairment. Patients 14 prospectively recruited aging (age 50+) patients with severe and profound hearing loss were pooled for analysis with 180 previously enrolled patients with demonstrated multisensory impairment. Patients were recruited as part of a cross-sectional case-control study at a tertiary care neurotologic/audiologic outpatient clinic. Interventions Patients with severe and profound hearing loss were identified and underwent point-of-care multisensory testing and cognitive testing. Main outcome measures Multisensory testing using the Affordable, Rapid Olfactory Measurement Array (AROMA) for olfaction, pure tone audiometric evaluations, and the Timed ‘Up and Go’ test for gait and balance. Cognitive impairment was assessed via the Montreal Cognitive Assessment for the Hearing Impaired (HI-MoCA). Results A total of 194 patients were included. 34% (n = 66) screened positive for cognitive impairment. Olfactory dysfunction, gait impairment, and sensorineural hearing loss were all significantly (p < 0.05) associated with higher odds of cognitive impairment (ORs = 3.17, 3.71, and 3.23, respectively in a multivariate model). Subjects with dysfunction in all domains were at highest risk for cognitive impairment (OR = 15.2, p < 0.001) compared to impairment in 2 domains (OR = 5.09, p < 0.001). Severe and profound hearing loss had higher odds (OR = 8.32) compared to mild-moderately severe hearing loss (OR = 2.81) of having incident cognitive impairment. Conclusions Dysfunction of the olfactory, auditory, and balance systems is associated with significantly increased odds of cognitive impairment. Patients with severe and profound hearing loss were more likely to have cognitive impairment.

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Abstract Objective To identify value of prognostic model constructed based on tumor module-associated differential autophagy genes in Head and Neck Squamous Cell Carcinoma (HNSC), and verified through in vitro and tissue experiments. Methods After obtaining the relevant information of HNSC patients from the GEO and TCGA databases, we used Weighted Correlation Network Analysis (WGCNA), multivariate Cox regression analysis, and survival analysis to construct a prognostic prediction model, and validated the prognostic value of the model. We used RT-qPCR and cell scratch assays to validate in vitro for the biological results with TU686 and CAL-27 cell lines. We collected pathological sections from 30 patients with laryngeal cancer, hypopharyngeal cancer, and 10 patients with vocal cord polyps, and immunohistochemical DAB staining was performed to detect the expression of GSK3B in these tissues. Results A total of 6163 differentially expressed genes were jointly identified between HNSC and control samples. WGCNA analysis revealed that the genes clustered in the brown module had the highest correlation with HNSC. Using the formula derived from the inclusion of 7 genes in the prognostic model, the risk scores were calculated for the training and validation sets of HNSC disease samples. Survival analysis results showed a significant difference in Overall Survival (OS) between the high and low-risk groups in both the training and validation sets (p < 0.05). The one-year, three-year, and five-year AUC values of the risk scores obtained from the prognostic model in the training and validation sets were all greater than 0.6. After knocking down GSK3B, the relative expression levels of si-GSK3B in the si-GSK3B1 and si-GSK3B2 groups were significantly lower than those in the NC group (both p < 0.05). We compared with the NC group, the migration ability of TU686 and CAL-27 cells was significantly decreased (both p < 0.05). We used immunohistochemical DAB method to detect and found that the content of GSK3B in laryngeal cancer was significantly higher than that in vocal cord polyps (p < 0.05), and the content of GSK3B also in pharyngeal cancer was significantly higher than that in vocal cord polyps (p < 0.05). Conclusion Prognostic model constructed based on tumor module-associated differential autophagy genes in HNSC holds prognostic value. Level of evidence Level 3.

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Abstract Objectives To evaluate the impact of minimal Extrathyroidal Extension (mETE) on structural recurrence, prognostic variables, and disease-free survival in patients with Differentiated Thyroid Carcinoma (DTC) treated surgically. Methods A retrospective cohort of 629 patients who underwent thyroidectomy for DTC was analyzed. Patients were divided into two groups: Group 1 (n = 413) with tumors confined to the thyroid, and Group 2 (n = 216) with minimal extrathyroidal extension. Clinical, pathological, and biochemical variables were compared between groups. The minimum follow-up period was 30-months or until death, with an average follow-up of 71.5-months. Univariate and multivariate analyses were performed to identify independent predictors of structural recurrence. Results Structural recurrence occurred in 6.5% of Group 1 and 22.7% of Group 2 patients (p < 0.001). Group 2 showed significantly higher rates of follicular carcinoma, tumor size > 2 cm, angiolymphatic invasion, pN1 disease, multicentricity, elevated postoperative thyroglobulin (Tg > 10 ng/mL), iodine-refractory disease, distant metastases, and higher late Tg levels (all p < 0.05). Even though the univariate associations were statistically significant, multivariate analysis identified only male sex (p = 0.018), postoperative Tg >10 ng/mL (p < 0.001), and iodine-refractory disease (p < 0.001) as independent predictors of structural recurrence, not mETE. Five-year disease-free survival was 94.1% in Group 1 and 79.2% in Group 2 (p < 0.001). Conclusion Minimal extrathyroidal extension was associated with several adverse prognostic factors and worse outcomes in univariate analysis. However, it was not an independent predictor of structural recurrence or reduced disease-free survival in this cohort. These findings highlight the need to understand mETE in the larger context of risk stratification in management of DTC. Level of evidence 3.

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Abstract Objective To describe and analyze the microscopic morphometry of the mastoid segment of the human facial nerve in the region of the stylomastoid foramen, in different age groups of elderly individuals. Methods Eighteen blocks of temporal bones from cadavers aged between 63 and 94 years old were used and divided into 3 age groups: 60-70, 71-80 and over 80-years-old. The nerve was collected, fixed in a glutaraldehyde and paraformaldehyde solution and then subjected to dehydration and resin embedding processes. Semi-thin cross-sectional sections (1 μm) were obtained using an ultramicrotome and stained with toluidine blue. Histological images were captured and analyzed using Zen 2.6 software. The variables were described by mean and standard deviation and compared between age groups (SPSS; p < 0.05). Results The Cross-Sectional Area (CSA) of the nerve, diameter of the myelinated fiber, CSA of the myelinated fiber, thickness of the myelin sheath and percentage of total area occupied by myelinated fibers were lower in the groups with older ages, with significant differences among all age groups (p < 0.001). The total number of myelinated fibers and density remained constant and did not present significant differences between age groups. CSA and axon diameter decreased at older ages, with significant differences only between the second and third groups (p < 0.001). The degree of myelination (g ratio) and the percentage of area occupied by the endoneurium, unmyelinated fibers and degenerating tissue were higher in the older age groups (p < 0.001). In the older age groups, there was an increase in the percentage of myelinated fibers with lower CSA and a reduction in the percentage of myelinated fibers with higher CSA. Conclusion The results indicate that the facial nerve presents morphometric variations suggestive of neurodegeneration, associated with aging. Level of evidence Level V.

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Abstract Objective To evaluate the cognition and the depressive symptoms of elderly individuals with hearing impairment before and after the use of Hearing Aids (HA), in order to determine whether auditory rehabilitation can influence cognition and mood. Methods This is a prospective longitudinal study including elderly participants (>60 years) treated at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo (USP), who had indication for the use of hearing aids for auditory rehabilitation. Prior to HA fitting, tests were applied to assess cognition (Mini-Mental State Exam, verbal fluency test, and clock drawing test), mood (Geriatric Depression Scale), and restriction in daily life activities due to hearing loss (HHIE). These tests were repeated at 6- and 12-months after HA fitting. Results The study included 56 elderly individuals with a mean age of 73.9-years (±6.9). After 6-months of HA use, a significant increase was observed in the MMSE score ‒ from 23.4 (±4.8) to 24.8 (±4.5) (p = 0.016) ‒ and in the clock test score ‒ from 5.7 (±3.7) to 7.0 (±3.0) (p = 0.016). Participants without initial cognitive decline showed no significant differences. Among those re-evaluated after 12-months, the MMSE score increased from 25.6 (±3.0) to 28.2 (±1.7) (p = 0.001). Verbal fluency improved from 11.0 (±2.7) to 14.3 (±4.2) (p = 0.0013), and the clock test from 7.5 (±2.1) to 8.5 (±1.3) (p = 0.0387). In the subgroup without initial cognitive decline, only verbal fluency showed a statistically significant improvement (p = 0.0031). Conclusion Auditory rehabilitation through HA fitting had a positive impact on cognition in elderly individuals with hearing loss, especially in those who present cognitive decline in the initial tests. Level of evidence According to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence, the present study corresponds to Level 3 evidence, being a non-randomized prospective longitudinal study with pre and post intervention assessments.

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Abstract Objectives Rhinoplasty outcomes can be affected by thick nasal skin, leading to prolonged swelling, delayed healing, and scarring. This study evaluates the effectiveness of Triamcinolone Acetonide (TA) administered via the Fine Administered Needle (FAN) technique to improve aesthetic outcomes in thick-skinned rhinoplasty patients. Methods This pilot study included patients aged ≥18 with confirmed thick nasal skin who underwent rhinoplasty followed by TA injection using the FAN technique. A single subcutaneous injection at the nasal tip ensured optimal distribution. Swelling was assessed with a Visual Analog Scale (VAS), and patient-reported outcomes were evaluated using the Rhinoplasty Outcomes Evaluation (ROE) questionnaire. Results The study included 17 patients with thick nasal skin (mean age 28.9-years; 58.8% female; 76.5% primary operations). ROE scores showed significant improvement, increasing from 16 (IQR4) to 22 (IQR2) by the third visit (p < 0.001). VAS scores for swelling decreased significantly in the infratip, tip-defining point, and supratip areas (p < 0.001). Subgroup analysis revealed no significant demographic differences. The procedure had a favorable safety profile with no major adverse effects or lasting complications. Conclusion TA injection via the FAN technique is a promising adjunctive treatment for optimizing postoperative outcomes in thick-skinned rhinoplasty patients. This approach effectively reduces swelling, enhances nasal contouring, and improves patient satisfaction while maintaining an acceptable safety profile. Further studies with larger sample sizes and extended follow-up are warranted to validate these findings. Level of evidence Level 4.

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Abstract Objectives The aim of this study was to evaluate the anatomical dimensions and boundaries involved in Draf IIA (DIIA) and Draf IIB (DIIB) frontal sinusotomies, and to determine how complete frontal beak removal affects the frontal sinus drainage pathway. Specifically, we compared the proportional increase in drainage area between DIIA and DIIB performed with and without complete frontal beak removal. Methods This retrospective radiological anatomical study analyzed 296 hemifaces (from 148 patients) who underwent paranasal sinus Computed Tomography (CT). Individuals over 18-years of age without evidence of paranasal sinus disease were included. We measured the anatomical distances defining the frontal recess and estimated the differences in frontal recess area for three approaches: Draf type IIA (DIIA), Draf type IIB without complete removal of the frontal beak (DIIBwoFB), and Draf type IIB with complete removal of the frontal beak (DIIB). Results The measured areas of the frontal ostium were as follows: 59.00 ± 24.34 mm2 (range: 0.55-160.00) for DIIA, 79.66 ± 30.29 mm2 (range: 0.85-200.00) for DIIBwoFB, and 147.00 ± 35.25 mm2 (range: 71.47-282.74) for DIIB. The proportional increase in drainage area was significantly higher when comparing DIIA to DIIB than to DIIBwoFB (3.64 ± 14.37 [range: 2.52-248.40] vs. 1.37 ± 0.18 [range: 1.00-2.64], respectively). Conclusion Among the evaluated surgical approaches, the greatest proportional increase in anatomical drainage area was achieved with Draf IIB combined with complete frontal beak removal. These findings underscore the importance of frontal beak resection when considering the Draf IIB approach. Level of evidence IV.

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Abstract Objectives Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is a common and severe subtype of Chronic Rhinosinusitis (CRS), characterized by persistent inflammation and tissue remodeling in the nasal cavity. Hypoxia, resulting from chronic inflammation, is believed to play a pivotal role in CRSwNP pathogenesis. This study aims to identify Hypoxia-Related Genes (HRGs) involved in CRSwNP and explore their potential as diagnostic biomarkers and therapeutic targets. Methods We retrieved transcriptomic datasets (GSE136825 and GSE179265) from the Gene Expression Omnibus (GEO) database. Differential expression analysis was conducted to identify Hypoxia-Related Differentially Expressed Genes (HRG-DEGs) in CRSwNP. Machine learning techniques, including Least Absolute Shrinkage and Selection Operator (LASSO) regression and random forest, were employed to identify key HRGs. Validation of these genes was performed using qRT-PCR on clinical CRSwNP and control tissue samples. Additionally, consensus clustering analysis was applied to categorize CRSwNP patients into different molecular subtypes based on HRG expression, followed by gene ontology (GO) enrichment and immune infiltration analysis. Results A total of 19 hypoxia-related Differentially Expressed Genes (DEGs) were identified. Through LASSO regression and Random Forest analysis, followed by validation using an external dataset and qRT-PCR of clinical samples, four hypoxia-related hub genes ‒ CXCR4, HMOX1, DTNA, and FBP1 ‒ were identified. Receiver Operating Characteristic (ROC) curve analysis demonstrated that all four genes had Area Under the Curve (AUC) values exceeding 0.8. Additionally, consensus clustering revealed two distinct clusters with different hypoxia characteristics. Conclusion This study identifies four key hypoxia-related genes (CXCR4, HMOX1, DTNA, and FBP1) that may serve as novel diagnostic biomarkers for CRSwNP. The molecular subtypes identified through clustering provide further insights into CRSwNP heterogeneity, suggesting the need for personalized treatment approaches targeting hypoxia-related pathways.

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Abstract Objectives Despite observational studies have indicated a potential association between Atopic Dermatitis (AD) and Chronic Sinusitis (CRS), it is uncertain whether there is a causal relationship between AD and CRS. To address this ambiguity, a two-sample bidirectional Mendelian randomization methodology was utilized to examine the potential causal association between AD with CRS. Methods The summary data for the Genome-Wide Association Study (GWAS) on AD and CRS were sourced from the FinnGen consortium. To investigate the causal link between AD and CRS, we applied several approaches, including Inverse-Variance Weighting (IVW), MR-Egger regression, weighted median, simple mode, and weighted mode methods. Furthermore, the heterogeneity, horizontal pleiotropy, and sensitivity were investigated using several methods. Results Based on the random-effect IVW approach, results showed a 15.8% increased risk of CRS in those with AD compared with non-AD populations (p = 7.771e-07, OR = 1.158, 95% CI 1.092-1.227). Inversely, there was no direct evidence that CR increased the risk of AD (p = 0.979, OR = 1.001, 95% CI 0.908-1.104). The MR-Egger intercept test results indicated an absence of horizontal pleiotropy in this study (AD: p = 0.381; CRS: p = 0.144). Additionally, the leave-one-out test demonstrated the results of both forward and backward analyses were reliable and robust. Conclusion Our study confirmed the causal effect of AD on CRS, with AD increasing the risk of developing CRS. Conversely, CRS did not affect the risk of developing AD. Our study suggested that in the prevention and treatment of CRS, physicians cannot ignore the impact of AD on CRS. Level of evidence Level 2.

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Abstract Objective To evaluate the efficiency of the Zetapalatopharyngoplasty (ZPFP) technique for Obstructive Sleep Apnea (OSA). Methods This retrospective study included 36 adult patients treated with ZPFP between 2012 and 2023. Clinical, polysomnographic data, and subjective assessments using the Epworth Sleepiness Scale (ESS) and the Sleep Apnea Quality of Life Index (SAQLI) were analyzed. Surgical success was defined as a ≥50% reduction in the Apnea-Hypopnea Index (AHI) or a postoperative AHI <20. The mean follow-up duration was approximately 40-months. Results The mean AHI decreased from 34.22 to 19.28 events/hour (p = 0.009), while desaturation time dropped from 51.09 to 17.71 min (p < 0.001). ESS scores improved from 12.36 to 6.25 (p = 0.002), indicating reduced daytime sleepiness. According to the SAQLI, 97% of patients experienced moderate to significant improvements in quality of life. Early complications included tonsillar bleeding (2.8%) and dysphagia (5.6%), while late complications involved pharyngeal reflux (8.3%) and voice changes (8.3%). Nosevere adverse events occurred. Conclusion ZPFP demonstrated favorable clinical and polysomnographic outcomes, offering a safe and effective surgical alternative for CPAP-intolerant OSA patients. Future prospective studies should assess its long-term effectiveness in reducing cardiovascular risks associated with untreated OSA. Level of evidence 3.

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Abstract Objectives To evaluate the discrepancies between psychophysical olfactory tests and self-perceived smell function in consecutive patients with long COVID-19-related olfactory dysfunction, and to compare the characteristics of this impairment with those observed in other nasal conditions, in order to improve diagnostic accuracy and guide targeted treatment strategies. Methods An observational study of 86 long COVID-19 patients assessed by the Barcelona Smell Test (BAST-24 Plus), Visual Analogue Scale (VAS), and the quality-of-life Sino-Nasal Outcome Test (SNOT-22). Results were compared with 120 healthy controls and 121 patients with chronic rhinosinusitis with Nasal Polyps (CRSwNP). Results Long COVID-19 patients reported a mean VAS score of 6.34 and a SNOT-22 score of 26.43, with question 21 (smell) accounting for 12.67% of the total. No correlation was found between VAS and total SNOT-22 score, but a moderate positive correlation was observed with question 21 (r = 0.488, p < 0.001). BAST-24 Plus scores were significantly lower than in controls for Detection, Identification, and Correct Answer (p < 0.001). Compared to the CRSwNP group, long COVID-19 patients showed less impairment in Detection and Identification (p < 0.001). A stronger negative correlation was observed between VAS and Identification (r = −0.629, p < 0.0001) than with Detection (r = −0.482, p < 0.0001), suggesting that odor identification dysfunction has a greater impact on subjective perception. Conclusions The subjective perception of olfactory dysfunction does not correlate with psychophysical test results in long COVID-19 patients and is characterized by a predominantly identification-dominant quantitative impairment, which differs from other disorders showing detection-dominant impairment. These findings highlight the need for specific diagnostic and therapeutic strategies. Level of evidence III.

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Abstract Objective Epithelial barrier dysfunction is central to the pathogenesis of Allergic Rhinitis (AR), yet its molecular mechanisms remain unclear. S100A8 is implicated in epithelial barrier disruption, but its role in AR is not fully understood. This study aimed to investigate S100A8 expression in AR and its association with barrier dysfunction. Methods Nasal mucosal tissues were collected from 30 AR patients and 30 Healthy Controls (HCs). Expression levels of S100A8 and tight junction proteins (ZO-1, E-cadherin, occludin) were assessed by Immunofluorescence (IF), Western Blot (WB), and RT-qPCR. Correlation analysis was performed to evaluate the relationship between S100A8 and tight junction markers. Human Nasal Epithelial Cells (HNECs) from HCs were stimulated with House Dust Mite (HDM) extracts, and S100A8 expression was silenced using siRNA to assess its role in HDM-induced barrier disruption. Results WB and RT-qPCR results showed that the expression of S100A8 was significantly enhanced in nasal mucosal samples of AR patients compared to the HC group. S100A8 mRNA level was significantly elevated, and its level was positively correlated with the Visual Analog Scores (VAS) and total nasal symptom scores (TNSS) of the patients. Moreover, IF further confirmed that S100A8 was enhanced in the AR group, and mainly localised in the nasal epithelium. The expression of ZO-1, E-cadherin, and occludin was markedly reduced in AR patients and showed a negative correlation with S100A8 levels. In vitro, HDM stimulation of HNECs led to a dose- and time-dependent increase in S100A8 expression, along with reduced levels of tight junction proteins. Silencing S100A8 via siRNA significantly restored tight junction protein expression, indicating that S100A8 inhibition may help preserve nasal epithelial barrier integrity. Conclusion S100A8 is upregulated in AR and associated with disease severity and epithelial barrier dysfunction. Targeting S100A8 may offer a therapeutic strategy to preserve nasal barrier integrity in AR. Level of evidence Level 3.

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Abstract Objective To validate and culturally adapt the SNOT-22 for use in patients with chronic rhinosinusitis in Colombia. Methods A cross-sectional study was conducted to assess the content validity, construct validity, and reliability of the SNOT-22 in a Colombian sample. Cultural adaptation involved expert review and patient testing to ensure comprehension and relevance. Results Item adaptation and comprehension were achieved through consensus by six expert rhinologists and subsequent validation with 15 otorhinolaryngologists and 24 patients. The third item was modified for better comprehension. Content validity indices confirmed the questionnaire’s relevance, sufficiency, and comprehension, though some redundancy was noted in emotional and ear/facial symptom domains. In a sample of 221 completed questionnaires, polychoric correlations showed positive inter-item relationships. Internal consistency was excellent (Cronbach’s α = 0.97; ω = 0.96), and the model demonstrated good fit. Convergent validity with the Visual Analog Scale showed a Spearman correlation of 0.74. The questionnaire also showed strong discriminative validity, differentiating patients with and without rhinosinusitis (mean score difference of 49-points; Mann-Whitney effect size = 0.41). The Area Under the Curve (AUC) was 0.92, with 71.5% sensitivity and 4.8% false positive rate. Conclusion The Colombian version of the SNOT-22 demonstrated strong patient comprehension, content validity, high internal consistency, and effective discriminative capacity. These results support its use as a reliable clinical tool for evaluating chronic rhinosinusitis in the Colombian population. Level of evidence III.

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Abstract Objective Anatomy-Based Fitting (ABF) is a relatively new cochlear implant fitting method launched to minimize frequency-to-place mismatch. This study aimed to assess the benefits of using the ABF map among experienced adult Cochlear Implant (CI) users regarding their subjective experiences and Quality of Life. Methods This prospective observational study compared the outcome measures between the ABF and the regular Conventional-Based Fitting (CBF) CI maps. Using selective sampling, nine ears were examined from eight experienced adult ME-DEL cochlear implant users. All participants underwent postoperative computed tomography scans, which were then analyzed using a surgical planning software called Otoplan® to determine the positions of intracochlear electrodes, their respective angular insertions, and cochlear duct length. The information from the Otoplan® was then imported into the Maestro 9.0 fitting software to generate the ABF map. The outcome measures compared were (i) Subjective ratings of the maps concerning speech understanding, listening comfort, and preferred map; and (ii) Cochlear implant Quality of Life - 35-items (CIQOL-35). The CBF map’s outcome assessment was completed before fitting the experimental ABF map. The review assessments for ABF were taken after six months of ABF use. Finally, their attitude towards the ABF map was obtained. Results The shifts of the ABF center frequencies varied largely concerning the CBF map across participants, ranging from 0.46 semitones to 23.94 semitones. Subjectively, all three domains were rated better for the ABF than the CBF maps (p < 0.05). Overall, the CIQOL-35 scores significantly improved after using the ABF map for six months, with the entertainment domain showing a significant increase in the mean difference (p < 0.05). 87.5% of participants wanted to continue using the ABF map, indicating a positive attitude towards the ABF map. Conclusion Results suggest that the ABF map could be an alternative to improve auditory experience and other QoL determinants.

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Abstract Objective To determine the occurrence of otoprotective effect of the use of antioxidants on noise exposure in experimental models with rodents through a systematic review. Methods An electronic search was conducted in EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science databases, and in the grey literature of articles published up to June 2022. In the PICO strategy, the studied population consisted of rodent animals exposed to high levels of sound pressure, the intervention consisted of the use of antioxidants, the comparison with the concomitant use of placebo and the results of audiological tests such as Evoked Otoacoustic Emissions and Brainstem Auditory Evoked Potential and the results of histological and immunohistochemical evaluations were collected as outcomes. The analysis of the numerical data was performed according to the Review Manager (Cochrane), using the mean difference as a measure of effect. Results 35 studies were included in the qualitative synthesis and 27 in the quantitative synthesis. The analysis carried out by CAMARADES indicates that most of the included studies demonstrate methodological quality, and the SYRCLE RoB risk of bias assessment protocol revealed a high risk of bias in all eligible studies. In the analysis of the meta-analysis, the effect generated by the use of antioxidants was notorious in comparison with groups that were exposed to the same noise, without the use of antioxidant. Using the ABR responses at the most commonly used frequencies of 2,000–32,000 Hz as outcomes, it was possible to observe in all analyses an otoprotective effect caused by the use of the antioxidant. Conclusion This systematic review with meta-analysis demonstrated the variable otoprotective effect of the use of antioxidants on exposure to sound pressure levels in experimental studies with rodents, despite the high risk of bias and great heterogeneity of the selected studies. Level of evidence: 1.

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Abstract Objective To evaluate the efficacy and safety of corticosteroids in Chronic Rhinosinusitis (CRS), focusing on health-related quality of life, disease severity, systemic steroid-sparing effects, and Serious Adverse Events (SAEs). Methods Following PRISMA 2020 guidelines, PubMed, Web of Science, and Cochrane CENTRAL were systematically searched for randomized and non-randomized studies in adults with CRS. Outcomes included SNOT-22 scores, endoscopic findings, systemic corticosteroid use, and SAEs. Risk of bias was assessed using RoB 2.0 and Newcastle-Ottawa Scale. Meta-analyses employed random-effects models, with pooled estimates reported as Mean Differences (MD) or Odds Ratios (OR) and 95% Confidence Intervals (95% CI). Results Eleven studies (3,542 patients) were included. Corticosteroid therapy significantly improved SNOT-22 scores (MD = −16.00, 95% CI: −18.91 to −13.09, p < 0.0001; I² = 90.3%) and endoscopic outcomes (MD = −2.32, 95% CI: −2.71 to −1.94, p < 0.001; I² = 61.2%). Local corticosteroids reduced systemic steroid dependence (OR = 0.30, 95% CI: 0.27-0.34, p < 0.0001; I² = 0%). No statistically significant increase in SAEs was observed (OR = 1.47, 95% CI: 0.44-4.93, p = 0.9848; I² = 0%). Heterogeneity was high for SNOT-22 and endoscopic outcomes, but funnel plots showed no major publication bias. Conclusion Corticosteroids improve quality of life and objective disease measures in CRS while reducing reliance on systemic steroids, with no significant increase in SAEs. Future studies should compare delivery modalities, assess long-term safety, and explore biomarker-guided strategies.

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Abstract Objective To provide evidence-based recommendations for the diagnosis, assessment of functional impact, and management of altered lingual frenulum in children. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on ankyloglossia, or lingual frenotomy were eligible for inclusion. The American College of Physicians’ guideline grading system was used for critical appraisal of evidence and recommendations for therapeutic interventions. Results There are several methods described in the literature for the evaluation of the lingual frenulum, and most of them lack internal or external validation. There are no data supporting a relationship between altered lingual frenulum and dysphagia, orofacial alterations, malocclusion, social limitations, obstructive sleep apnoea, or gastroesophageal reflux. According to the studies, an altered lingual frenulum does not cause speech delay; however, some studies with very low levels of evidence show that an altered lingual frenulum may make the pronunciation of some phonemes more difficult. In children with an altered lingual frenulum, lingual frenotomy may reduce maternal pain during breastfeeding. Therefore, in children with an altered lingual frenulum, lingual frenotomy may be a good therapeutic option when there is a complaint of pain during breastfeeding. There are several surgical techniques described in the literature for the release of the lingual frenulum, as well as different instruments that can be used for this purpose. There is no scientific evidence that one method is superior to another. Conclusion Lingual frenectomy may improve maternal pain during breastfeeding and may be an option in selected cases of phonetic alterations.

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Abstract Objective This systematic review aims to evaluate the effectiveness of Tezepelumab, a monoclonal antibody targeting the thymic stromal lymphopoietin, in patients affected by chronic rhinosinusitis with nasal polyposis, both with and without comorbid asthma. Methods A systematic search of the literature was conducted across PubMed, SCOPUS, and Google Scholar databases until April 2025. Studies were selected based on predefined inclusion criteria, focusing on adult patients with clinically diagnosed chronic rhinosinusitis with nasal polyps who received Tezepelumab treatment for at least four weeks and reported validated clinical outcomes. Studies involving patients receiving prior standard treatment and comorbid asthma were included. Outcome measures included sinonasal symptom scores, imaging scores, pulmonary function tests, quality of life assessments, systemic corticosteroid use, and the need for surgical intervention. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Result Out of 221 screened records, three randomized controlled trials involving a total of 691 patients met the eligibility criteria. Tezepelumab treatment resulted in significant improvements in nasal symptom scores, including reductions in nasal congestion and loss of smell, as well as improved quality of life and sleep-related symptoms. Objective assessments showed a reduction in polyp size and radiological scores, with fewer patients requiring systemic corticosteroids or surgical intervention compared to placebo. Improvements were also observed in lung function and disease control among patients with comorbid asthma. The effect size exceeded minimal clinically important difference thresholds across key outcome measures. Conclusion Tezepelumab demonstrated consistent and clinically meaningful benefits in the treatment of chronic rhinosinusitis with nasal polyps, including symptom relief, reduced polyp burden, and decreased need for corticosteroids or surgery. Its upstream mechanism offers potential advantages over existing biologic therapies. Further long-term and real-world studies are needed to confirm its role in clinical practice and define ideal patient selection strategies.

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Abstract Objectives This review aims to study the impact of menopause transition on the vestibular system. Methods A broad systematic search of biomedical databases was performed. Papers investigating the effects of changes in female sex hormones on the vestibular physiology or the relationship between these changes in midlife women and vestibular manifestations were reviewed. Data from basic science, epidemiological studies and clinical investigations were organized and elaborated. The authors also addressed the gaps and limitations of current literature. Results Hormonal modifications during menopause transition seem to affect the vestibular system. Accordingly, epidemiological investigations describe a remarkable prevalence of vestibular disorders in climacteric women. However, clinical studies exploring this relationship are scarce, and little is known about the clinical and pathophysiological aspects of these diseases. The predisposition to vestibular disturbances during the menopause transition might be the result of an intricate combination of hormonal effects in the nervous system. These effects encompass changes in energy metabolism, immune and inflammatory regulation, modulation of several neurotransmitter systems, integrity of microcirculation and neuroprotection and neuroplasticity pathways. As a result, structural consequences within the inner ear, changes in the transduction and modulation of peripheral signals and dysregulation of central vestibular circuits may occur. Additionally, patients may present with signs of disturbances in sensory processing or difficulties in recovering from functional damages to the vestibular system. These events may contribute to the manifestation of individual vulnerabilities, causing sensory complaints, and the onset or worsening of vestibular problems. Preliminary data also corroborate the impact of menopause transition in specific vestibular diseases. Conclusion There is a theoretical basis for understanding the menopause transition as a facilitating condition for vestibular symptoms and diseases. However, clinical studies addressing these issues are scarce. Exploring them is a promising field of investigation that could lead to improvement in care for vestibular patients.

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Abstract Objectives This systematic literature review is focused on comparing automated audiometry with manual audiometry in nonclinical settings, with the primary objective of obtaining a comprehensive understanding of the advantages, limitations, and overall efficacy of automated audiometry. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines and being registered at PROSPERO, the review utilises Joanna Briggs Institute Critical Appraisal tools to evaluate the quality and rigour of 11 selected research studies. Results Key findings highlight sensitivity and specificity ranging from 71% to 98.5%. Time efficiency considerations reveal a 12.3% faster smartphone screening time than conventional screening. The validation in children, as demonstrated, underscores the potential use of self-administered applications as initial tests for hearing problems in this demographic. Conclusion This comprehensive review underscores the validity, reliability, and potential advantages of automated audiometry over traditional methods in nonclinical settings. While manual audiometry has long been considered the gold standard, automated audiometry demonstrates comparable outcomes, yielding clinically acceptable audiograms and offering potential cost-saving benefits.