Tracheal stenosis represents a complex and challenging airway condition characterized by narrowing of the tracheal lumen due to fibrotic or inflammatory processes. Its aetiology can be congenital, iatrogenic, traumatic or inflammatory, with acquired causes being predominant in adults. This review provides a comprehensive overview of the pathophysiology, diagnostic approaches and management strategies, emphasizing a multidisciplinary approach for optimal outcomes. Management strategies have evolved from rigid surgical techniques to minimally invasive endoscopic procedures and open surgical operations, tailored to individual patient profiles. The recent SARS-Cov-2 pandemic highlights the importance of understanding iatrogenic tracheal stenosis. Prevention strategies include optimization of intubation practices, appropriate cuff pressure management and early tracheostomy in patients requiring prolonged mechanical ventilation. The importance of implementing standardized protocols for cuff pressure monitoring must be emphasized, along with considering early tracheostomy in high-risk patients.
The purpose of this paper is to provide an overview for chronic cough and specifically explore how allergies play a role in chronic cough. Recent literature focuses on the interplay between cough and allergic diseases, such as non-asthmatic eosinophilic bronchitis and allergic rhinitis. Additionally, newer studies explore the interplay between inflammation and cough sensitivity. The etiology of chronic cough is often multifactorial and can be difficult to narrow down. Allergic diseases often present with a cough as a main symptom and therefore allergic diseases should be explored as part of a work-up for a chronic cough. Additionally, allergic responses and inflammation have been shown to sensitize cough receptors, which may make patients more susceptible to developing a hypersensitivity cough or neurogenic cough.
USP 797 establishes minimum quality and safety standards for compounding sterile preparations and has important implications for otolaryngology practices, including allergen immunotherapy, nasal irrigations, intratympanic injections, and medication reconstitution. The 2022 revision, enforceable November 1, 2023, represents the first major update since 2008. This review summarizes key changes, highlights Section 21 for allergenic extracts, and discusses operational impacts on clinical practices. The revised USP 797 replaces traditional risk groups with a category-based framework, restructures beyond-use dating, expands immediate-use allowances, and introduces more prescriptive requirements for training, environmental monitoring, cleaning, documentation, and quality oversight. Section 21 establishes tailored standards for patient-specific allergenic extracts. These changes substantially increase time, cost, and administrative burden. While the updated USP 797 increases short‑term operational demands, it establishes a stronger foundation for long‑term improvements in patient safety, quality assurance, and consistency in compounding practices.
Climate change and air pollution have a growing impact on human health. This impact is particularly evident in rhinitis, a chronic inflammatory disease of the nasal mucosa that has increased in both prevalence and severity globally. Rhinitis worsens quality of life, increases healthcare utilization, and contributes to indirect economic costs. Emerging evidence demonstrates that rising temperatures, intensified extreme weather events such as wildfires and flooding, and poor air quality are contributing factors in the increased prevalence of rhinitis. This work aims to characterize the impact of climate change and air pollution on allergic and non-allergic rhinitis, emphasizing clinical implications. A focused review of current evidence on geographical variations of projected clinical impacts by continent was conducted. We also outline future directions that clinicians can take to mitigate disease burden and advocate for sustainability in the healthcare sector. Climate change and air pollution have confounding effects on rhinitis. Warming temperatures, extreme weather events, and increased air particulate matter contribute to global changes in pollen burden and exacerbation of rhinitis symptoms. The effects on allergic rhinitis are not evenly distributed as there is geographic variability in changing pollen exposure across the globe. Climate change and air pollution have a growing impact on human health, affecting allergic and non-allergic rhinitis prevalence, severity, and healthcare utilization worldwide. Therefore, ongoing physician advocacy is imperative. Through research, patient education, and global collaboration, healthcare providers can help mitigate the effects of climate change on public health.
The purpose of this review is to categorize and describe allergic and nonallergic causes, pathophysiology, subtypes, and treatment options for symptomatic nasal inflammation and rhinitis in general. Intranasal corticosteroids and antihistamines along with allergen immunotherapy are the standard of care for allergic rhinitis. While intranasal anticholinergics and corticosteroids are treatment options for non-allergic rhinitis. Both subtypes may benefit from surgical treatment with posterior nerve ablation/neurectomy and/or inferior turbinate reduction. Randomized control trials and meta-analyses on biologics and allergen extract adjuvants for allergic rhinitis, as well as capsaicin, acoustic resonance therapy, and inferior turbinate injection for nonallergic rhinitis are ongoing. In patients with symptomatic nasal congestion and rhinorrhea, thorough history and allergy testing can often elucidate a cause for rhinitis. Various treatment options exist for allergic and non-allergic rhinitis patients with symptoms refractory to pharmacotherapy, including allergen immunotherapy, surgical procedures, and even non-medicated acoustic therapy.
Transorbital neuroendoscopic surgery (TONES) provides minimally invasive access to the orbit and skull base through four principal orbital corridors: superior, lateral, medial and inferior. This review summarizes the current evidence base for each corridor, outlining anatomical considerations, expanding clinical indications and principles of approach selection, including the role of multiportal strategies. The superior corridor is the most established, with well-documented indications for anterior cranial fossa and frontal skull base tumors, spheno-orbital meningiomas, cerebrospinal fluid (CSF) leak repair, sinogenic complications and orbital roof fractures. The lateral corridor has emerged as an important route to the middle cranial fossa, cavernous sinus and Meckel’s cave, with increasing evidence supporting its use in selected sphenoid wing meningiomas and trigeminal schwannomas. The medial corridor provides targeted access for optic nerve decompression, medial orbital apex pathology and anterior cranial fossa tumors. The inferior corridor, though least frequently utilized, has defined applications for orbital floor reconstruction and access to the pterygopalatine and infratemporal fossa. Multiportal approaches combining transorbital with endonasal or open corridors extend the surgical options for complex multicompartment lesions. TONES is an evolving and increasingly adopted platform for minimally invasive skull base surgery. Corridor selection is primarily governed by lesion location, extent and characteristics, supported by a structured approach selection algorithm. Multidisciplinary collaboration and careful patient selection are essential to optimizing outcomes.
This review summarizes the current literature on Allergen Immunotherapy (AIT) for allergic rhinitis (AR), emphasizing recent innovations aimed at improving symptom control, safety, and adherence. AIT is a disease-modifying treatment for AR, with subcutaneous and sublingual immunotherapies serving as standards of care. Emerging approaches include alternative administration routes, immune modulation strategies, and modified allergen formulas. Intralymphatic immunotherapy has demonstrated efficacy comparable to established therapies while reducing injections, although long-term outcomes remain under investigation. Combination therapies using biologic agents such as dupilumab and adjuvant-based constructs including virus-like particles may improve symptom burden by shifting the immune response away from the type 2 inflammation pathway. Modified allergen formulas, such as allergoids, recombinant allergens, and peptide constructs, seek to reduce IgE-mediated allergenicity while maintaining immunogenicity. Despite promising advances, high cost, variable response, and limited long-term safety data remain important challenges in AIT development.
To review relevant medial orbital anatomy as well as the most commonly used approaches to this space. The use of the endoscopic endonasal approach for access to the medial orbit, including the intraconal space, has expanded allowing for removal of previously “inoperable” pathology. Each approach has their strength when considering access to the medial orbit, the transcaruncular incision allows for fast access with limited dissection while the transpalebral approach allows for visualization of the medial orbit but also extended access to the superior and lateral orbit. Conversely, the conjunctival approach allows for wider access to the orbital floor and the endonasal approach can be used when the pathology is medial to the optic nerve in the anterior fossa, parasellar region, and orbit.
To review current principles of orbital reconstruction after endoscopic endonasal resection of sinonasal tumours with orbital involvement, with emphasis on indications, reconstructive options, and functional outcomes after eye-sparing surgery. Recent studies support a selective, defect-based approach rather than routine reconstruction. Decision-making depends on defect location and extent, loss of structural support, periorbital status, and anticipated radiotherapy. The orbital floor and inferomedial orbit remain the most critical regions, whereas limited isolated defects of the medial wall, lateral wall, or roof may often be observed without rigid repair. Orbital reconstruction after tumour removal has shifted from ablative replacement to preservation of support, function, and cosmesis. Although available evidence is largely retrospective, primary reconstruction appears to reduce late globe malposition in selected patients. Better defect reporting, radiotherapy-adjusted algorithms, and prospective multicentre studies are needed to refine indications and outcomes.
To summarize posterior nasal nerve (PNN) ablation procedures and whether the etiology of rhinitis—allergic (AR) vs. non-allergic (NAR)—modifies post-procedural outcomes of symptoms and quality of life improvements. Three main procedures are used to target the PNN in patients with chronic rhinitis: cryoablation, radiofrequency ablation, and posterior nasal nerve neurectomy. Patients with chronic rhinitis have improvement in their symptoms with all three. When these results were analyzed by allergy status, most studies found no significant difference in the magnitude of benefit between the subgroups. Two systematic reviews found that individuals with NAR have greater symptomatic improvement at 12 months than those with AR. Both AR and NAR patients received benefit in symptom control after PNN ablation procedures, with possibly more benefit in NAR patients in the longer-term. Further studies with adequate power and standardized diagnostic criteria are needed to confirm these findings.
This review discusses current evidence on the epidemiology, pathophysiology, evaluation, and treatment of recurrent acute rhinosinusitis (RARS), with an emphasis on the role of comorbid allergic rhinitis (AR) as a key modifiable factor. We aim to clarify diagnostic challenges, highlight mechanistic links between AR and RARS, and discuss medical and surgical interventions while identifying gaps in research. RARS affects 1 in 3,000 adults annually, incurring substantial costs (1,091–1,207 per patient/year) and quality-of-life burdens. AR prevalence is markedly elevated in RARS (29
Palatal expansion describes the widening of the maxilla in the coronal plane. There has been increasing interest in this procedure for management of upper airway obstruction in adults and children. The development of orthodontic expansion techniques have heralded new paradigms for surgical and functional interventions for maxillary constriction and upper airway resistance in affected adults. Some children born with premature fusion of the palatal sutures may have symptoms of severe nasal obstruction. In cases such as those with congenital nasal pyriform aperture stenosis, infant surgical palatal expansion may offer an additional surgical option for the management of severe nasal obstruction. Maxillary expansion may be accomplished at any age, though the indications for this and timing of intervention varies considerably depending on the goals of the procedure and the patency of the midpalatal suture. There is a role for both tooth-anchored and mini-screw fixated appliances depending on the indications and goals of treatment.
Endoscopic approaches to benign orbital neoplasms have expanded substantially over the past two decades, offering minimally invasive alternatives to traditional open orbital surgery. This review summarizes current principles guiding patient selection, classification, and surgical approach in the management of benign orbital neoplasms. Endoscopic transnasal techniques remain central for medially located orbital lesions, however, advances in endoscopic transorbital surgery have broadened access to lesions previously considered unsuitable for endonasal corridors alone. Contemporary classification systems, including ORBIT, provide a shared framework for reporting tumor location and complexity, facilitating comparison of outcomes across centers Jafari et al. (Int Forum Allergy Rhinol. 13(10):1852–63, 2023). Increasing experience with multi-portal and combined approaches has refined corridor selection while maintaining favorable visual and functional outcomes in appropriately selected patients. Endoscopic transnasal and transorbital approaches now form a complementary armamentarium for benign orbital tumour surgery. Optimal outcomes depend on systematic patient selection, anatomic understanding, and surgical experience, with classification systems assisting, but not replacing expert clinical judgment.
To appraise the current status of endoscopic dacryocystorhinostomy (En-DCR) in the management of nasolacrimal duct obstruction (NLDO), with focus on outcomes in primary and revision settings, role of adjunctive therapies, and modifications for complex scenarios. Contemporary series demonstrate anatomical success rates of 96–99
To synthesize contemporary evidence on multimodality management of sinonasal and anterior skull base malignancies with orbital invasion, with particular emphasis on orbital grading, indications for exenteration, and the expanding role of orbit-preserving strategies. Recent evidence highlights a multidisciplinary shift toward orbit-preserving, function-sparing strategies. Induction chemotherapy and immune checkpoint inhibitors can reduce tumor volume and expand eligibility for orbit-preserving surgery. Advances in endoscopic techniques now safely address select patterns of invasion, while modern radiation modalities improve local control with reduced toxicity. Together, these developments support individualized multimodal protocols that balance oncologic clearance with organ preservation. Oncologic outcomes are driven more by tumor histology and depth and pattern of orbital invasion than by orbital sacrifice itself. In well-selected patients, coordinated use of systemic therapy, advanced surgery, and conformal radiation permits orbit preservation with survival comparable to exenteration, reserving orbital sacrifice for extensive patterns of invasion or pre-treatment dysfunction.
The purpose of this review is to summarize the literature surrounding endoscopic orbital decompression, and providing an overview of indications, operative steps, and alternatives. Endoscopic orbital decompression can be used for indications ranging from thyroid eye disease to infection, tumors, and trauma. The literature shows postoperative improvement in proptosis and visual function for medial, inferior, and combined orbital decompression. Decompression can achieve average proptosis reductions of 3.5–4 mm. Preservation of the inferomedial orbital strut and periorbital sling can lower the risk of postoperative diplopia. Personalized approaches for endoscopic orbital decompression can be tailored to each patient depending on the indication and extent of surgery with reduced adverse effects compared to open approaches.
To provide an overview of orbital complication in acute and chronic rhinosinusitis and to discuss current management options. This review highlights orbital complications of chronic rhinosinusitis which are under-reported in the current literature. Additionally included is a review of recently published management options and outcome data for orbital complications across a wide range of acute and chronic rhinosinusitis etiologies. The most up-to-date diagnostic criteria and anatomic relationships contributing to these complications are described. The prompt recognition and multi-disciplinary management of orbital complications of rhinosinusitis is critical to ensuring favorable patient outcomes.
This review synthesizes current literature on pediatric septoplasty and rhinoplasty, focusing on indications, optimal timing, and surgical techniques. Emphasis is placed on safety and long-term outcomes related to nasal airway patency and facial growth. These procedures are considered safe in appropriately selected children, with increasing use in younger patients. However, long-term data on reconstruction stability, revision rates, and effects on facial development remain limited. Recent studies show that pediatric septoplasty does not significantly affect midfacial growth; however, revision rates are higher in children compared to adults undergoing nasal surgery. Pediatric nasal surgery can be performed safely with minimal impact on growth. Early intervention may benefit children with severe obstruction, favoring endonasal procedures for younger patients and cautiously incorporating open septorhinoplasty techniques for older pediatric individuals. Higher revision rates and a lack of long-term follow-up highlight the need for ongoing research.
The purpose of this review is to summarize the history, evolution and current techniques regarding cleft lip repair. While surgical repair of cleft lip dates back to ancient times, modern techniques maintain the principal of rotation-advancement flap for repair, pioneered by Dr. D. Ralph Millard in the 1950s. Common contemporary cleft lip repair techniques include the modified Millard, Mohler, Fisher anatomical subunit approximation, and Noordhoff methods. Cleft lip is one of the most common craniofacial anomalies and given its central location on the face, has undergone continued changes in an attempt to achieve optimal functional and aesthetic results. Comprehensive knowledge of different surgical techniques is critical to providing patients with best outcomes, and improvement of surgical results.
Velopharyngeal complete concentric collapse (CCC) is a relatively common yet difficult-to-treat collapse pattern in patients with obstructive sleep apnea (OSA). This review summarizes CCC prevalence and risk factors, as well as management strategies beyond continuous positive airway pressure (CPAP) including lifestyle modifications, current surgical approaches, and emerging treatment options. Complete concentric collapse occurs in 20–30% of OSA patients. Recent work on noninvasive approaches, adaptations in pharyngeal surgery and maxillomandibular advancement (MMA) have demonstrated evidence of utility in CCC. Emerging therapies such as bilateral hypoglossal nerve stimulation (HNS) and ansa cervicalis stimulation (ACS) have shown promising preliminary data in these patients. Recent data on known nonsurgical and surgical options for CCC including pharyngeal surgery and MMA as well as novel therapies such as bilateral HNS and ACS is promising. Future work should focus on better defining the efficacy of such therapies in this population.
