PURPOSE OF REVIEW:This review summarizes the evidence supporting the use of immunotherapy across the full disease spectrum of head and neck squamous cell carcinoma (HNSCC) from early-stage, curative-intent settings to recurrent/metastatic disease. It also examines emerging data on swallowing outcomes and outlines the incidence and management of immune-related adverse events (irAEs). RECENT FINDINGS:Immunotherapy has become integral to the management of advanced HNSCC, and recent trials demonstrated promising benefits in resectable disease, although overall survival data remain immature. Early evidence also suggests that peri-operative immunotherapy may confer functional advantages by reducing the proportion of patients requiring postoperative chemoradiation, an important consideration given the well established impact of cisplatin-based chemoradiation on swallowing outcomes. As the use of immunotherapy widens, irAEs become more prevalent, necessitating early detection and refined management strategies. SUMMARY:A robust and growing evidence base supports the use of immunotherapy in HNSCC across both curative-intent and advanced settings. Further research is required to optimize patient selection, define optimal sequencing and combination strategies in early-stage disease, and incorporate functional outcomes, particularly swallowing, into future trial designs.
PURPOSE OF REVIEW:Advances in genetic reprogramming and groundbreaking first-in-human gene therapy trials have generated significant momentum for treating sensorineural hearing loss. This review evaluates the expanding potential of biological approaches for hearing restoration. RECENT FINDINGS:The mammalian organ of Corti possesses limited natural regenerative capacity. Recent studies are attempting to restore hearing by genetically reprogramming supporting cells into hair cells. While merely modulating cell signaling pathways in the inner ear is currently insufficient to regenerate hair cells, expressing hair cell-specific specific transcription factors can partially activate hair cell identity. However, current attempts at reprogramming are only partially successful, yielding only immature and nonfunctional "hair cell-like cells." SUMMARY:To develop viable gene therapies, future research must identify the molecular mechanisms that maintain supporting cell identity in the mature cochlea. Targeting and suppressing these gene networks in addition to activating hair cell gene networks is essential to improve the complete transition of supporting cells into functional hair cells, paving the way for translating these regenerative strategies into effective clinical treatments.
PURPOSE OF REVIEW:Awareness of retrograde cricopharyngeal dysfunction (RCPD) has accelerated substantially in the last 5 years, amongst both physicians and patients, especially with growing patient communities on social media. As the volume of research has grown rapidly, this review provides a timely synthesis of current evidence on diagnosis, treatment, and in particular, treatment failure, an area that remains underexplored despite its importance to clinical decision-making. RECENT FINDINGS:RCPD lacks a validated diagnostic test; high-resolution impedance manometry offers pathophysiological insight but has yet to yield normative diagnostic thresholds. Injection of botulinum toxin-A (BoNT-A) into the cricopharyngeus muscle remains first-line treatment, delivered either transorally in the operating theatre or percutaneously in-office, with comparable efficacy but differing doses and side-effect profiles. Reported success rates are high but heterogeneous, reflecting variable outcome definitions. Evidence on managing treatment failures - including repeat injection, dose escalation, and surgical salvage - remains sparse and largely anecdotal. SUMMARY:Standardized diagnostic criteria and outcome measures are needed to enable meaningful cross-study comparison and evidence-based management of RCPD, particularly for patients who fail first-line BoNT-A therapy. Realistic pretreatment counselling and wider publication of treatment failures are recommended to strengthen the evidence.
PURPOSE OF REVIEW:Tympanic membrane retraction is a common condition in otology. In most cases, it does not lead to significant complications. However, because there is a risk of progression to cholesteatoma, accurate diagnosis and appropriate management are crucial. In this review, we present the diagnostic strategy and the conservative or surgical management options available for patients with tympanic membrane retractions. RECENT FINDINGS:Diagnosis is primarily clinical and tympanic membrane retractions may be incidentally identified in asymptomatic patients. Conservative management through close observation remains the first-line approach for mild to moderate retractions. Surgical interventions, including ventilation tube insertion, cartilage tympanoplasty, Eustachian tube balloon dilatation, and mastoid procedures, are generally reserved for cases complicated by cholesteatoma or significant hearing impairment. SUMMARY:Evidence-based consensus on optimal management is lacking. Prospective or randomized studies are needed to establish validated management strategies.
PURPOSE OF REVIEW:To describe the various techniques in performing a tympanomastoidectomy canal wall reconstruction with mastoid obliteration for surgical management of chronic otitis media and cholesteatoma, and to assess the outcomes and complications compared to the more traditional canal wall up and canal wall down surgical techniques. Additionally, the purpose of this review is to highlight the versatility and novelty of this approach in addressing other middle ear pathologies such as glomus tympanicum. RECENT FINDINGS:As canal wall reconstruction (CWR) with mastoid obliteration (MO) has become more recognized, several modifications and variations in the technique have been described with good results - from how the canal wall is taken down, to what material is being used for reconstruction and obliteration, including both autologous and alloplastic materials. Indications for the use of CWR with MO have also expanded to include those with large glomus tympanicum or patients needing canal wall down (CWD) reversal. SUMMARY:CWR with MO is a useful alternative approach to addressing middle ear pathology, particularly cholesteatoma, as it provides enhanced visualization seen with CWD while also preserving native EAC anatomy. Reconstruction can be performed with a variety of materials, each with relative advantages and disadvantages.
PURPOSE OF REVIEW:Difficulties swallowing medicines is common, even in those with no other swallow issues. Yet, for many, daily safe and optimized ingestion and absorption of medicines is critical. In this review, we explore current evidence regarding pill swallowing patterns and recommendations for optimising pill swallowing. RECENT FINDINGS:Pill swallowing difficulties are common and are associated with factors such as polypharmacy and larger dosage forms. Patient-reported screening tools for pill dysphagia are emerging as a valuable approach for identifying pill swallowing difficulties. However, the clinical evaluation and management of pill dysphagia remain variable, highlighting the need for standardized assessment protocols and clinical practice guidelines. Integrating pill swallow challenges into instrumental swallowing assessments will help to inform clinically appropriate management pathways. Dosage form characteristics, including pill size, shape, and formulation, remain key determinants of swallowing performance. Use of pill-swallowing aids such as lubricants may improve patients' perceived ease and confidence with pill intake. SUMMARY:Routine screening and integration of pill-swallowing assessments into dysphagia management should become standard practice. Future research should prioritize robust evaluation of pill characteristics, pill-swallowing aids and educational interventions focused on safe medication administration practices, to optimize pill swallowing safety, adherence, and therapeutic outcomes.
PURPOSE OF REVIEW:The objective of this article is to summarize recent advances in research regarding the pathophysiology of pepsin in EER and emerging technologies for EER management. RECENT FINDINGS:Recent research adds mechanistic support for pepsin-mediated injury during EER, including an emerging role in chronic pulmonary fibrotic diseases. Innovative diagnostics aim to measure pepsin activity and endocytosis, while novel biomarkers of gastroduodenal reflux highlight opportunities for multiplex diagnostic assays and personalized treatment approaches. Preclinical studies increasingly support direct pepsin inhibition by HIV protease inhibitors leading to an ongoing clinical trial to evaluate fosamprenavir for LPR. SUMMARY:Research continues to make strides towards EER-specific diagnostics and therapeutics. Areas of critical need remain, such as ICD-10-CM diagnostic codes for EER/LPR, a fit-for-purpose outcomes tool for regulatory approval of novel treatments, and drug delivery platforms such as a laryngopharyngeal inhaler to target EER disease sites.
PURPOSE OF REVIEW:This review summarizes nonviral genome-editing delivery platforms for hereditary hearing loss, focusing on lipid nanoparticles (LNPs) and engineered virus-like particles (eVLPs), and discusses their advantages over adeno-associated virus-based delivery, as well as the barriers to clinical translation. RECENT FINDINGS:Recent advances have established LNPs as a clinically advanced nonviral platform, although challenges related to inner ear biodistribution, cell type specificity, endosomal escape, and immunogenicity remain to be addressed. In parallel, eVLPs have undergone substantial technical evolution, progressing from early low efficiency systems to advanced base editor- and prime editor-eVLP architectures that enhance cargo loading and editing efficiency. Extracellular vesicle-based genome editing has also emerged as an additional platform, although issues related to reproducibility, loading efficiency, and scalability remain major hurdles. SUMMARY:Nonviral genome editing platforms expand the therapeutic toolkit for hereditary hearing loss by enabling transient delivery of genome editors with potential safety advantages. Future efforts should focus on characterizing biodistribution and immunogenicity, refining cell type-specific tropism, and establishing scalable manufacturing processes to enable successful clinical translation.
PURPOSE OF REVIEW:Optical coherence tomography (OCT) is a noninvasive optical imaging technique to image soft tissue and thin bony structures with high resolution, approaching that of histology. This review summarizes recent progress in the clinical application of OCT for tympanic membrane and middle ear disease. RECENT FINDINGS:Recent reports from clinical trials show that OCT is having a meaningful impact on the diagnosis of fluid in the middle ear. In parallel with this, numerous groups are obtaining previously unattainable normative data in vivo on human middle ear structures. OCT is also starting to be used for functional assessments of the middle ear in the clinical setting by detecting sound and pressure-evoked motion. SUMMARY:OCT allows real-time noninvasive radiation-free structural and functional imaging of the tympanic membrane and middle ear at the point of care. As artificial intelligence becomes more commonplace in medicine, it is likely that OCT will become a key technology for the otolaryngologist. The data provided by OCT can be used to train machine learning algorithms for the segmentation of ear structures, which will ultimately support the automated diagnosis of ear disease. This will also aid in objectively tracking disease progression over time. Thus, OCT presents much promise for our field by revolutionizing office-based otological diagnostics.
PURPOSE OF REVIEW:Temporal bone surgery requires high precision drilling near critical anatomical structures. Traditional planning relies on expertise and the mental reconstruction of 2D imaging, which is cognitively demanding and might lead to errors. This review provides an overview on the steps required to generate accurate models and the current state of patient-specific 3D-printed models as tools for preoperative rehearsal, intraoperative navigation, and patient communication. RECENT FINDINGS:Advances in high-resolution imaging, segmentation routines and 3D-printers have streamlined the creation of patient-specific replicas of the temporal bone. Reports demonstrate that physical rehearsal on these models could aid determining surgical corridors, safely navigate aberrant anatomy, and refine approaches for accessing complex pathology. In the operating room, these models can serve as 3D references, potentially reducing the cognitive load associated with interpreting traditional 2D imaging data. 3D-printed models might improve patient comprehension and shared decision-making by translating abstract data into a tangible format despite limited reports in temporal bone surgery. SUMMARY:Patient-specific models show immense promise for enhancing surgical precision and safety, but the current literature is limited by a lack of high-level evidence and standardized reporting. Future research must transition from feasibility studies to rigorous clinical validation before these models are introduced into clinical standard of care.
PURPOSE OF REVIEW:Graduated autonomy is a foundational principle of surgical education, yet no standardized framework exists for how autonomy should be structured, assessed, or achieved within head and neck oncologic and microvascular reconstructive fellowship training. This review examines contemporary models of graduated autonomy and integrates recent educational literature with institutional experience to explore competency development and training consistency. RECENT FINDINGS:Recent surgical education literature supports competency-based assessment and structured entrustment as central to operative autonomy progression. Supervisory trust decisions are increasingly recognized as multifactorial, incorporating technical skill, judgment, and procedural complexity rather than time-based advancement alone. In parallel, team-based operative models in head and neck oncologic and microvascular reconstructive surgery improve efficiency while maintaining oncologic and reconstructive outcomes, creating an environment conducive to progressive autonomy with consistent faculty oversight. SUMMARY:Graduated autonomy paired with structured assessment, individualized entrustment, and team-based operative workflows supports reliable development of technical proficiency and intraoperative judgment in fellowship training. Emerging literature and institutional experience suggest competency-based autonomy models can be implemented while preserving patient outcomes. Continued refinement and standardization of these frameworks are essential for advancement of fellowship education in head and neck oncologic and microvascular reconstructive surgery.
PURPOSE OF REVIEW:Head and neck (H&N) reconstruction presents unique economic and system-wide considerations due to the resource-intensive nature of reconstructive techniques, such as free flap reconstruction and multidisciplinary perioperative care requirements. This article highlights the current cost and price drivers within H&N reconstruction. In addition, we review challenges and initiatives to address these drivers and consider a framework for value-based care (VBC) interventions in H&N reconstruction. RECENT FINDINGS:H&N reconstruction cost drivers include operative time, postoperative monitoring setting, and complication management within the surgical global period. Current system-wide considerations for H&N reconstruction include operating room and specialized workforce availability, postoperative intensive care unit utilization, and streamlined perioperative care pathways such as enhanced recovery protocols. Early VBC interventions have shown promise through length of stay reduction and cost containment, however, there is significant opportunity for further aligning reimbursement with drivers of costs and outcomes for H&N reconstruction. SUMMARY:While previous efforts have predominantly focused on cost drivers in the perioperative period, significant opportunities exist to further align cost-saving measures with better outcomes across H&N reconstruction care. A framework for VBC in H&N reconstruction supports the development of interventions to align cost and price drivers with value.
PURPOSE OF REVIEW:Six systematic reviews and meta-analyses (2019-2025) have compared reconstructive options for circumferential pharyngeal defects following total laryngopharyngectomy. This narrative review synthesises their findings, examines where they conflict and why their conclusions diverge, and weighs factors that fall below systematic-review level but affect flap selection. RECENT FINDINGS:Free jejunal flap (FJF) demonstrates the lowest fistula rate (8-11%); in the largest network meta-analysis (1357 patients), FJF had a 93% probability of ranking first for fistula avoidance. Tubed anterolateral thigh (ALT) showed non-significant trends toward lower flap failure and 30-day mortality. Differences in fistula rates between FJF and ALT vary with analytical method. Stricture rates overlap (FJF 11-20%, ALT 13-19%) and should not drive flap choice. Adjuvant radiation therapy is associated with a near five-fold increase in FJF stricture; this concern recedes in salvage cases. The U-shaped pectoralis major flap had the lowest stricture rate in the network meta-analysis. SUMMARY:Flap selection requires balancing fistula risk against perioperative mortality and donor-site morbidity, modified by defect extent, thigh adiposity, anticipated radiation therapy, and institutional experience. No randomised trials exist. Progress will require prospective comparative data and regionalisation.
PURPOSE OF REVIEW:Dorsal augmentation rhinoplasty is a technically demanding procedure that requires careful selection of grafting materials and techniques to achieve durable and aesthetically pleasing results. This review summarizes contemporary approaches to dorsal augmentation rhinoplasty, emphasizing material selection, surgical indications, and evolving techniques. RECENT FINDINGS:Autologous grafts (septal, auricular, and costal cartilage) are widely used due to their lack of immunogenicity and relatively low rates of infection and extrusion. Diced cartilage techniques have gained recent popularity due to their flexibility and smooth dorsal contouring. Alloplastic and allogeneic materials can be carefully considered in specific patient populations who accept their associated risks. Injection filler rhinoplasty may be considered for patients seeking a lower-cost, temporary option for nasal augmentation with minimal downtime. SUMMARY:A comprehensive understanding of the spectrum of surgical techniques for dorsal augmentation rhinoplasty is essential for individualized surgical planning. Familiarity with the indications, strengths, and limitations of each approach will enable surgeons to optimize outcomes in dorsal augmentation rhinoplasty.
PURPOSE OF REVIEW:Facial scarring represents a significant clinical and psychosocial burden for patients. This review summarizes current evidence for prophylactic and therapeutic scar management techniques relevant to ear, nose, and throat surgeons, covering risk stratification, wound closure principles, dressings, intralesional agents, laser therapy, radiation, and adjunctive treatments. RECENT FINDINGS:The evidence base for facial scar management continues to expand, with recent meta-analyses, and RCTs improving our understanding of both conservative and surgical treatment strategies. While established therapies are further validated, emerging combination approaches and novel adjuncts are broadening the therapeutic treatment repertoire. Key areas of progress include non-invasive dressing products, intralesional pharmacotherapy, energy-based devices, and radiation protocols, though significant gaps in high-quality evidence particularly for the head and neck region is an ongoing issue. SUMMARY:Facial scar management requires identification of modifiable risk factors, appropriate scar classification, and tailored evidence-guided selection of therapies. No single universal treatment exists, and treatment plans must be patient focussed. High-quality randomized controlled trials specific to the head and neck region remain limited, and multicentre collaborative research is needed to establish consensus guidelines.
PURPOSE OF REVIEW:The purpose of this manuscript is to review current literature of modern cartilaginous microtia reconstruction techniques and describe evolving biotechnological advancements within this field. We additionally offer opinions on technical refinements from our institutional experience with autologous rib cartilage reconstruction performed for nearly 30 years. RECENT FINDINGS:Autologous rib cartilage reconstruction is the gold standard for microtia treatment. There is active research in developing alternative framework materials, including allogenic and tissue-engineered cartilage. Advancements in technology such as three-dimensional bioprinting play an increasing role in the personalization and precision of auricular reconstruction. SUMMARY:Microtia reconstructive surgery presents a challenge in balancing aesthetic goals with minimal morbidity. Cartilage offers framework strength as well as pliability for custom shaping. Tissue-engineered cartilage for microtia is promising, prompting research in this field focused on elucidating long-term durability and safety. A robust understanding of cartilaginous options for auricular reconstruction in the context of modern evidence and technology can improve both patient and surgeon satisfaction.
PURPOSE OF REVIEW:Modest improvements in survival following oral cavity cancer have increased the population of long-term survivors, shifting attention toward speech and swallowing outcomes. However, functional outcome measurement remains heterogeneous and inconsistently reported, limiting comparability across studies and translation to clinical decision-making. This review evaluates current speech and swallowing outcome measures used in oral cavity cancer, with particular attention to glossectomy populations, and proposes a pragmatic framework for standardized, multidimensional assessment. RECENT FINDINGS:Recent literature highlights the importance of integrating tongue-specific metrics (e.g., lingual strength, range of motion) with function-focused measures (e.g., diet level, speech intelligibility) and patient-reported outcomes. Tools such as instrumental swallow assessments, performance-based masticatory testing, and validated patient-reported instruments capture complementary dimensions of recovery. Emerging technologies, including speech-tracking approaches, offer greater sensitivity to subtle changes in function. Nonetheless, no unified core outcome set exists for oral cavity cancer, and oral phase-specific metrics remain underdeveloped, particularly in patients undergoing tongue resection and reconstruction. SUMMARY:No single instrument adequately captures the multidimensional functional consequences of oral cavity cancer treatment. We propose a domain-anchored measurement framework integrating physiologic, performance-based, and patient-reported outcomes to improve precision, harmonization, and clinical relevance in survivorship research and rehabilitation.
PURPOSE OF REVIEW:Caudal septal deviation represents a challenging surgical problem with significant functional and aesthetic implications. This review examines recent advances in surgical techniques for correcting caudal septal deviations, with emphasis on appropriate technique selection based on deviation type and severity. RECENT FINDINGS:The surgical management of caudal septal deviation has evolved toward more nuanced, tissue-preserving approaches that balance adequate correction with maintenance of structural integrity. Contemporary practice emphasizes cartilage remodelling when anatomically appropriate, with techniques ranging from simple suture stabilization to complex reconstruction with grafting. Improved understanding of nasal septal biomechanics, including regional thickness variations and critical junction points, has enabled more rational surgical planning and technique selection. Recognition that deviation severity, cartilage quality, and the presence of concomitant deformities should guide approach selection has led to algorithm-based treatment strategies. SUMMARY:Successful management requires thorough anatomical understanding, accurate classification of deviation type, and appropriate technique matching to pathology. A graduated surgical approach progressing from conservative remodelling to complex reconstruction optimizes outcomes while minimizing complications. No single technique addresses all deviation patterns; the modern surgeon must command multiple approaches and understand their respective indications, advantages, and limitations to achieve consistently favourable results.
Purpose of reviewThe purpose of this review is to present an overview of principles of motor learning (PML) and summarize the most recent evidence regarding the application of PML to optimize voice therapy intervention.Recent findingsThe principles of motor learning that have been proven effective in sport, neuroscience, physical therapies and motor speech and swallowing therapies are now being demonstrated to be relevant and effective in voice therapy.SummaryCurrent research is in its early stages with a small number of retrospective, prospective and experimental studies investigating aspects of practice, feedback, instruction and modelling. Low participant numbers are noted as a limitation in many studies. Research shows motor learning principles are effective, but large-scale studies are needed to develop a deeper understanding of how to optimise the PML in individual therapeutic scenarios.
PURPOSE OF REVIEW:This review provides a comprehensive update on advancements and evolving paradigms in cleft-related facial skeletal surgery. It evaluates recent literature concerning the integration of artificial intelligence in surgical prediction, optimal orthognathic surgical sequencing, the utility of virtual surgical planning (VSP) and patient-specific implants (PSIs), strategies for managing skeletal surgery related velopharyngeal insufficiency (VPI) and airway patency, the evolution of alveolar bone grafting (ABG) techniques, and the increasing emphasis on patient-reported outcome measures (PROMs). RECENT FINDINGS:Recent studies demonstrate that machine learning models utilizing preadolescent cephalometric data can predict the need for orthognathic surgery with high accuracy (over 83%). The implementation of 3D VSP has validated the mandible-first surgical sequence and significantly improved occlusal accuracy while reducing preoperative planning time. While PSIs reduce skeletal relapse in large maxillary advancements (>10 mm), they carry a higher risk of hardware removal compared to conventional plates. Regarding speech and airway management, safe maxillary advancement thresholds have been established to minimize VPI risk, and preserving prior pharyngeal flaps during surgery, if possible, is highly recommended to prevent speech deterioration. In alveolar reconstruction, synthetic grafts and allografts combined with osteogenic agents (like rhBMP-2) are showing success rates comparable to traditional iliac cancellous autografts, with a marked shift toward earlier intervention (ages 4-8) and outpatient procedures. Finally, while orthognathic surgery significantly improves psychosocial well being and facial aesthetics, significant disparities in care access persist based on insurance status and geopolitical factors. SUMMARY:The landscape of cleft-related facial skeletal surgery is rapidly advancing through the integration of artificial intelligence, 3D digital planning, and novel biomaterials. These innovations allow for earlier, more accurate surgical predictions, reduced operative morbidity, and enhanced long-term skeletal stability. Balancing structural advancements with airway and speech preservation remains a delicate, patient-specific process. Ultimately, while surgical and technological refinements continue to optimize functional and aesthetic results, addressing socioeconomic barriers is critical to ensuring timely care and maximizing health-related quality of life for all cleft patients.
