Background: Chronic otitis media (COM) is a major contributor to preventable conductive hearing loss in developing nations. The circumferential tympanomeatal flap technique, which achieves 360-degree elevation of the meatal skin and annular tissue, has been advocated as a superior approach to ensure comprehensive graft support and improve surgical outcomes, particularly for anterior and large central perforations (LCPs). Dedicated prospective data characterizing its standalone clinical and audiological profile warrant further documentation. To evaluate graft uptake and postoperative hearing improvement following the circumferential tympanomeatal flap technique in type I tympanoplasty among patients with inactive mucosal COM. Methods: This prospective observational study was conducted at Department of Otorhinolaryngology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana (Ambala), Haryana, India from January 2024 to January 2025. Thirty patients with inactive mucosal COM, aged 15-55 years, satisfying predefined selection criteria, underwent type I tympanoplasty via the circumferential flap technique. Pure tone audiometry was conducted preoperatively and at 3 months postoperatively. Graft integrity was evaluated at 1 and 3 months. Results: The mean patient age was 28.0 years, with male predominance (70.0%). The mean preoperative air–bone gap (ABG) was 24.07 ± 7.38 dB. Postoperatively, the mean ABG was 12.73 ± 5.95 dB, yielding a mean hearing gain of 11.62 ± 6.23 dB. Successful graft incorporation was recorded in 93.33% of patients at both 1-month and 3-month assessments. Complication rates were minimal. Conclusion: The circumferential tympanomeatal flap technique produces satisfactory graft incorporation and substantial audiological benefit in patients with inactive mucosal COM. The 360-degree elevation of the tympanomeatal complex provides comprehensive graft coverage and stable annular support, particularly advantageous for anterior and LCPs.
Background: Antimicrobial resistance (AMR) is a growing global health threat, partly driven by inappropriate antibiotic use. Despite frequent management of infectious conditions, little is known about antibiotic prescribing practices among ear, nose, and throat (ENT) physicians in Belgium. Methods: A national, anonymous survey was conducted between March and August 2024 among ENT physicians and residents in Belgium. The questionnaire assessed demographics, prescribing motivations, perceptions of AMR, and decision-making in 4 cases. Data were analyzed using descriptive statistics and associations were evaluated using frequencies, percentages, and γ tests. Results:One hundred thirty-nine respondents completed the survey (response rate of 14.1%). Most were specialists (76.3%, n = 106) and worked in peripheral hospitals (71.2%, n = 99). While 71.2% reported using guidelines in the past month, 54.7% indicated a preference for clinical experience over guideline adherence. Residents and university-affiliated ENT physicians were significantly more guideline-compliant (γ = 0.316, P = .028). Although 96.4% acknowledged AMR as a global issue, nearly half (48.9%) remained neutral regarding their personal contribution to its development. Conclusion: Belgian ENT physicians balance guideline use with clinical experience when prescribing antibiotics. While general awareness of AMR is high, individual accountability is less recognized. Strengthening awareness of personal prescribing impact and supporting collaboration between peripheral and academic centers may enhance antimicrobial management in otolaryngology. However, these findings should be interpreted with caution because of the modest response rate and disproportionate representation of ENT residents.
The aim of this review is to evaluate the underlying pathophysiology, diagnostic challenges, and current therapeutic strategies for nasal hyperreactivity (NHR) across different upper airway inflammatory phenotypes. A comprehensive narrative literature review was conducted utilizing established scientific databases, including PubMed/Medline, Scopus, Web of Science, and Embase, covering articles published up to 2026. A structured search strategy was applied using keywords such as “nasal hyperreactivity,” “neurogenic inflammation,” “cold dry air provocation,” and “transient receptor potential (TRP) channels.” Peer-reviewed clinical trials, mechanistic studies, and authoritative guidelines were included to synthesize the current evidence regarding the diagnosis and management of NHR. Nasal hyperreactivity affects up to two-thirds of rhinitis patients, independent of their atopic status. Its pathophysiology is heavily driven by neurogenic inflammation and the upregulation of TRP channels, specifically TRPV1 and TRPM8, on afferent sensory nerves. While subjective symptom history is commonly utilized in clinical settings, the cold dry air provocation test remains the most reliable objective diagnostic tool, though it is currently underutilized in routine practice. Traditional pharmacotherapies often yield suboptimal results, making targeted neuromodulatory interventions, such as “nasal capsaicin treatment,” highly promising, despite some practical administration challenges. Nasal hyperreactivity represents a distinct and burdensome clinical phenotype requiring a targeted, mechanism-driven therapeutic approach. Establishing standardized objective diagnostic biomarkers and enhancing the accessibility of neuromodulatory therapies are essential steps to optimize patient care and alleviate the significant clinical burden associated with this condition.
A patient treated with chemoradiation for a T3 N2b M0 supraglottic squamous cell carcinoma developed regional recurrence at the site of a healed temporary tracheostomy which had been performed over 10 years prior for an unrelated illness requiring intensive care. This phenomenon has not been reported in the literature and raises the hypothesis of tissue healing post-tracheostomy altering the lymphatic drainage of the larynx. The patient was treated with further chemoradiotherapy, surgical resection of the tracheal tumor mass with new tracheostomy formation. The patient continued to be closely followed up and enjoyed a good quality of life without any signs of recurrence, until he died of pneumonia.
Background: The purpose of the present exploratory study was to compare the 3 different levels of phonological awareness (i.e., the syllabic, intrasyllabic, and phonemic levels) between Dutch-speaking children with a cleft palate with or without a cleft lip (CP ± L) and typically developing peers. Methods: Seven Dutch-speaking children with a CP ± L, aged between 6 and 12 years, were included in this study. A control group consisting of 7 children without a CP ± L was composed and matched based on age, gender, and socio-economic status. Phonological awareness was assessed using 2 tests: (1) the phonological awareness subtest of the Dutch version of the Clinical Evaluation of Language Fundamentals, Fourth Edition (CELF-IV-NL), which was administered to all children and (2) the Dutch Phonological Awareness Test (PAT), which was administered only to children younger than 10 years. Differences in phonological awareness were assessed on the syllabic, intrasyllabic, and phonemic levels. Results: No statistically significant differences in scores on the phonological awareness subtest from the CELF-IV-NL were observed between children with and without a CP ± L. When comparing their scores on the different levels of phonological awareness, again no differences could be observed. Similarly, no statistically significant differences were observed in the scores of the Dutch PAT between the 2 groups. However, some descriptive differences could be observed. The median percentile scores of children with a CP ± L were considerably lower than the median score of children without a CP ± L for the subtests “rhyme” and “segmentation” of the PAT. Conclusion: The findings of this exploratory study did not provide evidence of differences in phonological awareness skills between children with CP ± L and their peers across the 3 levels assessed. For some specific phonological tasks (i.e., rhyme and segmentation), lower scores were descriptively observed in children with a CP ± L. Although evidence did not emerge to show differences in the 3 different levels of phonological awareness between children with a CP ± L and their peers, it remains important for speech-language pathologists to be attentive to these different levels, especially considering the relationship between phonological awareness, deficits in speech production, and development of literacy.
