Autoimmune inner ear disease (AIED) encompasses immune-mediated sensorineural hearing loss occurring either in isolation or in association with systemic autoimmune, vasculitic or autoinflammatory disorders. Its diagnosis remains difficult because progressive or fluctuating hearing loss is not specific to immune-mediated cochlear injury, and no disease-specific biomarker has been validated. This review examines AIED from the combined perspectives of otology and rheumatology, focusing on systemic disease associations, pathogenic mechanisms, diagnostic limitations and therapeutic evidence. Experimental studies implicate blood–labyrinth barrier disruption, inflammatory cell recruitment, adaptive immune responses and microvascular injury, although direct confirmation of these mechanisms in primary human AIED remains limited. Clinically, serial audiometry, exclusion of alternative causes and targeted assessment for systemic inflammatory disease remain central to evaluation. Corticosteroids are commonly used as initial treatment, but therapeutic responsiveness does not establish the diagnosis. Evidence supporting conventional immunosuppressants and biologic agents remains insufficient for routine application in primary AIED. We distinguish findings obtained directly from patients with suspected AIED from evidence derived from related systemic disorders and experimental models, and identify the methodological priorities needed to improve diagnostic classification and treatment evaluation.
Transoral robotic surgery (TORS) has reshaped the surgical management of head and neck neoplasms since its introduction in the mid-2000s, offering a minimally invasive transoral route to lesions of the oropharynx, larynx, hypopharynx, and nasopharynx. This narrative review synthesizes the technical foundations, current clinical evidence, and emerging directions of TORS, with explicit attention to study rigor and evidentiary hierarchy. Powered by the da Vinci platform, TORS provides magnified three-dimensional visualization and wristed instrumentation that enable en bloc resection with reduced external morbidity, shorter hospitalization, and the potential to spare or de-intensify adjuvant radiotherapy in selected human papillomavirus (HPV)-driven oropharyngeal cancers. For early-stage oropharyngeal disease, local control rates of 90–95% and disease-specific survival above 90% are consistently reported, and recent systematic reviews and large multicenter cohorts, including the international Recurrent Tumors of the Upper Aerodigestive Tract (RECUT) experience, confirm durable oncologic and functional outcomes in both primary and salvage settings, although randomized trials have yielded nuanced, sometimes divergent quality-of-life results. We appraise outcomes by anatomical subsite, the de-escalation trial landscape, complications and their mitigation, learning-curve dynamics, health economics, and the rapidly evolving integration of artificial intelligence in segmentation, augmented-reality navigation, intraoperative margin assessment, and outcome prediction. Recent evidence confirms that TORS is a valuable but expertise-dependent option whose benefit is greatest in carefully selected patients managed within multidisciplinary, high-volume pathways. We conclude by defining the principal unresolved questions and the evidence required to position TORS appropriately within contemporary multidisciplinary care.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a clinically heterogeneous inflammatory disorder characterized by persistent sinonasal inflammation and a notable tendency for recurrence, even in patients receiving appropriate medical and surgical treatment. This heterogeneity largely reflects differences in underlying inflammatory endotypes, which in turn influence clinical presentation, risk of postoperative relapse, and response to therapy. In the majority of patients, type 2 (T2) inflammation represents the dominant immunologic profile, driven by cytokines such as interleukin (IL)-4, IL-5, IL-13, and thymic stromal lymphopoietin (TSLP). Targeting these pathways has become a central focus in recent therapeutic strategies. In this context, the introduction of biologic agents has substantially altered the management of patients with severe and difficult-to-control disease. Data from phase 3 randomized trials have consistently shown meaningful reductions in polyp burden and symptom severity, along with decreased reliance on systemic corticosteroids and a lower need for revision surgery. These findings are supported by real-world studies, which suggest that the benefits of biologic therapies extend to more heterogeneous patient populations, including those with comorbid asthma or aspirin-exacerbated respiratory disease. Despite these advances, several important questions remain unresolved. In particular, there is a need for more precise patient selection based on reliable biomarkers, as well as clearer guidance on long-term treatment strategies. Issues related to cost-effectiveness and the optimal timing of treatment discontinuation or switching also continue to represent areas of ongoing debate in clinical practice.
Africa has the highest global otitis media (OM) burden; however, regional trends and projections remain underexplored. We assessed the OM burden (incidence, prevalence, mortality, and disability-adjusted life years [DALYs]) across Africa (1992–2021) and forecasted 2037 trends. Data for this study were extracted from the Global Burden of Disease (GBD) database 1992 to 2021 and were analyzed using joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis and Auto Regressive Integrated Moving Average (ARIMA) projections. Africa’s age-standardized incidence rate (ASIR) slightly increased (+0.02% average annual percentage change, AAPC), while the prevalence (−0.18%), mortality (−2.73%), and DALY rates (−0.39%) declined. In 2021, Eastern Africa had the highest ASIR/ age-standardized mortality rate (ASMR); Central Africa had the highest age-standardized prevalence rate (ASPR)/age-standardized DALY rate (ASDR). Children aged <9 years bore the greatest burden. The APC analysis shows that age and period were correlated with incidence rate. Decomposition analysis showed that population growth positively drove increases in disease burden, while aging negatively affected the growth. Projections estimate that ASIR will rise to 6,019.27 per 100,000 by 2037, while ASPR and ASDR will decline to 1,730.65 and 34.11 per 100,000. Reducing OM's disease burden necessitates strategies better aligned with African population needs and global collaboration.
Shear Wave Elastography (SWE) has emerged as a transformative ultrasound-based imaging modality for the quantitative assessment of tissue stiffness, providing valuable insights into the biomechanical properties of normal and diseased tissues. Unlike conventional ultrasonography, which primarily relies on morphological evaluation, SWE enables real-time, reproducible, and relatively operator-independent measurements of tissue elasticity. In recent years, its application has expanded considerably within head and neck imaging, where tissue stiffness serves as a potential biomarker for disease characterization, diagnosis, and treatment monitoring. This narrative review provides a comprehensive overview of the physical principles, quantitative parameters, technical considerations, and clinical applications of SWE in the head and neck region. Current evidence supporting its use in thyroid nodules, salivary gland disorders, cervical lymph node evaluation, oral soft tissue lesions, periodontal assessment, and temporomandibular joint and masticatory muscle disorders is discussed. The integration of SWE with conventional B-mode and Doppler ultrasonography has demonstrated improved diagnostic confidence, enhanced lesion characterization, and reduced reliance on invasive diagnostic procedures in selected clinical scenarios. Despite its promising clinical utility, several challenges remain, including variability in acquisition protocols, machine-dependent elasticity measurements, lack of universally accepted cutoff values, and limited standardization across institutions. Nevertheless, ongoing technological advancements and the growing interest in artificial intelligence, radiomics, and multiparametric ultrasound approaches are expected to further enhance the diagnostic and prognostic capabilities of SWE. Overall, SWE represents a valuable non-invasive adjunct to routine head and neck imaging and holds significant potential as a quantitative biomarker in precision medicine.
