This systematic review aims to evaluate the applications of three-dimensional (3D) printing in cochlear implantation (CI), focusing on its roles in surgical training, pre-operative planning, intraoperative assistance, and device innovation. A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted from inception to August 30, 2025. Keywords included “Cochlear Implant” OR “Cochlear Implantation” AND “3D printing”. Additional articles were identified through manual cross-referencing. Eligible studies were original research articles in English that investigated the use of 3D printing in CI. Exclusion criteria included reviews, conference papers, and studies unrelated to CI. Reporting completeness was evaluated using the STROBE checklist, while methodological risk of bias was independently assessed using validated, domain-specific tools (ROBINS-I, SYRCLE, and adapted QUADAS-2 domains). Due to profound study heterogeneity, a narrative synthesis was performed. Of the 76 publications identified, 22 studies met the inclusion criteria, with a marked increase after 2021. The included literature was divided into three functional areas: teaching models/surgical training (n = 13), preclinical research/device innovation (n = 3) and clinical/anatomical applications in humans (n = 6). The reported empirical accuracies ranged from 16 to 400 microns. The mean STROBE score was 14.8 ± 3.1, indicating moderate to high reporting quality. However, a rigorous methodological assessment revealed a high risk of bias among human and cadaveric series due to non-comparative designs and a lack of blinding on the part of the researchers, whilst studies using synthetic simulators demonstrated a predominantly low risk of bias. This review underscores the transformative potential of 3D printing in CI, particularly in enhancing surgical training and improving procedural outcomes. As the first systematic review focusing exclusively on cochlear-implant–specific applications, it addresses a critical gap in the literature and highlights opportunities for future research to standardize methodologies and explore long-term clinical impacts.

A pyolaryngocele is a rare, potentially life-threatening complication of laryngocele, resulting from secondary infection and obstruction of the saccular neck. Clinical severity ranges from mild dysphonia to acute airway compromise. We report a 51-year-old man with a sore throat, dysphagia, and dyspnea. Flexible laryngoscopy and contrast-enhanced CT revealed an internal pyolaryngocele. After emergency tracheostomy and intravenous antibiotics, the patient underwent CO2 laser microlaryngoscopic excision and marsupialization. Postoperative recovery was uneventful, with complete healing and no recurrence at follow-up. This case underscores the importance of early diagnosis and highlights CO2 laser surgery as an effective, minimally invasive option. Internal pyolaryngocele is a rare airway emergency that requires prompt management. CO2 laser excision appears to be a safe and effective first-line approach in selected internal cases.

Objective: Mucoepidermoid carcinoma (MEC) is the most common malignant tumour of the parotid gland. This systematic review and meta-analysis aims to evaluate treatment strategies, survival, recurrence, and prognostic factors in primary parotid MEC. Materials and Methods: A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, the Cochrane Library, Scopus, and Google Scholar were searched to identify eligible observational studies and clinical trials on primary parotid MEC. Pooled estimates of overall survival (OS), disease-specific survival (DSS), and local, regional, and distant recurrence rates were calculated. Prognostic factors associated with survival and recurrence were analysed. Results: Twenty-one studies involving 7192 patients were analysed. Histologic grade was low in 32.2%, intermediate in 41.8%, and high in 26.1%. Surgical treatment included total parotidectomy (2606 patients) and superficial parotidectomy (1642), with facial nerve preservation achieved in 1993 of 4111 reported cases. Positive margins occurred in 18% of patients, and postoperative radiotherapy was administered in 50%. Mean follow-up was 72.6 months. Pooled OS rates were 100% at 1 year, 90% at 5 years, and 70% at 10 years; DSS was 100% at 5 years and 90% at 10 years. Recurrence rates were 10% local, 0% regional, and 10% distant. High-grade histology, advanced T/N stage, positive surgical margins, and intraparotid lymph node metastasis were associated with poorer outcomes. Conclusions: Parotid MEC generally has favourable short- and intermediate-term outcomes. Based on evidence and institutional experience, we propose a grade-based workflow integrating tumour grade, T/N status, and adverse pathological features to guide surgical extent, elective neck dissection, and adjuvant radiotherapy. Prospective studies with standardized reporting are needed.

Background: Hearing loss is highly prevalent among older adults and represents a growing public health burden. Increasing attention has been given to the associations between hearing loss, cognitive decline, and dementia risk. Cochlear implantation is an established intervention for adults with severe-to-profound sensorineural hearing loss who obtain limited benefit from conventional amplification, but its potential cognitive effects remain debated. Objective: This narrative review summarizes current evidence on cognitive outcomes after cochlear implantation in adults and older adults, with particular attention to cognitive domains, long-term trajectories, methodological limitations, and clinical implications. Main findings: Available evidence suggests that cochlear implantation may be associated with improvement or stabilization of selected cognitive domains, particularly attention, executive function, working memory, and memory. However, findings are heterogeneous across studies, cognitive tools, and follow-up durations. Prospective longitudinal studies using hearing-adapted or visually presented cognitive batteries support the possibility of postoperative cognitive benefit, but the magnitude and durability of this effect vary between individuals and domains. Long-term studies suggest that cognitive improvement may be strongest during the first postoperative years and may later stabilize or attenuate, whereas auditory and quality-of-life benefits appear more consistently sustained. Conclusions: Cochlear implantation should be regarded as an established hearing rehabilitation strategy with robust benefits for auditory performance and quality of life, and as a potentially cognition-supportive intervention in selected older adults with severe-to-profound hearing loss. Current evidence does not yet prove that cochlear implantation prevents dementia. Future studies should use standardized hearing-adapted cognitive protocols, longer follow-up, adequate comparison groups, and clinically meaningful cognitive endpoints.

Objective:Chronic kidney disease (CKD) is a global health problem with a significant impact on patients' quality of life. Haemodialysis, a common treatment for advanced CKD, can profoundly affect vestibular function, which plays a critical role in maintaining balance and spatial orientation. Methods:This prospective study was conducted over a 6-month period at the Magna Graecia University and included 18 adult patients with CKD stage 5, undergoing haemodialysis. Vestibular function was assessed using the Visual Analogue Scale (VAS) for the symptom of unsteadiness and the video Head Impulse Test (vHIT) for the vestibulo-ocular reflex (VOR) gain. Results:Our results showed a statistically significant decrease in VOR gain from 0.99 at T0 to 0.92 at T1 (T-test p = 0.034 and Welch Test p = 0.037), accompanied by an increase in VAS instability scores, after the dialysis session. These results suggest a worsening of vestibular function as a result of haemodialysis. Conclusions:These results highlight the need for early diagnosis and timely intervention, such as vestibular rehabilitation, to reduce the risk of falls and improve the quality of life in CKD patients undergoing haemodialysis. Future research should investigate the long-term effects of haemodialysis on vestibular function.

BACKGROUND AND OBJECTIVES:Various approaches have been developed to treat diseases of the lateral skull base. The endoscopic transorbital approach has been recently used as stand-alone or as a complementary approach for selected pathologies of the anterior, middle, and posterior cranial base. However, its anatomy and applicability to structures of temporal bone (TB) at the lateral skull base have not been previously described. We propose the endoscopic transorbital approach as an alternative to access structures of the TB at the lateral skull base, a strategy introduced herein as the endoscopic transorbital extended middle cranial fossa approach (ETEMF). This study aims to evaluate its feasibility. METHODS:ETEMF was carried out in 7 cadaveric heads (14 sides). The tegmen, internal acoustic canal, and petrous apex were unroofed and structures exposed. Anatomy relevant to ETEMF was examined. RESULTS:Structures including the crista ovale, eustachian groove, tegmen, petrous internal carotid artery, cochlea, geniculate ganglion, the superior and lateral semicircular canals, internal acoustic canal, intracanalicular, labyrinthine, and tympanic portions of facial nerve were exposed. The crista ovale, foramen ovale, foramen spinosum, eustachian groove, greater superficial petrosal nerve, and arcuate eminence served as major landmarks during the dissection. Minimal retraction of the orbital globe and dura were required. CONCLUSION:Exposure of the TB anatomy at the lateral skull base is feasible through ETEMF. This is the first study to propose this application. Major structures within the TB are accessible through this approach. Additional studies are necessary to define its role in the surgical armamentarium.

Purpose This study analysed the main artificial intelligence (AI) models for the diagnosis of cholesteatoma on computed tomography (CT), evaluating their performance and comparing them with each other. The increasing application of AI in radiology requires a systematic comparison of available methodologies. Methods A systematic literature review was conducted, selecting relevant articles from the main databases. The included studies had to fulfil specific criteria regarding methodology, use of AI models for cholesteatoma diagnosis and results in terms of sensitivity and specificity. Results The meta-analysis included three studies evaluating the MobilenetV2, Densenet201 and Resnet50 AI models. All models demonstrated high levels of sensitivity and specificity in the diagnosis of cholesteatoma at CT. No statistically significant differences were found between the performance of the various models, suggesting a robust common diagnostic capability between the different neural network architectures. Conclusions AI is making rapid progress in imaging, with recent studies already showing remarkable performance in cholesteatoma diagnosis. The speed of technological development is promising. However, to ensure safe and effective implementation in clinical practice, further studies are needed to validate and standardise these AI models. Future research should focus not only on the diagnostic accuracy, but also on the robustness, reproducibility and clinical integration of these emerging technologies.

Background/Objectives: This systematic review and meta-analysis evaluates the surgical, functional, and aesthetic outcomes of scapular free flaps in maxillary reconstruction. The primary objective is to assess early surgical complications, fistula formation, donor site morbidity, dental restoration, normal dietary intake, aesthetic compromise, and eye-related issues. Secondary objectives include total free flap necrosis, the need for revision procedures, and functional performance of the upper limb. Methods: A systematic review was conducted following the PRISMA guidelines. Eligible studies were identified by searching PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar, with the last search conducted on 10th February 2025. Inclusion criteria were studies reporting on patients undergoing maxillary reconstruction with scapular free flaps, and which provided data on at least one of the primary or secondary outcomes. A single-arm meta-analysis was performed to assess the outcomes of scapular free flap reconstruction. The risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scale, with two independent reviewers performing the assessment. Results: From an initial search of 310 articles, 6 studies were included in the qualitative and quantitative synthesis, encompassing 231 patients with a mean age of 52.9 years (95% CI 44.9–60.8). Early general surgical complications occurred in 24% (95% CI 13–40) of patients, while 12% (95% CI 4–31) experienced fistula formation. Donor site morbidity was reported in 10% (95% CI 6–17) of cases, with a mean DASH score of 10.49, indicating low upper limb impairment. Dental rehabilitation was achieved in 56% (95% CI 42–70), and 52% (95% CI 31–72) of patients resumed a normal diet. Aesthetic compromise was observed in 27% (95% CI 9–58), and 36% (95% CI 28–44) reported eye-related issues. Conclusions: Scapular free flap is a reliable option for maxillary reconstruction with favourable outcomes, particularly in complex composite defects requiring both bone and soft tissue reconstruction. However, the evidence is limited by risk of bias, significant heterogeneity, and imprecision due to the small number of studies and participants. Larger, more robust trials are needed to confirm these findings.

Background/Objectives: The voice is often perceived as a natural and spontaneous means of communication, but it involves complex interactions among physiological, psychological, and environmental factors. For teachers, whose profession relies heavily on vocal use, understanding and managing vocal strain is crucial. This study investigates the correlation between ambient noise levels in classrooms and teachers’ self-assessed voice-related quality of life, as measured by the Voice Handicap Index (VHI). The focus is on how classroom acoustics affect vocal health, considering the high incidence of vocal fatigue among educators. Methods: A pilot exploratory study was conducted from September 2022 to November 2022 involving four primary school teachers (two language and two science) from an Italian primary school. Classroom noise levels were recorded using the “Listen Responsibly” app at intervals during lessons. Following each lesson, teachers completed the VHI questionnaire to evaluate their voice-related quality of life. Statistical analyses included simple and multiple linear regressions, logistic regression, and Spearman’s correlation to assess the relationships between noise levels and VHI scores. Results: The study yielded 60 observations categorized into VHI Grade 1 (0–30) and Grade 2 (31–60). Significant differences were observed in average noise levels between these groups, with Grade 2 exhibiting higher noise levels (p < 0.0001). Simple and multiple linear regression analyses confirmed a positive correlation between average recorded noise and VHI scores, with each unit increase in noise associated with a 0.72 unit increase in VHI score (p < 0.0001). Logistic regression identified average recorded noise > 59.5 dB as a significant predictor of higher VHI grades (p < 0.0001). Spearman’s correlation confirmed a strong positive correlation (ρ = 0.77, p < 0.01). Conclusions: The study demonstrates a significant relationship between increased classroom noise levels and worse voice-related quality of life among teachers. These findings highlight the need for improved acoustic management in schools to reduce vocal strain. Implementing noise reduction strategies and enhancing classroom acoustics can help mitigate vocal health issues among educators, ultimately improving their professional and personal well-being.

BACKGROUND:The most frequent form of vertigo in pediatric age is represented by vertigo linked to migraine, with a prevalence of 32.7%. This group of pathologies has received a redefinition of the diagnostic criteria to adapt them to the pediatric age with a new classification of the clinical pictures. We have several kinds of problems with these conditions that often have a significant impact on patients' and parents' quality of life: the diagnostic approach involves different tools for the different age groups contained in the pediatric range; the treatment of this type of vertigo is not consolidated due to the limited availability of trials carried out on pediatric patients. Focusing on this topic, the aim of this review was to provide an update on the more recent clinical advances in the diagnosis and treatment of Vestibular Migraine (VM) in children.METHODS:We searched the PubMed, Embase, and Cochrane library databases for articles published in English from January 2015 to April 2023. The secondary search included articles from reference lists, identified by the primary search. Records were first screened by title/abstract, and then full-text articles were retrieved for eligibility evaluation. The searches combined a range of key terms ("Pediatric" AND "Childhood" AND "dizziness" OR "vertigo" AND "vestibular").RESULTS:Migraine-related vertigo, in its most recent definitions and classifications, is the most frequent group of balance pathologies in pediatric age. The results from the various experiences present in the literature suggest a clinical approach to be integrated with the use of instrumental tests selected according to the age of the patient and the reliability of the results.CONCLUSION:Knowing the timeline of the applicability of vestibular tests and the information that can be obtained from them is fundamental for diagnostic accuracy. Therapy is strongly conditioned by the limited availability of pediatric trials and by the wide range it includes, from very young children to adolescents.

Objective. This research aims to validate the digits-in-noise (DIN) test for the Italian language and develop a version capable of independently assessing both ears while maintaining acceptable administration times. Methods. Individual digits from 0 to 9 in Italian were recorded and adjusted to equalise recognition probabilities. An iOS application (APP) was developed for the independent ear test using triplets in noise. The application incorporates a new proprietary adaptive procedure developed by Amplifon to minimise the number of steps required to determine the Speech Reception Threshold (SRT). Thirty-nine subjects were recruited for equalisation of digits, 45 normal-hearing and 62 with various degrees of hearing loss for normative-data assessment. Results. The results demonstrate the ability to determine a threshold value for normal hearing consistent with the existing literature and identify threshold values corresponding to the main World Health Organization hearing loss categories. Conclusions. A DIN test for the Italian language has been developed and validated to evaluate the SRT of each ear individually. The adaptive algorithm optimises the necessary steps while maintaining acceptable test duration for both ears. Users can autonomously conduct the test using a standard personal iOS device (tablet or smart- phone).

Purpose: Meniere's disease (MD), a disorder of the inner ear, presents numerous therapeutic challenges, and intratympanic (IT) gentamicin has been proposed for intractable cases. However, controversy regarding dosage and method persists. The purpose of this study was to assess the efficacy and safety of low-dose IT gentamicin on vertigo attacks in MD using a clinical symptomatology-based method, wherein administration was repeated only if vertigo attacks recurred, with a 2-week interval between injections. Materials and methods: This study included 88 patients with unilateral intractable MD. All patients received one to five IT injections with 0.5 ml of 10 mg of gentamicin (80 mg/2 ml) with an interval of 2 weeks between injections. Vertigo attacks were evaluated before and after therapy and categorized into classes A-F according to the 2015 Equilibrium Committee criteria. Audiovestibular assessments, including Pure Tone Audiometry and Vestibulo-Ocular Reflex evaluations, were performed. Results: Before treatment, patients had an average of 4.4 vertigo attacks/month; after treatment, this average decreased to 0.52. The majority of patients (57 %) reached Class A or B vertigo control with five or fewer gentamicin injections. VOR gain was slightly affected on the healthy side and significantly reduced on the affected side. No hearing deterioration was found in any of the treated patients. Conclusions: Low-dose IT gentamicin administration based on clinical symptomatology can produce a satisfactory control of vertigo attacks after treatment. This protocol primarily affected the vestibular function, as demonstrated by the significant reduction in VOR gain on the affected side, while avoiding cochlear damage. The lack of adverse events and preservation of hearing underscore the safety and efficacy of this method. These findings have significant clinical implications, suggesting that a low-dose, clinical symptomatology-based gentamicin treatment regimen could be an effective and safe strategy for managing unilateral Meniere's disease in a larger population.

Introduction recent studies have shown that around 30 % of men and 20 % of women at the age of 70 have a hearing loss, rates that rise to 55 % and 45 % respectively at the age of 80. Treatment options include hearing aids and cochlear implants. Cochlear implant surgery under local anesthesia (L.A.) is gaining popularity for its potential benefits. We analyzed the current literature comparing L.A. and general anesthesia (G.A.) surgery by assessing operation duration, post-operative observation time and length of hospital stay. Methods The study was conducted following the PRISMA guidelines. The search was performed on different database for articles published from 1984 to 2023. Comparative studies between cochlear implants in L.A. and G.A. with information on duration of surgery, length of hospital stay and time in postoperative care unit (PACU) were included. Results Of 65 articles identified, 5 studies were included, involving 634 patients. The studies showed that L.A. surgery had a shorter surgical time than G.A. (p < 0.0001). No significant differences were found in length of hospital stay (p = 0.14) or time in PACU (p = 0.08). The cost of anesthesia was significantly lower for L.A. Discussion The LA procedure has become popular, especially among elderly patients. The LA procedure has a shorter operative time and lower costs, without significantly affecting hospitalisation or time in PACU. Our study highlighted the advantages of L.A. in cochlear implant surgery, also showing the relatively low costs of the procedure. Better post-operative management could bring further benefits for patients and reduce hospital costs.

Background: This study aims to retrospectively investigate the prognostic significance of the tumor microenvironment, with a focus on TILs (tumor-infiltrating lymphocytes), in relation to survival in a large cohort of patients with parotid gland cancer, and it uses the method proposed by the International TILs Working Group in breast cancer. Methods: We included a cohort of consecutive patients with biopsy-proven parotid cancer who underwent surgery between January 2010 and September 2023. A retrospective review of medical records, including surgical, pathological and follow-up reports, was performed. The density of TILs was determined according to the recommendations of the International TILs Working Group for breast cancer. Results: A weak negative correlation (p = 0.3) between TILs and time of survival and a weak positive correlation (p = 0.05) between TILs and months of survival (high TILs were correlated with longer survival in months) were identified. High TILs were weakly negatively, but not statistically significantly p (0.7), correlated with the grading of tumor; this means that high TILs were associated with low-grade tumors. Conclusions: Contrary to previous preliminary reports, this retrospective work found no statistically significant prognostic role of TILs in parotid gland malignancies. This case series represents the largest cohort ever reported in the literature and includes all malignant histological types. Future larger molecular studies may be useful in this regard.

Objective To evaluate and compare choroidal thickness (CT) between patients with Meniere's disease (MD) and a control group. Methods This case–control analytical study was conducted on 37 subjects with MD and 37 healthy subjects. Subfoveal CT (SCT), large choroidal vessel (LCV) layer thickness, and mean subfoveal LCV thickness/mean SCT ratio were measured using enhanced‐depth imaging optical coherence tomography (EDI‐OCT) in the eyes on the MD side (ipsilateral), the contralateral eyes, and the control group. Results A statistically significant difference was observed in the mean SCT values between the ipsilateral and control groups after adjustment for age, sex, and migraine ( p = 0.04). Moreover, there was a statistically significant difference between the mean subfoveal LCV thickness values and the mean subfoveal LCV thickness/mean SCT ratio between the ipsilateral and control groups ( p = 0.006, and p < 0.001, respectively). Patients with a duration of disease over three years had a greater mean subfoveal LCV thickness/mean SCT ratio (67.35 ± 11.56 and 60.66 ± 11.27, respectively), which was statistically insignificant ( p = 0.08). Conclusion We found a thicker choroid and Haller layer, and a greater subfoveal LCV thickness/SCT ratio on the MD side compared to the controls. Furthermore, patients with a greater duration of disease had a lower subfoveal LCV thickness/SCT ratio. These findings may reflect the role of the trigeminal vascular system (TVS) and neurovascular pathophysiology in MD patients. More extensive studies are required to reach more definitive conclusions about the association between CT and MD. Level of Evidence 4 Laryngoscope , 134:1889–1893, 2024

The ability to analyze perilymph could allow inner ear pathologies to be studied. However, today, perilymph sampling is only performed for research purposes because of the risk of negative outcomes such as hearing loss or balance disorders. This paper aims to analyze the current literature on perilymph sampling and propose a method to collect perilymph in clinical settings. The published literature on perilymph sampling and its analyses was screened, and the results were analyzed and discussed in this mini review. Also, articles that discussed microneedle technology were reviewed and included in the analysis of the data. Based on the results of this review, we would like to propose a feasible technique to perform perilymph sampling in clinical settings. A total of eight studies analyzing perilymph were identified; data on proteomic, metabolomic and miRNA features present within human perilymph were collected and described. Two articles describing the use and auditory outcomes post microneedle drug injection into the inner ear were identified. Based on the methods for perilymph sampling described in humans and the recent innovations introduced by the use of microneedles, we suggested a feasible method to collect perilymph in the outpatient setting. The analysis of perilymph undoubtedly represents a valid instrument to fully understand inner ear diseases. A combination of traditional and innovative techniques, such as gaining access to the round window through the transcanalar approach using micro-endoscopes and microneedles to perform sampling, might simplify the sampling procedure and make it practicable in a clinical setting.

To explore the potential role of miR-449a as biomarker for laryngeal squamous cell carcinoma (LSCC), especially in the decision strategy of neck dissection (ND). Each patient underwent total laryngectomy and bilateral ND (levels II–IV); during surgery, tissue samples of around 1 × 0.5 cm were extracted from both healthy tissue adjacent to the tumor and the visibly affected tumor tissue. The extraction of total RNA, encompassing miRNA, was performed using a mirVana PARIS kit. To detect miR449a, cDNA was synthesized from 200 ng of RNA using a TaqMan miRNA reverse transcription kit. The study group was formed of 66 patients (62 males, and 4 females) with LSCC, aged between 39 and 77 years (mean 60 + 14.56 yr). MiR-449a was up-regulated in twenty-eight tumors (42

Background: Revision rhinoplasty is a technically demanding surgical procedure that can put every surgeon in trouble. The main issue of these cases is often an altered osteocartilaginous framework following over-resection during the first intervention. Moreover, the available septal or auricular cartilage for grafting is usually not enough. This review aims to examine contemporary advances in applications of fresh frozen cartilage in rhinoplasty. Methods: A structured review of the current literature (up to December 2023) was performed on four bibliographic databases: PubMed, EMBASE, Cochrane and Medline. The search terms were combinations of “Rhinoplasty” and “Cartilage Graft”, “Allograft” or “Fresh Frozen Cartilage”. The citations of selected studies and review articles were also evaluated if present. Results: The research resulted in 152 articles, and only ten met the inclusion criteria: nine clinical articles and one in vitro study. One of the ten eligible articles was excluded. Conclusions: Fresh frozen rib cartilage proved to be a viable alternative to autologous rib grafts and irradiated homologous rib graft. Despite the higher costs, FFRG can provide a sufficient amount of tissue for grafting avoiding donor site complications and reducing the operative time and proved to have more chondrocytes and to be less prone to resorption compared to irradiated rib.