In cholesteatoma surgery, precise tissue resection is important, as the diseased tissue needs to be completely removed while preserving the ossicular chain to prevent recurrence and hearing loss. The ability to precisely ablate tissue using a pulsed [Formula: see text] diode laser operating in single-trigger mode was investigated. Single laser pulses with a duration of [Formula: see text] were applied with a power ranging from [Formula: see text] via a multimode optical fiber. Fiber distance to tissue was varied from [Formula: see text], and irradiation angles from [Formula: see text]. Porcine ear cartilage with [Formula: see text] remaining perichondrium on top served to represent the human ossicle structure with cholesteatoma. Further ablation experiments were performed on human cholesteatoma and ossicle samples. Ablation craters were measured by optical coherence tomography (OCT), and tissue damage assessed with haematoxylin and eosin (H&E)-stained sections. The ablation depth reached up to [Formula: see text] when operating at [Formula: see text] power output without causing damage to the underlying cartilage. Laser pulses with [Formula: see text] successfully ablated cholesteatoma, but did not damage the ossicles. The results show that a [Formula: see text] diode laser pulses can be used to effectively remove cholesteatoma, potentially preserving ossicles and hearing ability.

Laser-assisted middle ear surgery using a blue wavelength laser is a sufficient treatment option for chronic otitis media. Definitive treatment of chronic otitis media necessitates complete removal of all sites of inflammation. Laser-based surgical techniques have demonstrated promise for achieving thorough resection while preserving auditory function. This study examines the clinical outcomes associated with the use of a 445 nm diode laser, specifically regarding recurrence rates and postoperative hearing restoration in patients with chronic otitis media. A cohort of 53 patients (21 Laser respectively 32 microsurgical) undergoing microscopic middle ear surgery for chronic otitis media at the Department of Ear, Nose and Throat Medicine, University of Lübeck, was included based on guideline-driven indications. The surgical intervention employed a fiber-guided approach using a commercial 445 nm wavelength diode laser for tissue ablation, operated in pulse mode with a laser peak power of up to 4 Watt, compared to conventional microsurgical techniques. Retrospective analysis was performed to evaluate recurrence and audiometric outcomes, assessed via pure-tone averages for air and bone conduction thresholds. Six months postoperatively, patients in the diode laser cohort exhibited a significant improvement in hearing outcomes compared to those treated with conventional microsurgical techniques (median AC-PTA improved from 45.36 dB to 30.67 dB in the laser group versus 43.48 dB to 44.45 dB in the microsurgical group; p = 0.0163). All documented recurrences occurred exclusively within the microsurgical treatment group. Blue laser-assisted middle ear surgery represents a safe and efficacious modality for the management of chronic otitis media.

Zusammenfassung Aktive Mittelohrimplantate (AMEIs), insbesondere die Vibrant Soundbridge (VSB), sind eine etablierte Behandlungsoption für Kinder mit konduktivem oder gemischtem Hörverlust, wenn konventionelle Hörhilfen nicht ausreichend wirksam oder schlecht toleriert sind. Die Evidenz zu ihrem Einfluss auf die gesundheitsbezogene Lebensqualität (HrQoL) ist bislang begrenzt. Ziel dieser Scoping-Review war es, die vorhandene Literatur zur HrQoL bei Kindern und Jugendlichen mit AMEIs systematisch darzustellen. Die Review erfolgte nach Arksey und O’Malley sowie den Empfehlungen des Joanna Briggs Institute. PubMed und Web of Science wurden 2025 systematisch durchsucht. Eingeschlossen wurden qualitative und quantitative Studien zur HrQoL bei 0–18-Jährigen mit AMEIs. Vier Studien wurden eingeschlossen, überwiegend mit VSB-versorgten Vorschul- und Schulkindern mit Gehörgangsatresie. Die Implantation war mit verbesserten auditiven Leistungen und positiven patienten- oder elternberichteten Ergebnissen verbunden. Es zeigten sich Vorteile in Kommunikation, sozialer Teilhabe, emotionalem Wohlbefinden und Geräteakzeptanz. Die Evidenz war jedoch durch kleine Stichproben und heterogene Outcome-Maße limitiert. AMEIs können die hörbezogene Lebensqualität von Kindern positiv beeinflussen, auch in psychosozialen Bereichen. Zukünftige Studien sollten standardisierte HrQoL-Instrumente und longitudinale Designs nutzen.

Background/Objectives: Squamous cell carcinoma of the nasal vestibule (SCCNV) represents a rare malignancy traditionally managed by radical surgical resection, frequently at the cost of substantial functional impairment and disfiguring aesthetic consequences. This study investigates an organ-preserving therapeutic strategy integrating high-dose-rate interventional radiotherapy (HDR-IRT; brachytherapy) with organ-preserving surgery. Material and Methods: A retrospective analysis of patients with primary SCCNV treated using HDR-IRT between 2008 and 2022, excluding recurrent disease and cutaneous squamous cell carcinomas. Interstitial HDR-IRT catheters were implanted intraoperatively, with radiation delivered twice daily to a target volume encompassing the tumor and a 10-15 mm safety margin. Results: Fifty-one patients were included, with a median age of 71 years. The median total dose was 40 Gy. Gross total resection was performed in 7 patients, and subtotal resection in 44. The median follow-up was 35 months. The 5-year nose preservation rate was 90%, with local control at 84%, regional failure-free survival at 94%, and overall survival at 82%. In total, 49 acute toxicity events were documented, including two grade 3 events, while 35 chronic toxicity events were reported, including one grade 3 event. At 3 years, 84.3% of cosmetic outcomes were rated as satisfactory, 9.8% as acceptable, and 5.9% as unsatisfactory. Conclusions: The OSIRIS approach, combining HDR-IRT with organ-preserving surgery, is an effective treatment for SCCNV, offering high organ preservation and favorable long-term disease control, with manageable toxicity and positive cosmetic outcomes.

Background:Active middle ear implants (AMEIs), particularly the Vibrant Soundbridge (VSB), are established treatment options for children with conductive or mixed hearing loss when conventional devices are insufficient or poorly tolerated. While audiological outcomes are well documented, evidence on health-related quality of life (HrQoL) in pediatric patients remains limited. Objective:This scoping review aimed to map and summarize existing evidence on HrQoL in children and adolescents fitted with AMEIs. Methods:A scoping review was conducted following Arksey and O'Malley and Joanna Briggs Institute guidelines. PubMed and Web of Science were searched in October and November 2025. Qualitative and quantitative studies assessing HrQoL in children and adolescents (0-18 years) with AMEIs were included. Study selection and data extraction were performed independently by two reviewers. Results:Four studies met the inclusion criteria, mainly involving preschool and school-aged children implanted with the VSB due to congenital or unilateral aural atresia. AMEI use was associated with improved auditory performance and positive patient- or parent-reported outcomes. HrQoL was assessed using generic (e.g., KINDL-R) and hearing-specific instruments (e.g., SSQ12, APHAB). Reported benefits included better communication, social participation, emotional well-being, and high device acceptance. Long-term data indicated stable audiological and subjective outcomes. However, studies were few, sample sizes small, and outcome measures heterogeneous. Conclusion:Current evidence suggests that AMEIs can positively affect hearing-related quality of life in children, extending beyond audiological benefit to psychosocial domains. Nevertheless, the evidence base is limited and methodologically heterogeneous. Future studies should apply standardized, validated pediatric HrQoL instruments and longitudinal designs to better capture developmental and everyday-life impacts.

OBJECTIVES:The 445 nm diode lasers have already been used successfully and safely for cholesteatoma surgery. However, the ablation of low absorbing and strongly scattering anemic tissue, such as keratinizing squamous epithelium of the cholesteatoma becomes challenging with low laser power. The initiation of ablation often occurs abruptly and not reproducibly with a noticeable acceleration after the start of carbonization. This study investigates whether a thin layer of blood on an adequate tissue model can improve light absorption and ablation. MATERIALS AND METHODS:Porcine aortic tissue served as a model for pale, weakly absorbing tissue. Blood volumes of 2.5-110 μL were pipetted onto punch samples with a diameter of 12 mm. Tissue ablation was performed with a 445 nm diode laser at continuous wave powers of 1 W and 4 W at working distances of 1 mm and 2 mm to the distal tip of the transmitting multimode optical fiber, being moved with a speed of 5 mm/s across the tissue. Ablation depths and blood layer thicknesses were measured using optical coherence tomography (OCT). A theoretical model was used to estimate the optimal amount of blood to achieve the deepest ablation. RESULTS:Different blood layer thicknesses were examined, ranging from 17 μm to 1.3 mm. With the blood layer thickness of 50-100 μm the maximum ablation depth of approximately 370 μm was measured with a power of 4 W. Without blood, no ablation was achieved. However, it could be shown that the optimal blood layer thickness depended on the selected parameters, such as laser power and working distance. The experimental results closely matched model predictions, confirming the model's validity in estimating the ablation outcomes. CONCLUSION:A thin blood layer enhances laser ablation of low-absorbing tissue with 445 nm laser radiation, such as cholesteatoma, allowing precise tissue removal.

Otitis media is a complex disease. The pathogenesis of both acute and chronic otitis media results from a complex interplay of anatomical, microbiological, and immunological factors. Identified risk factors include patient-related aspects such as nutrition, allergies, ethnicity, and genetic predisposition, as well as environmental factors such as socioeconomic status, tobacco use, attendance at daycare centers and recurrent respiratory infections. During the COVID-19 pandemic, strict measures led to a significant decline in the incidence of acute otitis media. However, infections with variants such as Omicron showed an increased rate of secretory otitis media. In the post-COVID phase, complication rates due to middle ear infections rose again, with prevalence returning to pre-lockdown levels. Preventive measures focus on ensuring adequate Eustachian tube function, treating allergies, and consistently administering pneumococcal vaccinations. In contrast, surgical treatment remains the gold standard for chronic middle ear infections and cholesteatoma. However, radical removal can be associated with high morbidity rates, underscoring the need for innovative approaches. These include optical coherence tomography (OCT) and minimally invasive laser surgery. Furthermore, new insights into the role of the immune system in the pathogenesis of both acute and chronic otitis media could open up new therapeutic possibilities for the future. This article discusses the current state of knowledge on the pathophysiological mechanisms, classification, diagnosis, and treatment of otitis media, as well as new treatment models and their implications.

The present study investigated the bacterial and fungal communities and cross-domain network interactions in patients with chronic Otitis media in response to the natural monoterpene medicinal 1,8-Cineol as a promising treatment option. While the bacterial community showed modest changes with preserved core genera, the fungal community underwent dramatic diversification and network expansion. This suggests that treatment may have disrupted competitive exclusion mechanisms in the latter, allowing for increased diversity and interactions, despite no significant changes in traditional diversity metrics. Investigations on the microbial community compositions in Otitis media patients upon 1,8-Cineol treatment revealed significantly different initial microbial signatures in responders and non-responders. Notably, therapy-responding COM patients demonstrated a baseline situation with significantly higher abundances of different gram-negative Pseudomonas species. In contrast, significantly elevated levels of various gram-positive Corynebacterium species were observed in the non-responder group compared to the 1,8-Cineol responding patients. These keystone taxa may represent new targets for therapeutic intervention or biomarkers for treatment response.

BACKGROUND/AIM:The monoterpene 1,8-Cineol is a natural plant-based anti-inflammatory agent that is used to treat different respiratory diseases with regard to its mucolytic and anti-microbial properties. 1,8-Cineol has recently been shown to support the natural microbial colonization of the middle ear, the intestinal bacterial community, as well as the clinical inflammatory situation of patients with chronic otitis media (COM). The aim of this study was to understand better the influence of 1,8-Cineol treatment on the systemic balances of inflammatory mediators of the interleukin-10 (IL-10) family of cytokines. PATIENTS AND METHODS:Plasma concentrations of cytokines IL-10, IL-19, IL-20, Il-22, IL-24 and IL-26 were analyzed in patients with COM with regard to 1,8-Cineol (CNL-1976®) treatment using ELISA measurements. RESULTS:Data revealed significantly increased concentrations of cytokines IL-19 and IL-26 in plasma samples from patients with COM compared to healthy donors as well as a significant positive correlation between IL-10 and IL-19. Of note, patients with COM revealed significantly reduced plasma levels of IL-26 in response to 14 days of 1,8-Cineol administration. CONCLUSION:1,8-Cineol treatment actively modulates the systemic inflammatory environment in patients with chronic otitis media. By resetting disrupted cytokine balances, this plant-based agent offers a promising, target-specific therapeutic strategy for managing persistent middle ear inflammation and potentially mitigating associated systemic comorbidities.

The human auditory system must encode sounds and separate relevant input from noise. Hearing loss hurts both processes, but profound hearing loss and deafness can be treated with a Cochlear Implant (CI). Here, we probe the human brains adaptation to electrical hearing with a CI in unilaterally implanted CI users with normal or aided contralateral hearing, in the first and seventh month after CI activation. In addition to clinical measures of speech comprehension, electroencephalography (EEG) recordings during passive listening to amplitude-modulated (AM) sounds and an active spatial listening task with competing talkers were analyzed. We demonstrate that, first, adaptation to hearing with a CI is accompanied by decreasing cortical overrepresentation and increasing auditory temporal coding fidelity: After six month of CI use, auditory phase-locking during passive listening relatively decreased for 4-Hz AM sounds but increased for 40-Hz AM sounds. Second, strongest benefits of listening with the CI (i.e., CI on vs. off) in the spatial-listening task occurred when the CI ear was primarily exposed to target sound. Here, the power of lateralized alpha oscillations (~10 Hz) served as a robust signature of spatial attention, independent of time (1st vs 7th month) and listening modality (with vs. without CI). Stronger lateralized alpha modulation in the hemisphere contralateral to the non-implanted ear suggests asymmetrical allocation of auditory spatial attention, operating preferentially on the input to the non-implanted ear. These findings highlight CI-related plasticity in auditory perception and a persistent attentional bias toward the non-implanted ear, emphasizing the need to consider bilateral auditory input in CI rehabilitation. ### Competing Interest Statement The authors have declared no competing interest.

The human auditory system must distinguish relevant sounds from noise. Severe hearing loss can be treated with cochlear implants (CIs), but how the brain adapts to electrical hearing remains unclear. This study examined adaptation to unilateral CI use in the first and seventh months after CI activation using speech comprehension measures and electroencephalography recordings, both during passive listening and an active spatial listening task. Neural phase-locking to amplitude-modulated sounds interacted with time, such that phase-locking longitudinally increased stronger for 40 Hz compared with 4 Hz. In the spatial listening task, the benefit of performing the task with the CI on vs. off was most pronounced when the CI ear was primarily exposed to target speech. Lateralized alpha oscillations (~10 Hz) reliably marked CI users' focus of spatial attention. Stronger alpha modulation in the hemisphere opposite to the nonimplanted ear indicates an attentional bias toward the acoustically hearing ear. Our findings suggest that adaptation to hearing with a CI is accomplished by dynamic changes in auditory phase locking and a bias in auditory spatial attention.

Background: Chronic rhinosinusitis (CRS) is a widespread inflammatory disease of the paranasal sinuses and the standard treatment includes surgery and the administration of corticosteroids or antibiotics. Antibiotics are well known to influence the microbial composition of the gut, including a reduced bacterial diversity and an increased antibiotic resistance. This underlines the need for alternative treatment approaches, especially regarding vulnerable patients such as children. Therefore, we evaluated the intestinal microbiota of CRS patients regarding plant-based anti-inflammatory monoterpene 1,8-Cineol, which is administered as the clinically approved drug Soledum® for the therapy of different inflammatory airway diseases including CRS. Methods: Microbiome analysis from stool samples was performed from 31 CRS patients before and after 1,8-Cineol administration using 16S rRNA gene next generation sequencing using dissimilarity-based and taxonomic approaches. Results: Data revealed elevated abundances of specific taxa including Bacteroides and Faecalibacterium as part of the physiologic gut microbial community and no overall disturbances in response to 1,8-Cineol treatment. Of note, abundances of intestinal Akkermansia muciniphila tend to increase during the course of 1,8-Cineol administration. Conclusion: Our data recommend 1,8-Cineol as a valuable addition to the current standard treatment of inflammatory diseases, without running the risk of profound changes of the gut microbial community.

Aktive Mittelohrimplantate, insbesondere die Vibrant Soundbridge (VSB), stellen eine etablierte Option zur audiologischen Versorgung von Kindern mit Schallleitungs-, Schallempfindungs- oder kombiniertem Hörverlust dar, wenn konventionelle Hörsysteme nicht ausreichend sind oder nicht getragen werden können. Neben funktionellen Verbesserungen gewinnt die Erfassung der gesundheitsbezogenen Lebensqualität (Health-related Quality of Life, HRQoL) zunehmend an Bedeutung. Während für Erwachsene mit Cochlea-Implantaten bereits umfangreiche Daten zur Lebensqualität vorliegen, existieren bislang nur wenige, methodisch heterogene Studien zur HRQoL bei Kindern mit aktiven Mittelohrimplantaten. Das vorliegende Protokoll beschreibt die Durchführung eines Scoping Reviews gemäß der Methodologie des Joanna Briggs Institute (JBI), um die internationale Evidenzlage zu identifizieren, systematisch zu erfassen und zu analysieren. Eingeschlossen werden empirische Studien ab dem Jahr 2012 ohne Einschränkung hinsichtlich Studiendesign oder Qualität. Die Ergebnisse sollen ein besseres Verständnis für die vielfältigen Dimensionen der Lebensqualität bei betroffenen Kindern ermöglichen und als Grundlage für zukünftige Forschungsarbeiten sowie die Entwicklung bedarfsorientierter klinischer und pädagogischer Interventionen dienen.

1,8-Cineol is a natural plant-based therapeutic agent and is commonly used to treat a broad range of acute and chronic airway inflammatory diseases. 1,8-Cineol has recently been shown to attenuate the checkpoint molecule PDL-1 in circulating monocytes in patients with chronic Otitis media (OM) and was associated with an improved clinical outcome. Hypoxia-inducible factor (HIF) is thought to play an essential role in the middle ear inflammatory process, mainly due to dysfunctions of the eustachian tube. However, the unambiguous impact of 1,8-Cineol on hypoxia-driven immune alterations of human monocytes and the related inflammatory microenvironment have not been investigated thus far. Therefore, we used the human monocytes to investigate the impact of 1,8-Cineol on the cellular hypoxia response with regards to expression levels of different adhesion molecules, chemokine receptors, and different cell stress-related proteins. Furthermore, the secretion patterns of a variety of chemokines and cytokines were evaluated. The study aimed to better understand the influence of the monoterpene 1,8-Cineol on hypoxia and normoxia-associated monocyte characteristics and related inflammatory processes, all of which are crucial for the development of various human diseases.

Abstract:Active middle ear implants, particularly the Vibrant Soundbridge (VSB), represent an established audiological treatment option for children with conductive, sensorineural, or mixed hearing loss when conventional hearing aids are insufficient or cannot be worn. In addition to functional improvements, the assessment of health-related quality of life (HRQoL) is gaining increasing importance. While extensive data on quality of life exist for adults with cochlear implants, only a few methodologically heterogeneous studies have examined HRQoL in children with active middle ear implants. This protocol outlines the methodology for conducting a scoping review based on the Joanna Briggs Institute (JBI) guidelines, aiming to identify, systematically collect, and analyze the international evidence. Empirical studies published since 2012 will be included without restrictions regarding study design or quality. The results aim to provide a comprehensive understanding of the multidimensional aspects of quality of life in affected children and to serve as a foundation for future research as well as the development of needs-based clinical and educational interventions.

BACKGROUND/AIM:Head and neck squamous cell carcinoma (HNSCC) is an aggressive epithelial malignancy of the upper aerodigestive tract, associated with poor survival. As part of the HNSCC microenvironment, the interleukin-18 (IL-18)/IL-18 binding protein (IL-18BP) signaling is becoming increasingly interesting as a potential biomarker and therapeutic target. However, the systemic expression levels of IL-18BP in the context of the immunological environment in HNSCC patients remain unexplored. MATERIALS AND METHODS:ELISA measurements of plasma IL-18-BP were carried out with regard to associated inflammatory markers such as C-reactive protein, acute phase protein ferritin, and IL-18 in 34 patients with HNSCC before and during the course of radio(chemo)therapeutic treatment and in correlation to the clinicopathological parameters. RESULTS:Plasma IL-18BP concentrations were significantly elevated in HNSCC patients compared to healthy controls and correlated strongly with IL-18 levels before and after treatment. However, plasma ferritin levels, which were also elevated, showed no correlation with IL-18 or IL-18BP. Notably, changes in IL-18BP and IL-18 levels following therapy exhibited a well-maintained balance, indicating a functional feedback mechanism. CONCLUSION:The results demonstrate a robust IL-18/IL-18BP feedback regulation in HNSCC, which likely aids tumor cells in evading anti-tumor immune responses. This balance, unaffected by radiotherapy or chemoradiotherapy, underscores the potential of IL-18BP as a therapeutic target and a prognostic biomarker in HNSCC.

Introduction The dilation of the Eustachian tube using balloon eustachian tuboplasty (BET) is an established therapy to treat ventilation disorders of the eustachian tube. In this study the influences of age and gender on the development of tube dysfunction after BET were examined for the first time. Particular attention was paid to tubal function and quality of life after BET.

BACKGROUND:Head and neck squamous cell carcinoma (HNSCC) represents a common and heterogeneous malignancy of the oral cavity, pharynx and larynx. Surgery and radio(chemo)therapy are the standard treatment options and also have great influence on the composition of the tumor microenvironment and immune cell functions. However, the impact of radio(chemo)therapy on the distribution and characteristics of circulating monocyte subsets in HNSCC are not fully understood.METHODS:Expression patterns of adhesion molecules and chemokine receptors CD11a (integrin-α L; LFA-1), CD11b (integrin-α M; Mac-1), CD11c (integrin-α X), CX3CR1 (CX3CL1 receptor) and checkpoint molecule PD-L1 (programmed cell death ligand-1) were investigated upon radio(chemo)therapeutic treatment using flow cytometry. Furthermore, comprehensive analysis of plasma cytokines was performed before and after treatment using ELISA measurements.RESULTS:Our data reveal a partial recovery of circulating monocytes in HNSCC patients upon radio(chemo)therapeutic treatment, with differential effects of the individual therapy regimen. PD-L1 expression on non-classical monocytes significantly correlates with the individual plasma levels of chemokine CXCL11 (C-X-C motif chemokine 11).CONCLUSIONS:Further comprehensive investigations on larger patient cohorts are required to elucidate the meaningfulness of peripheral blood monocyte subsets and chemokine CXCL11 as potential bioliquid indicators in HNSCC with regard to therapy response and the individual immunological situation.

Background: Diced cartilage (DC) plays an integral role in rhinoplasty, and its application is well established in nasal dorsal augmentation rhinoplasty as a diced cartilage framework (DCF). Methods: Fifteen patients requiring nasal dorsal augmentation were included. Two different types of DCF were applied: DC wrapped in fascia lata or Lyomesh (R) and DC embedded in platelet-rich fibrin (PRF). Postoperative ultrasound follow-ups were performed at intervals of one month, three months, and one year after surgery using a high-frequency linear ultrasound transducer. The aim was to depict the viability of the DCF in vivo. Results: DCF was successfully depicted using ultrasound imaging in all 15 patients. Ultrasound rendered DC as hypoechoic and inhomogeneous areas. Perifocal hypoechoic edema was detected, which significantly decreased by the one-year follow-up. During the one-year postoperative period, very little DC had decreased in diameter and the framework was fully intact, with no signs of migration. On high-frequency ultrasound, DC wrapped in fascia lata or Lyomesh (R) appeared as a hypoechoic and inhomogeneous area clearly limited by a thin hyperechoic envelope material, whereas DC embedded in PRF presented as a hypoechogenic area that spread laterally along the bone and nasal cartilage on both sides. Using color Doppler imaging, neovascularization of the DCF was identified in 7 of 15 patients at the postoperative examination. Conclusion: High-resolution ultrasound is an accurate, non-invasive imaging method appropriate for visualizing DCF in augmentation rhinoplasty. Additionally, it is possible to detect nascent neovascularization within grafts by using color Doppler imaging. (c) 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Einleitung Die maligne Otitis externa ist eine fortschreitende und lebensbedrohliche Infektion des Schläfenbeins. Betroffen sind primär immungeschwächte und an Diabetes mellitus erkrankte Patienten. Eine erfolgreiche Therapie besteht aus der Kombination einer operativen Sanierung, einer gezielten Antibiose und der Therapie der immunsupprimierenden Nebendiagnosen.