This observational single-center study, conducted from 2021 to 2024, evaluated patient tolerance of laryngeal electromyography (LEMG) using a standardized post-procedural questionnaire completed by 97 patients undergoing LEMG for suspected laryngeal neuromuscular dysfunction. After the procedure, patients completed a structured questionnaire designed to assess procedural tolerance across five domains: overall perception, pain intensity (visual analogue scale [VAS]), anxiety, cooperation, and post-procedural discomfort. A total tolerance score (range 0-21) was calculated for each patient. We additionally analyzed the correlation between tolerance scores and specific patient variables, including age, sex, and body mass index (BMI). Based on the total tolerance score, 32 patients (32.99%) reported excellent tolerance, 33 (34.02%) good tolerance, 9 (9.28%) poor tolerance, and 3 (3.09%) very poor tolerance. Female patients demonstrated a significantly better tolerance than male patients. No significant association was observed between tolerance score and age or BMI. No significant discomfort affecting swallowing/breathing, or voice, or any important external bleeding was reported. LEMG is generally well tolerated when performed using a standardized technique. Patient tolerance varies between individuals and appears to be influenced more by subjective factors. The structured questionnaire proved useful and provides a more extensive assessment of LEMG tolerability in clinical practice. However, because this is a single-center study, further research is needed to validate this tolerance questionnaire.

Background-Vocal fold motion impairment resulting from laryngeal nerve injury poses a recurring prognostic dilemma in clinical practice. While laryngeal electromyography (LEMG) has been increasingly adopted as an objective tool for neuromuscular assessment, the specific prognostic value of spontaneous activity for predicting recovery of vocal fold motion remains incompletely defined. This systematic review aimed to evaluate the relationship between the presence of spontaneous activity on LEMG and subsequent vocal fold motion recovery across observational studies. Methods-A systematic search of MEDLINE (via PubMed), Embase, Scopus and the Cochrane Library databases was conducted in accordance with PRISMA guidelines, covering publications up to March 2026. Results-Across the included studies, the presence of spontaneous activity on LEMG-particularly fibrillation potentials-was consistently associated with poor recovery of vocal fold motion. Patients demonstrating active denervation potentials showed significantly lower rates of meaningful functional recovery compared to those in whom spontaneous activity was absent. This association held across multiple etiological subgroups, including post-surgical and idiopathic cases, though the strength of the relationship varied with the timing of LEMG relative to injury onset and the duration of follow-up. Conclusions-Spontaneous activity on LEMG represents a clinically meaningful predictor of unfavorable prognosis for vocal fold motion recovery. Standardization of LEMG protocols and reporting criteria across future studies remains essential to strengthen the evidence base in this field.

Background and Clinical Significance: Vestibular drop attacks are a rare but disabling manifestation of Ménière’s disease. This study aimed to demonstrate the value of multimodal audiovestibular assessment in documenting vestibular deficit after intratympanic gentamicin therapy. Case presentation: A 57-year-old woman with refractory Tumarkin crises underwent serial audiological and vestibular testing before and after intratympanic gentamicin treatment. Post-treatment testing demonstrated right-sided vestibular hypofunction with caloric areflexia, reduced vestibulo-ocular reflex gain, corrective saccades on video head impulse testing, and absent cervical vestibular-evoked myogenic potentials. Hearing thresholds showed transient deterioration with near-baseline recovery during follow-up. Vestibular drop attacks resolved completely. Conclusions: Multimodal audiovestibular assessment provides objective documentation of treatment-induced vestibular hypofunction after intratympanic gentamicin therapy in refractory Ménière’s disease.

OBJECTIVE:To evaluate the safety and efficacy of irreversible electroporation for non-thermal ablation of tonsils in adults. STUDY DESIGN:Prospective interventional case series of 24 adult patients referred for tonsillectomy that were followed for 3 months. SETTING:Academic medical center. METHODS:The procedures were performed under general anesthesia or sedation. Irreversible electroporation was applied to the tonsils using the ENTireTM system. Pain was assessed daily using a pain scale for the first postoperative week. Tonsil sizes were assessed at baseline and 1 and 3 months postoperatively. The Tonsil and Adenoid Health Status Instrument and the Snore-Visual Analog Scale (VAS) questionnaires were administered at baseline and at 3 months. RESULTS:In total, 23 adult patients (mean age: 36.5 ± 14.0; mean body mass index [BMI]: 25.5 ± 4.1) completed the study. No bleeding was observed intra- or postoperatively. Procedural time was 7.98 ± 2.62 minutes. A pain scale score below 2 was reported 4.5 ± 1.7 days after intervention. Reduction in tonsillar size was observed from 2.4 ± 0.9 pre-intervention to 1.3 ± 1.0 at 3 months post-intervention (P < .001). Tonsil and Adenoid Health Status scores decreased from 17.7 ± 13.0 to 0.96 ± 1.7 (P < .001). The Snore- VAS score decreased by 72%. CONCLUSION:This is the first clinical study to investigate the use of irreversible electroporation for tonsillar ablation. Irreversible electroporation shows promise as a minimally invasive procedure for reducing the size of tonsillar hypertrophy and alleviating symptoms, with negligible bleeding and significantly less pain. Multicenter studies are in progress to evaluate long-term efficacy including in children.

Background and Objectives: Extramedullary plasmacytoma (EMP) is a rare monoclonal B-cell neoplasm that typically affects the head and neck region, with a predilection for the sinonasal tract. Clinical presentation is often nonspecific, leading to delayed diagnosis. This study aims to improve our understanding of sinonasal EMP by reviewing the recent literature and presenting a case series from our clinical experience. Materials and Methods: A systematic review of published cases of sinonasal EMP from 2000 to 2023 was conducted using the PubMed database, yielding 28 eligible cases. Additionally, we retrospectively analyzed three patients diagnosed and treated at our institutions. Inclusion criteria included histologically and immunohistochemically confirmed EMP without evidence of systemic multiple myeloma. Data on demographics, tumor location, symptoms, treatment, and outcomes were collected and analyzed descriptively. Results: Sinonasal EMP most commonly presented with unilateral nasal obstruction and epistaxis. Tumors were primarily located in the nasal cavity and paranasal sinuses, often extending beyond a single anatomical site. In the literature cohort, the most frequent treatment was combined surgery and radiotherapy (35.71%), followed by radiotherapy alone (17.86%). Recurrence was reported in 10.71% of cases, and 7.14% of patients died due to disease progression. All three patients in our case series underwent surgical excision; two received postoperative radiotherapy. No recurrences or progression to multiple myeloma were observed during follow-up (12–24 months). Conclusions: Sinonasal EMP is a rare but radiosensitive tumor with a favorable prognosis when treated with surgery and/or radiotherapy. Early diagnosis, histopathological confirmation, and exclusion of systemic disease are essential. Multidisciplinary management and long-term follow-up are critical due to the risk of recurrence and transformation into multiple myeloma.

Background: Sudden-onset bilateral mixed hearing loss in adults is an extremely rare condition but challenging to diagnose and treat. Conductive hearing loss is associated with otitis media, while the simultaneous presence of a sensorineural component requires supplementary investigation for possible shared pathophysiological mechanisms. Case Presentation: We report the case of a 41-year-old male who was admitted to our hospital with a 48 h history of bilateral, fast progressive hearing loss following a viral illness. The audiologic testing revealed bilateral severe mixed hearing loss. Tympanometry indicated the presence of middle-ear effusion, and myringotomy confirmed the existence of pressurized serous fluid. Treatment consisted of systemic and intratympanic corticosteroids, antibiotics, and supportive therapy. The patient had an unexpected full recovery of auditory function within one month. Discussion: Multiple hypotheses were considered. We hypothesized the coexistence of unrelated conductive and sensorineural hearing loss or a unifying pathological process. Theories discussed include a direct viral insult to the cochlear structures or even pressure-mediated damage to the basal cochlea due to the simultaneous inward displacement of the oval and round windows. The complete resolution of hearing loss is the indicator of a reversible etiology, possibly due to transient inner ear dysfunction secondary to middle-ear pathology or viral infection. Conclusions: This case illustrates the complexity of diagnosing acute mixed hearing loss. This report emphasizes a rare case of sudden-onset bilateral mixed hearing loss with a complete recovery, contributing valuable insight into under-reported and diagnostically complex presentations.

Background: Dysphonia, a common symptom after thyroid surgery, is most often caused by damage to the recurrent laryngeal nerve. Laryngeal electromyography (LEMG) is used as a qualitative diagnostic tool to distinguish neurological etiology from other causes of dysphonia. The purpose of this study is to establish the value of LEMG as a predictor factor in the recovery of unilateral recurrent paralysis post-thyroidectomy. Methods: This study included 11 patients with unilateral vocal fold palsy (UVFP) evidenced on the videostrobolaryngoscopy (VSL) after thyroidectomy. Electrical activity of thyroarytenoid (TA) muscles of the patients included in the study was recorded through LEMG and the prognosis of the lesions was classified as excellent, fair, or poor based on the presence of spontaneous activity and motor unit recruitment. Results: LEMG at the first clinic visit showed an excellent prognosis in three of the cases, a fair prognosis in three of the cases, and five of them indicated a poor prognosis. At 6 months after the first LEMG, patients with a poor prognosis were unchanged and showed no LEMG improvement. Those with an excellent prognosis showed an increased recruitment response, and LEMG was normal. In one patient with a fair prognosis and minimal spontaneous activity, LEMG recruitment decreased during reevaluation. The other two fair-prognosis patients had a normal LEMG. Conclusions: A correlation was found between LEMG findings and functional recovery of the vocal cords, demonstrating that the presence of spontaneous activity represents a negative prognostic factor. However, due to limited patient cohorts, the sensitivity of the LEMG as a prognostic tool in the functional recovery of the larynx is not yet established and requires further research.

Abstract The rhino-bronchial syndrome is a condition characterised by chronic rhinosinusal inflammation and simultaneous chronic pulmonary pathology (asthma, chronic obstructive pulmonary disease, chronic bronchitis). The most prominent link is between sinonasal pathology, specifically allergic rhinitis, and asthma, characterized by increased eosinophil infiltration in both the nasal and bronchial mucosa, independently of the level of allergen exposure. Chronic rhinosinusitis, especially when associated with nasal polyps, can be an important risk factor for asthmatic patients and vice-versa. The patients with rhino-bronchial syndrome need a multidisciplinary approach by a medical team: otorhinolaryngologist, pneumologist and allergologist.

BACKGROUND. Granulomatosis with polyangiitis (GPA) is a systemic necrotising vasculitis in which rhinosinusal disease is the most frequent and often earliest manifestation. Because sinonasal symptoms mimic chronic rhinosinusitis and other destructive midline disorders, timely diagnosis is frequently delayed. MATERIAL AND METHODS. This review synthesizes current evidence on the clinical presentation, investigation, diagnosis, and management of rhinosinusal manifestations of GPA, with emphasis on endoscopic, radiologic, serologic, and histopathological findings. It also outlines ENT-specific approaches to local care and their integration with systemic immunosuppression. RESULTS. Sinonasal involvement occurs in 70–90% of GPA cases, commonly preceding pulmonary or renal disease. Characteristic but non-specific endoscopic findings include crusting, ulceration, and necrosis, while imaging may demonstrate mucosal thickening and bony destruction. ANCA serology and biopsy support diagnosis but have limited sensitivity in localized disease, requiring multidisciplinary correlation. Management is centered on systemic immunosuppression (glucocorticoids with rituximab or cyclophosphamide), complemented by local measures such as saline irrigation, debridement, and topical corticosteroids. Surgery is reserved for complications or reconstructive purposes in remission. CONCLUSION. Rhinosinusal disease is both a diagnostic entry point and a major determinant of morbidity in GPA. Early recognition, coordinated multidisciplinary evaluation, and balanced integration of systemic and local therapies are essential to reduce irreversible damage and improve longterm outcomes.

This review focuses on the contribution of medical imaging in the diagnosis of peripheral vestibular disorders. This is a narrative review based on a focused literature search conducted using PubMed and the Cochrane Library. Imaging is not usually recommended in initial consultations for vestibular disorders because only 5–10% of MRI scans reveal findings directly related to the disease. The study is a review of the literature that highlights the utility and limitations of imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). It follows the diagnostic approach from history and physical examination to laboratory tests and imaging. Some conditions like vestibular neuritis and benign paroxysmal positional vertigo (BPPV) have limited imaging utility due to the fine details required. Conversely, high-resolution CT and MRI are important for diagnosing Meniere’s disease, acoustic neuroma, and superior canal dehiscence. The role of imaging varies a lot among specific conditions. Advances in imaging technology, particularly high-resolution MRI, promise enhanced diagnostic capabilities.

Introduction: Odontogenic sinusitis is a frequent disease of the maxillary sinus, resulting from a dental inflammatory condition or a foreign body migrated in the sinus cavity. We performed a clinical retrospective study aimed to review the two surgical endoscopic approaches for odontogenic maxillary sinusitis middle and inferior meatotomy, in terms of realistic indications, efficacy, outcomes, and possible complications. Materials and Methods: In our study, we included a number of 400 patients with odontogenic maxillary sinusitis divided into two groups, treated in our hospital over five years, from January 2019 to December 2023. The patients included in this research were over 18 years old, diagnosed with odontogenic maxillary sinusitis, and underwent either middle meatal antrostomy or inferior meatotomy. Results: We examined the medical records of 400 patients. The vast majority of patients had a history of dental interventions, and the most affected tooth was the first maxillary molar. The symptoms at admission were typical for sinusitis: nasal obstruction, anterior or posterior rhinorrhea, hyposmia to anosmia, cacosmia, and pain or facial pressure. 80% of the patients in the study underwent middle meatal antrostomy, while 20% underwent inferior meatotomy. There were no significant differences between these two approaches in terms of efficacy, complication rates, recovery, or relapses. The complications that occurred after the surgical treatment were minor and with a very low frequency. The most reported were middle meatus synechiae and the persistence of the meatotomy ostium, with mucus recirculation (in patients with inferior meatotomy). Conclusions: Endoscopic surgical treatment of odontogenic maxillary sinusitis can be done as middle or inferior meatotomy, each having specific indications. The maxillary antrostomy is preferred in the majority of cases, as it is a procedure in which the natural ostium of the maxillary sinus is enlarged, thereby maintaining the natural drainage pathway of the sinus. However, the inferior meatotomy is preferred in the case of foreign bodies or maxillary sinus retention cysts localized at the level of the sinus floor or in the alveolar or lateral recesses, or as part of a combined approach (inferior and middle meatotomy), when the ablation of a "fungus ball" is required.

Abstract Digital planning and 3D printing have seen a significant impact in personalised presurgical planning in ENT pathology. However, segmentation and 3D printing of the cranium and especially the sinuses in ENT sinonasal pathologies are still fraught with challenges. This article will provide a comprehensive analysis, from segmentation to 3D printing, to provide insights into the future directions of 3D printing in sinonasal pathology and its implications for patient care.

Abstract Dysphonia is a frequent symptom in paediatric patients and it has a prevalence between 6 - 24%. In young patients, dysphonia has a direct importance because it impairs their communicative behaviour, their psychological status and also their social life. The most diagnosed voice pathologies in children are vocal nodules followed by vocal cord cysts, infectious and inflammatory causes, sulcus vocalis, laryngeal membranes, iatrogenic vocal cord paralysis, neurological causes, psychogenic factors, traumatic or irritative factors or, less commonly, laryngeal neoplasms. A correct diagnosis of dysphonia in paediatric patients is important for learning, voice training and their psychological development. Children with dysphonia have to be assessed with adequate equipment. It is recommended to use tools that are appropriate to the tolerance and cooperation of the patients and allow to have a good visualization of the vocal folds. Suitable preventive methods, early diagnosis, appropriate treatment of voice disorders should be taken into consideration in these cases. In this article, some of the most frequent causes of dysphonia in paediatric patients and their treatment options in order to achieve a proper voice are reviewed.

Abstract BACKGROUND. Angiosarcoma is a neoplastic tumor that originates from endothelial cells, accounting for less than 2% of all sarcomas. The sinonasal localization of angiosarcoma is uncommon. It is a highly aggressive tumor with an increased risk of local recurrence. CASE REPORT. We present the case of a 24-year-old male patient with 1 month of left side epistaxis, left nasal obstruction, headache and left hemifacial paresthesia. The CT scan of the skull and paranasal sinuses performed with intravenous contrast showed a macronodular heterogenous tissue lesion, partially hyperdense spontaneously, iodophilic, with multiple vascular trajectories apparently of the arterial type, localised in the left maxillary sinus and ipsilateral nasal cavity. The first result from histopathological examination concluded for sinonasal angiofibroma with no signs of malignancy. Even if a wide resection was performed by external and endoscopic approach, a quite quick local recurrence appeared. After the second surgical resection of the tumor, the histopathological examination correlated with immunohistochemical tests and the clinical-imaging aspect concluded on sinonasal angiosarcoma. The proper treatment was delayed because of the histopathological examination misinterpretation. CONCLUSION. A thorough histopathological examination and immunohistochemistry have an important role for an adequate diagnosis of sinonasal angiosarcoma.

Abstract Aerosol drug administration has a long history as an important part of the treatment for different respiratory disorders in both adult and paediatric patients. The nebulization process permits the drug delivery directly to the upper and lower airways tracts, allowing increased local effectiveness, and avoids systemic side effects. The aerosol therapy is mainly used in pneumology for lower respiratory tract disorders, a series of drugs having a proven efficacy. Few publications present the efficacy and safety of ENT nebulization, despite its worldwide utilization. Topical drug delivery to the nasal cavities and paranasal sinuses via aerosols appears to be an interesting, but also a challenging alternative. The transport and deposition of drugs and aerosol particles into the sinuses is debatable due to several factors: sinuses are poorly perfused and virtually non-ventilated cavities; they are protected by the efficient particle filtration function of the nasal cavities. The review evaluates the efficacy and safety of aerosol therapy in rhinologic pathology.