Die Inzidenz von mit humanen Papillomaviren (HPV-)assoziierten Oropharynxkarzinomen („oropharyngeal squamous cell carcinoma“, OPSCC) nimmt weltweit zu, insbesondere bei jüngeren Männern ohne klassische Risikofaktoren. Hochrisiko-HPV-Typen sind die Hauptursache. Prophylaktische Impfstoffe bieten erstmals eine effektive Primärprävention, deren Wirksamkeit bislang über die Reduktion oropharyngealer HPV-Infektionen belegt ist. Ziel war die Darstellung des aktuellen Evidenzstands zur HPV-Impfung in der Prävention von OPSCC, einschließlich Impfquoten, Leitlinienempfehlungen und Implikationen für Betroffene und Angehörige. Dazu erfolgte eine systematische Literaturrecherche in PubMed (2000–2025) zu HPV-Impfung und OPSCC und die Berücksichtigung von Übersichtsarbeiten, Metaanalysen, Kohorten- und randomisierten Studien sowie von nationalen und internationalen Leitlinien. Die HPV-Impfung reduziert die Prävalenz oropharyngealer Hochrisiko-HPV-Infektionen um 80–90

Objective:Large Language Models such as ChatGPT are increasingly being discussed as tools to support medical decision-making. The aim of this study was to investigate whether the quality of responses generated by ChatGPT (GPT-4) to guideline-based ENT questions improves when the underlying evidence-based S3 guideline is provided as a PDF together with the respective question. Methods:Thirty guideline-based questions were derived from five current S3 guidelines. ChatGPT answered each question in two runs: once without and once with provision of the respective guideline as a PDF together with the question. Three ENT specialists independently and anonymously evaluated the responses regarding content accuracy and length/conciseness (scale 1-3). Results:Providing the guideline as a PDF together with the respective question resulted in a significant improvement in accuracy (1.77 vs. 1.26; p = 0.003) and conciseness (1.96 vs. 1.50; p = 0.004). A significant correlation between accuracy and conciseness was observed (p < 0.001). Interrater reliability was fair to moderate. Conclusion:The targeted provision of evidence-based guidelines as a PDF together with the respective guideline-based ENT question significantly improves response quality in ChatGPT. These findings highlight that the integration of medically sound primary sources is crucial for the accuracy and reliability of LLMs. LLMs therefore appear to be a potentially supportive tool in clinical and scientific assistance but do not replace medical expertise. In particular, potential "hallucinations" require continued critical medical and scientific oversight.

Abstract A peritonsillar abscess (PTA) displays a purulent infection arising from acute tonsillitis, involving a variety of aerobic and anaerobic bacteria. Fusobacterium necrophorum , a gram-negative anaerobe, is considered a significant risk factor for complications like Lemierre’s syndrome. This study aimed to analyze the microbiological spectrum of PTA and its impact on the clinical course and outcomes. This retrospective study included all patients diagnosed with PTA at a tertiary care center between January 2018 and June 2023. Data on patient demographics, inflammatory markers, microbiological aspects (including species identification and antibiotic therapy), and clinical management were collected. Overall, 321 patients with a mean age of 34.1 years were included. Most patients (80.1%) underwent tonsillectomy, while others received surgical incision and drainage (18.1%) or no surgical treatment (1.9%). Patients with tonsillectomy had a significantly longer hospital stay compared to those with incision and drainage (5.4 ± 2.5 days vs. 4.4 ± 1.3 days; adjusted p = 0.004). Surgical complications were more frequent in patients with tonsillectomy (13.6% vs. 1.7%; adjusted p = 0.048), whereas ipsilateral recurrence was more common in patients with incision and drainage (8.6% vs. 0.0%; adjusted p = 0.004). Higher CRP levels at admission ( p = 0.002) were predictive for a higher risk of infection-related complications. Streptococcus pyogenes was the most frequently identified pathogen (25.9%), followed by Streptococci of the anginosus group (15.3%), and Fusobacterium necrophorum (FN; 11.5%), which was significantly more common in adolescents (age < 18 years; 25.3%) than in adult patients (9.5%; adjusted p = 0.020) and had high antibiotic susceptibility rates with 100% to clindamycin and 96.6% to penicillin or aminopenicillin with beta-lactamase inhibitor, the latter being administered to the majority (87.2%) of patients as empiric antibiotic treatment. This study provides insights into the demographic, clinical, and microbiological characteristics of PTAs. Consistent with previous literature, this study shows a higher frequency of FN in PTAs in adolescents and young adults. However, unlike previous reports, this was not associated with increased complication rates.

Introduction Tympanomastoid surgery, encompassing intricate middle ear and mastoid procedures, necessitates a standardized classification system to ensure consistent documentation, enhance comparability, and improve outcome analysis across different clinical settings. The SAMEO-ATO classification, established by the International Otology Outcome Group (IOOG), provides a comprehensive framework that categorizes surgical interventions into key components, covering both mastoid operations (SAMEO) and middle ear surgeries (ATO).Methods We analyzed correlations between specific subgroups within the SAMEO-ATO framework and the duration of surgery. Data were retrospectively collected from 300 patients at a university hospital, categorized according to the SAMEO-ATO classification, and statistically analyzed to determine associations between subgroups and operative time.Results Our findings indicated that the type of surgical approach (e.g., endaural vs. retroauricular), as well as the specific components of mastoidectomy, external auditory canal reconstruction, mastoid cavity obliteration, middle ear access, tympanic membrane reconstruction, and ossicular chain reconstruction, significantly influenced surgery duration.Conclusions The results suggest that the SAMEO-ATO classification can serve as a valuable predictive tool for estimating procedural complexity in tympanomastoid surgery. These findings contribute to the growing body of evidence supporting the utility of the SAMEO-ATO classification in otological practice and underscore its potential as a framework for outcome-oriented research in middle ear and mastoid surgery.

Zusammenfassung Large Language Models wie ChatGPT werden zunehmend als Unterstützung in der medizinischen Entscheidungsfindung diskutiert. Ziel dieser Studie war es zu untersuchen, ob sich die Qualität der von ChatGPT (GPT-4) generierten Antworten auf leitlinienbasierte HNO-Fragestellungen verbessert, wenn die zugrunde liegende evidenzbasierte S3-Leitlinie gemeinsam mit der jeweiligen Frage als PDF bereitgestellt wird. Es wurden 30 leitlinienbasierte Fragen aus 5 aktuellen S3-Leitlinien erstellt. ChatGPT beantwortete jede Frage in 2 Durchläufen: einmal ohne und einmal mit Bereitstellung der jeweiligen Leitlinie als PDF zusammen mit der Frage. Drei HNO-Fachärzte bewerteten die Antworten anonymisiert hinsichtlich inhaltlicher Richtigkeit und Länge/Prägnanz (Skala 1–3). Die gemeinsame Bereitstellung der Leitlinie als PDF mit der jeweiligen Frage führte zu einer signifikanten Verbesserung der Richtigkeit (1,77 vs. 1,26; p=0,003) und der Prägnanz (1,96 vs. 1,50; p=0,004). Es bestand eine signifikante Korrelation zwischen Richtigkeit und Prägnanz (p<0,001). Die Interrater-Reliabilität war fair bis moderat. Die gezielte Bereitstellung evidenzbasierter Leitlinien als PDF gemeinsam mit der jeweiligen leitlinienbasierten HNO-Fragestellung an ChatGPT verbessert die Antwortqualität signifikant. Die Ergebnisse unterstreichen, dass die Einbindung medizinisch fundierter Primärquellen für die inhaltliche Richtigkeit und Zuverlässigkeit von LLMs entscheidend ist. LLMs erscheinen somit als potenziell unterstützendes Instrument in der klinischen und wissenschaftlichen Assistenz, ersetzen jedoch nicht die ärztliche Expertise. Insbesondere potenzielle „Halluzinationen“ erfordern weiterhin eine kompetente ärztliche und wissenschaftliche Überprüfung.

BACKGROUND:The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing worldwide, particularly among younger men without classical risk factors. High-risk HPV types are the primary cause. Prophylactic vaccines offer the first effective means of primary prevention, with efficacy demonstrated primarily through the reduction in oropharyngeal HPV infections. OBJECTIVE:This article aims to present the current evidence on HPV vaccination for prevention of OPSCC, including vaccination coverage, guideline recommendations, and implications for patients and their close contacts. MATERIALS AND METHODS:A systematic literature search was performed in PubMed (2000-2025) on HPV vaccination and oropharyngeal cancer, including systematic reviews, meta-analyses, and cohort and randomized studies as well as national and international guidelines. RESULTS:Human papillomavirus vaccination reduces the prevalence of oropharyngeal high-risk HPV infections by 80-90% and significantly lowers the risk of persistent infections. Relatives and sexual partners of OPSCC patients have a mildly increased risk of HPV-associated malignancies. Vaccination coverage in Germany is particularly low among boys; therapeutic HPV vaccines are currently being investigated in clinical trials. Modeling studies indicate that substantial reductions in the OPSCC incidence can only be achieved with significantly higher vaccination rates than those currently seen in Germany. CONCLUSION:Human papillomavirus vaccination is an effective tool for primary prevention of oropharyngeal infections and, indirectly, OPSCC. Sustainable impact requires gender-neutral and easily accessible vaccination programs, targeted inclusion of close contacts, and further research into therapeutic vaccination strategies.

Introduction: Subgroups with a poorer prognosis exist among patients with human papillomavirus positive oropharyngeal squamous cell carcinoma (HPV-positive OPSCC). This study aims to identify histological and genetic differences within HPV-positive OPSCC and correlate these findings with patient outcomes. Methods: The study included 102 OPSCC patients, all tested positive for high-risk HPV DNA and p16INK4a expression. Based on histomorphological classification (HPV Prediction Classification, HPV PC), all cases were categorized as either classic HPV-positive OPSCC (cHPV) or non-classic HPV-positive OPSCC (non-cHPV). Nextgeneration sequencing (NGS) of selected genes was performed on 55 tumor samples, correlating results with morphological status and survival. Results: Of all cases, 49 % (n = 50/102) were categorized as non-cHPV, histomorphologically resembling HPVnegative OPSCC, and showed significantly poorer overall survival (p = 0.004) and five-year survival rate (5YS: 83.9 % vs. 58.4 %). Multivariate analyses identified HPV PC as an independent prognostic marker (p = 0.027). NGS revealed loss-of-Function (LOF) mutations in TP53 in three non-cHPV samples. Additionally, PIK3CA/PTEN mutations were found in 35.7 % (10/28) of non-cHPV cases. The cumulative burden of gene mutations was higher in the non-cHPV subgroup compared to the cHPV subgroup (n = 53, p = 0.1). Conclusion: HPV PC distinguished two histomorphological subgroups within HPV-positive OPSCCs: cHPV with excellent prognosis and non-cHPV with poorer overall survival. Non-cHPV tumors also exhibited higher overall mutation rates, notably LOF-TP53 and PIK3CA/PTEN mutations. These morphological subtypes, along with their corresponding mutational profiles, warrant further investigation as potential biomarkers for de-escalation intervention trials.

The term “larynx organ preservation” (LOP) has become a synonym for non-surgical laryngeal cancer treatment based on chemotherapy and radiation multimodality therapy [simultaneous chemoradiation (CRT) or neoadjuvant chemotherapy followed by radiotherapy (NCT+RT)]. Currently, the distinction between good and bad candidates for LOP is not clear, and the decision for surgical or non-surgical treatment depends on the patient’s needs and desires, the experience and recommendation of the surgeon, the philosophy of the institution, and others. Nevertheless, the major disadvantage of LOP by CRT and NCT+RT is the potential need for salvage surgery due to tumor persistence after the application of full per-protocol treatment. Head and neck surgeons worldwide complain that in principle, salvage surgery is frequently possible after CRT but causes major complications and is not feasible in a relevant number of patients. While NCT+RT is globally used to select responders for LOP, NCT alone has not been shown to improve overall survival. Therefore, this procedure has lost its influence in standard head and neck cancer treatment beyond LOP. Recently, NCT as part of the perioperative transoral surgical treatment concept in head and neck cancer is gaining interest again. In addition to conventional chemotherapy, the combination with immune checkpoint inhibitors as a neoadjuvant concept has shown to be effective in non-controlled trials by opening a new door of encouraging treatment options for LOP.

To evaluate the accuracy of intraoperative predictions made by otologic surgeons regarding postoperative air conduction (AC) thresholds following middle ear surgery. This retrospective study analyzed clinical data from 103 patients who underwent various middle ear surgeries between January 2024 and May 2025. At the end of each procedure, surgeons estimated the expected postoperative AC threshold based on intraoperative findings. These predictions were compared to actual postoperative audiometric outcomes. The absolute difference between estimated and measured AC thresholds was calculated across standard frequencies and compared. Influencing factors such as pathology, surgical procedure, surgeon experience, and gender were assessed. Surgeons accurately predicted the direction of hearing change (improvement, stability, or deterioration) in most cases. However, the average absolute deviation between estimated and actual AC thresholds was 11.3 ± 6.7 dB, with the largest discrepancies observed at higher frequencies. Estimation accuracy was significantly better in cases of simple tympanic membrane perforation compared to complex pathologies like cholesteatoma. No significant differences were found between surgical techniques, surgeon gender, or experience level. Surgeons tended to anticipate improved hearing following successful ossicular reconstruction or membrane repair, whereas poorer outcomes were predicted when reconstruction was suboptimal or mass removal disrupted sound conduction. While surgeons can reliably judge the general direction of postoperative hearing outcomes, their ability to predict precise AC thresholds based on intraoperative impressions is limited. These findings underscore the need for realistic preoperative counseling and suggest that future improvements may come from integrating clinical data with machine learning tools to enhance predictive accuracy in otologic surgery.

The auricular cough reflex (Arnold’s reflex) is a vagally mediated somato-visceral response triggered by stimulation of the external auditory canal (EAC). While classically considered rare, its clinical relevance in otologic procedures remains underexplored. This study aimed to evaluate the prevalence, lateralization, and potential risk factors of the Arnold reflex during routine otologic examinations, with particular attention to examiner handedness, hearing aid use, and EAC inflammation. In this prospective observational study, 404 consecutive patients undergoing bilateral ear wax removal in a university otology clinic were assessed for reflex-induced coughing. Reflex occurrence, laterality, instrument type, hearing aid use, signs of local infection, age, and sex were documented. Statistical analyses included chi-square tests, logistic regression, and McNemar’s test. A cough reflex was elicited in 52 patients (12.9

INTRODUCTION:Cholesteatoma, a challenging entity in otologic surgery, necessitates a standardized classification system for effective communication among healthcare providers and consistent reporting of surgical outcomes. The ChOLE Classification System, introduced by Linder et al., stages cholesteatoma based on extension (Ch), ossicular chain status (O), life-threatening complications (L), and Eustachian tube function and mastoid pneumatization (E). METHODS:We classified 199 patients who underwent cholesteatoma surgery between 2019 and 2023 in our University Hospital to assess the distribution of the ChOLE stages and to examine the relationship between the ChOLE stages and the duration of surgery. RESULTS:This study revealed significant correlations between the ChOLE stage and respective subgroups of the classification and duration of surgery and thus complexity of procedure. CONCLUSION:Despite limitations, the ChOLE classification proves valuable in predicting surgical complexity and optimizing patient care. Further research is warranted to validate these findings and enhance cholesteatoma management strategies.

Introduction In the last decades, new technological devices and instruments have been developed to overcome the technical limits of transoral laser microsurgery (TOLS). The recent introduction of 3D-exoscopy (3Dex) seems to be a promising tool in the field of diagnostic and operative laryngology as an alternative to the traditional microlaryngoscopy applying an operating microscope (OM).

Background Antigen-specific immune response is a hallmark of cancer immunotherapy. Potential antigens in head and neck squamous cell carcinoma (HNSCC) include tumor-associated antigens (TAAs), mutation-associated neoantigens (MANAs) and viral proteins, including high-risk human papillomavirus (HPV) proteins. Studies combining multiple antigens for cellular therapy renewed interest in TAAs. While intratumoral expression of antigens is frequent, immunotherapy does not induce durable tumor regression in the majority of HNSCC patients. Impaired HLA class I antigen processing as a key factor of immune evasion in HNSCC has been recognized previously, but the precise mechanisms remain elusive.

Introduction Up to 25% of patients with HPV-positive oropharyngeal carcinoma (HPV+OPSCC) develop recurrence. Biomarkers for the early identification of this subcohort are missing. The aim of this study was to identify a transcriptome (mRNA)-based expression profile associated with the development of recurrence in patients with HPV+OPSCC.

Einleitung Bis zu 25% der Patienten mit einem HPV-positiven Oropharynxkarzinom (HPV+OPSCC) entwickeln ein Rezidiv. Biomarker zur frühzeitigen Identifikation dieser Subkohorte fehlen. Ziel dieser Studie war es ein Transkriptom (mRNA)-basiertes Expressionsprofil zu identifizieren, welches mit der Entwicklung eines Rezidivs bei Patienten mit einem HPV+OPSCC in Zusammenhang steht.

Introduction Laryngeal exposure in direct laryngoscopy when using a Kleinsasser laryngoscope and the operating microscope may prove to be complicated at times. The use of angled endoscopes is a way to gain insight into laryngeal areas that are difficult to expose directly, especially in the anterior commissure. To allow the use both of hands during microlaryngoscopy, we use a semi-robotic endoscope-holding- system, which enables high maneuverability as well as precise positioning of the endoscope. In this multimedia presentation we aim to demonstrate our clinical experience with endoscopically assisted microlaryngoscopic surgery.

Einleitung Der schwer einzustellende Larynx, bei welchem die direkte Einsicht der Glottisebene mit dem Operationsmikroskop unter Verwendung der Kleinsasser-Rohre erschwert ist, ist jedem operativ tätigen HNO-Arzt bekannt. Die Verwendung von gewinkelten Endoskopen ist eine Möglichkeit, um Einsicht in schwer zu exponierende Larynxareale zu nehmen. Um beidhändiges Operieren zu ermöglichen, verwenden wir einen halbrobotischen Endoskop-Halte-Arm. Mit diesem Beitrag möchten wir unsere klinische Erfahrung bei endoskopisch assistierten mikrolaryngoskopischen Operationen demonstrieren.

The two pillars of therapy for oropharyngeal squamous cell carcinoma (OPSCC) are upfront surgery and primary chemoradiotherapy. Substantial regional preferences exist with regard to the selection of treatment. Despite new therapeutic approaches, patient survival remains poor, with an approximate overall survival (OS) rate of 50% at five years. This study was conducted to investigate a potential survival benefit depending on the treatment modality in OPSCC patients. We retrospectively collected data of 853 patients with histologically confirmed OPSCC from the Giessen and Maastricht cancer databases. To identify risk factors affecting survival, a Cox-proportional hazard model was applied to 442 patients with complete data sets. Based on this cohort a matched-pair analysis with 158 patients was performed to compare OS rates of patients treated either with upfront surgery or primary chemoradiation. For the collective cohort, patients treated with upfront surgery had significantly improved OS rates compared to patients treated with primary chemoradiation. In the matched-pair analysis adjusted for patients' T-, N- and HPV-status as well as risk profile, we observed that both treatment approaches offered equivalent OS rates. Our study emphasizes that treatment recommendations should be made whenever possible on the basis of side-effect profiles caused by the therapeutic approach used. To draw further conclusions, results of the ongoing "best of" (NCT2984410) study are eagerly awaited, investigating the functional outcome after treatment of OPSCC patients.

Tumor growth and survival requires a particularly effective immunosuppressant tumor microenvironment (TME) to escape destruction by the immune system. While immunosuppressive checkpoint markers like programmed cell death 1 ligand (PD-L1) are already being targeted in clinical practice, lymphocyte-activation-protein 3 (LAG-3), T-cell immunoglobulin and mucin-domain containing-3 (TIM-3) and V-domain Ig suppressor of T cell activation (VISTA) inhibitors are currently under investigation in clinical trials. Reliable findings on the expression status of those immune checkpoint inhibitors on tumor-infiltrating lymphocytes (TILs) in the TME of oropharyngeal squamous cell carcinoma (OPSCC) are lacking. This work aims to describe the expression of LAG-3, TIM-3, and VISTA expression in the TME of OPSCC. We created a tissue microarray of paraffin-embedded tumor tissue of 241 OPSCC. Expression of the immune checkpoint protein LAG-3, TIM-3, and VISTA in OPSCC was evaluated using immunohistochemistry and results were correlated with CD8+ T-cell inflammation and human papillomavirus (HPV)-status. 73 OPSCC stained positive for LAG-3 (31%; HPV+:44%; HPV-:26%, p = 0.006), 122 OPSCC stained positive for TIM-3 (51%; HPV+:70%; HPV-:44%, p < 0.001) and 168 OPSCC (70%; HPV+:75%; HPV-:68%, p = 0.313) for VISTA. CD8+ T-cells were significantly associated with LAG-3, TIM-3 and VISTA expression (p < 0.001, p < 0.001, p = 0.007). Immune checkpoint therapy targeting LAG-3, TIM-3, and/or VISTA could be a promising treatment strategy especially in HPV-related OPSCC. Future clinical trials investigating the efficacy of a checkpoint blockade in consideration of LAG-3, TIM-3, and VISTA expression are required.

Carcinogenesis of human papillomavirus (HPV)-related (+) oropharyngeal squamous cell carcinoma (OPSCC) differs from HPV-negative (–) OPSCC. HPV-related immune-escape-mechanism could be responsible for the development and progression of HPV+ tumors and an immunophenotype different from HPV– OPSCC is expected. The purpose of this study was to analyze the expression of programmed cell death protein 1 ligand 1 (PD-L1) and its prognostic relevance in relation to CD8+ tumor infiltrating lymphocytes (TILs) and the major histocompatibility complex (MHC) I expression in OPSCC. We quantified PD-L1 expression on tumor cells (TC) and macrophages and MHC I expression in association to CD8+ TILs by immunohistochemistry on tissue microarray derived from 171 HPV+/-OPSCC. HPV-status was determined by p16INK4a immunohistochemistry/HPV-DNA detection. Presence of CD8+ TILs, PD-L1 expression on TC, and a more frequent loss of MHC I in HPV+ compared to HPV- OPSCC was detected. A high amount of CD8+ TILs in the whole cohort and in HPV+ OPSCC and PD-L1 expression on TC in HPV- OPSCC was associated with favorable overall survival. There was a trend for an improved outcome according to PD-L1 expression (macrophages) in HPV+ OPSCC without reaching statistical significance. CD8+ TILs and PD-L1-expression have prognostic impact in OPSCC and might present useful biomarkers for predicting clinical outcome and personalized therapy concepts.