PurposeMaxillary cancers extending to the deep craniofacial spaces represent one of the most challenging scenarios in head and neck oncology. Integrating compartmental surgery principles with combined endoscopic–open approaches may optimize deep-margin control, a key determinant of oncologic radicality.MethodsA retrospective analysis included 34 patients treated between 2019 and 2025 at four referral centers using combined compartmental maxillary resection (CCMR). Procedures were assigned to CCMR types 1–3 according to the compartmental resection performed; preoperative imaging, including assessment of posterior deep spaces and the infratemporal fossa (ITF), informed template selection.ResultsITF infiltration was absent in 38.2% of cases, partial in 35.3%, and extensive in 26.5%. Resection types were CCMR type 1 in 32.4%, type 2 in 38.2%, and type 3 in 29.4%. Negative margins were achieved in 79.4%; posterior and medial margin control remained reliable even with partial or extensive ITF involvement. Median follow-up was 21 months. Local control rates at one and three years were 81.9% and 75.1%, respectively.ConclusionCCMR appears to be a feasible and anatomically standardized surgical strategy for selected maxillary cancers arising from the oral cavity or maxillary sinus with deep craniofacial extension. By integrating compartmental resection principles with combined endoscopic–open approaches, this technique may support margin-oriented surgical planning and reliable control of deep posterior and medial margins, including in cases with ITF involvement. Further studies with longer follow-up are needed to define its oncologic impact.

BackgroundTo evaluate current clinical practices, attitudes, and considerations regarding hearing and structure preservation (HSP) in cochlear implant surgery among international experts.MethodsA cross-sectional online survey comprising 42 structured items was distributed to 75 HEARRING members, including surgeons, audiologists, and scientists. The questionnaire covered HSP indications and candidate evaluation, electrode array selection, surgical techniques, fitting strategies, and training.ResultsThirty-one experts from 16 countries completed the survey. Most respondents (87.1%) supported HSP surgery in all patients with normal cochlear anatomy, regardless of the severity of hearing loss, primarily to preserve cochlear structures and optimize long-term outcomes. Strong consensus emerged regarding atraumatic principles, including slow electrode array insertion, flexible electrode arrays, round window access, and routine intraoperative corticosteroid use. Image-based planning was unanimously endorsed for electrode array selection, and all experts favoured longer electrode arrays even in patients with functional low-frequency hearing. Variability persisted in the adoption of genetic testing, perioperative management, intraoperative monitoring, and fitting strategies, although anatomy-based fitting was most frequently selected. Training of surgeons and audiologists was universally regarded as essential.ConclusionsThis survey demonstrates a clear evolution toward a shared expert framework for HSP-oriented cochlear implantation surgery, with several principles approaching consensus. Remaining variability highlights a) areas for future research and development and b) supports the continued international collaboration toward standardized HSP practice.

It is widely recognized that latent infection is the predominant mode of Epstein-Barr virus (EBV) infection in nasopharyngeal carcinoma (NPC) in which a specific set of latent genes is responsible for driving the development of the disease. However, the expression of these latent genes does not adequately explain the various transformed phenotypes of NPC cells. Using an established high-throughput quantitative reverse transcription PCR array, we found that several EBV lytic genes were more widely expressed in primary NPC tissues than previously recognized. We focused on a lytic gene, BILF1, which encodes a constitutively active G protein-coupled receptor (GPCR). We showed that BILF1 was expressed in tumour cells from primary NPC tissues at both mRNA and protein levels, and in the absence of BZLF1 expression. RNA sequencing analysis of BILF1-expressing immortalised nasopharyngeal epithelial (NPE) cells demonstrated that the profile of BILF1-regulated genes significantly overlapped with gene signatures of micro-dissected NPC, indicating that the expression of BILF1 is relevant to the pathogenesis of NPC. In accordance with these observations, pathway analysis of the transcriptome of BILF1-expressing cells showed the involvement of BILF1 in key biological processes typically deregulated in NPC. To examine whether BILF1 expression influenced epithelial cell behaviour, functional studies showed that BILF1 enhanced cell proliferation, migration, invasion and colony formation. In addition, BILF1 increased AKT activation in NPE cells, which was responsible for the increase in cell migration. Taken together, our data convincingly point to an oncogenic role for BILF1 in NPC. © 2026 The Pathological Society of Great Britain and Ireland.

Sphenoid sinus mucoceles are rare lesions that account for less than 2% of all sinonasal mucoceles. In revision cases, surgery is more challenging because prior operations alter the normal anatomy and remove important surgical landmarks. A 79-year-old male presented with a headache 10 years after prior sphenoid surgery for fungal disease. Preoperative MRI showed a multiloculated, expansile sphenoid mucocele. Bony erosion involved the sellar floor and the right internal carotid artery (ICA) canal, with additional erosion of the mid-clivus. Endoscopic transnasal marsupialization was performed using the posterior choana and nasal septum as fixed landmarks to localize the sphenoid face. After entering the sphenoid sinus, the optic nerve prominence, ICA prominence, opticocarotid recess, and sella were identified on the posterior wall. A stepwise compartment-by-compartment approach was used to drain the mucocele and remove all septations under continuous visualization of these landmarks. The anterior sphenoid wall was completely removed to establish wide and durable drainage. All mucocele compartments were successfully drained. All posterior sphenoid landmarks were clearly identified. Bony dehiscence was noted at the sellar floor, mid-clivus, and right ICA canal. The dura was intact at all sites. No complications occurred. The headache improved after surgery. Follow-up confirmed a patent sphenoidotomy with no recurrence. This technique provides a safe and systematic approach to revision sphenoid mucocele surgery. It may be applied to other complex sphenoid lesions in which altered anatomy and skull-base dehiscence require careful landmark-based dissection.

The objective is to determine the effect of noise exposure on the vestibular system using vestibular-evoked myogenic potential (VEMP). A literature search was conducted in January 2023 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Fourteen original clinical research articles were selected based on the objectives and selection criteria. All studies were at level III evidence. Altogether, 462 participants aged between 15 and 67 years were found. There was a significant male predominance (84.4%). Three studies reported acute noise exposure, while 11 reported chronic noise exposure. Cervical VEMP (cVEMP) was performed in 14 studies, and ocular VEMP (oVEMP) in 3 studies. Abnormal cVEMP and oVEMP were reported in all included studies, 58.85% and 44.3%, respectively. A meta-analysis was not performed because of the heterogeneity of the patient groups and the variability of the methods used to measure outcomes. Analysis of the result indicates that noise exposure of both acute and chronic nature alters both cVEMP and oVEMP, as shown in all studies. However, the data must be interpreted cautiously due to heterogeneity across the studies until randomized controlled studies with a large sample size are carried out. Cite this article as: Saniasiaya J, Kulasegarah J, Seluakumaran K, Narayanan P. Role of vestibular-evoked myogenic potential to assess noise exposure: A systematic review. B-ENT. 2025;21(2):56-65.

INTRODUCTION:Meniere's disease (MD), or idiopathic endolymphatic hydrops, has been well-established in adults. However, due to the lack of understanding of pathomechanism and the progression of MD in children, managing this condition remains a challenge. The review aims to investigate the clinical management and outcome of treatments in children and adolescents with MD. METHODS:A systematic literature review was conducted in accordance with PRISMA guidelines to identify articles that assessed the outcome of treatment among children with MD. Information regarding the child's demographic data, MD symptoms, investigations, treatment, and outcomes was extracted from the included studies. The primary outcome was defined as the success of treatment based on the resolution or improvements of symptoms, while the secondary outcome was determined by recurrence or worsening symptoms or the presence of complications. RESULTS:The review included 12 studies published between 1958 and 2024. Fifty-seven children were noted, with a mean age of 9.9 ± 3.1 (range 5-14 years) and female predominance (60 %). Most of the included articles were from Asian countries (66.6 %), followed by Europe (16.7 %) and the USA (16.7 %). Improvement of symptoms was reported in 91.7 % of the included studies, with recurrence reported in four studies and persistence in symptoms found in one study. Diuretics were the most favoured intervention. Endolymphatic sac decompression is the favoured surgical option. Complications reported include worsening hearing found in two children (3.5 %). CONCLUSION:Pharmacological and surgical treatment results in good outcomes in children with MD. However, the quality of the evidence is inadequate to recommend the ideal intervention until a better-quality study has been completed. Future randomised controlled studies with a large sample size are warranted to determine the ideal intervention in children with MD.

OBJECTIVE:The effect of noise on the postural control process is of ongoing interest. This exploratory study aims to determine the effect of personal listening devices (PLD) on postural stability among adolescents and young adults. METHODS:Participants aged between 13 and 25 with a history of PLD usage were included. The study was carried out in two parts. The first part involved determining the PLD listening level and the preferred sound level. In the second part, postural stability was assessed using the modified Clinical Test for Sensory Interaction in Balance (mCTSIB) and dynamic postural stability. RESULTS:64 participants were recruited with a mean age of 18.78 (SD: 3.11). The majority were female (62.5%) and of Chinese ethnicity (38.1%). The reported mean PLD listening level and preferred volume levels were 57.50 dB (SD: 6.15) and 46.48% (SD: 15.98), respectively. Male PLD users had higher listening levels and preferred volume levels. Adolescents were found to have a higher listening level than young adults. Female PLD users revealed a higher sway and postural stability index than male PLD users. Young adults were found to have a higher sway and postural stability index. Statistical significance is demonstrated between the age of PLD users and mCTSIB sway index (coef: 0.367; p = 0.003). CONCLUSION:The current study suggests that the younger generation is susceptible to postural instability following PLD exposure. Yet, the provided data is inadequate to draw a conclusion, and future randomised controlled studies with large sample sizes are warranted.

Inner ear malformations (IEMs) represent unique challenges in cochlear implantation, potentially influencing electrode placement during surgery and neural responsiveness. Thus, electrically evoked cortical auditory potentials (eCAEPs) were suggested to be performed as objective measures of higher-level auditory perception at the cortical level in assessing cochlear implant (CI) outcomes in this complex population. This study aims to evaluate preliminary findings of P1 latency in eCAEPs among CI recipients with several types of IEMs at different positions of electrodes, that is, apical, medial, and basal regions. A cohort of five CI recipients with IEMs was evaluated using postoperative eCAEPs recordings, and P1 latency was analyzed at different positions of electrodes. The mean age of the subjects was 14.01 ± 5.51 years, with common cavity malformations, incomplete partition type I (IP-I), incomplete partition type II (IP-II), and enlarged vestibular aqueduct. Early data suggest P1 responses were generally present in all IEM cases in this cohort, with the mean of P1 latency for the electrode at apical, medial, and basal regions of 108.2 ± 13.4, 124.0 ± 23.6, and 140.0 ± 41.5 ms, respectively. These findings may reflect differential cortical response across IEM types at multiple CI electrode locations.

OBJECTIVE:Emerging reports show that personal listening device usage causes vestibular impairment. This study aims to investigate the effect of personal listening device usage on vestibular impairment. METHODS:Subjects between 13 and 25 years were recruited. Each subject underwent a personal listening device usage questionnaire and quantification of sound exposure level, followed by a series of vestibular tests. Statistical analyses were performed to identify the association between personal listening device characteristics, sound exposure level and vestibular function. RESULTS:A total of 131 participants were recruited, with a mean age of 20 ± 2.55 years. The mean duration of personal listening device usage per day was 5.53 ± 2.76 hours. Noise exposure from personal listening device usage was noted to cause more saccular damage in adolescents. A correlation was found between the preferred listening level, the 40-hour equivalent continuous exposure level (r = 0.406, p = 0.029) and the latency right p13 among adolescents. CONCLUSION:Sound exposure levels among adolescents are higher than among young adults. Personal listening device usage resulted in saccular damage among adolescents.

INTRODUCTION:Unsafe earphone listening habits can pose a risk of hearing loss, and early audiogram threshold shifts could occur at extended high frequencies (EHFs, 9-16 kHz) despite normal thresholds at the conventional test frequencies (0.25-8k Hz). Preliminary reports also suggest that regular earphone users could suffer from vestibular impairment. This study investigated the vestibular function among young adult users with normal audiograms at the conventional test frequencies with and without EHF hearing loss. It is hypothesised that those with EHF loss from earphone usage suffer early deficits in vestibular function. METHODS:Regular earphone users aged 12 to 25 years were questioned regarding their earphone listening behaviours. Their audiogram thresholds were determined at conventional and EHFs and grouped into those with and without EHF loss. Each participant underwent cervical vestibular evoked myogenic potential (cVEMP), subjective visual vertical (SVV), and video Head Impulse Test (vHIT) to assess the function of their saccule, utricle, and semicircular canals, respectively. Results obtained from these parameters were compared between those with and without EHF loss. RESULTS:While all 131 subjects tested had normal audiogram thresholds at 0.5 to 8 kHz, 15.3% had EHF hearing loss. The average duration of earphone usage per day was significantly longer in those with EHF loss than those with normal EHF (P = .008), but their preferred listening volume and total years of listening were comparable. While there was no statistical significance in the findings of the SVV and VHIT test, a significant reduction of the amplitude cVEMP was noted (P < .001), suggesting that those with EHF hearing loss may also have early vestibular damage, particularly to the saccule. CONCLUSION:Earphone users with EHF loss may have concomitant early saccule damage. cVEMP may be an alternative tool to detect early noise-induced cochlear damage, although a large cohort study is required to justify this.

Introduction Vestibular end-organs are deemed low-risk organs at risk (OAR) in the context of radiotherapy contouring in nasopharyngeal carcinoma (NPC) treatment. To date, existing literature on the effect of radiotherapy on vestibular function among post-irradiated NPC patients remains elusive. The main aim of this study is to determine the effect of radiotherapy on vestibular function, specifically the semicircular canal (SCC), in post-irradiated NPC patients. Methods A total of 31 post-irradiated NPC patients (10 patients in the prospective group and 21 patients in the cross-sectional group) were assessed by using the video head impulse test (VHIT) and adult dizziness handicap inventory (DHI) and compared with 36 healthy patients (control group). The vestibular ocular reflex (VOR) gain and the presence of saccade of individual SCCs were assessed and compared with the control group. VOR gain and the presence of saccade were correlated with the mean radiation dose of the cochlea. Results VOR gain of all SCCs among post-irradiated NPC patients was grossly reduced, significantly seen in all the right-sided semicircular canals and left anterior semicircular canal (p < 0.05), corresponding with a high DHI score. Persistently reduced VOR gain was demonstrated among subjects 3 months post-radiotherapy (p > 0.05). Right lateral SCC saccade was significantly positively correlated with mean radiation of cochlea (r = 0.667). Conclusion Vestibular hypofunction was demonstrated in SCC among post-irradiated NPC patients and is found to be progressive as well as radiation dose-dependent.

BACKGROUND:Advancements in endoscopic sinus and skull base surgery created a need for standardized terminology to describe sphenoid sinus surgery. Although classification systems exist for other sinuses, one for endoscopic sphenoid sinus surgery is lacking. Developing such a system would standardize procedure descriptions and promote a common language among surgeons. This study aimed to develop a new classification system for endoscopic sphenoid surgery. METHODS:Consensus on a novel endoscopic sphenoid surgery classification system by running the Delphi procedure with 16 rhinology experts from around the world. RESULTS:Four Delphi rounds were required to reach a consensus on all stages of the classification. The average percentage of agreement on the stages of classification progressively increased from 70.83% in the first round to 87.68% in the last round. The rejection rates continuously decreased from 8.81% in the first round to 4.44% in the last round. The classification system was developed as follows: stage 1, presphenoid surgery; stage 2A, partial sphenoidotomy; stage 2B, complete sphenoidotomy; stage 2C, transpterygoid sphenoidotomy; stage 3A, Rostral sphenoidectomy; and stage 3B, extended sphenoid drill-out. CONCLUSIONS:This novel endoscopic sphenoid surgery classification system facilitates the description of different sphenoid sinus procedures, providing surgeons with better opportunities for discussion and communication.

Objective: Persistent postural-perceptual dizziness (PPPD) is a chronic functional disorder where treatment should be tailored to the individual needs. While customized therapy with a physiotherapist has evidence-based benefits, it comes at a cost and the facility may not be available to some, especially in rural areas. An alternative option is a home-based treatment called MEND (Move, Eye, Neck stretching, and Deep breathing exercises) therapy. This study aimed to assess the efficacy of MEND therapy in PPPD compared to the hospital-based vestibular rehabilitation therapy (VRT). Methods: 59 PPPD patients completed the randomized-controlled study comparing MEND therapy (intervention) and hospital-based VRT (control). EuroQOL Group quality of life questionnaire (EQ-5D), Dizziness Handicap Inventory (DHI), and 21-question Depression, Anxiety, and Stress Scale (DASS-21) were monitored at baseline, 4 weeks, and 12 weeks. Results: At the end of the study, 100% patients on MEND therapy found it beneficial compared to 79.3% in the control group. The MEND therapy provided significant improvements in the physical (P = .007), functional (P = .0006), emotional (P = .0003), and total (P = .0003) with a medium to large effect size. The control group showed significant improvement only in the functional elements of DHI (P = .04), and total DHI (P = .04) with a small to medium effect size. Conclusion: The MEND therapy is an effective option that incorporates all elements of therapy for PPPD. Cite this article as: Teh CS, Ain Abdullah N, Rafidah Kamaruddin N, Binti Mohd Judi K, Fadzilah I, Prepageran N. MEND Therapy: A home based option for persistent postural-perceptual dizziness (PPPD). B-ENT. 2024;20(1):34-44.

Introduction Obstructive salivary gland disease is a frequently encountered clinical entity that can present to various health practitioners. Obstructive sialadenitis can lead to recurrent infections and debilitating quality-of-life issues. Objective There is a paucity of published data regarding obstructive salivary disorders among the multiracial Asian population. The present study aimed to determine the demographic pattern and risk factors of obstructive salivary gland disorders with the goal of better management of this condition. Methods A retrospective cross-sectional study was conducted at a tertiary institution over a period of 5 years. Results A total of 256 (9.84 for every 1,000) patients were found to have salivary disorders, 10% of who were diagnosed to have obstructive disorder. Among the obstructive salivary disorders, 76% had sialolithiasis, 19% had recurrent parotitis, and 1 patient had chronic sialadenitis. We observed a small female preponderance for obstructive salivary disorders. This study revealed that smoking is a significant risk factor ( p = 0.041; prevalence ratio = 2.54, 95% confidence interval 1.12-5.78), and smokers were 2.5 times more likely to develop obstructive salivary disorders. There was no statistical correlation between the prevalence and other risk factors like infection, dehydration, intake of medications, history of diabetes mellitus, radiotherapy, and autoimmune disorders. Conclusion Our study results demonstrated that the prevalence of obstructive salivary gland disorders was 0.1%. This study provided a better understanding of the prevalence and risk factors of obstructive salivary disorders, which facilitate timely management and improves quality of life.

Eastern Cooperative Oncology Group (ECOG) is gaining importance as a valuable outcome measure in the field of oral cavity carcinoma (OCC). This study aimed to assess pre- and post-treatment ECOG changes in Malaysian OCC patients undergoing various treatments. We conducted a 12-36 months longitudinal observational study with 63 squamous cell carcinoma patients, evaluating ECOG perfomance, medical history, symptoms, sociodemographics, clinical details, and treatment modalities (surgery, surgery + radiotherapy, or surgery + chemotherapy and radiotherapy [CCRT]). OCC patients aged 50-70 years are at risk for impaired quality of life (QOL) up to several years after diagnosis. The analysis of the association between baseline ECOG Performance Status (ECOG-PS) scores and demographic data revealed a statistically significant correlation only within the age group, demonstrating a p-value of 0.031. CCRT treatment has a more pronounced effect on patient performance status, with significant results in the 3-year overall survival rate and poor ECOG-PS score in patients post-CCRT, as well as radiotherapy. These results highlight the need to provide OCC patients with specialised interventions and support, especially while they are undergoing CCRT, to lessen the potential negative effects on their general well-being and quality of life.

Petrous cholesteatoma is an entity of significant clinical ramifications especially concerning surgical risks it poses due to close proximity with vital skull-base neurovascular structures. Despite the challenges, surgical extirpation is still the treatment of choice. Conventional methods comprise external trans-mastoid routes through trans-labyrinth, retro-sigmoid, and middle cranial fossa. In this paper, we present a man native to Borneo, previously surgically treated for cholesteatoma who presented with a recurrence at the petrous apex. It was excised entirely via endoscopic trans-canal supra-labyrinth approach. Endoscopic removal is currently gaining favor amongst skull-base surgeons as more complex cases have been dealt successfully and reported worldwide. Nonetheless, it is an intricate procedure that requires a highly skilled and confident operator which demands experience.