Zusammenfassung Der laryngotracheale Übergang (LTÜ) stellt aufgrund enger anatomischer Verhältnisse, komplexer Strömungsverhältnisse und der Nähe zu Glottis und Krikoid eine funktionell kritische Zone dar. Ausgedehnte Stenosen, Krikoiddefekte und ein suprastomaler Vorderwandverlust überschreiten häufig die Möglichkeiten konventioneller Resektions- und Rekonstruktionsverfahren. Darstellung der aktuellen Rolle mikrovaskulärer Rekonstruktionen am LTÜ mit Fokus auf Indikationen, Techniken und Grenzen aus Sicht von HNO- und Thoraxchirurgie. Narrative Literaturübersicht zu klinisch etablierten Verfahren der Lappenrekonstruktion am LTÜ. Für kurze, nicht voroperierte Defekte bleiben Krikotrachealresektion und segmentale Trachealresektion mit End-zu-End-Anastomose Standardverfahren. Mikrovaskuläre Rekonstruktionen kommen vor allem bei langen, zirkulären LTÜ-Defekten, ausgedehntem Krikoidverlust, vorbestrahlten oder mehrfach voroperierten Regionen sowie nach komplexen Vorinterventionen zum Einsatz. Der freie radiale Unterarmlappen ist in der aktuellen Literatur die am besten etablierte Option für lange tracheale und laryngotracheale Defekte und kann mit Knorpelverstärkungen und mukosaler Auskleidung kombiniert werden. Knochentragende Lappen wie der mediale Femurkondylenlappen (Medial femoral Condyle Flap, MFC) und der thorakodorsale Skapulaspitzenlappen (Thoracodorsal Artery scapular Tip Flap, TDAST) ermöglichen in ausgewählten Fällen larynxerhaltende Rekonstruktionen mit Wiederherstellung einer tragfähigen Ring- bzw. Posteriorstruktur. Präfabrizierte Konzepte, ALT-basierte Lappen, Jejunumtransplantate und gestielte Lappen spielen eine ergänzende Rolle in Grenz- und Salvage-Situationen. Die mikrovaskuläre Rekonstruktion erweitert das Spektrum der Chirurgie des laryngotrachealen Übergangs über konventionelle Resektionsverfahren hinaus und kann in hochkomplexen Situationen einen funktionsfähigen oberen Atemweg bei vertretbarer Morbidität wiederherstellen. Angesichts begrenzter Evidenz aus Fallserien ist eine interdisziplinäre Planung und Bündelung dieser Eingriffe in erfahrenen Zentren entscheidend.

Vestibular dysfunction significantly contributes to dizziness, balance issues, and falls, yet causal treatments are still unavailable. The vestibular ganglion (VG), the primary sensory ganglion of the vestibular nerve, is increasingly seen as a key site of vestibular degeneration. Neural stem cells (NSCs) have been identified in several areas of the auditory and vestibular pathways. Endogenous activation of NSCs represents a promising regenerative strategy. However, the presence of NSCs within the VG remains uncertain. In this study, VG tissue from postnatal day (PND) 8 Sprague-Dawley rats was isolated, enzymatically dissociated, and cultured in serum-free neurosphere conditions. The dissociated VG cells reliably formed free-floating neurospheres that grew over multiple passages. Immunocytochemistry showed expression of NSC and progenitor markers, including Sox-2, Nestin, Musashi-1, Atoh-1, and doublecortin, in both neurospheres and VG tissue sections. Additional analyses demonstrated persistence of Sox-2-, Atoh-1-, and Nestin-positive populations in the adult VG. After differentiation, individual cells from neurospheres developed into β-III-tubulin-positive neurons, glial fibrillary acidic protein (GFAP)-positive astrocytes, and myelin basic protein (MBP)-positive myelinating glial cells, while a significant portion retained Nestin expression, indicating a progenitor-like state. These findings demonstrate that VG-derived cells meet the main criteria of NSCs: self-renewal, progenitor formation, and multipotent differentiation into neuronal and glial lineages. Our results provide the first evidence of a neurogenically capable cell population in the postnatal rat VG and support the persistence of progenitor-associated cell populations into adulthood. This identifies the VG as a novel endogenous regenerative reservoir, positioning it as a promising target for strategies that activate resident cells to restore vestibular function.

This study evaluates the imaging quality and radiation dose of six flat-panel volume CT protocols with varying technical parameters, including examination time (“Artis Icono” angiography system (Siemens Healthcare AG, Erlangen, Germany): 14s DCT HEAD MICRO CARE (14s I), 14s DCT HEAD MICRO CARE 4 (14s II), 8s DCT HEAD 70kV CARE 1 (8s I), 8s DCT HEAD 70kV CARE 3 (8s II), 4s DCT HEAD CARE FB (4s I), 4s DCT HEAD CARE FB 2 (4s II)) for middle ear visualization in human skull specimens. A scoring system assessed the delineation of 28 anatomical structures, narrowed to eight for detailed evaluation. Protocols 14s I and 8s I achieved the highest image quality, exceeding the clinical threshold. 8s I protocol demonstrated an optimal balance between image quality and radiation safety, adhering to the ALADA principle (“as low as diagnostically acceptable”). While 14s I offered superior detail, it involved higher radiation exposure without substantial further image improvement, indicating a saturation effect. Shorter protocols, such as 4s I, offered radiation-sparing advantages but did not consistently meet clinical image quality standards. Protocol 8s I is recommended as the standard for middle ear imaging, with 4s I as a potential alternative for cases requiring minimized radiation exposure and reduced motion artifact susceptibility.

Bystander activation represents an innate-like mechanism by which T cells, particularly effector and memory subsets, can become activated in the absence of cognate antigen recognition. Using human tonsil organoid cultures as a physiologically relevant model, we investigated bystander activation of CD4+ memory T cells in situ in comparison to superantigen stimulation. Tonsillar T cells were stimulated with pertussis toxin - a component of the childhood pertussis vaccine - in comparison to TSST-1 as the staphylococcal superantigen and assessed for activation status, cytokine expression, RNA expression, and metabolic reprogramming. We observed robust T cell activation and cytokine production as well as transcriptional changes comparable to that elicited by TSST-1. Notably, both bystander- and superantigen-activated T memory cells exhibited a metabolic shift toward glycolysis as the dominant energy pathway. These findings demonstrate the similarities of bystander and superantigen-induced T cell activation and show up pathways to sway bystander activation depending on the immunological context.

Background:Patients with head and neck cancer (HNC) face significant challenges in accessing coordinated care due to the complexity and multimodality of their treatment and the impact on vital functions. The COVID-19 pandemic has disrupted cancer care while accelerating the adoption of digital health solutions. Mobile health (mHealth) apps offer potential solutions for remote symptom monitoring, communication between patients and providers, and continuity of care. Nevertheless, their acceptance among patients with HNC remains limited due to age-related digital divides and concerns about accessibility. Objective:The aim of this study was to investigate the impact of the COVID-19 pandemic on patients with HNC and to explore their attitudes toward mHealth apps as a supplement to cancer treatment. Methods:A secondary analysis of a cross-sectional survey was conducted between January 2023 and May 2024 at Julius Maximilian University of Würzburg in Germany. A total of 355 patients with HNC were recruited and completed the structured "Cancer and COVID-19" survey via the Corona Health app or in paper form. The 25-question survey assessed sociodemographic information, the impact of the pandemic on diagnosis/treatment/aftercare, and interest in mHealth apps. Descriptive statistics and bivariate correlations were used for the analysis. Results:The cohort comprised 261 (74%) men and 94 (26%) women with an average age of 67 (SD 11.5) years. Most participants (n=264, 74%) stated that the pandemic had no impact on their cancer treatment, although 20% (n=71) experienced disruptions, particularly in follow-up appointments and treatment monitoring. Only 10% (n=36) currently used health apps, but 57% (n=203) expressed a willingness to use mHealth technologies. Younger patients, patients with higher education, and participants who were more affected by the pandemic showed greater openness to digital health solutions. The most significant barriers included age, digital literacy, and perceived usefulness, while preferred app features included interaction with physicians (n=160, 45%) and data sharing with researchers (n=153, 43%). Conclusions:Although the COVID-19 pandemic had only a limited direct impact on HNC care at the institution at hand, it revealed significant patient interest in mHealth apps. However, significant barriers remain, particularly among older adults with lower digital literacy. Future mHealth initiatives should focus on improving digital literacy, addressing privacy concerns, demonstrating clinical benefits, and developing personalized, accessible solutions to optimize cancer care for this vulnerable population.

Optische Biopsie bezeichnet lichtbasierte In-vivo-Verfahren, die in Echtzeit aus Bild- oder Spektraldaten auf Gewebeidentität bzw. Dignität schließen. In einer Review der wissenschaftlichen Publikationen der letzten fünf Jahre analysieren wir die in der Kopf-Hals-Chirurgie eingesetzten Verfahren nach Prinzip, klinischem Einsatz, Evidenz und Reifegrad. Zu den optischen Biopsietechnologien zählen konfokale Laserendoskopie, optische Kohärenztomografie, Hyperspektralbildgebung, Autofluoreszenz im Nahinfrarot (NIRAF), Raman-Spektroskopie, die photoakustische Bildgebung und Fluorescence-Lifetime-Imaging; sie unterstützen Biopsiesteuerung, Margin-Mapping und die Schonung kritischer Strukturen. Ergänzend liefern molekulare NIR-Tracer hohen Tumor-zu-Hintergrund-Kontrast und die laser-induzierte Breakdown-Spektroskopie identifiziert knöcherne Infiltration. Morphologische Kontrasttechniken (Kontaktendoskopie, NBI/SPIES) schärfen die Erkennung oberflächlicher Läsionen und mikrovaskulärer Muster, ermöglichen also eine optische Diagnose, gelten im engen Wortsinn jedoch nicht als optische Biopsie. Die Studienlage ist vielversprechend, aber heterogen; konsistente Vorteile auf Patientenebene sind bislang begrenzt. Routinetauglich sind die NIRAF zur Parathyreoidea-Identifikation und morphologische Kontrasttechniken als Ergänzung zur Weißlichtendoskopie. Alle übrigen Verfahren sollten in strukturierten Programmen mit standardisierter Endpunkterfassung (z.B. R0-Rate, Re-Operationen, Lebensqualität) eingesetzt werden. Kurz- bis mittelfristig werden multimodale Fusion, KI-gestützte Auswertung mit offenen Datensätzen und externer Validierung, sowie die Integration in Navigations- und robotische Workflows die klinische Wirkung und Übertragbarkeit erhöhen.

Die akute Mastoiditis im Kindesalter ist eine seltene, aber ernste Folge der Mittelohrentzündung. Einheitliche Richtlinien für Definition, Diagnose und Behandlung fehlen. Gemäß der aktuellen Datenlage kann folgendes Prozedere empfohlen werden: Die Diagnose wird im Wesentlichen anhand klinischer Kriterien mit klassischen Leitsymptomen gestellt. Die akute Mastoiditis wird stationär und interdisziplinär behandelt. Neben der kalkulierten i.v.-Antibiotikagabe (Mittel der Wahl: Ampicillin + Sulbactam) sollte großzügig die Indikation zur Parazentese gestellt werden. Eine CT- oder MRT-Bildgebung ist erforderlich bei unklarem Befund, Verdacht auf Komplikationen, schlechtem Allgemeinzustand, fehlender Besserung nach 24–48 h der Behandlung und vor einer geplanten Operation. Die Mastoidektomie ist bei Komplikationen oder nach spätestens 48 h konservativer Therapie ohne Besserung indiziert. Dieser Beitrag stellt einen praxisnahen Algorithmus für das Vorgehen bei Kindern mit akuter Mastoiditis vor.

An initial application of Confocal laser microendoscopy (CLE) in basal cell carcinoma (BCC) was promising, yet data in this field are still limited. Tumor vasculature, which can be clearly visualized by CLE, differs significantly from that of normal tissue, but has not yet been systematically analyzed as a target of CLE in BCC. By systematically assessing vascular features, we aim to define diagnostic criteria that support a more standardized and objective use of CLE in BCC. CLE imaging was performed in nine patients with histologically confirmed facial BCC. Forty artifact-free vascular sequences (20 BCC, 20 healthy skin) were analyzed using five predefined criteria independently rated by three blinded reviewers. Diagnostic accuracy, sensitivity, specificity, and interrater agreement were calculated. Normal skin showed regular, well-defined, round vessels of uniform size, whereas BCC demonstrated heterogeneous, dilated, and elongated vessels with indistinct borders and variable flow. Mean sensitivity and specificity were 91.7 ± 4.7

In the resection of cutaneous squamous cell carcinomas (cSCC) of the auricle, the challenge lies in ensuring a safe excision with adequate surgical margins in an aesthetically and functionally sensitive area, while keeping the resulting defect as small as possible. To contribute to achieving this goal, the present study is the first to investigate the potential of confocal laser endomicroscopy (CLE) as a method of optical biopsy for cSCC. A total of 82 CLE sequences (from 7 patients) showing cSCC or healthy tissue were blinded and presented to four different investigators for evaluation; in addition, presence of individual malignancy criteria derived from the literature were assessed. The distinction between healthy tissue and cSCC was achieved reliably. On average, the investigators reached a sensitivity of 96.95

This exploratory study aimed to systematically evaluate vascular features in confocal laser endomicroscopy (CLE) for distinguishing cutaneous squamous cell carcinoma (cSCC) from healthy skin, assessing both the overall diagnostic value of these features using a composite vascular scoring system and the performance of individual criteria. CLE video sequences of tumor and corresponding healthy skin were retrospectively analyzed in nine patients, using histopathology as the reference standard. Six vascular criteria were defined from the literature, three associated with healthy tissue and three with tumor tissue. Three experienced investigators performed a blinded assessment, and a majority decision determined the presence of each criterion. Sensitivity, specificity, predictive values, and interrater agreement were calculated. A composite vascular score (0–6) was derived, and ROC analysis was used to determine the optimal cutoff for discriminating tumor from healthy tissue. The features with the highest diagnostic relevance were “honeycomb-like capillaries” and “round vascular structures” for healthy tissue, and “leaky capillaries” for tumor sequences. ROC analysis identified a cutoff of ≥ 3 (Youden index 0.905, AUC 0.96). Within the analyzed dataset, the composite vascular score achieved a sensitivity of 100

Nasal cavity carcinoma (NCC) arises in an anatomically and aesthetically critical region. Complete resection with negative margins is mandatory, yet even minimal additional tissue removal may cause substantial cosmetic and functional morbidity and increase the need for reconstruction. This underscores the need for an intraoperative optical biopsy. We report the first evaluation of confocal laser endomicroscopy (CLE) as a potential tool for optical biopsy in NCC. In this pilot feasibility study including six patients, a blinded evaluation of 68 CLE video sequences (34 normal mucosa, 34 tumor), containing 4500 images, was performed independently by three investigators. A previously established scoring system from CLE studies in head and neck squamous cell carcinoma was applied to determine NCC-specific cut-off values and to assess concordance with investigator-based evaluations. Compared with normal mucosa, tumor sequences exhibited greater structural heterogeneity, atypical vascular patterns, increased variation in cell size, and indistinct cell borders. Investigators achieved an average sensitivity of 86.27

Objective:The resection of skin tumours of the auricle is confronted with the challenge of keeping the resection defect as small as possible and at the same time achieving a complete resection. Probe-based confocal laser endomicroscopy (CLE) is an optical procedure that enables real-time, non-invasive assessment of the epithelium with up to 1000x magnification in vivo. The aim is to evaluate the feasibility of CLE in basal cell carcinoma (BCC) of the auricle. Methods:Sixty-four video sequences (4,872 images) of CLE images of 8 different patients with BCC on the auricle were analysed. Each video sequence was assigned a histologic diagnosis. The sequences were presented to 4 physicians with experience in CLE in a blinded fashion. Dignity was assessed dichotomously using criteria such as cell size, tissue homogeneity and fibrosis. Results:BCC is characterised by inhomogeneous tissue with enlarged, poorly demarcated cells, partly interrupted by cell-free fibrosis. The assessment of dignity based on the CLE sequences achieved an average sensitivity of 86.7% and a specificity of 94.5%. The interrater reliability (Fleiss Kappa) showed substantial agreement (κ = 0.76). Conclusions:The results demonstrate the initial feasibility of intraoperative CLE for optical biopsy of facial skin tumours. The technique has the potential to serve as a non-invasive diagnostic tool in intraoperative decision making. Further studies are needed to evaluate its use as an adjunct to optimise or reduce the use of invasive frozen section pathology in the treatment of BCC.

Pediatric dysphagia represents a complex and multifactorial clinical challenge with potentially profound implications for development, nutritional status, pulmonary health, and overall quality of life. In infants and children, the early identification of swallowing difficulties is critical due to their impact on growth trajectories, neurodevelopment, and the psychosocial well-being of both the child and caregivers. This comprehensive article examines the importance of a systematic, interdisciplinary diagnostic approach in evaluating pediatric dysphagia in a university hospital. Based on a ten-year retrospective cohort study involving 223 pediatric patients aged one month to sixteen years, we investigate how the integration of clinical history, physical examination, and state-of-the-art instrumental techniques - such as flexible endoscopic evaluation of swallowing (FEES) - within a collaborative, multi-specialist framework can enhance diagnostic precision. Findings underscore the necessity of individualized, developmentally sensitive diagnostic pathways involving phoniatricions, ENT specialists, pediatricians, speech-language pathologists, radiologists and nutrition experts.

Abstract:Optical biopsy denotes light-based in vivo techniques that infer tissue identity in real time from image or spectral data. In a review of the literature covering the past five years, we analyze the modalities used in head and neck surgery by principle, clinical application, evidence, and technology readiness. Optical biopsy technologies include confocal laser endomicroscopy, optical coherence tomography, hyperspectral imaging, near-infrared autofluorescence (NIRAF), Raman spectroscopy, photoacoustic imaging and fluorescence lifetime imaging; these support biopsy guidance, margin mapping, and preservation of critical structures. In addition, molecular NIR tracers provide high tumor-to-background contrast and laser-induced breakdown spectroscopy identifies osseous invasion. Morphological contrast techniques (contact endoscopy; narrow-band imaging/ SPIES) sharpen the detection of superficial lesions and microvascular patterns-thus enabling optical diagnosis-yet, in the strict sense, do not constitute optical biopsy. The evidence base is promising but heterogeneous; consistent patient-level benefits remain limited to date. At present, NIRAF for parathyroid identification and morphological contrast techniques as adjuncts to white-light endoscopy are suitable for routine use. All other modalities should be implemented within structured programs with standardized endpoint ascertainment (e.g., R0 resection rate, reoperations, quality of life). In the short to medium term, multimodal fusion, AI-assisted analysis with open datasets and external validation and integration into navigation and robotic workflows are likely to increase clinical impact and generalizability.

The submental arterial island flap (SMIF) is used mostly for closing defects in the oral cavity, but also has its uses for oropharyngeal reconstruction. Since the duration of surgery is shorter compared with that for free flaps, it appears to be a good option for patients with severe anesthesiological risk factors. Therefore, the present study evaluated the functional and oncological outcomes of reconstructing defects after oropharyngeal carcinoma resection with a SMIF in these patients. A total of 10 patients underwent resection of lateral oropharyngeal carcinoma and ipsilateral neck dissection with closure of the defects using a SMIF. Oncological evaluation consisted of endoscopic and radiological standard-of-care restaging, while functional evaluation included a phoniatric swallowing examination with penetration-aspiration scale-score 6 months after surgery. All patients had T2 or T3 carcinoma, while 7 out of 10 patients had nodal involvement. Additionally, 7 out of 10 patients exhibited p16 expression. Pathological clear margins could be achieved in all patients. In all patients, no local, regional or distant recurrence occurred (median follow-up time, 26 months; range, 12-33 months). All patients had complete oral intake with their feeding tubes removed, with 1 patient restricted to dysphagia diet. Despite the severe comorbidities, there were no surgery-related or anesthesia-related complications. One patient who refused the recommended postoperative radiation developed enoral hair growth requiring regular trimming to avoid dysphagia. The SMIF is a reliable flap for reconstruction of lateral oropharyngeal defects with good oncological and functional outcomes. The reduced anesthesia duration appeared to be beneficial for patients with severe cardiac or pulmonary comorbidities. Male patients should be selected to undergo postoperative radiation to prevent enoral hair growth.

Background:The laryngotracheal junction (LTJ) is a functionally critical zone, due to its narrow anatomy, complex airflow dynamics, and proximity to the glottis and cricoid cartilage. Extensive stenoses, cricoid defects, and stomal anterior wall loss frequently exceed the possibilities of conventional resection and reconstruction. Objective:To outline the current role of microvascular reconstruction at the LTJ, with a focus on indications, techniques, and limitations from the perspective of otolaryngology and thoracic surgery. Methods:Narrative literature review of clinically established flap reconstruction techniques at the LTJ, including recent case series and key publications. Results:For short, non-pretreated defects, cricotracheal resection and segmental tracheal resection with end-to-end anastomosis remain the standard of care. Microvascular reconstructions are mainly used for long, circumferential LTJ defects, extensive cricoid loss, previously irradiated or multiply operated regions, and complex treatment interventions. The radial forearm free flap is currently the best-established option for long tracheal and laryngotracheal defects and can be combined with cartilage reinforcement or a mucosal lining. Osseous flaps such as the medial femoral condyle flap and the thoracodorsal artery scapular tip flap allow larynx-preserving reconstruction, with restoration of a stable ring or posterior framework in selected cases. Prefabricated constructs, ALT-based flaps, jejunal grafts, and pedicled flaps play an adjunctive role in borderline and salvage situations. Conclusion:Microvascular reconstruction extends the therapeutic spectrum for LTJ surgery beyond conventional resection techniques and can provide a functional airway in highly complex situations and with acceptable morbidity. Given the limited evidence base from case series, interdisciplinary planning and centralisation of these procedures in experienced centres are essential.

(1) Background: Innate lymphoid cells (ILCs) are potent cytokine producers that regulate local immune responses in tissues. Natural killer (NK) cells belong to group 1 ILCs and play an important role in tumor clearance and defense against intracellular pathogens. ILC2 and 3 have been implied in allergic responses and other chronic inflammatory diseases. The role of these cells in the pathogenesis of chronic rhinosinusitis (CRS) is not completely understood. There are changes in the cellular infiltrate in the mucosa of patients with CRS with and without polyps. The aim of this study was to characterize the number and phenotype of NK cells, ILC2s and ILC3s in patients with CRS. (2) Methods: Tissue samples were collected from patients with CRS with and without nasal polyps who were undergoing nasal sinus surgery as well as control patients who were undergoing surgery due to non-inflammatory reasons. Lymphocytes were isolated from the tissues using mechanical and enzymatic dissociation. Peripheral blood lymphocytes were obtained from the same patients. All cells were examined by multicolor flow cytometry. NK cells were analyzed for the distribution of CD56dimCD16+ and CD56brightCD16- subsets and the expression of IL18Rα, CD16, CD57, GATA3, TCF1 and NKp44. In ILC2s, GATA3 and IL18Rα expression was determined, and ILC3s as well as NKp44+ and NKp44-ILC3 subsets were analyzed for the expression of IL18Rα. (3) Results: There were significantly fewer NK cells in the nasal polyps compared to the peripheral blood of patients with CRSwNP and tissues from CRSsNP patients, which both showed higher levels of TCF1 expression. Irrespective of the disease condition, NK cells in tissues showed lower CD16 expression and a lower frequency of the CD56dimCD16+ subset compared to the peripheral blood mononuclear cells. Additionally, a smaller percentage of NK cells were terminally matured, as measured by CD16+ and CD57+ expression, in all examined nasal mucosa tissues. In the tissue ILC3s, we predominantly found cells from the NKp44- subset in all groups. ILC3s from CRSsNP patients showed the highest frequencies of IL18Rα+ cells of all examined tissues. ILC2s from the polyps ofCRSwNP patients showed higher levels of GATA3 expression than their peripheral blood counterparts. (4) Conclusions: We found that tissue-resident NK cells in mucosa from the nose and sinuses are a more heterogenous and less mature population than those in peripheral blood. Expression of the examined markers in NK cells was similar among groups. NK cell frequency, both in blood and tissue from CRSsNP patients, was higher than in the other groups, indicating that these cells might play an important role in this phenotype. Changes in the IL18Rα expression of ILC3s suggest a potential role of IL18 signaling in CRS pathogenesis.

BACKGROUND:Fever is an important symptom in pediatric ear, nose, and throat (ENT) infections. The current German S3 guideline, "Fever Management in Children and Adolescents," addresses the management of acute fever in otherwise healthy children and adolescents in an outpatient setting. OBJECTIVE:The aim of this article is to summarize the key statements of the S3 guideline on fever management and to assess their practical relevance to the field. The focus is on clinical assessment, temperature measurement, symptom-oriented therapy, parental counseling, and rational antibiotic use. MATERIALS AND METHODS:A narrative review was conducted based on the current "Fever management in children and adolescents" S3 guideline from the Association of the Scientific Medical Societies in Germany (AWMF), with particular consideration of ENT-relevant clinical situations and related topics such as earache, sore throat, and rhinosinusitis. RESULTS:The assessment of feverish children depends not only on temperature readings, but above all on their general condition, warning signs, and clinical context. In children over 1 year of age, tympanic temperature measurement is considered sufficiently accurate in most cases, while axillary measurement is not recommended for reliable temperature determination. When fever is rising, with cold hands and feet or shivers, children and youths should be cared for and covered according to their need for warmth. Antipyretics can be used to alleviate discomfort and pain-not solely to lower the temperature. They are not suitable for preventing febrile seizures. Antibiotics should be prescribed restrictively, rationally, and in accordance with guidelines, as fever itself is not an indication for antibiotics. CONCLUSION:These recommendations support a structured, cautious, and safety-oriented approach to febrile children. In addition to recognizing warning constellations, clear caregiver counselling, symptom-based treatment, and consistent antibiotic stewardship are key elements of care.

Enzymes exemplify the adaptability of biological systems through their multifunctional roles across tissues. Thus, xenobiotic metabolizing enzymes, traditionally recognized for their contributions to detoxification, biosynthesis, and signaling, also play specialized roles in the nasal cavity, where they encounter volatile compounds on a daily basis. In olfactory tissues, xenobiotic metabolizing enzymes act as odorant metabolizing enzymes, influencing not only volatile xenobiotic clearance but also sensory perception. These enzymes operate within a coordinated network of phase I, II, and III reactions, and are distributed across epithelial and neuronal cell types in both the olfactory and respiratory regions of the nasal cavity. Their expression patterns, activity, and regulatory dynamics suggest that xenobiotic metabolism can modulate olfactory function, with potential implications for toxicity, protection, and sensory modulation. This review first considers the risks posed by airborne xenobiotics and their impact on olfaction, then examines the function, expression, and regulation of odorant metabolizing enzymes, and finally highlights current experimental models and methodological advances that provide insights into xenobiotic and odorant metabolism in the nasal cavity.