What predicts spoken language outcomes in hearing-impaired children has been insufficiently understood, particularly with respect to cross-modal neural activation and sign language input. This study assessed neural activation in the auditory cortices of Czech-learning preschoolers with cochlear implants (CI), hearing aids (HA), and normal-hearing (NH) controls. The children were exposed to auditory speech, visual silent speech, and sign language, while hemodynamic activity was recorded using fNIRS. In response to auditory speech, CI children had weaker cortical activation than both NH and HA children. Rather surprisingly, sign language yielded reliable activation in the right auditory cortex of normal-hearing children, arguably reflecting the processing of the regular, relatively slow, sign language rhythm patterns. Visual silent speech failed to elicit reliable hemodynamic activation in hearing-impaired children, but yielded a non-significant trend in CI children left-laterally. Inverted hemodynamic responses were observed for silent speech in HA and NH children, possibly indicating auditory suppression during speech imagery. Experience with sign language modulated auditory speech processing: CI children with prior sign language input exhibited reliable cortical activation to auditory speech (unlike CI children without sign language input), suggesting a scaffolding effect of early experience with sign language on the development of spoken language. The findings advance the current understanding of how auditory and visual language processing develop in children with hearing loss, and highlight the cross-modal contributions of sensory experience and early language exposure.

Summary Background: Surgical training represents fundamental pillars of successful laryngeal framework surgery. Experimental training on animal laryngeal models is a cheap and affordable method to gain knowledge, experience, and skills for laryngeal surgery. This study was focused on the porcine larynx and its possible applications for training in laryngeal surgery for both open and microlaryngeal techniques. Methods: Five porcine larynges were dissected following our own dissection manual and subsequently studied. Key steps of the dissection were documented by photos. Results: All extra- and intralaryngeal muscles that are present in humans are present in the porcine larynx as well, but the oblique arytenoid muscle is missing. Cricothyroid muscle consists of three bellies in contrast to two bellies in humans. The superior laryngeal nerve is divided into two main branches before entering the larynx in all cases. The recurrent laryngeal nerve is divided into two main branches in 4 of the 5 larynges. When simulating the endoscopic view into the laryngeal inlet, prominent vestibular folds must be taken into consideration. Conclusion: The porcine larynx is a suitable model for training in laryngeal surgery – open-techniques as well as for phonosurgery and microlaryngeal surgery. The branching pattern of the recurrent laryngeal nerve in pigs resembles the human larynx and could be used for re-innervation technique studies or laryngeal transplantation. Key words animal model – larynx – superior laryngeal nerve – recurrent laryngeal nerve – surgical training – laryngeal microsurgery

Summary Introduction: Laryngeal chondrosarcoma (LCS) is a rare, slow-growing malignancy that can mimic common laryngeal pathologies, presenting significant challenges in differential diagnosis. Symptoms such as slow onset of progressive hoarseness, dyspnea, and dysphagia, often asymptomatic in nature, can lead to incidental detection. Given the rarity of this condition, understanding its clinical presentation and management is crucial. Methods: This paper describes four cases of grade 2 LCS treated at our institution, placed within the context of a comprehensive review of current literature on LCS. This review methodically examines the diagnosis complexities, characteristic symptoms, and treatment modalities associated with LCS. Results: While our patients underwent total laryngectomy and bilateral neck dissection due to the advanced stage of the disease, the review reaffirms the preference for conservative, function-preserving methods such as wide excision and partial laryngectomy when the treatment circumstances allow. The review also discusses Transoral robotic surgery (TORS) as a potential new treatment modality and discusses adjuvant therapies. Recent studies suggest that proton beam therapy might be an effective approach. Prognostic indicators play a crucial role in determining outcomes. LCS generally has a favorable prognosis, but high-grade tumors may experience poorer outcomes. As the review notes, the LCS recurrence rate of 25–40% underscores the necessity for long-term patient monitoring and follow-up. Conclusions: These cases enrich existing literature by sharing our experiences in managing grade 2 LCS. Given the rarity of this condition, each case report provides valuable insight, enhancing our understanding of its clinical presentation and management. Key words laryngeal chondrosarcoma – cartilaginous tumor – head and neck – prognosis – therapy

Objectives: To describe the impact of neuromuscular electrical stimulation (NMES) on two different types of unilateral vocal fold paralysis (UVFP): in the paramedian and median positions. Methods: Subjects underwent 12-minute-long sessions of NMES for 5 consecutive days (1 hour of intervention in total). A modified electrode placement was used to target the adductor muscles of the larynx. Acoustic, electroglottographic, imaging, auditory-perceptual, and self-perceived data were collected. Results: Apart from SPL, the results showed significant improvement in all vocal parameters for the subject with the paralyzed vocal fold in the paramedian position, but not for the subject with the paralyzed vocal fold in the median position. Both subjects demonstrated the activation of the cricothyroid muscles with the NMES application. They also reported no negative symptoms in the larynx or the presence of delayed onset muscle soreness postintervention. Conclusions: The results of this study support the use of NMES as an effective method for the treatment of UVFP in the paramedian position.

Objectives: To provide a state-of-the-art review on studies on the microbial basis of otitis media with effusion (OME). Sources: PubMed database, published textbooks. Methods: Review of the literature using the following search words: “otitis media with effusion,” “middle ear,” “bacterial pathogens,” and “microbiome”. Results: The beginning of the 21st century brought methods of massive parallel sequencing into practice. Following this, a multitude of studies dealing with the microbial nature of OME have been published. These studies suggest that “adenoid reservoir“ theory may not explain complete pathogenesis of OME. Other chronic respiratory diseases also have their influence, as well as the influence of the host response to pathogens. The production of mucins, especially MUC5AC and MUC5B, probably plays a significant role. Some studies also indicated a possible protective effect of certain bacterial genera. Conclusion: The availability of new microbiological methods has allowed better understanding of the pathophysiology of OME. New pathogens have been identified, and knowledge about the possible protective effects of some bacterial species has been gained. However, further research is needed on both middle ear and respiratory tract dysbiosis and the host response to microorganisms. The potential protective effects of some bacterial genera may lead to the development of probiotics as a novel treatment modality for OME. Key words otitis media with effusion – adenoid reservoir – adenoids – microbiome – bacteria

Summary Early hearing detection and intervention (EHDI) system is a key tool in a paedaudiological care. In the Czech Republic, it is based on a three--level nationwide detection of children with hearing impairments, diagnosis, and intervention for ensuring proper hearing and speech development. The outputs have been processed by the National Screening Centre of the Institute of Health Information and Statistics of the Czech Republic since 2023. The analysis included results from 2016–2023 in maternity hospitals (screening), ENT departments (rescreening), and paedaudiology centres (definitive diagnostics). The results confirm an increase in newborn screening coverage from 86.0% in 2016 to 95.8% in 2023. Approximately 4.3% of newborns underwent rescreening in 2023, with regional differences ranging from 1.4 to 7.0%. The interpretation of these differences in rescreening is debatable, as they may reflect both a good quality of primary screening and negative organizational or technical factors. The cooperation of legal representatives also plays an important role in the outcome. The definition of quality indicators and an introduction of regular automatic reports for individual workplaces are being prepared. In conclusion, it can be stated that the EHDI system in the Czech Republic is functional and effective, but its sustainability requires ongoing methodological support, quality reporting, and feedback to health care providers. Key words hearing screening – news – monitoring – control

Clinical consequences of mineral and bone disorder (CKD-MBD) remain still a therapeutic and prognostic challenge. Moreover, osteoporosis was recently recognized as significant contributor to bone pathology in kidney patients. Thus, close multidisciplinary cooperation between nephrologists, osteologists and other medical specialities is mandatory. Centre for renal osteopathy and calciphylaxis (CROC) was established in our University Hospital in 2022 to provide the as best as possible clinical practice in this so difficult and important topic. Our aim is to review CROC´s three years of experience. CROC is a platform for cooperation of nephrology, clinical osteology, clinical biochemistry, endocrinology, otorhinolaryngology, and other medical specialities and focuses namely on these problems: In all situations, patients were diagnosed, treated, and monitored according to prospective protocols. Three years of working together allowed us to build up a dedicated and experienced multidisciplinary team, successfully covering all aspects of mineral and bone problems in CKD patients. However, further effort is mandatory to implement our experience in even broader clinical practice. Supported by MH CZ – DRO (UHHK, 00179906) and by COOPERATIO programs

Tonsillectomy (TE) is one of the most performed head and neck surgeries. Patients range from children to seniors, and there is a wide range of indications and various complications related to TE. The most feared complication is post-tonsillectomy haemorrhage (PTH). Multicentric retrospective study, conducted between 2014 and 2018, includes data from 8166 patients who underwent TE. Among these patients, 3889 were men (47.62%) and 4277 were women (52.28%), with a mean age of 29.06 years. For this study, we analysed a total of 14,030 unilateral tonsillectomies (resected tonsils), of which 2,302 were performed primarily as unilateral surgeries, while 11,728 were part of bilateral procedures. Late post-tonsillectomy haemorrhage (LPTH) was significantly associated with the type of surgery performed (unilateral versus bilateral procedure; p < 0.0001). In the unilateral group, bleeding occurred in 217 cases (9.43%), while in the bilateral group, it was noted in 1062 cases (18.11%). When analysing the total sample (14030 unilateral tonsillectomies), the incidence of LPTH was found to be 9.12%. The occurrence of bleeding in our sample was influenced by several factors, including hospital choice, age, and gender (p < 0.0001). Additionally, the use of anticoagulants was associated with bleeding (p = 0.0449), as was antiplatelet medication (p = 0.0160). However, factors such as the spectrum of indications, surgical technique, surgeon experience, and the use of electrocoagulation during surgery did not impact LPTH. The severity of bleeding was linked to the use of anticoagulants (p = 0.0002) and antiplatelet medication (p = 0.0404). Our study highlighted the importance of methodology when studying LPTH as the outcome of unilateral and bilateral TE procedures. LPTH occurrence was most influenced by the choice of hospital and the patient’s age and gender. The severity of bleeding was affected by the use of anticoagulants and antiplatelet agents. The manner in which LPTH was treated did not affect the likelihood of LPTH recurrence.

Summary Congenital laryngeal anomalies present a heterogeneous group of conditions, most commonly manifesting as inspiratory or biphasic stridor and swallowing difficulties in neonates and infants. Their true prevalence is likely underestimated, particularly in milder forms. The aim of this article is to provide an overview of the most common congenital laryngeal anomalies and current diagnostic and therapeutic approaches in paediatric otolaryngology. The review summarizes literature-based knowledge on key congenital laryngeal pathologies, including laryngomalacia, bilateral vocal fold paresis, subglottic stenosis, subglottic haemangioma, laryngeal webs, and clefts. Both conservative and surgical strategies are presented, including pharmacological treatment (e. g., propranolol for subglottic haemangioma), as well as endoscopic and open surgical interventions. The article also highlights frequent associations with other congenital malformations and syndromes, underscoring the need for multidisciplinary management. Early diagnosis and timely intervention are essential to prevent complications such as respiratory failure or aspiration. A comprehensive and individualized approach is crucial for the effective management of congenital laryngeal anomalies in the paediatric population. Key words laryngomalacia – congenital subglottic stenosis – vocal fold paresis – subglottic haemangioma – paediatric otolaryngology

Summary Introduction: Voice disorders require a complex evaluation including subjective and objective methods. Aim of the study: Overview. Comparison of the values of the parameters between groups of patients and controls, verification of the treatment results, and analysis of the correlation between selected parameters before treatment. Methods and design: 102 dysphonic patients and 68 non-dysphonic subjects were evaluated in the prospective study. The following parameters were analyzed: lowest and highest achieved phonation intensity (SPLmin, SPLmax), range of achieved intensities (SPLrange), lowest and highest achieved phonation frequency (fo_min, fo_max), average intensity and average fundamental frequency of the speaking voice (SPLspeech, fo_speech), maximum phonation time (MPT), jitter (JITT), Dysphonia Severity Index (DSI), GRBAS scale, subjective degree of vocal difficulty (0, 1, 2, 3), and score of the VHI-30 CZ questionnaire. Results: Compared to controls, patients had statistically significantly higher pre-treatment SPLmin, JITT, GRBA, subjective voice difficulty score, VHI-CZ 30, and lower SPLrange, fo_max, MPT, DSI. There was no statistically significant difference in subscale S in both men and women. In comparison to the pre-treatment state, at 3 months after treatment (n = 37), we found statistically significantly higher values of SPLrange, fo_max in females. The values of JITT, DSI, GRBA, subjective voice difficulty, and VHI-CZ 30 score were lower in both males and females. At 1 year after treatment (N = 23), we demonstrated statistically significantly higher values of SPLrange, SPLspeech in both males and females, and fo_max in females. The values of JITT, parametres G, R, B, A in the GRBAS scale, subjective degree of voice difficulty, VHI-CZ 30 in both males and females, and DSI in males were lower. We found weak to moderate correlation of selected parameters in the pretreatment group. Conclusion: A comprehensive voice examination is necessary for diagnosis, treatment, and further research. Our results show that although individual tests provide different information about voice disorders, they are to some extent related. Key words dysphonia – perceptual assessment – videolaryngostroboscopy – acoustic evaluation – aerodynamic – VHI-CZ 30 questionnaire

Summary This review article outlines the current clinical applications of wideband tympanometry (WBT), a modern and advanced method for assessing the mechanics of the middle ear transmission system. Compared to conventional tympanometry, WBT enables analysis over a broader frequency range. The article places WBT within the historical context of immittance testing development, explains its underlying principles, and highlights its advantages over conventional methods. The main section focuses on clinical applications, primarily in the diagnosis of middle ear diseases such as secretory otitis media, otosclerosis, ossicular chain discontinuity, tympanic membrane perforation, and chronic otitis media. The article further explores the use of WBT in evaluating inner ear pathologies, such as endolymphatic hydrops and third window syndrome, implementation of WBT in newborn hearing screening, and summarizes potential new areas of application, including intracranial pressure monitoring and early postoperative follow-up after middle ear surgery. The discussion also addresses the limitations of the method, the need for standardized interpretation of results, and the potential offered by future integration of artificial intelligence in analyzing complex WBT data. Key words acoustic impedance tests – tympanometry – middle ear diseases – wideband tympanometry

The study compares the efficacy of adenoidectomy and myringotomy on the treatment of otitis media with effusion (OME) in children depending on the size of adenoids (AV) and age. A total of 509 children with OME lasting at least 3 months, who underwent endoscopic adenoidectomy (AT) and myringotomy without the insertion of a ventilation tube in the years 2010–2019 were enrolled in the study. The efficacy of AT and myringotomy on OME was evaluated with regard to the size of the adenoids, their relationship to the tubal tori, the viscosity of middle ear effusion and the age of the child. To evaluate the effect of age, children were divided into two groups—up to 4 years and over 4 years. The efficacy of AT and myringotomy in OME treatment was demonstrated in both groups. Within the entire group, a significantly greater benefit of AT and myringotomy was found in children with adenoids in contact with the tubal tori (grade B) or compressing them (grade C) (p = 0.039). Other parameters were not statistically significant. Neither the size of the adenoids relative to the choanae, nor the children age, nor the type of middle ear effusion (serous, mucous) had an effect on the treatment. AT and myringotomy is an effective surgical procedure in the treatment of OME not only in children older than 4 years, but also in younger children. The effect of the surgery is affected by the contact of adenoids to tubal tori.

Introduction: The Tinnitus Handicap Inventory (THI) is a key tool for assessing the impact of tinnitus on a patient‘s life, emotional state and sleep quality, allowing for treatment planning and monitoring. It is also used by researchers to collect data, contributing to a better understanding of this complex dia gnosis. Methodology: The linguist then compiled these versions into a fi nal version, which was edited for best comprehensibility while preserving the original meaning of the questions. This Czech version was then translated back into English by a second linguist to check its factual consistency with the original. Result: It was confi rmed by both linguists and experts that both the translation and the back-translation were meaningfully consistent with the original. Conclusion: The translation of the THI has been methodologically rigorous, is ready for validation and promises to make a signifi cant contribution to tinnitus dia gnosis and research in the Czech Republic, and an electronic version of the questionnaire could be easily made available for wider use. Key words tinnitus – THI – Tinnitus Handicap Inventory – Czech version of THI – language adaptation – tinnitus evaluation

Summary Introduction: The authors present the current status of hearing screening of five-year-old children in the Czech Republic. Materials and methodology: The Institute of Health Information and Statistics of the Czech Republic (ÚZIS) processed the reporting of health services for hearing examinations in children aged 5 from 1. 1. 2019 to 30. 9. 2024 based on data from health insurance companies (National Register of Paid Health Services, NRHZS). Results: When audiometric hearing screening of children aged 5 began in 2019, the screening code 71112 was reported to health insurance companies for only 11% of five-year-old children. In the following years, there has been a gradual increase in reporting. According to preliminary data, in the first 3 quarters of 2024, the number of reported examinations increased to 25%, and after adding the tone audiogram code, 41% of five-year-old children were audiometrically examined. The data obtained from the signal codes (71031–71034) showed that in the population of five-year-old children, the incidence of unrecognized hearing loss was 2–3%, of which approximately 60% of children have a hearing impairment on both sides. Conclusion: Performing audiometric hearing screening of five-year-old children, and correct and consistent reporting of the relevant codes (71112, 71031–71034) will enable monitoring of the hearing status of the child population in the Czech Republic with the possibility of early initiation of treatment so as to enable optimal development of the child‘s communication abilities and skills before starting school. Key words hearing screening – audiometric examination – five-year-old child

Summary Introduction: The Czech National Cancer Registry provides important epidemiological data on malignant tumours of the head and neck. The aim of the analysis is to evaluate the development of incidence, mortality, and prevalence of head and neck, larynx, and thyroid cancers in 1977–2023. The increasing number of patients with these diagnoses suggests possible changes in risk factors, including the impact of papillomavirus infection. Objectives: The main objective of the study is to analyse long-term trends in head and neck cancer in the Czech Republic, including changes in five-year survival of patients and the impact of treatment in comprehensive cancer centres. The study also focuses on the importance of correct reporting of diagnoses according to the International Classification of Diseases (ICD) and Tumour, Node, Metastases (TNM) classification, which are crucial for accurate statistical evaluation of health data. Methods: The analysis is based on data from the Institute of Health Information and Statistics of the Czech Republic and the National Cancer Registry of the Czech Republic in 1977–2023. Diagnoses of malignant neoplasms of the upper respiratory tract, swallowing tract, and thyroid carcinoma were evaluated. Epidemiological parameters included incidence, mortality, and prevalence of these diagnoses. To assess the effectiveness of treatment, the results of five-year survival in patients treated in comprehensive cancer centres were compared with those treated outside these centres. Results: The incidence of pharyngeal cancer (C01, C09–C10) increased from 211 cases in 1989 to 856 cases in 2023. The study shows a significant increase in the incidence of thyroid cancer, with the number of patients increasing from 301 in 1989 to 1,244 in 2023. The five-year survival rate for patients with thyroid cancer was around 93%, while for laryngeal cancer it was around 49%. A significantly higher five-year survival was recorded in patients treated in comprehensive cancer centres. Conclusion: The results confirm an increasing incidence of head and neck cancer. The improvement in five-year survival indicates the positive impact of modern treatment strategies and specialized care. For further optimization of cancer care, consistent reporting of diagnoses according to ICD and TNM is crucial, which will enable accurate statistical evaluation. Key words National Cancer Registry – head and neck cancer – thyroid carcinoma – laryngeal carcinoma – complex oncological centre