Head and neck cancer represents one of the most nutritionally vulnerable oncologic populations, driven by tumor-related functional impairment, treatment toxicities, and complex metabolic alterations. Malnutrition and skeletal muscle loss are highly prevalent at diagnosis and frequently worsen during therapy, impairing treatment tolerance, functional status, and clinical outcomes. This narrative review synthesizes clinical and mechanistic evidence on the interrelated roles of malnutrition, low skeletal muscle mass, mucosal toxicity, and systemic inflammation across the perioperative, definitive treatment, and post-acute recovery phases. Particular emphasis is placed on the limitations of body mass index-based assessment and the importance of integrating validated screening tools with context-appropriate phenotypic evaluation of muscle depletion. Beyond conventional energy replacement, we examine the evidence supporting perioperative immunonutrition, discuss the contextual limitations of immune-modulating strategies during chemoradiotherapy, and consider emerging adjunctive metabolic approaches. Mucositis is conceptualized not only as a local toxicity but also as a contributor to reduced intake and inflammation-driven catabolism. The post-treatment phase is highlighted as a critical period for continued monitoring of body composition and functional recovery. Collectively, the available evidence supports a shift from weight-centered nutritional paradigms toward an integrated, body composition-oriented and inflammation-aware framework for supportive care in head and neck oncology.

PURPOSE:Early cochlear implantation during the critical period of neuroplasticity leads to better auditory and language outcomes but presents unique anesthetic challenges in infants. This study retrospectively examined anesthesia-related events throughout the full diagnostic and surgical process over a 10-year period, focusing on pediatic population undervent cochlear implantation - especially under the age of 18 month. METHODS:Data from 175 children under age 3 were analized who received cochlear implants between 2014 and 2024. Anesthesia-related events during audiological tests (BERA/ASSR), imaging (CT/MRI), and surgery were recorded. Collected variables were demographics, comorbidities, ASA and Mallampati scores, anesthetic techniques, procedure durations, complications, and ICU admissions. A subgroup analysis was conducted for patients implanted before 18 months. RESULTS:Of the 175 patients, 35 (20.2%) received implants before 18 months and 8 (4.6%) before 12 months. Anesthesia-related complications occurred in 14 cases (8.1%) in the study population, with laryngospasm during extubation being the most frequent (n = 8); all resolved without reintubation. Difficult intubation was noted in 3 patients, mainly those with craniofacial anomalies. Four children required postoperative ICU care. No complications were observed during diagnostic procedures. No significant association was found between complication rates and age, ASA status, or Mallampati score. CONCLUSION:Cochlear implantation, even in infants under one year, is safe with appropriate anesthesia and experienced teams. Complications were rare and manageable. Recognizing anesthesia risks helps optimize care and reassure parents, supporting timely intervention within the neuroplastic window.

Patients exhibited progressive saddle nose deformity as a result of GPA. To reconstruct the nose, a single-stage open rhinoplasty was conducted involving the placement of an independent L-shaped costal cartilage implant. Graft formation and fixation were performed according to the author-developed method. From 2012 to 2023, seven patients with severe saddle nose deformity underwent implantation of modified L-shaped costal cartilage strut grafts. Except for one complicated case, all patients reported satisfaction with the surgical outcomes. In this study, the visual appeal of the nose and the respiratory capabilities of the patients improved significantly. The L-shaped costal cartilage strut graft is an effective technique for saddle nose deformity correction. This technique provides excellent outcomes, including improved nasal function and aesthetics. Further studies with a larger sample size are needed to confirm these findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

OBJECTIVES:Our study aimed to evaluate the impact of magnetic resonance (MR) image artefacts caused by the OSI300 implant system on the ability to visualize specific cranial structures. METHODS:One cadaveric head was unilaterally implanted and underwent MR imaging in 1.5 and 3 Tesla magnetic fields under the following conditions: (1) no device, (2) Cochlear BI300 plus OSI300 with magnet, (3) Cochlear BI300 plus OSI300 with spacer, (4) Cochlear BI300 plus OSI300 without magnet or spacer using the institutional head and inner ear protocol and with metal artefact reduction (MAVRIC SL). Blinded image scoring was performed independently by three radiologists. RESULTS:Excluding diffusion and susceptibility weighted imaging (DWI and SWI) anatomical structures contralateral to the OSI300 implant were highly visible in all conditions. Artefact size was clearly improved after magnet removal and with metal artefact reduction technique. DISCUSSION:The OSI300 system produces image artefacts in both 1.5 and 3.0 Tesla MR imaging and, as previous research has reported, with the coil magnet removed, offers the least amount of distortion and artefact. CONCLUSION:While certain sequences such as DWI, FLAIR and SWI showed notably reduced diagnostic value, the MAVRIC SL sequences proved to reduce implant artefact resulting in diagnostic quality examinations.

Bevezetés: A Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Karának Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikáján 1995-ben történt az első cochlearis implantáció. 2022. augusztus 11-én lehetőség nyílt klinikánkon a hazánkban még kevésbé ismert, de nemzetközileg elismert implantátumgyártó cég, az Advanced Bionics által forgalmazott HiRes Ultra 3D implantátum beültetésére. Célkitűzés: Klinikánkon jelenleg a páciensek a Cochlear Ltd., illetve a MED-EL GmbH készülékeivel kerülnek rehabilitációra. Ezen ellátási spektrum kiszélesítése érdekében megtörtént az első Advanced Bionics cochlearis implantációs műtét klinikánkon. A jelen tanulmány célja e tapasztalatok ismertetése. Módszer: Tanulmányunk során beültetésre került egy HiRes Ultra 3D implantátum. Az operáció alatt elektrofiziológiai mérések (elektromosan kiváltott stapediusreflex-küszöb [ESRT], idegiválasz-telemetria [NRT] és impediancia) történtek. Eredményeinket az Active Insertion Monitoring rendszer segítségével rögzítettük. Eredmények: Az impedanciaértékek megfelelőek voltak, az idegi válasz és az elektromos stapediusreflex kiváltható volt. A klinikai protokoll értelmében a közvetlen sebzárás után az elektróda cochleán belüli pozícióját kis dózisú fluoroszkópos felvétellel is ellenőriztük. Megbeszélés: Rövid távú tapasztalataink azt mutatják, hogy az Advanced Bionics implantátum teljes mértékben alkalmas a belsőfül-eredetű irreverzibilis halláskárosodás kezelésére. Következtetés: Eredményeink alapján az implantátum lehetőséget nyújt a hallásmaradvány megőrzésére is. Műtéttechnikai szempontból hasonló konstrukciót kínál, mint a jelenlegi klinikai portfólióban szereplő másik két gyártó készülékei. Orv Hetil. 2024; 165(45): 1772–1778.

Introduction: The first cochlear implantation was performed in 1995 at the Department of Otorhinolaryngology and Head and Neck Surgery of the Albert Szent-Gyorgyi Medical School at the University of Szeged. On August 11, 2022, our clinic had the opportunity to insert the HiRes Ultra 3D implant, distributed by Advanced Bionics, a company that is less known in Hungary but internationally well-recognized. Objective: Currently, patients at our clinic are rehabilitated with devices from Cochlear Ltd. and MED-EL GmbH. To broaden this range of services, the first Advanced Bionics cochlear implantation surgery was performed at our clinic. Method: In our study, a HiRes Ultra 3D implant was implanted. During the operation, electrophysiological measurements (electrically evoked stapedius reflex threshold [ESRT], neural response telemetry [NRT], and impedance) were performed. The results were recorded using the Active Insertion Monitoring system. Hereinafter, we would like to review our initial experience. Results: The impedance thresholds were adequate, and both the neural response and the electrical stapedius reflex were responsible included . In accordance with the clinical protocol, after the immediate wound closure, the position of the electrode within the cochlea was also checked with low-dose fluoroscopic imaging. Discussion: Our short-term experience indicates that Advanced Bionics implant is fully suitable for serve sensorineural hearing loss. Conclusion: Based on our results, the implant offers the possibility of preserving residual hearing. From a surgical technique perspective, it provides a construction similar to the other two manufacturers' current devices in the clinical portfolio.

Bevezetés: A cochlearis implantátum egy hallásjavító eszköz, amely elektromos impulzusokkal közvetlenül stimulálja az idegsejteket. A beültetett elektródasor ideális elhelyezése elengedhetetlen a készüléket viselők számára. Számos hazai és nemzetközi vizsgálat igazolt szignifikáns összefüggést a műtét után helyreállított elektromos hallás minőségével. Az optimális beültetés során az elektródákat a lehető legközelebb helyezzük el a ganglion spirale sejtjeihez, így az összpontosított stimuláció javíthatja a beszédértést és a beszédkészséget. Célkitűzés: Célunk az elektródasor elhelyezkedésének vizsgálata és a cochlea középtengelyéhez mért legkisebb távolságának optimalizálása, mindemellett a kedvezőbb pozíció virtuális elemzése és a behelyezett elektródák alakjának digitalizált újratervezése. Módszer: Kutatásunkhoz 10 perimodiolaris beültetett elektródasor pozicionálási eredményét dolgoztuk fel. Az intraoperatív képalkotó eljárások eredményeit elektrofiziológiás módszerekkel (impedancia, idegiválasz-telemetriai vizsgálat) vetettük össze. Eredmények: Méréseink alapján virtuálisan megalkotott elektródasorokat vetettünk össze, amelyek különböző szögben deformált (0°, 15°, 30°, 45°) bazális szakasszal rendelkeznek. Az elektrofiziológiás és a képalkotó technikák megerősítik, hogy az elektródasor kedvezőbb helyzetbe kerül, amennyiben az közelebb tud helyezkedni a cochlea középtengelyéhez. Következtetés: Az újraformált elektródasorok pozicionálása drasztikus hatással lehet a későbbi beszédértésre, a beszéd minőségére és a készülék energiafogyasztására. Orv Hetil. 2024; 165(37): 1452–1460.

Reviewing the literature, Osia 2 system implantation is predominantly performed under general anesthesia (GA). Although in the pediatric population GA is inevitable, in adult cases, especially with high anesthesiological risks, local anesthesia (LA) is an obvious solution. The aim of this article is to provide a detailed demonstration of Osia 2 implantation under LA. In our case series of five adult implant recipients, the surgical procedure was carried out without encountering any difficulties during or after the operation. Based on our experiences, implantation of the Osia® 2 System under local anesthesia is an easy and safe method for patients.

OBJECTIVES:Hearing implants often limit the assessment of magnetic resonance examinations due to susceptibility artefacts. Our aim was to evaluate the impact of artefacts attributed to the Osia®2 implant system in terms of utility in visualizing selected cranial structures. METHODS:A BI300 implant and an OSI200 actuator were implanted into a human cadaver head in the audiologically most favourable position according to the manufacturer's guidelines. Scanning was accomplished using the institutional head and inner ear protocol with a General Electric 1.5 Tesla scanner with retained and removed implant magnet, extended with T1 and T2 weighted sequences with metal-artefact reduction (MAVRIC SL). Image quality was evaluated by three radiologists. RESULTS:The Osia®2 produced significant artefacts in most of the series of standard imaging sequences predominantly on the ipsilateral side of the head. The majority of the artefacts were caused by the implant magnet. Even without removing the magnet, MAVRIC SL improved image quality to such an extent that it became comparable with that after magnet removal. CONCLUSIONS:The standard sequences suffer considerable quality loss due to the artefacts, attributed predominantly to the magnetic component. Metal-artefact reduction sequences are effective in obtaining sufficient-to-good quality images without surgical magnet removal.

Introduction: Cochlear implant is a hearing enhancement device that directly stimulates nerve cells with electrical impulses. The optimal placement of the implanted electrode array is crucial for device wearers. Numerous domestic and international studies have confirmed a significant correlation between the quality of restored electrical hearing after surgery. During optimal implantation, electrodes are placed as close as possible to the spiral ganglion cells, allowing for more focused stimulation to improve speech perception and speech intelligibility. Objective: Our aim is to investigate the positioning of the electrode array and optimize the smallest distance to the cochlear midline. Additionally, we analyze the favourable position virtually and digitally redesign the shape of the inserted electrodes. Method: For our research, we analyzed the positioning results of 10 perimodiolar implanted electrode arrays. The results of intraoperative imaging procedures were compared with electrophysiological methods (impedance, neural response telemetry examination). Results: Based on our measurements, we compared virtually created electrode arrays with differentially deformed basal segments (0 degrees, 15 degrees, 30 degrees and 45 degrees). Electrophysiological and imaging techniques confirm that the electrode array is in a more favourable position when it is closer to the cochlear midline. Conclusion: The repositioning of the reshaped electrode array can have a drastic impact on future speech perception, speech quality, and device energy consumption.

The Cochlear (TM) Baha (R) 6 Max is a high-power sound processor (SP) with a fitting range up to 55 dB HL for treating patients with conductive, mixed, or single-sided sensorineural hearing loss. Our objective was to compare the audiological performance and the subjective experience of the Baha 6 Max SP among experienced adult users of the Baha 4 or Baha 5 SP on the Baha Attract system. Fifteen adults (>= 18 years) with bilateral mixed (n = 7) or bilateral conductive (n = 8) hearing loss were recruited as part of the pilot study. After 2 weeks of trial period with the new SP, the performance of Baha 5 and Baha 6 Max SP was tested in a single-blind study. Pure tone audiometry, speech audiometry, and signal-to-noise ratio were determined with both SPs and in the unaided condition. The results of the subgroups with different types of hearing loss were analyzed. Subjective experience and quality of life questionnaires were also completed and compared between the SPs and the unaided hearing condition. Aided thresholds with the Baha 6 Max SP were significantly better on 250 and 8000 Hz than with the Baha 5 SP. The Baha 6 Max SP also provided better suprathreshold test results and signal-to-noise ratio, which the patients' subjective assessments in both subgroups corroborated. Based on our results, the data shows that the Baha 6 Max SP is an optimal solution for patients using the Baha Attract system.

The CochlearTM Osia® 2 is an active transcutaneous implant designed to treat patients with different types of hearing loss. Due to its size, implantation needs appropriate practice since the necessity of extended flap creation and bone work can be an issue in some cases. The goal of our study was to determine whether fixation of the OSI200 implant was necessary for the performance of patients with conductive or mild mixed hearing loss. The vibroacoustic performance of the Osia 2 system, with and without BI300 fixation, was evaluated through tests conducted on a head model. In addition, three patients underwent surgery using the modified minimally invasive subperiosteal pocket technique; the OSI200 implant was placed in a tight subperiosteal pocket without fixing it with the BI300 implant. To evaluate the audiological performance of the non-fixated Osia 2 system, we compared the preoperative unaided pure tone and suprathreshold testing with the Baha 5 sound processor and the non-fixated Osia 2 system aided thresholds. Initial results indicate that omitting fixation does not significantly impair the function of the Osia 2 system. The findings of the clinical assessment support the fact that the Osia 2 system performed better than the Baha 5 system on Softband, both in pure tone and suprathreshold tests. According to our results, we have found that utilizing the subperiosteal pocket method and implanting Osia 2 without BI300 fixation may be a viable option. This approach has shown promising results in terms of improving hearing ability with minimalization of surgery related complications.

Abstract Brain abscess is a rare but life-threatening infection of the brain. It often occurs as a complication of infection, trauma, or surgery. This case presents a brain abscess in a 22-month-old boy that developed after a transnasal injury with a foreign body. A minimal-invasive, transnasal, endoscopic-controlled technique was used, during which the foreign object was removed and the abscess drained. Bacteriological samples were obtained and the abscess cavity irrigated. Postoperative care included antibiotics and daily irrigation of the abscess cavity. Follow-up MRI scans showed reduction in abscess size. A spinal drain was inserted temporarily to address rhino-liquorrhoea. The patient remained asymptomatic during one-year of follow-up. This case report highlights the occurrence of a brain abscess in childhood following a transnasal injury and demonstrates a minimal-invasive, transnasal, endoscopic-controlled surgical technique. The findings underscore the importance of considering brain abscess as a potential complication in cases of head trauma, particularly in atypical presentations.

OBJECTIVE:Osia is a new, transcutaneous, active bone-conduction implant. This study aimed to compare the BAHA Attract and the first-generation Osia system after BAHA Attract to Osia conversion surgery.METHOD:Five patients who had previously used the BAHA Attract system were converted to the first generation of the Osia system. Surgical aspects of the two different systems, audiological performance and subjective opinions of the patients were investigated. Pure tone audiometry and speech audiometry in quiet was performed with each patient's BAHA 5 sound processor on Attract, and the test battery was repeated six weeks after the Attract to Osia conversion and at different time points after the first fitting. Details of the surgery and patients' feedback were analysed.RESULTS:Audiology tests showed significant improvement when using either system; however, the Osia system performance was better. Based on patient feedback, all the five implantees preferred the Osia system.CONCLUSION:The study results suggest that the Osia system is a safe and powerful hearing implant that provides good clinical outcomes.

Continuous technological advances result in the availability of new bone conduction hearing implants, of which their suitability for pediatric patients is of major concern. The CochlearTMOsia® 2 is a new active osseointegrated steady-state implant system that uses digital piezoelectric stimulation to treat hearing loss. The implant in the United States was approved for patients aged 12 years and above, whereas the CE mark is independent of age, the only requirement is body weight of at least 7 kg. Therefore, further clinical studies are required to assess device characteristics in younger patients. The aim of our study was to perform a morphometric study among 5–12-year-old children, and to develop a surgical protocol for Osia 2 system implantation based on these findings. We examined retrospectively cranial CT scans of 5–12-year-old patients from our clinical database. We measured the bone and soft-tissue thickness in the region of interest, and the position of the sigmoid sinus. 3D printed temporal bones were also used for planning. Soft-tissue thickness varied between 3.2 ± 0.5 mm and 3.6 ± 0.6 mm and bone thickness varied between 3.5 ± 1.1 mm and 4.7 ± 0.3 mm. The sigmoid sinus was located 1.3 ± 0.2 cm posterior to the ear canal, and the anterior distance was 4.8 ± 0.9 to 7.1 ± 1.1 mm. Our morphometric studies showed that patients aged 5–12 have different anatomical dimensions compared to adults, but that implantation of the Osia 2 system is feasible in these patients using an altered implant positioning recommended by our data. The Cochlear™ Osia® 2 is, therefore, an option for hearing rehabilitation in younger pediatrics.

We reviewed 63 patients with primary intracerebral haemorrhage (PICH) in basal ganglia treated by computed tomography (CT)-guided stereotactic aspiration to evaluate the impact of surgical timing and degree of haematoma volume reduction on neurological outcome evaluated with Glasgow Outcome Score (GOS). In 19 patients operation was performed within 24h from the symptom onset with more than 60% of haematoma volume reduction. At 3 weeks 11 patients (58%) achieved a favorable outcome (GOS 4 or 5). In the other 44 patients only 10 (23%) recovered to GOS 4 or 5. These differences were statistically significant. At 6 months a still larger proportion of patients with early radical decompression showed favorable outcome, however, the difference was not statistically significant. The results demonstrate that early and radical stereotactic aspiration provided a better neurological outcome at the early recovery phase, though the beneficial effect on the final outcome was not significant statistically.

Bevezetés: Az emberi sziklacsont a halántékcsont része, egy bonyolult és változatos anatómiai felépítésű struktúra. A sziklacsonton végzett beavatkozások előtt, a műtéti szövődmények megelőzése érdekében, nélkülözhetetlen a biztos anatómiai tudás és kézügyesség megszerzése, valamint az egyes műtéti lépések és mozdulatok begyakorlása. A VOXEL-MAN Tempo 3D fül-orr-gégészeti szimulátor a virtuális valóság és a robotika alkalmazásával nyújt gya-korlási lehetőséget. Célkitűzés: A Szegedi Tudományegyetem 2019-ben VOXEL-MAN fül-orr-gégészeti szimulátort helyezett üzembe az Orvosi Készségfejlesztési Központban. Results: The simulator shows the anatomical structure of the temporal bone virtually, yet realistically, the real spatial location of the important anatomical structures and their distance from each other and from the surgical instrument. The system allows ear surgery to be performed realistically (two-handed bone work with a drill and suction) with tactile (vibration) and visual (bleeding) feedback. One can improve surgical skills with one- or two-handed tasks. Bone work in ear surgeries can be performed in a reproducible manner from routine, high-resolution computer to-mography of the temporal bone of a real patient. Conclusion: With reference to our experience, the simulator is excellent for practicing each surgical step. In the fu-ture, we intend to use this virtual system in undergraduate and postgraduate training in otolaryngology.

Bone-anchored hearing aids (BAHAs) have been used for multiple types of hearing loss both in pediatric and adult cases. In the last decades, the percutaneous BAHA® Connect System (Cochlear Ltd., Sydney, Australia) was replaced by the fully implanted transcutaneous, magnet-based BAHA® Attract System (Cochlear Ltd., Sydney, Australia). Since the implantable part of the Attract device is fully covered with soft tissue, skin complications that were frequently observed in the percutaneous system, could be eliminated. As an outcome of this important advantage of the Attract System, conversion of the percutaneous into a transcutaneous system should be considered. In the following methodology report, a possible surgical technique is described. The method can easily be adopted to different conditions in which the replacement of the percutaneous device is necessary.

Introduction: For the treatment of asymmetry of the midface due to permanent peripheral facial nerve palsy of different etiologies - which means a great psychical burden for the patients - several surgical solutions have been described. Aim: Our goal was to elaborate a minimally invasive surgical technique, that, on one hand, restores an adequate nasolabial fold, which is the most determinative keystone of facial symmetry. On the other hand, our technique can give an appropriate lift for the malar fat pad with shorter operative time and burden, with much lower complication rate and shorter recovery period compared to the classic static sling suspension techniques. Method: Out method is based on the formation of a neo-nasolabial fold, which is then suspended to the temporal fascia by permanent threads thus restoring facial symmetry and giving a lifting effect on the midfacial soft tissues as well. Results: Between 2014 and 2017, six patients had been operated with this nasolabial lifting technique of the malar fat pad without any major complications under local anesthesia on an outpatient basis at our Department. Conclusions: As our surgical exploration is minimal, the postoperative period is shorter, no visible scars remain on the face and the complication rate is negligible. If necessary, suspension could easily be adjusted, and as the technique is reversible, no other possible facial reconstruction methods are excluded. Our method can symmetrize the face in resting position completely on the long term, which is the most important issue for our patients according to their feedback. Orv Hetil. 2019; 160(22): 869-872.

Endoscopic arytenoid abduction lateropexy (EAAL) is an effective glottis enlarging procedure for the treatment of bilateral vocal cord palsy (BVCP). The postoperative glottic configuration changes can be evaluated by modern, high-resolution, 3D image reconstructions. Functional results are described by spirometry as well as objective and subjective phoniatric tests.