European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery最新文献

{"title":"Fat graft-reinforced repair of refractory cervical chyle leak after neck dissection.","authors":"Jong-Lyel Roh","doi":"10.1007/s00405-026-10679-x","DOIUrl":"https://doi.org/10.1007/s00405-026-10679-x","url":null,"abstract":"<p><strong>Purpose: </strong>Chyle leak is an uncommon but clinically significant complication after neck dissection, particularly in the left lower neck, where the thoracic duct is most vulnerable. High-output or persistent leakage may result in metabolic derangement, wound complications, and delayed recovery. Surgical intervention becomes necessary when conservative management is unsuccessful. This study describes a standardized surgical technique combining targeted lymphatic ligation with autologous abdominal fat graft reinforcement and reports its clinical outcomes.</p><p><strong>Methods: </strong>Five patients who developed refractory or high-output chyle leak after neck dissection at a university hospital cancer center underwent surgical repair. Conservative measures, including dietary fat restriction, pressure dressing, closed suction drainage, and octreotide, were employed before surgery. Operative management consisted of precisely identifying the leaking lymphatic channel, ligation with 4 - 0 polypropylene sutures, and placement of a peri-umbilical fat graft to reinforce the repair.</p><p><strong>Results: </strong>All patients showed immediate cessation of chyle leakage following surgery. None required reoperation, thoracic duct embolization, or thoracoscopic intervention. A regular oral diet was resumed within 3-5 days, and all patients were discharged without complications. Follow-up assessments confirmed durable resolution without recurrence or donor-site morbidity.</p><p><strong>Conclusion: </strong>Targeted lymphatic ligation combined with autologous fat grafting reinforcement was technically feasible and was associated with successful leak control in this small descriptive case series. Larger comparative studies are required to define the independent contribution of fat graft reinforcement.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global practices in paediatric olfactory dysfunction: a cross-sectional survey of paediatric ENT surgeons.","authors":"Gina M Spencer, Kunwar Karim, Agnieszka Dzioba, Elise M Graham, Peng You, Thomas Hummel, Janine Gellrich, Paula Coyle, Hannah Burns, Shazia Peer, Faisal Zawawi, Jérome R Lechien, Valentin A Schriever, Eishaan K Bhargava, Katherine L Whitcroft","doi":"10.1007/s00405-026-10668-0","DOIUrl":"https://doi.org/10.1007/s00405-026-10668-0","url":null,"abstract":"<p><strong>Background: </strong>Olfactory dysfunction (OD) in children remains underdiagnosed and poorly characterised. Despite its known impacts on nutrition, quality of life, safety awareness, and psychosocial development, no standardised diagnostic or management pathway currently exists for paediatric OD. This study aimed to characterise global practice patterns and identify diagnostic and therapeutic challenges unique to paediatric care.</p><p><strong>Methodology/principal: </strong>A 44-item cross-sectional online survey was distributed to a verified international network of paediatric otolaryngologists across 36 countries via a closed professional platform. The survey assessed five domains: diagnostic practices, management protocols, technology and innovation, education and training, and barriers to effective care. Regional grouping was used to facilitate meaningful statistical comparisons. Categorical variables were evaluated using chi-square tests, with odds ratios and 95% confidence intervals reported for significant findings.</p><p><strong>Results: </strong>Of 351 potential participants, 167 responded (47.6% response rate). Most respondents (83%) reported seeing children with OD, yet 95% saw fewer than ten such patients annually. Psychophysical testing was never performed by 54.8% of respondents, while 88.4% routinely ordered cross-sectional imaging. Testing frequency increased significantly with patient age (Cochran's Q p < .001). The most common barriers to objective testing were insufficient training (44.3%), time constraints (29.9%), and funding limitations (28.1%). Multidisciplinary collaboration was negligible. Significant regional variation was observed across most practice domains.</p><p><strong>Conclusions: </strong>Paediatric OD care is characterised by functional underinvestigation, fragmented multidisciplinary collaboration, and systemic educational gaps. These findings support urgent development of standardised clinical guidelines, age-appropriate validated assessment tools, and formal interdisciplinary care pathways.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining malignancy risk stratification in cervical lymphadenopathy: development of the LASSO-LAP score (novel clinical scoring system version 2).","authors":"Mehmet Aslan, Baransel Algan, Şeyma Yaşar, Ebru Özer Öztürk, Yusif Hajiyev","doi":"10.1007/s00405-026-10734-7","DOIUrl":"https://doi.org/10.1007/s00405-026-10734-7","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative differentiation of cervical lymphadenopathy remains clinically challenging. While systemic immune-inflammatory indices provide prognostic value, their simultaneous diagnostic evaluation is often hindered by multicollinearity. This study aimed to integrate comprehensive hematological and nutritional markers with established clinico-radiological predictors using a penalized machine learning approach to refine our previously developed malignancy risk score.</p><p><strong>Methods: </strong>A retrospective cohort of 420 patients undergoing excisional biopsy for cervical lymphadenopathy was analyzed. Fourteen candidate predictors were initially evaluated for baseline characteristics. However, to prevent mathematical tautology arising from indices derived from identical complete blood count (CBC) parameters, eight structurally redundant indices were excluded. Subsequently, the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was employed on the optimized pool of six predictors for final variable selection and regularization. A weighted multiparametric clinical scoring system was subsequently developed, and its diagnostic performance was assessed via Receiver Operating Characteristic (ROC) analysis.</p><p><strong>Results: </strong>There were 420 individuals in the final development cohort (240 non-malignant and 180 malignant). Six independent variables without multicollinearity were found using LASSO regression: age, male gender, roundness index, conglomeration, Level V involvement, and neutrophil-to-lymphocyte ratio (NLR). With an internal validation area under the curve (AUC) of 0.859 (95% confidence interval (CI): 0.822-0.895), the resulting 11-point risk score showed high discriminating ability. The model correctly classified patients into low (11.1%), moderate (35.7%), and high (85.0%) malignancy risk categories in an independent temporal validation cohort of 57 patients, maintaining strong predictive accuracy (AUC: 0.867). There was no statistically significant diagnostic difference between this simplified, NLR-based model and a more complicated, previously developed multi-index model, according to a matched DeLong test (p = 0.566).</p><p><strong>Conclusion: </strong>The 11-point clinical scoring system provides a robust and practical method of preoperative malignancy risk stratification for cervical lymphadenopathy. Demonstrating that a streamlined NLR-integrated model achieves the same level of diagnostic accuracy as complex composite indices, this tool avoids mathematical tautology and provides accessible, evidence-based guidance on the optimal timing of biopsies in routine practice.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"machine learning prognostication in nasopharyngeal carcinoma: a european multicentre analysis of survival and risk of second malignancy\" - when the best second-cancer model cannot beat predicting \"no\" for everyone.","authors":"Yi Li","doi":"10.1007/s00405-026-10697-9","DOIUrl":"https://doi.org/10.1007/s00405-026-10697-9","url":null,"abstract":"","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Flunarizine and cinnarizine in the prophylaxis of vestibular migraine and migraine-associated menière's disease: An 8-month retrospective study.","authors":"Leonardo Scotto di Santillo, L Califano","doi":"10.1007/s00405-026-10671-5","DOIUrl":"https://doi.org/10.1007/s00405-026-10671-5","url":null,"abstract":"","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Electrocochleographic findings in patients with Ménière's disease: associations with hearing thresholds and endolymphatic hydrops.","authors":"Xu Liu, Jiaying Pan, Wuqing Wang","doi":"10.1007/s00405-026-10669-z","DOIUrl":"https://doi.org/10.1007/s00405-026-10669-z","url":null,"abstract":"","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative pathological lymph node parameters in head and neck squamous cell carcinoma: a comprehensive analysis of complementary prognostic value in clinically relevant subgroups.","authors":"Cornelius H L Kürten, Valentin Funk, Sarah Theurer, Marc Ingenwerth, Vinithagowry Sivakumar, Elena Lazzarini, Sara Aksu, Thomas Gauler, Maja Guberina, Sylvia Hartmann, Anke Daser, Kerstin Stähr, Stefan Mattheis, Stephan Lang, Timon Hussain","doi":"10.1007/s00405-026-10684-0","DOIUrl":"https://doi.org/10.1007/s00405-026-10684-0","url":null,"abstract":"<p><strong>Purpose: </strong>Quantitative pathological lymph node parameters (qpLNP), i.e. lymph node yield (LNY), lymph node ratio (LNR), and weighted lymph node ratio (WLNR), are potential prognostic markers in head and neck squamous cell carcinoma (HNSCC). Incorporation into post-operative staging may help to direct more precise adjuvant treatment regimens. Available data warrant more detailed subgroup analyses, we therefore evaluated their prognostic value with particular attention to neck dissection laterality, pN0 disease, and patients without recommendation for adjuvant therapy.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 410 surgically treated HNSCC patients from a single tertiary center (2010-2020). Data-derived cutoffs were determined by recursive partitioning. Overall survival was analyzed using Kaplan-Meier estimates, log-rank tests, and multivariable Cox regression. 67 patients with HPV-associated oropharyngeal carcinoma were analyzed separately.</p><p><strong>Results: </strong>In 343 patients with HPV-unrelated HNSCC, LNY, LNR, and WLNR were independently associated with overall survival on multivariable analysis (LNY: HR 1.58, p=0.012; LNR: HR 1.77, p=0.026; WLNR: HR 2.30, p<0.001). Discriminative performance increased from LNY (C-index 0.55) to LNR (0.59) to WLNR (0.61). Prognostic signal was primarily driven by the ipsilateral and not the contralateral neck. LNY (HR 1.92, p=0.044) and WLNR (HR 2.31, p=0.038) showed prognostic value in patients without adjuvant therapy, and LNY remained independently prognostic in node-negative patients on multivariable analysis (HR 1.88, p=0.027). Site-specific analyses in patients with HPV-unrelated oropharyngeal carcinoma and oral cavity carcinoma treated with bilateral neck dissection confirmed independent prognostic value for LNY and WLNR in both subgroups. In HPV-associated oropharyngeal carcinoma, qpLNP held no prognostic value. Here, extranodal extension was the dominant prognostic factor.</p><p><strong>Conclusion: </strong>LNY, LNR, and WLNR provide complementary prognostic information in HPV-unrelated HNSCC. The validity of LNY in node-negative patients emphasizes its value as a quality control parameter for surgery while WLNR's performance in patients without adjuvant therapy suggests additional value in patient stratification for adjuvant treatment.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of beta-blockers use with risk and clinical outcomes of head and neck cancer: a systematic review and exploratory meta-analysis.","authors":"Luqing Erik Zhang, Yuka Aizawa, Akihiro Oishi, Somi Kanai, Yoshimasa Sumita, Hideaki Hirai, Kei Tomihara","doi":"10.1007/s00405-026-10685-z","DOIUrl":"https://doi.org/10.1007/s00405-026-10685-z","url":null,"abstract":"<p><strong>Purpose: </strong>Preclinical evidence suggests beta-blockers (BBs) may inhibit stress-induced tumor progression, but clinical data on their association with head and neck cancer (HNC) outcomes remain conflicting. This study evaluated the association between BB use and the risk and prognosis of HNC.</p><p><strong>Methods: </strong>A comprehensive search of five databases was conducted. We performed a meta-analysis to assess cancer risk, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) between BB users and non-users. Heterogeneity was explored by subgroup and sensitivity analyses.</p><p><strong>Results: </strong>Seven studies were included. BB use was significantly associated with a reduced risk of HNC (RR = 0.58, 95%CI: 0.45-0.75). But in patients with HNC, BB use was linked to poor prognostic outcomes. Users demonstrated significantly worse DFS (HR = 1.85, 95%CI: 1.10-3.11) and DSS (HR = 1.82, 95%CI: 1.39-2.39). Exploratory subgroup analysis identified that cancer type might be a potential source of heterogeneity.</p><p><strong>Conclusions: </strong>These findings suggest a potential inverse association between BB use and the development of HNC. This estimate should be regarded as exploratory because it is derived from only two eligible non-lip head and neck cancer cohorts. In diagnosed patients, observational data link BB use to poorer DFS and DSS. However, given the statistical fragility of these prognostic estimates and potential confounding by indication, these trends must be interpreted with caution. Current evidence does not support BBs as adjuvant therapy for HNC. Future studies should prioritize adjustment for comorbidities and stratification by HPV status and tumor subsite.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Comment on \"Melatonin and oxidative DNA damage in REM- and NREM-related obstructive sleep apnea: an exploratory analysis of sleep-stage phenotypes\".","authors":"Ercan Saruhan, Emre Ispir, Gulnihal Kutlu","doi":"10.1007/s00405-026-10664-4","DOIUrl":"https://doi.org/10.1007/s00405-026-10664-4","url":null,"abstract":"","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical timing in patients with cocaine-induced midline destructive lesions: when and how.","authors":"Matteo Trimarchi, Basile N Landis, Daniel Simmen, Hesham Saleh, Charles East, Philippe Herman, Mario Bussi, Enrico Robotti, Manuel Bernal-Sprekelsen, Giovanni Serpelloni, Isam Alobid, Bright Oworae Howardson, Alessia Pennacchi, Piero Nicolai, Valerie J Lund","doi":"10.1007/s00405-026-10718-7","DOIUrl":"https://doi.org/10.1007/s00405-026-10718-7","url":null,"abstract":"<p><strong>Purpose: </strong>Cocaine-induced midline destructive lesions (CIMDL) may cause progressive septonasal and palatal destruction, but the optimal timing of reconstruction remains undefined. Because relapse is common, particularly within the first year, premature surgery may lead to failure and, in advanced cases, severe complications. This work synthesizes the available evidence and expert opinion to guide surgical timing and practical management.</p><p><strong>Methods: </strong>We performed a narrative evidence-based review of studies addressing cocaine relapse, abstinence verification, and reconstructive or prosthetic management in CIMDL, integrated with multidisciplinary expert consensus. Key relapse data were drawn from large longitudinal cohorts, including national treatment and follow-up studies and analyses of continuing care and initial abstinence.</p><p><strong>Results: </strong>Relapse risk remains clinically significant throughout the first 12 months after treatment, with weekly-use relapse rates of approximately 20-24% at 12 months. Beyond 12 months, increases appear smaller in longitudinal cohorts. Early sustained abstinence is protective, with at least 12 weeks of abstinence during treatment associated with substantially lower relapse rates. As self-report is often unreliable, repeated toxicology testing combined with serial endoscopic assessment offers objective monitoring, facilitates shared review with patients, and may improve adherence. Reconstructions beyond simple septal perforations are usually staged, and relapse during treatment can irreversibly compromise outcomes.</p><p><strong>Conclusions: </strong>Based on relapse dynamics and expert consensus, reconstruction in CIMDL should be deferred until at least 12 months of toxicology-verified abstinence within a multidisciplinary pathway including structured monitoring, optimized prosthetic care, staged surgery, and prolonged postoperative surveillance.</p>","PeriodicalId":520614,"journal":{"name":"European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}