Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

{"title":"Optical coherence tomography of the tympanic membrane and middle ear: clinical applications.","authors":"Julien B Azimzadeh, Brian E Applegate, John S Oghalai","doi":"10.1097/MOO.0000000000001147","DOIUrl":"10.1097/MOO.0000000000001147","url":null,"abstract":"<p><strong>Purpose of review: </strong>Optical coherence tomography (OCT) is a noninvasive optical imaging technique to image soft tissue and thin bony structures with high resolution, approaching that of histology. This review summarizes recent progress in the clinical application of OCT for tympanic membrane and middle ear disease.</p><p><strong>Recent findings: </strong>Recent reports from clinical trials show that OCT is having a meaningful impact on the diagnosis of fluid in the middle ear. In parallel with this, numerous groups are obtaining previously unattainable normative data in vivo on human middle ear structures. OCT is also starting to be used for functional assessments of the middle ear in the clinical setting by detecting sound and pressure-evoked motion.</p><p><strong>Summary: </strong>OCT allows real-time noninvasive radiation-free structural and functional imaging of the tympanic membrane and middle ear at the point of care. As artificial intelligence becomes more commonplace in medicine, it is likely that OCT will become a key technology for the otolaryngologist. The data provided by OCT can be used to train machine learning algorithms for the segmentation of ear structures, which will ultimately support the automated diagnosis of ear disease. This will also aid in objectively tracking disease progression over time. Thus, OCT presents much promise for our field by revolutionizing office-based otological diagnostics.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"326-332"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary management of tympanic membrane retraction.","authors":"Johan Bastianpillai, Paraskevi Karamitsou, Ananth Vijendren","doi":"10.1097/MOO.0000000000001152","DOIUrl":"10.1097/MOO.0000000000001152","url":null,"abstract":"<p><strong>Purpose of review: </strong>Tympanic membrane retraction is a common condition in otology. In most cases, it does not lead to significant complications. However, because there is a risk of progression to cholesteatoma, accurate diagnosis and appropriate management are crucial. In this review, we present the diagnostic strategy and the conservative or surgical management options available for patients with tympanic membrane retractions.</p><p><strong>Recent findings: </strong>Diagnosis is primarily clinical and tympanic membrane retractions may be incidentally identified in asymptomatic patients. Conservative management through close observation remains the first-line approach for mild to moderate retractions. Surgical interventions, including ventilation tube insertion, cartilage tympanoplasty, Eustachian tube balloon dilatation, and mastoid procedures, are generally reserved for cases complicated by cholesteatoma or significant hearing impairment.</p><p><strong>Summary: </strong>Evidence-based consensus on optimal management is lacking. Prospective or randomized studies are needed to establish validated management strategies.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"291-295"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photon-counting detector computed tomography for temporal bone: does higher resolution matter?","authors":"Madison V Epperson, Shuai Leng, John I Lane, Matthew L Carlson","doi":"10.1097/MOO.0000000000001145","DOIUrl":"10.1097/MOO.0000000000001145","url":null,"abstract":"<p><strong>Purpose of review: </strong>Photon-counting detector computed tomography (PCD-CT) represents a major technological advancement in computed tomography, offering improved spatial resolution, reduced image noise, and increased dose efficiency compared with conventional energy-integrating detector CT (EID-CT). Because many clinically relevant structures within the temporal bone are submillimeter in size, the temporal bone represents an ideal region for determining whether these technical improvements translate into meaningful clinical benefits. This review evaluates the emerging literature on PCD-CT in temporal bone imaging and examines whether higher spatial resolution meaningfully impacts clinical decision-making.</p><p><strong>Recent findings: </strong>Recent studies demonstrate improved visualization of middle ear anatomy, ossicular prostheses, cochlear implant electrode arrays, and superior semicircular canal dehiscence with PCD-CT compared with conventional CT. Improved spatial resolution and reduced metal artifact have been shown to enhance assessment of prosthesis positioning, cochlear duct measurements, and differentiation of true versus near semicircular canal dehiscence. However, given the recent availability of PCD-CT, most studies to date have focused on cadaveric studies, phantom studies, or patient studies evaluating image quality rather than diagnostic accuracy or clinical outcomes.</p><p><strong>Summary: </strong>PCD-CT provides substantially improved visualization of submillimeter temporal bone structures and may improve diagnostic confidence in select clinical scenarios. Nevertheless, evidence demonstrating improved clinical outcomes remains limited, and further clinical studies are needed to define the role of PCD-CT in routine temporal bone imaging.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"333-341"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of endoluminal treatment of Zenker's diverticulum and complete pharyngo-oesophageal obstruction.","authors":"Cameron Schauer, Jacqueline Allen","doi":"10.1097/MOO.0000000000001159","DOIUrl":"https://doi.org/10.1097/MOO.0000000000001159","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endoscopic approaches to surgery of the foregut, in particular, the upper oesophageal sphincter (UES), continue to develop, providing options for management that were previously unavailable. This review examines endoluminal surgical tunnelling approaches (third space endoscopy) to treat Zenker diverticulum and the more rare condition of complete oesophageal stenosis.</p><p><strong>Recent findings: </strong>Endoluminal surgical approaches to the UES such as Z-POEM (per-oral endoscopic myotomy) that utilize gastroscopes and upper gastrointestinal endoscopic instrumentation, are increasingly being utilized for management of UES dysfunction, with excellent safety and utility. Advantages of these techniques include overcoming access issues (trismus, osteophytes, and neck rigidity), ability to address the septum to its base whilst preserving mucosa, and enhanced visualization provided by insufflation in the surgical field. Multiple variations of these techniques are being reported, and the scope of application is expanding. POETRE (per-oral endoscopic tunnelling for restoration of the oesophagus) has been described to manage complete oesophageal luminal occlusion, and we describe application of this technique as a variation of the 'rendezvous procedure' to successfully reestablish communication from hypopharynx to oesophagus and stomach.</p><p><strong>Summary: </strong>Minimal access endoluminal 'third space' approaches to the upper oesophageal sphincter and oesophagus provide safe access, enhanced visualization and the ability to manage UES and oesophageal disease in the elderly population where anatomical issues may impede rigid endoscopy and open approaches contribute enhanced risk of complications. Z-POEM and POETRE can be successfully applied to treat Zenker diverticuli, cricopharyngeal dysfunction and complete hypopharyngeal-oesophageal obstruction. Third space endoscopy promotes increased collaboration between clinicians and subspecialities for the benefit of patients.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunotherapy in head and neck squamous cell carcinoma: oncologic and functional outcomes.","authors":"Harrison R R Bell, Mark J McKeage, Catherine H Han","doi":"10.1097/MOO.0000000000001158","DOIUrl":"https://doi.org/10.1097/MOO.0000000000001158","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the evidence supporting the use of immunotherapy across the full disease spectrum of head and neck squamous cell carcinoma (HNSCC) from early-stage, curative-intent settings to recurrent/metastatic disease. It also examines emerging data on swallowing outcomes and outlines the incidence and management of immune-related adverse events (irAEs).</p><p><strong>Recent findings: </strong>Immunotherapy has become integral to the management of advanced HNSCC, and recent trials demonstrated promising benefits in resectable disease, although overall survival data remain immature. Early evidence also suggests that peri-operative immunotherapy may confer functional advantages by reducing the proportion of patients requiring postoperative chemoradiation, an important consideration given the well established impact of cisplatin-based chemoradiation on swallowing outcomes. As the use of immunotherapy widens, irAEs become more prevalent, necessitating early detection and refined management strategies.</p><p><strong>Summary: </strong>A robust and growing evidence base supports the use of immunotherapy in HNSCC across both curative-intent and advanced settings. Further research is required to optimize patient selection, define optimal sequencing and combination strategies in early-stage disease, and incorporate functional outcomes, particularly swallowing, into future trial designs.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde cricopharyngeal dysfunction: 5 years on, what is the evidence, who are the failures?","authors":"Trina Kailin Chia, Zhou Hao Leong","doi":"10.1097/MOO.0000000000001153","DOIUrl":"10.1097/MOO.0000000000001153","url":null,"abstract":"<p><strong>Purpose of review: </strong>Awareness of retrograde cricopharyngeal dysfunction (RCPD) has accelerated substantially in the last 5 years, amongst both physicians and patients, especially with growing patient communities on social media. As the volume of research has grown rapidly, this review provides a timely synthesis of current evidence on diagnosis, treatment, and in particular, treatment failure, an area that remains underexplored despite its importance to clinical decision-making.</p><p><strong>Recent findings: </strong>RCPD lacks a validated diagnostic test; high-resolution impedance manometry offers pathophysiological insight but has yet to yield normative diagnostic thresholds. Injection of botulinum toxin-A (BoNT-A) into the cricopharyngeus muscle remains first-line treatment, delivered either transorally in the operating theatre or percutaneously in-office, with comparable efficacy but differing doses and side-effect profiles. Reported success rates are high but heterogeneous, reflecting variable outcome definitions. Evidence on managing treatment failures - including repeat injection, dose escalation, and surgical salvage - remains sparse and largely anecdotal.</p><p><strong>Summary: </strong>Standardized diagnostic criteria and outcome measures are needed to enable meaningful cross-study comparison and evidence-based management of RCPD, particularly for patients who fail first-line BoNT-A therapy. Realistic pretreatment counselling and wider publication of treatment failures are recommended to strengthen the evidence.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pill popping and medication munching: how we manage the swallowing of medications.","authors":"Shakeela Saleem, Anna Miles, Jacqui Allen","doi":"10.1097/MOO.0000000000001156","DOIUrl":"10.1097/MOO.0000000000001156","url":null,"abstract":"<p><strong>Purpose of review: </strong>Difficulties swallowing medicines is common, even in those with no other swallow issues. Yet, for many, daily safe and optimized ingestion and absorption of medicines is critical. In this review, we explore current evidence regarding pill swallowing patterns and recommendations for optimising pill swallowing.</p><p><strong>Recent findings: </strong>Pill swallowing difficulties are common and are associated with factors such as polypharmacy and larger dosage forms. Patient-reported screening tools for pill dysphagia are emerging as a valuable approach for identifying pill swallowing difficulties. However, the clinical evaluation and management of pill dysphagia remain variable, highlighting the need for standardized assessment protocols and clinical practice guidelines. Integrating pill swallow challenges into instrumental swallowing assessments will help to inform clinically appropriate management pathways. Dosage form characteristics, including pill size, shape, and formulation, remain key determinants of swallowing performance. Use of pill-swallowing aids such as lubricants may improve patients' perceived ease and confidence with pill intake.</p><p><strong>Summary: </strong>Routine screening and integration of pill-swallowing assessments into dysphagia management should become standard practice. Future research should prioritize robust evaluation of pill characteristics, pill-swallowing aids and educational interventions focused on safe medication administration practices, to optimize pill swallowing safety, adherence, and therapeutic outcomes.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is pepsin in the foreground of extraesophageal reflux management yet?","authors":"Tina L Samuels, Pelin Ergun, Nikki Johnston","doi":"10.1097/MOO.0000000000001154","DOIUrl":"10.1097/MOO.0000000000001154","url":null,"abstract":"<p><strong>Purpose of review: </strong>The objective of this article is to summarize recent advances in research regarding the pathophysiology of pepsin in EER and emerging technologies for EER management.</p><p><strong>Recent findings: </strong>Recent research adds mechanistic support for pepsin-mediated injury during EER, including an emerging role in chronic pulmonary fibrotic diseases. Innovative diagnostics aim to measure pepsin activity and endocytosis, while novel biomarkers of gastroduodenal reflux highlight opportunities for multiplex diagnostic assays and personalized treatment approaches. Preclinical studies increasingly support direct pepsin inhibition by HIV protease inhibitors leading to an ongoing clinical trial to evaluate fosamprenavir for LPR.</p><p><strong>Summary: </strong>Research continues to make strides towards EER-specific diagnostics and therapeutics. Areas of critical need remain, such as ICD-10-CM diagnostic codes for EER/LPR, a fit-for-purpose outcomes tool for regulatory approval of novel treatments, and drug delivery platforms such as a laryngopharyngeal inhaler to target EER disease sites.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of paediatric nasal and maxillofacial surgery on midfacial growth.","authors":"Daniel Phung, Ryan Winters","doi":"10.1097/MOO.0000000000001132","DOIUrl":"10.1097/MOO.0000000000001132","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review explores recent evidence on the long-term effects of pediatric nasal and maxillofacial surgery on midfacial growth, emphasizing the impact of modern techniques, timing and cephalometric outcome measures.</p><p><strong>Recent findings: </strong>Systematic reviews confirm that conservative pediatric septal surgery does not seem to compromise midfacial growth when cartilage-preserving techniques are used. There is a trend towards inclusion of septoplasty at time of primary cleft lip repair rather than deferring, with improved nasal airflow and unaffected midfacial growth. Early cleft palate repair appears to be safe with respect to maxillary retrusion. Standardized cephalometric reporting remains lacking.</p><p><strong>Summary: </strong>Contemporary evidence supports the safety of growth-preserving pediatric midfacial surgery, with early intervention offering functional and neurocognitive benefit, though standardized long-term outcome data remains an area for further research.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"286-289"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving facial scar outcomes: an evidence-based update.","authors":"Emma Ho, Joseph Latif, Catherine Meller","doi":"10.1097/MOO.0000000000001136","DOIUrl":"10.1097/MOO.0000000000001136","url":null,"abstract":"<p><strong>Purpose of review: </strong>Facial scarring represents a significant clinical and psychosocial burden for patients. This review summarizes current evidence for prophylactic and therapeutic scar management techniques relevant to ear, nose, and throat surgeons, covering risk stratification, wound closure principles, dressings, intralesional agents, laser therapy, radiation, and adjunctive treatments.</p><p><strong>Recent findings: </strong>The evidence base for facial scar management continues to expand, with recent meta-analyses, and RCTs improving our understanding of both conservative and surgical treatment strategies. While established therapies are further validated, emerging combination approaches and novel adjuncts are broadening the therapeutic treatment repertoire. Key areas of progress include non-invasive dressing products, intralesional pharmacotherapy, energy-based devices, and radiation protocols, though significant gaps in high-quality evidence particularly for the head and neck region is an ongoing issue.</p><p><strong>Summary: </strong>Facial scar management requires identification of modifiable risk factors, appropriate scar classification, and tailored evidence-guided selection of therapies. No single universal treatment exists, and treatment plans must be patient focussed. High-quality randomized controlled trials specific to the head and neck region remain limited, and multicentre collaborative research is needed to establish consensus guidelines.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"234-240"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}