Acta otorrinolaringologica espanola最新文献

{"title":"Clinical characteristics, treatment patterns, and oncological outcomes in patients with squamous cell carcinoma of the head and neck at very advanced age (≥80 years).","authors":"Leyre Pérez-Ugarte, Anna Holgado, Cristina Vázquez-López, Cristina Valero, María Casasayas, Arnau Masó, Santiago Rodríguez, Xavier León","doi":"10.1016/j.otoeng.2026.512412","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512412","url":null,"abstract":"<p><strong>Introduction: </strong>Population aging has increased the number of patients with head and neck squamous cell carcinoma (HNSCC) who are very elderly (≥80 years). However, patients ≥80 years remain poorly characterized, and their clinical profile and prognosis continue to be a subject of debate. The objective of this study is to specifically analyze the characteristics and oncological outcomes of patients with HNSCC aged ≥80 compared with younger patients.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study using a prospective institutional database that included patients diagnosed with HNSCC between 1985 and 2025. Patients were grouped according to age at diagnosis (<70, 70-79, and ≥80 years). Clinical and tumor characteristics, treatment patterns, and survival were evaluated.</p><p><strong>Results: </strong>Patients aged ≥80 years had a distinct clinical profile, with poorer functional status, a greater comorbidity burden, lower exposure to toxic agents, and less cervical lymph node involvement. Despite a higher proportion of early- stage disease, they showed significantly lower disease-specific survival. With increasing age, there was a progressive shift toward less intensive treatments. Age ≥80 years was independently associated with worse disease-specific survival, although part of this effect was mediated by functional status and comorbidity.</p><p><strong>Conclusion: </strong>Patients with HNSCC aged ≥80 years constitute a clinically distinct population whose outcomes cannot be extrapolated from younger cohorts, supporting the need for individualized therapeutic strategies based on functional status rather than chronological age.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512412"},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247921","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":"External validation of the PATH classification in patients with recurrent head and neck squamous cell carcinoma treated with salvage surgery.","authors":"Fernando López, Martina Kóepke, Claudia Llorente, Patricia García-Cabo, Juan Pablo Rodrigo","doi":"10.1016/j.otoeng.2026.512414","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512414","url":null,"abstract":"<p><strong>Background and objective: </strong>The PATH classification, proposed in 2024, stratifies patients with recurrent head and neck squamous cell carcinoma (HNSCC) treated with salvage surgery into 4 stages using pathological variables routinely reported. The aim was to externally validate it in an independent cohort and to compare its prognostic performance with that of rpTNM staging.</p><p><strong>Patients and methods: </strong>Retrospective observational study of 87 patients with recurrent HNSCC treated with salvage surgery with radical intent between 2014 and 2024. Disease-specific survival was estimated using the Kaplan-Meier method. Discrimination of both systems was compared using Harrell's concordance index (C-index) and the Akaike information criterion (AIC).</p><p><strong>Results: </strong>Five-year disease-specific survival was 65.9% (PATH I), 92.3% (PATH II), 37.4% (PATH III) and 13.5% (PATH IV), with significant differences between stages (p = 0.003), although without an ordered gradient. The rpTNM system did not discriminate between its stages (p = 0.674). The PATH classification showed greater discrimination (C-index 0.670 vs. 0.572; AIC 291.0 vs. 304.1). The 48 patients in rpTNM stage IV were redistributed across all 4 PATH categories, with survival ranging from 85.7% to 15.2%. Margin status was the only variable with independent prognostic impact (70.0% vs. 17.8%; p < 0.001). In a post hoc analysis, grouping PATH I-II versus III-IV showed robust separation (74.4% vs. 31.7%; HR 3.57 in the adjusted multivariable model).</p><p><strong>Conclusions: </strong>The PATH classification outperforms rpTNM staging in prognostic discrimination and reduces the heterogeneity of stage IV. The gradient across its 4 stages was not reproduced, its discriminative value being concentrated in the dichotomization defined by its first 2 hierarchical criteria and, predominantly, in margin status.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512414"},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247673","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":"Latent class analysis-based prognostic classification in laryngeal carcinoma: beyond TNM staging.","authors":"Anna Holgado, Arnau Masó, Cristina Valero, Cristina Vázquez-López, David Rubio, Marta Casadellà, Xavier León","doi":"10.1016/j.otoeng.2026.512417","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512417","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study is to identify latent clinical-biological profiles using latent class analysis (LCA) and to compare their prognostic capacity with that of the TNM system.</p><p><strong>Materials and methods: </strong>A retrospective study of 489 patients with squamous cell carcinoma of the larynx (2000-2020). LCA was performed using eight indicator variables: age, sex, toxic consumption, sub-location, T category, N category, Karnofsky index, and host index. TNM staging was grouped into three categories (stages I-II, III, and IV) as no survival differences were observed between stages I and II (p = 0.056). Prognostic capacity was compared using the C-index, Royston-Sauerbrei D-statistic, and integrated Brier score (IBS).</p><p><strong>Results: </strong>The LCA identified three classes: Class 1 (n = 257, 52.6%), early glottic carcinoma, N0; Class 2 (n = 143, 29.2%), advanced supraglottic carcinoma with good functional status; and Class 3 (n = 89, 18.2%), defined by functional impairment and an unfavorable inflammatory-nutritional profile. Five-year disease-specific survival was 93.9%, 74.4%, and 40.8%, respectively (p < 0.001). The LCA achieved a higher Royston-Sauerbrei D-statistic (6.73 vs. 5.45; p < 0.001) and a lower prediction error (IBS: 0.086 vs. 0.092) than the simplified TNM, with no significant difference in Harrell's concordance index (0.758 vs. 0.732; p = 0.39). In the cross-validation analysis, the simplified TNM lost its discriminatory power within Class 3 (C-index = 0.560; p = 0.130).</p><p><strong>Conclusions: </strong>LCA identifies three prognostic profiles in laryngeal carcinoma with greater risk-stratification capacity and lower prediction error than the simplified TNM, highlighting a high-risk subgroup determined by host status rather than tumor extent.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512417"},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247709","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":"Compromised nasal skin in functional rhinoplasty: a literature review and proposal of a clinical management protocol.","authors":"Virginia Martínez-Villasmil, Marta Fernández-Míguez, María Casanova-Ramón, Carmen Caldas-Pozuelo, Franklin Mariño-Sanchez","doi":"10.1016/j.otoeng.2026.512413","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512413","url":null,"abstract":"<p><p>Rhinoplasty is one of the most complex procedures in facial surgery, particularly in the context of revision surgery. The integrity of the nasal skin-soft tissue envelope (SSTE) is a critical factor for both aesthetic and functional outcomes, and vascular compromise of this structure may lead to one of the most feared complications: cutaneous necrosis. The aim of this review is to synthesize the available evidence regarding risk factors and therapeutic strategies in the management of compromised nasal skin following rhinoplasty. A literature review was conducted in PubMed and Embase to identify studies describing cutaneous necrosis following rhinoplasty surgery. The main risk factors identified were revision surgery, smoking, and aggressive thinning of the cutaneous flap. The available literature suggests that early initiation of therapies such as topical nitroglycerin, hyperbaric oxygen therapy, and pentoxifylline may improve tissue salvage in selected cases. A clinical protocol integrating preoperative assessment and an early intraoperative and postoperative management algorithm is proposed. Early identification of high-risk patients and the implementation of a standardized multimodal approach may help optimize skin viability in complex rhinoplasty procedures.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512413"},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247690","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":"Endoscopic Pericranial Flap Harvesting: Does Frontal Incision Orientation Matter? A Cadaveric Study.","authors":"Mauricio López-Chacón, María Jesús Rojas-Lechuga, Natalia Arango, Sara Jubés, Mohammed Albouq, Isam Alobid","doi":"10.1016/j.otoeng.2026.512411","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512411","url":null,"abstract":"<p><strong>Background and objectives: </strong>The pericranial flap is a useful reconstructive option in endoscopic anterior skull base surgery, particularly when the nasoseptal flap is unavailable. Minimally invasive flap harvesting requires a frontal incision that should optimize both surgical exposure and aesthetic outcome. However, the influence of incision orientation (horizontal or vertical) on the final dimensions of the flap has not been systematically evaluated. The aim of this study was to assess endoscopic flap harvesting and compare the impact of both incision orientations on flap dimensions in a fresh cadaveric model.</p><p><strong>Materials and methods: </strong>Dissections were performed on six fresh human cadaveric head specimens (4 males and 2 females), assigned to two groups: horizontal frontal incision (n = 3) and vertical frontal incision (n = 3). In all cases, a suprabrow suprapericranial dissection was performed under endoscopic visualization, elevating an inferiorly based pericranial flap. Craniocaudal flap length and maximum flap width were recorded. Comparisons between groups were performed using the Mann-Whitney U test.</p><p><strong>Results: </strong>The mean flap length was 98.3 mm in the horizontal group and 105 mm in the vertical group. The mean flap width was 71 mm in the horizontal group and 77 mm in the vertical group. No statistically significant differences were identified in either length (p = 0.164) or width (p = 0.700) between the two incision orientations. The suprabrow dissection consistently preserved the supratrochlear and supraorbital neurovascular pedicles.</p><p><strong>Conclusions: </strong>Both incision orientations allow harvesting of pericranial flaps with comparable dimensions and are potentially suitable for anterior skull base reconstruction. The choice of incision orientation should be individualized according to aesthetic considerations and natural skin tension lines, as the final flap dimensions depend primarily on the extent of deep dissection and preservation of the vascular pedicle.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512411"},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149247736","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":"Cross-cultural Adaptation and Validation of the Spanish Version of the Generic Body-Focused Repetitive Behavior Scale-45 (GBS-45) for the Assessment of Rhinotillexomania.","authors":"Natalia Arango-Cabezas, María Jesús Rojas-Lechuga, Katherine Yuen-Ato, Paola Aguilera, Lucía Prieto, Ramón Moreno-Luna, Manuel Bernal-Sprekelsen, Steffen Moritz, Isam Alobid","doi":"10.1016/j.otoeng.2026.512416","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512416","url":null,"abstract":"<p><strong>Introduction: </strong>Body-focused repetitive behaviours (BFRBs) may lead to significant physical and psychosocial consequences. Rhinotillexomania is a common and underdiagnosed behaviour for which no validated Spanish-language instruments are currently available for specific assessment. The Generic Body-Focused Repetitive Behavior Scale-45 (GBS-45) is a transdiagnostic tool designed to assess the severity and functional impact of BFRBs. The aim of this study was to validate and cross-culturally adapt the rhinotillexomania-specific section of the GBS-45 for a Spanish-speaking population.</p><p><strong>Materials and methods: </strong>This prospective multicentre study included adult patients with nasal septal perforation secondary to rhinotillexomania (n = 29) and a healthy control group (n = 32). Cross-cultural adaptation was performed according to standardised methodology. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability (1-2 weeks) was analysed using the intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. Discriminant validity was assessed using the Mann-Whitney U test.</p><p><strong>Results: </strong>The Spanish version demonstrated excellent internal consistency (α = 0.931 at baseline; α = 0.937 at retest). Temporal stability was high (overall ICC = 0.937; r = 0.939; 95% CI 0.899-0.964; p < 0.001). Significant differences were observed between cases and controls in the total score and across all specific items (p < 0.001).</p><p><strong>Conclusions: </strong>The Spanish version of the GBS-45 for rhinotillexomania is a reliable and valid instrument, useful for clinical assessment and follow-up in Spanish-speaking populations.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512416"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168597","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":"Otoneurology myths. A review endorsed by the SEORL-CCC Otoneurology Committee.","authors":"Virginia Franco-Gutiérrez, Paz Pérez-Vázquez","doi":"10.1016/j.otoeng.2026.512415","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512415","url":null,"abstract":"<p><p>Throughout the history of medicine, successive scientific advances have led to the abandonment of certain previously established statements or clinical practices. Otoneurology has been no exception, and this has resulted in substantial changes in the traditional approach to these topics. These facts are reflected in the following paper, where, based on concepts previously published in the literature and selected in accordance with the PRISMA guidelines, we examine the objective data that would make it necessary to discard them in favour of a better clinical practice.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512415"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167601","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":"Brain herniation after endoscopic craniofacial resection for olfactory neuroblastoma.","authors":"C Rodríguez-Prado, A García-Lliberós, E Zapater-Latorre","doi":"10.1016/j.otoeng.2026.512393","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512393","url":null,"abstract":"","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512393"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167881","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":"Is p16 immunohistochemistry sufficient to define HPV-related oropharyngeal carcinomas?","authors":"Guillem Viscasillas, Cristina Vázquez, Cristina Valero, Anna Holgado, David Rubio, Krzystof Zawada, Laia Alemany, Xavier León","doi":"10.1016/j.otoeng.2026.512390","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512390","url":null,"abstract":"<p><strong>Introduction: </strong>The characterization of human papillomavirus (HPV) infection in oropharyngeal carcinomas is prognostically relevant, but there may be discordance between p16 expression and molecular detection of viral DNA.</p><p><strong>Materials and methods: </strong>Retrospective study of 620 patients with squamous cell carcinoma of the oropharynx treated between 1991 and 2024 with joint determination of HPV by PCR and p16. Epidemiological, clinical, and therapeutic characteristics were analyzed according to HPV status, as well as specific, overall, and recurrence-free survival.</p><p><strong>Results: </strong>Overall, 74.0% of tumors were PCR-/p16-, 19.4% were PCR+/p16+, and 6.6% were discordant (3.9% PCR+/p16-; 2.7% PCR-/p16+). Five-year specific survival was significantly higher in the PCR+/p16+ group (P = 0.0001). No differences in survival were observed between the discordant and double-negative groups (P = 0.311). In the multivariable analysis, considering PCR+/p16+ patients as the reference category, the risk of death from tumor was 4.97 times higher in PCR+/p16-, 5.42 times higher in PCR-/p16+, and 3.63 times higher in PCR-/p16-. Similar findings were obtained in the cohort treated with radical intent. The prognostic differences remained for deaths from oropharyngeal tumor, second neoplasm, or non-oncological causes.</p><p><strong>Conclusions: </strong>Only double-positive tumors (PCR+/p16+) show the prognostic benefit of HPV-related oropharyngeal carcinomas. Discordant tumors had a similar outcome to double-negative tumors. The combination of PCR and p16 improves prognostic accuracy and allows for the adequate identification of patients who are candidates for specific therapeutic strategies.</p>","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512390"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119951","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":"Oral and laryngeal secondary syphilis.","authors":"Julia C Pipaon, Sarah Figueras, Carmelo Morales","doi":"10.1016/j.otoeng.2026.512387","DOIUrl":"https://doi.org/10.1016/j.otoeng.2026.512387","url":null,"abstract":"","PeriodicalId":93855,"journal":{"name":"Acta otorrinolaringologica espanola","volume":" ","pages":"512387"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119963","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}