Hno最新文献

Head and neck oncological surgery has long been guided by stable therapeutic principles; however, advances in tumor immunology, the emergence of neoadjuvant immunotherapy and the distinct biology of human papillomavirus (HPV)-associated carcinomas are driving a paradigm shift. This article summarizes current developments and underlying biological mechanisms, focusing on biomarkers for patient selection and response assessment. Beyond conventional radiological criteria, immunopathological parameters are gaining relevance for monitoring and evaluating treatment efficacy. Despite immuno-oncological progress, surgery remains a cornerstone but is evolving into an integrated component of multimodal treatment strategies. With the approval of perioperative pembrolizumab following the positive Keynote-689 results, neoadjuvant therapy in head and neck cancer is becoming a clinical reality, heralding a new era in head and neck oncological surgery.

Intraoperative pathology plays a central role during surgical interventions where precise margin assessment and evaluation of tumor dignity are critical for balancing functional preservation and oncological safety. In otorhinolaryngology, the method is used particularly in squamous cell carcinomas (SCC) of the oral cavity, pharynx and larynx. The diagnostic accuracy is generally high for SCC but varies depending on the anatomical site and is particularly limited by pretreatment processes, such as radiotherapy or neoadjuvant chemotherapy. For non-SCC entities, such as salivary gland tumors or lymphomas, the diagnostic value of intraoperative pathology is considerably more limited. New technologies such as stimulated Raman histology and rapid immunohistochemistry could accelerate and further refine intraoperative diagnostics in the head and neck region in the future.

Background: The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing worldwide, particularly among younger men without classical risk factors. High-risk HPV types are the primary cause. Prophylactic vaccines offer the first effective means of primary prevention, with efficacy demonstrated primarily through the reduction in oropharyngeal HPV infections.

Objective: This article aims to present the current evidence on HPV vaccination for prevention of OPSCC, including vaccination coverage, guideline recommendations, and implications for patients and their close contacts.

Materials and methods: A systematic literature search was performed in PubMed (2000-2025) on HPV vaccination and oropharyngeal cancer, including systematic reviews, meta-analyses, and cohort and randomized studies as well as national and international guidelines.

Results: Human papillomavirus vaccination reduces the prevalence of oropharyngeal high-risk HPV infections by 80-90% and significantly lowers the risk of persistent infections. Relatives and sexual partners of OPSCC patients have a mildly increased risk of HPV-associated malignancies. Vaccination coverage in Germany is particularly low among boys; therapeutic HPV vaccines are currently being investigated in clinical trials. Modeling studies indicate that substantial reductions in the OPSCC incidence can only be achieved with significantly higher vaccination rates than those currently seen in Germany.

Conclusion: Human papillomavirus vaccination is an effective tool for primary prevention of oropharyngeal infections and, indirectly, OPSCC. Sustainable impact requires gender-neutral and easily accessible vaccination programs, targeted inclusion of close contacts, and further research into therapeutic vaccination strategies.

Since 01.01.2019, the central tracking of conspicuous hearing screening results in the federal state of Baden-Württemberg has been carried out by a specially established hearing screening center for newborn hearing screening based in Heidelberg and Stuttgart. In this paper, we report on the current conceptualization and implementation of tracking in the federal state. A screening program is only effective and goal oriented if all involved parties-including parents, birthing facilities, specialists in private practice, and other service providers-work together. The amount of work involved in providing information, carrying out the screening examinations, and performing confirmatory diagnostics within the specified timeframe is immense. A follow-up mechanism in terms of quality assurance for newborn hearing screening appears to be necessary.

Background: The TNM system, implemented since 1958, is an established tool for classifying solid tumors and categorizing them based on tumor size and extent, regional lymph node involvement, and the presence of distant metastases. The current 9th edition of the TNM system offers extensive revisions in the head and neck area, with a particular focus on the clinical, radiological, and pathological extracapsular spread of lymph node metastases and the corresponding prognostic relevance.

Materials and methods: The 9th edition of the TNM classification of the Union for International Cancer Control (UICC) served as the basis for the review. It was published in July 2025 and should be implemented from January 2026. The background to the corresponding changes is explained based on a detailed literature search.

Results: As before, revisions to the TNM classification were made particularly for human papillomavirus (HPV)/p16-positive oropharyngeal cancers with regard to extracapsular extension. For nasopharyngeal cancers, there was a modification to the UICC stages due to improved prognostic significance. Specifications were also made for the depth of invasion of oral cavity cancers. Minor salivary gland cancers have now been included in the classification system alongside cancers of major salivary glands.

Conclusion: Following extensive revisions in the head and neck area, there have been notable changes, particularly in the field of HPV/p16-positive oropharyngeal cancer. The extent to which these changes will prove to be prognostically relevant remains to be seen after the new TNM system has been implemented in clinical routine.

Operative ear, nose and throat (ENT) medicine in Germany is facing a profound structural change, which is significantly influenced by the ongoing hospital reform, the expansion of outpatient surgery services and technical innovations. University and peripheral hospitals, practices, medical care centres and private clinics differ significantly in terms of resources, specialisation, remuneration systems and training opportunities. The reform is leading to a greater concentration of complex ENT services in high-performance centres, while standardised procedures are increasingly being performed on an outpatient basis. Hybrid forms of diagnosis-related groups (DRGs) and the Ambulantes Operieren im Krankenhaus (AOP; outpatient surgery) catalogue extensions are intended to promote sector-specific remuneration but are creating new economic tensions, especially for clinics with high standby costs. At the same time, outpatient surgery centres and practices are gaining in importance, but some face structural disadvantages. Digitalisation, artificial intelligence-based planning, robotic assistance and intraoperative imaging are fundamentally changing surgical work and opening up new possibilities in precision, documentation and training. This creates new requirements for surgical training: while highly complex procedures remain centre based, basic procedures must increasingly be learned in the outpatient sector. This requires cross-sectoral rotation models, consolidated curricula, digital simulation and reliable funding for outpatient training positions. Overall, the future of surgical ENT care lies in coordinated interaction between hospitals and practices, structural cooperation, modern remuneration systems, and technical and ecological innovation.

Artificial intelligence (AI) and robotics are transforming the foundations of medical practice. Their integration creates new opportunities for precision, individualization and efficiency but also raises fundamental ethical questions about knowledge, responsibility and legitimacy. This article summarizes the main opportunities and risks of the use of AI and robotics in medicine and shows how these technologies reshape the epistemic, normative and social dimensions of medical practice. While numerous ethical principles and guidelines provide initial guidance, the real impact arises only when the principles are embedded in concrete clinical, institutional and procedural contexts. There are three guiding ideas that are proposed as the basis of such ethics: epistemic transparency, shared responsibility and discursive-procedural legitimacy. These form the foundation of a learning, reflective and patient-centered ethics of the responsible use of technology.

Background: Research is a central pillar of academic otorhinolaryngology. However, clinicians increasingly face difficulties with integrating scientific activity into their demanding clinical routines.

Objective: This study aimed to assess research motivation, perceived barriers, and structural conditions among clinicians at German university ENT departments and to derive practical recommendations for improvement.

Materials and methods: An anonymized online survey was distributed among otorhinolaryngologists working in German academic hospitals. Data were analyzed descriptively.

Results: Of 131 respondents, 84% worked fulltime, 89% held a doctoral degree, and 28% had completed habilitation. While extrinsic motivation dominated among doctoral candidates, habilitation aspirants were more driven by intrinsic factors such as scientific curiosity and enjoyment of research. Main obstacles included insufficient staffing, high documentation load, and lack of protected research time. Research was frequently conducted outside of regular working hours. Although research development was regularly addressed by management levels, only 36% felt adequately supported. Moreover, 68% of participants reported no perceived benefit of research engagement for their surgical training opportunities.

Conclusion: These findings highlight a systemic tension between clinical demands and research. To ensure sustainable academic productivity in university ENT departments, institutional strategies such as protected time, reduction of the bureaucratic burden, and transparent support mechanisms are needed.

Background and objective: In addition to cancer-related survival, significant non-cancer-related modifiable risk factors are increasingly recognized in head and neck cancer due to disease localization and oncological therapy. Dysphagia in particular has an impact on overall survival, especially due to consequences such as aspiration pneumonia and malnutrition. This study aimed to assess these risks and possible influencing factors in a typical patient population of a German head and neck cancer center.

Methods: Patients with hypopharyngeal and laryngeal cancer were examined as part of a retrospective cohort study. Uni- and multivariable logistic regression was used to investigate the influence of independent variables on dysphagia- and diet-dependent outcome variables. Factors influencing survival were identified using Kaplan-Meier curves and Cox regression analysis.

Results: Pretherapeutic underweight (hazard ratio, HR, 2.025) and pneumonia (HR 1.569) were identified as significant risk factors for survival in 214 patients. At the same time, pretherapeutic underweight was found to be an influencing factor for pretherapeutic dysphagia (OR 7.6), which, in turn, was an influencing factor for posttherapeutic dysphagia (odds ratio, OR, 12.1). The presence of pre- and posttherapeutic dysphagia had a significant influence (OR 4.0) on the development of pneumonia.

Conclusion: The results indicate that early and consistent treatment of malnutrition and dysphagia could improve long-term survival. Further studies on interventions addressing these influencing and risk factors are necessary to extend the outcome evaluation of pretreatment, early, and inpatient rehabilitation measures after oncological therapy beyond solely subjective patient-centered outcome measures. These future investigations should also address the consequences of dysphagia on disease management, quality of life, morbidity, and mortality as well as the costs associated with its complications.