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

Purpose of review: Systematic follow-up protocols, often including regular imaging, are an essential component of posttreatment care for head and neck cancer, aimed at the early detection of disease relapse and mitigating treatment-related morbidity. However, there is no consensus on the optimal length of follow-up and the value of imaging in surveillance.

Recent findings: Most head and neck cancer recurrences occur within 1-2 years after treatment. After 2 years, the recurrence rate decreases significantly, and after 3 years, recurrences are infrequent. Most of the recent studies suggest that prolonged scheduled follow-up programs are not necessary, as asymptomatic salvageable late recurrences are rare. Imaging surveillance for the early detection of otherwise undetected recurrences is supported by many studies, although its impact on survival remains unclear.

Summary: Recent literature emphasizes intensive follow-up programs during 1-2 years, as well as patient education for self-observation of alarming symptoms. Prolonged surveillance programs after 2-3 years may not be effective in detecting asymptomatic recurrences. While personalized surveillance based on risk factors is suggested, a lack of strict evidence hampers stratification. Imaging may be of value in detecting early asymptomatic recurrences at least up to 2 years, but disagreement exists regarding its utility in improving survival.

Purpose of review: Adnexal carcinomas (AC) are rare skin lesions predominantly affecting elderly individuals. These tumors are often located in the head and neck region and are influenced by factors such as sun exposure, prior radiation therapy, and immunosuppression. Understanding the pathogenesis and management of AC is crucial for improving patient outcomes.

Recent findings: AC may arise de novo or from preexisting benign lesions. They may act as cutaneous markers for hereditary syndromes, highlighting the need for their early identification. Accurate diagnosis is critical, requiring adequate biopsy for proper characterization, as superficial excisions may lead to mistakes. Surgical treatment remains the primary approach, with wide (at least 1 cm) surgical margins also recommended for lesions with lower malignancy potential. Mohs surgery is particularly useful for tumors located in cosmetically sensitive areas, offering precise resection and clear margins.

Summary: AC are classified into good, intermediate or poor prognosis categories based on the risk of local recurrence and distant metastasis. This classification assists in determining the need for adjuvant treatments and follow-up strategies. The proper understanding of risk factors, pathogenesis, and treatment options is essential to improve outcomes and ensure optimal management of AC.

Purpose of review: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been recognized as a diagnostic entity since 2017. It has been shown to exhibit indolent behaviour, and lobectomy alone is advocated as the treatment of choice. In this review, the diagnostic challenges including interobserver variation, the role of artificial intelligence, and the latest data on the risk of recurrence or metastasis, is evaluated.

Recent findings: Diagnosis of NIFTP is reliant on examination of the entire tumour-parenchymal interface. Strict criteria are required in order to establish a diagnosis. Inter-observer variation exists even among experienced thyroid pathologists. Recent studies continue to support the nonaggressive nature of NIFTP lesions.

Summary: NIFTP is considered a low risk follicular-cell derived thyroid neoplasm. Adherence to diagnostic criteria is crucial in accurately applying the diagnosis. Further long-term follow up is required in order to establish guidelines on the long term management of these patients.

Purpose of review: Currently, no universally accepted definition or management strategy for chronic rhinosinusitis (CRS) and its acute exacerbations (AECRS) exists. This review aims to provide an overview of the current research in this field and to present recent advances in diagnosis and management.

Recent findings: A variant in the CDHR3 gene has been identified as a risk factor for AECRS, associated with increased viral replication, type-2 cytokine upregulation, and downregulation of Toll-like receptor mediated responses. Microbiome studies show that patients with AECRS are more likely to harbor rare microbial taxa, and most strains isolated during exacerbations form biofilms. Biologic therapies targeting type-2 inflammation have reduced exacerbation rates and decreased the need for antibiotics and systemic corticosteroids. Culture-directed antibiotics may improve longer-term endoscopic outcomes, though short-term symptom and quality-of-life benefits remain unclear. Cost-effectiveness modeling suggests observation is usually the most efficient initial strategy, unless the probability of bacterial etiology exceeds ~49%. In addition, a new patient-informed definition of AECRS has been proposed, although further validation is needed.

Summary: Advances in genetics, microbiome analysis, and biologic therapy offer promising avenues, yet definitions and outcome measures remain inconsistent. Robust, long-term studies are still needed to harmonize definitions and standardize management.

Purpose of review: This review summarizes recent advances in the use of botulinum toxin (BoNT) for laryngeal disorders. It highlights the growing therapeutic relevance of BoNT across both motor and sensory conditions, focusing on novel indications, evolving mechanisms of action, and innovations in injection techniques.

Recent findings: BoNT remains the primary treatment for laryngeal dystonia, with increasing personalization in dosing, target selection, and outcome assessment. New evidence supports its application in functional dysphonia, vocal process granuloma, chronic cough, inducible laryngeal obstruction, and abnormal throat sensation. Studies suggest both peripheral and central neuromodulatory effects, including modulation of afferent input and neuroplastic changes. Guidance techniques such as electromyography, ultrasound, and flexible endoscopy are improving injection accuracy. Adjunctive therapies, including pharmacological agents and sensory retraining approaches, show promise for partial or nonresponders.

Summary: BoNT is an increasingly versatile and well tolerated treatment across a broadening spectrum of laryngeal disorders. As knowledge of laryngeal neurobiology expands, BoNT is being redefined as both a focal therapeutic and a neuromodulator with broad implications for voice and airway management.

Purpose of review: This review explores the pathogenesis, diagnosis, and treatment of cough caused by rhinitis and related conditions, emphasizing new advancements.

Recent findings: Upper airway cough involves multiple inflammatory and neurogenic mechanisms, including postnasal drip stimulation of cough receptors, inflammatory mediator release, and sensory neural hypersensitivity. Diagnosis requires comprehensive clinical evaluation, with increasing emphasis on identifying specific disease endotypes. Management has expanded from conventional therapies to include biologics and targeted procedures, while emerging treatments provide additional options for refractory cases.

Summary: Chronic cough frequently results from upper airway conditions, including allergic rhinitis, nonallergic rhinitis, chronic rhinosinusitis, and postviral cough. Diagnosis and treatment depend on symptom assessment, endoscopy, imaging, and biomarkers. Management targets the underlying etiology through pharmacotherapy, immunotherapy, and procedural interventions; however, further research remains essential to optimize understanding and treatment of affected patients.

Purpose of review: Sinonasal mucus biomarkers have emerged as a powerful, noninvasive tool to better understand the immunopathology of chronic rhinosinusitis (CRS). This review highlights the evolving role of mucus biomarkers as they move from discovery-phase research toward potential clinical implementation and identifies critical gaps that must be addressed before their integration into routine decision-making.

Recent findings: Mucus biomarkers provide valuable insights into CRS endotypes, disease severity, olfactory dysfunction, and potentially biologic choice. Recent studies have shown associations between mucus cytokine and protein profiles with postoperative olfactory recovery, polyp recurrence, and responsiveness to biologic therapy. Advances in collection devices hold potential to standardize sampling methods, while machine learning approaches are increasingly being applied to high-dimensional biomarker datasets, improving the ability to predict outcomes and guide therapy selection. Despite these advances, unresolved challenges include optimal sampling site, assay standardization, and prospective validation in clinical trials.

Summary: Mucus biomarkers are transforming our understanding of CRS by linking local immune dysfunction with clinical manifestations, such as quality-of-life impairment, olfactory loss, and disease recurrence. With continued refinement, integration of mucus biomarker profiling with machine learning and clinical datasets may enable precision diagnostics and personalized treatment strategies for CRS.

Purpose of review: Management of fetal airway obstruction requires a multidisciplinary approach to optimize the safety of the pregnant patient and fetus. For severe cases of fetal airway obstruction, ex-utero intrapartum treatment (EXIT) is recommended. This review highlights indications and rationale for EXIT and presents an approach to fetal airway management from an otolaryngologic perspective.

Recent findings: Approach to the fetus with airway obstruction differs in the literature. Recent studies have sought to identify prenatal risk factors that portend the need for surgical intervention at delivery, with identification of three fetal anomalies that justify delivery modification: micrognathia, congenital high airway obstruction, and head and neck masses. There remains heterogeneity within this cohort, contributing to the varied approach to fetal airway obstruction. What remains consistent is the need for early identification of at-risk fetuses and multidisciplinary input throughout pregnancy to ensure that the appropriate teams are present at delivery.

Summary: EXIT is a mainstay in the management of fetal airway obstruction, as it enables airway intervention while preserving uteroplacental circulation. Further research is needed to define indications for EXIT and develop management algorithms starting from identification of airway obstruction on prenatal imaging. Multidisciplinary collaboration is tantamount to a successful procedure.

Purpose of review: This article synthesises the recent sinus microbiome literature, identifying common themes in research findings as well as surveying the varied methodological approaches used across these studies.

Recent findings: While there remains no clear consensus as to which microbes define dysbiosis in chronic rhinosinusitis (CRS), certain trends are emerging. Increasingly, the evidence points towards a pathogenic role in the overabundance of Moraxella, Haemophilus and Pseudomonas species, whilst the genera Cutibacterium, Anaerococcus and Dolosigranulum tend towards commensalism. However, the roles of the most common genera in the sinus microbiome, Staphylococcus and Corynebacterium, remain uncertain. Given the diversity and abundance of species within these genera, species and function-level analyses are needed to clarify their contributions to the aetiopathogenesis of CRS. Comprehensive study of the sinus microbiome in healthy individuals further shows that community composition shifts with age, suggesting that dysbiosis may manifest differently across the lifespan. Beyond bacteria, growing evidence highlights the importance of fungi and viruses, underscoring the need to incorporate these microbionts into future analyses.

Summary: Progress towards a clinically meaningful consensus will require standardised approaches to sequencing, species-level resolution in these analyses, and consideration of the heterogeneous clinical and immunological subgroups of CRS.

Purpose of review: This review aims to provide a comprehensive analysis of the pathophysiology and treatment of middle ear myoclonus (MEM), a rare and under-recognized cause of objective and subjective tinnitus.

Recent findings: MEM is increasingly recognized as a distinct subset in tinnitus patients, with symptoms arising from involuntary contractions of the stapedius and/or tensor tympani muscles. Pharmacological management currently centres around agents such as clonazepam, carbamazepine, and piracetam. Surgical resection of middle ear tendons has yielded highly encouraging results, albeit with risks such as hyperacusis and symptom recurrence due to tendon reattachment. Endoscopic surgical techniques offer improved visualization and reduced invasiveness. Emerging data support the potential role of botulinum toxin as a less invasive and reversible therapeutic option, particularly with intratympanic delivery methods demonstrating early safety and efficacy in recent studies.

Summary: MEM is a complex otologic condition with limited high-quality data guiding its diagnosis and management. Due to its variable presentations and response to treatment, a multidisciplinary and individualized approach remains essential. While pharmacological treatments and surgical outcomes are generally favourable, interest in botulinum toxin continues to grow. Further large-scale, controlled studies are needed to clarify pathophysiological mechanisms, optimize diagnostic accuracy, and standardize treatment protocols.