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

Purpose of review: This review summarizes the latest advances in applying the rehabilitation treatment specification system (RTSS) to voice therapy.

Recent findings: Recent RTSS work has moved beyond conceptual endorsement to practical demonstrations in vocal rehabilitation. Multiple studies now provide complete RTSS specifications of voice therapy protocols and everyday clinical care, supporting content validity and enabling direct comparison of treatment components across approaches and sites. RTSS-guided intervention development has produced componentized protocols that translate treatment theories into explicit ingredient-target hypotheses suitable for refinement through empirical testing. RTSS-based mapping has also clarified overlap and meaningful differences across evidence-based therapies. Finally, RTSS-informed evidence synthesis has reduced heterogeneity in meta-analytic work by regrouping studies according to mechanism-relevant component categories (organ functions vs. skills & habits), yielding more interpretable patterns of treatment effects.

Summary: The RTSS is emerging as a practical infrastructure for cumulative, component-based voice therapy science, supporting clearer intervention reporting, mechanistic interpretation, cross-disciplinary transfer, and scalable adoption in routine documentation.

Purpose of review: Presbyphonia has long been framed as a laryngeal disorder driven by presbylaryngis, yet emerging evidence suggests that age-related respiratory decline plays a central but under-recognized role in symptomatic vocal aging. This review synthesizes work on respiratory aging, speech-breathing patterns, and respiratory muscle performance in older adults with presbyphonia, and evaluates early attempts to target these systems in rehabilitation.

Recent findings: Laryngeal atrophy and glottic insufficiency are common in aging but do not reliably predict presbyphonia. Age-related reductions in lung elasticity, chest wall compliance, respiratory muscle strength, and respiratory interoception alter speech breathing and may compound glottic inefficiency. Recent studies indicate that "exuberant" voice therapies targeting maximal vocal function outperform gentler, skill-based approaches. Preliminary trials combining these therapies with respiratory muscle strength training, particularly inspiratory training, suggest added benefits for vocal effort, fatigue, and connected speech, though underlying mechanisms remain unclear.

Summary: Respiratory aging appears to meaningfully influence symptom severity in presbyphonia yet remains poorly characterized in the condition. Incorporating respiratory assessment, kinematic measures of speech breathing, and targeted respiratory training may enhance diagnostic precision and optimize therapy outcomes. Future work should clarify how respiratory mechanics and sensory monitoring interact with laryngeal deficits and identify which older adults benefit most from respiration-focused rehabilitation.

Purpose of review: Childhood hearing loss remains a major yet under-addressed public health challenge in low-income and middle-income countries (LMICs). Despite global policy momentum following the World Report on Hearing, early detection programmes remain fragmented, urban-centred, and difficult to scale. This review synthesizes evidence from recent newborn, infant, preschool, and school-age screening pilots (2024-2025) to clarify emerging models, persistent barriers, and policy implications for expanding equitable early hearing screening in resource-constrained settings.

Recent findings: Recent studies demonstrate growing interest in community-based delivery, task-shifting to non-specialist health workers, and the use of portable and digital tools - including smartphone-based OAE, tablet screeners, and remote audiology services. Pilots across Africa and Asia show high feasibility and caregiver acceptability but reveal substantial challenges: limited diagnostic capacity, workforce shortages, high loss-to-follow-up, and uncertain programme costs. School-based and preschool screening programmes offer a critical second opportunity for detection, particularly for late-onset and infection-related hearing loss, and show strong potential when integrated into existing education or child-health platforms.

Summary: Scalable early hearing detection in LMICs requires context-specific models, strengthened referral pathways, and sustainable financing. Digital tools and task-shifting offer promising avenues but need rigorous validation and integration into national systems. Future research should prioritize cost-effectiveness, culturally grounded family-centred approaches, and embedding screening within broader child-health policy frameworks.

Purpose of review: Provision of hearing healthcare in Nepal is evolving due to expanding screening programmes, new epidemiologic data and growing surgical and rehabilitative capacity. Recent literature offers updated prevalence estimates, insights into rural disparities, and evidence on the lack of ear care and hearing health amongst the population including health professionals.

Recent findings: Recent studies highlight the high burden of hearing impairment in remote provinces where there is often limited knowledge, the feasibility of infant-hearing screening in low-resource settings, and new data on paediatric cochlear implant outcomes. Earlier literature contextualises chronic otitis media, school-aged hearing loss, and sociocultural barriers. Workforce limitations, financing, and patchy geographic distribution of services remain substantial challenges.

Summary: Despite resource constraints, Nepal is making meaningful progress in screening, epidemiologic characterisation, and surgical rehabilitation. Further advances will require integration of ear and hearing care into primary health systems, scaling of newborn screening, equitable cochlear implant access, workforce expansion, and implementation research to guide policy.

Purpose of review: This review highlights the growing need for coordinated, multidisciplinary survivorship models for individuals treated for head and neck cancer (HNC), as modern treatments have improved survival for the group but also led to a higher prevalence of complex, multisystem late sequelae. The importance of authorities and academic societies in incorporating rehabilitation as part of treatment in national cancer plans is reviewed. As healthcare systems strive to integrate hospital-based and community-based services, the balance between centralisation of specialisation and the desire for patient-centred care is challenged. The Copenhagen Model for HNC Rehabilitation, provides a structured and standardised framework for assessing patient needs, enhancing care coordination across sectors, and deliver specialised, patient-centred rehabilitation from the early postoperative period through late sequelae, salvage treatment, and advance care planning.

Recent findings: Dysphagia remains one of the most frequent and burdensome late sequelae after treatment of HNC, contributing to impaired quality of life, airway protection problems, nutritional concerns, and emotional distress. The Copenhagen Model offers a structured model for managing late sequelae after surgically treated HNC by systematic patient stratification, home-based visits, and multidisciplinary efforts with comprehensive clinical assessments, identifying unmet rehabilitation needs and initiating interventions. This systematic approach has contributed to creating an increased focus on palliative care and advanced care planning and to a greater degree of refraining from treatment.

Summary: Insights from this model suggest that structured, multidisciplinary team-based rehabilitation can enhance the detection of late effects, promote well tolerated and effective therapeutic strategies, and strengthen patient-centred outcomes in survivorship care. The clinical experience underscores the need for ongoing research to refine interventions, assess long-term functional outcomes, and optimise multidisciplinary collaboration in HNC rehabilitation. Additionally, patients' posttreatment experiences influence clinicians' perspectives on the scope of future treatments, underscoring the need for surgeons' participation in rehabilitation and importance of research into prehabilitation assessment and communication.

Purpose of review: This review evaluates the current state of artificial intelligence (AI) in head and neck cancer (HNC) rehabilitation services by mapping current applications across rehabilitation pathways and allied healthcare professionals (AHPs), and outlines future directions and recommendations for integrating AI into routine healthcare.

Recent findings: HNC care is highly specialized and requires intensive collaboration among many professionals, yet rehabilitation services remain fragmented, and AI developments are limited. More broadly, AI applications are emerging across multiple rehabilitation domains, including speech and swallowing assessment, motion analysis, nutrition support, mental health detection, and administrative automation. The most mature tools with high Technology Readiness Levels (TRLs) support patient education, telehealth communication, and real-time monitoring, particularly in dietetics, physiotherapy, and speech therapy. Low TRLs - such as multidisciplinary decision support, personalized exercise planning, mental health detection, and automated speech disorder assessment - remain in early development. Major barriers include fragmented data infrastructures, limited representativeness of HNC populations, ethical concerns, and the need to preserve the therapeutic patient-provider relationship. large language models (LLMs) show potential for structuring information and generating rehabilitation plans but require expert oversight.

Summary: AI has the potential to enhance coordinative rehabilitation and shows promise for both health care providers and patients. However, meaningful progress toward clinical implementation requires rigorous validation, the development of shared standards, and strong interdisciplinary collaboration.

Purpose of review: The purpose of this study is to describe why this review is timely and relevant. Endotyping, the organization of rhinologic inflammation around immunologic precepts, has evolved from a research subject to a clinically relevant tool with the advent of targeted biologics in chronic rhinosinusitis (CRS). This review highlights recent progress but also the challenges to implementing endotype-based care into routine clinical practice.

Recent findings: Describe the main themes in the literature covered by the article. Recent literature demonstrates organization of patients around multiple endotypes, most prominently Type 2, Type 1/3, pauci-inflammation, and mixed inflammatory profiles. Three principal approaches to endotyping have been widely utilized: cellular (histology-based) analysis, single-biomarker, and multibiomarkers assays. Emerging machine-learning models further enhance data-driven multibiomarkers classification. Importantly, developed endotypes demonstrate correlates with key clinical features, postoperative outcomes, and responsiveness to sinus surgery and biologic therapy.

Summary: Describe the implications of the findings for clinical practice or research. Increase use of precision biologics necessitates developing well validated endotypes to better select therapy for patients. Three major approaches - histology-based, single-biomarker, and multibiomarker strategies - are commonly employed, each with distinct advantages and limitations. Moving forward, standardization of methods, development of cost-effective testing, and rigorous clinical validation remain essential steps.

Purpose of review: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a common yet complex and heterogeneous inflammatory condition that can be refractory to standard medical and surgical treatment. Patients with refractory disease may be candidates for biologics, medications that specifically target the biomarkers associated with sinonasal inflammation. The purpose of this review is to review the current literature regarding the appropriate use of biologics in the management of CRSwNP.

Recent findings: There are three currently approved biologics in the management of CRSwNP, dupilumab, omalizumab, and mepolizumab. Each biologic has demonstrated clinical efficacy in the management of CRSwNP. Current guidelines from multiple professional institutions recommend considering biologics in patients with refractory CRSwNP who have either undergone or are unable to undergo sinus surgery. Patients should be monitored closely for biologic-related adverse events and treatment response 6 months after therapy should be assessed. In poor responders to biologic therapy, alternative biologics or revision surgery can be considered.

Summary: Biologic therapy has demonstrated efficacy in the management of CRSwNP that is refractory to standard medical and surgical therapy and may be a good treatment option in this patient population.

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: 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.