Abstract: Background and Clinical Significance: Acute pediatric rhinosinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Involvement of Enterobacter species is rare and typically linked to chronic or nosocomial infections. Typical cases of acute rhinosinusitis in children present with abundant nasal discharge, headache, and fever, and are generally managed with systemic antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), mucolytics, and topical intranasal treatment. Atypical presentations prompt for heightened clinical attention and, depending on the symptoms and patient status, surgical interventions might be considered; Case Presentation: We report the case of a previously healthy 5-year-old boy presenting with painful unilateral palpebral edema, minimal ipsilateral nasal discharge and persistent headache despite standard rhinosinusitis therapy. Imaging revealed complete right maxillary sinus opacification. As clinical response to ceftriaxone and dexamethasone was minimal, we opted for endoscopic sinus surgery. A nasal swab culture identified Enterobacter spp. in the nasal discharge; Conclusions: Unusual pathogens like Enterobacter spp. can cause acute sinusitis in children without prior risk factors. Early surgical intervention and culture-adjusted antimicrobial therapy remain critical for favorable outcomes.

Abstract: (1) Background: Extrapulmonary tuberculosis (EPTB) of the head and neck is a rare but difficult diagnosis due to mostly absent pulmonary involvement and high clinical resemblance to neoplastic or chronic inflammatory conditions. This diagnosis still poses a challenge for otorhinolaryngologists, due to non-specific symptoms and the low index of suspicion in non-endemic regions. (2) Methods: This study presents a retrospective review of nine cases of head and neck EPTB diagnosed at two regional hospitals in southern Romania. Patients presented with pharyngeal, laryngeal, or cervical lymph node involvement. All cases underwent surgical biopsies for histopathological and microbiological confirmation, followed by standard anti-tubercular therapy. (3) Results: In all nine cases, surgical biopsies were essential for the accurate diagnosis and excluding malignancy or other granulomatous diseases. Diagnostic delays were observed due to atypical clinical presentations. Integration of biopsy findings with anti-tubercular treatment resulted in favorable disease control and clinical recovery. (4) Conclusions: Head and neck EPTB requires a high index of suspicion and clinical discernment. Surgical biopsy remains a critical diagnostic tool in practice and should be considered early in the diagnostic process when encountering atypical lesions. A timely use improves diagnostic accuracy, may eliminate delays, ensures patient safety, and improves therapeutic outcomes.

Abstract: Background: Although upper and lower respiratory tract diseases coexist, studies discussing the relationship between chronic rhinitis (CR) and chronic obstructive pulmonary disease (COPD) are limited. Fluticasone nasal sprays are common treatment options for patients with rhinitis. Therefore, we aimed to investigate the effects of fluticasone nasal spray on patients with both CR and COPD. Methods: A retrospective review was performed using data from former smokers with CR and COPD at China Medical University Hospital (CMUH). Based on their medication history, patients were allocated into Group A, who had received treatment with fluticasone nasal spray, and Group B, who had never received this treatment. Pulmonary function test results, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), were collected for both groups before treatment and one year after treatment. Statistical analysis was performed to evaluate the impact of fluticasone nasal spray treatment on pulmonary function. Results: A total of 123 former smokers were included, with 62 patients in Group A and 61 patients in Group B. At the baseline, there was no significant difference in age, sex, and pulmonary function between the two groups. After one year of treatment, Group A showed an upward trend in pulmonary function, with FEV1 increasing from 1.613 ± 0.554 to 1.708 ± 0.675 (P < 0.05) and FVC increasing from 2.540 ± 0.694 to 2.670 ± 0.839 (P < 0.05). Whereas, Group B exhibited a downward trend in pulmonary function after one year, with FEV1 decreasing from 1.609 ± 0.554 to 1.544 ± 0.517 (P < 0.05) and FVC decreasing from 2.586 ± 0.665 to 2.495 ± 0.679 (P < 0.05). Conclusions: The use of fluticasone nasal spray can improve pulmonary function in former smokers with both CR and COPD. This finding supports the "one airway, one disease" theory.

Abstract: Background/Objectives: Controlling balance in young adults is generally effortless and can occur automatically with minimal cognitive involvement. However, this ability may be compromised when integration conflicts arise due to impairments in vestibular, visual, or somatosensory functions. Hence, psychomotor symptoms linked to emotional states can also influence postural control. The purpose of this study was to understand the effect of anxiety and depression on balance in young adults. Methods: Our study included 50 young adults (21.86 ± 2.63 years), consisting of 13 males and 37 females. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and De-pression Scale (HADS), while balance assessed through the modified Clinical Test for the Sensory Interaction on Balance (mCTSIB). Data analysis was conducted using Pearson’s correlation coefficient test and Kruskall-Wallis test. Results: Pearson's cor-relation analysis indicated that young adults exhibited stable postural control. Howev-er, a positive correlation (0.259, p < 0.1) was observed between anxiety levels and the sway index. Additionally, positive correlations were found between anxiety and both somatosensory (0.281, p < 0.05) and visual (0.276, p < 0.1) ratios. Conclusions: The re-sults suggest that higher anxiety levels are associated with reduced postural balance, with sensory inputs, particularly visual and somatosensory, playing a key role in this decreased stability.

Abstract: Background/Objectives: Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by compromised mucociliary clearance and chronic respiratory manifestations. Anosmia, or the loss of smell, is a lesser-known but clinically relevant symptom that can significantly impact patient safety, nutritional status, and overall quality of life. The RSPH4A (c.921+3_921+6delAAGT) founder mutation is highly prevalent among Puerto Rican individuals with PCD and may carry distinct phenotypic implications. This study aimed to evaluate olfactory function in Puerto Rican PCD patients with this mutation using the Brief Smell Identification Test (BSIT) and to assess associations with age and sex. Methods: We conducted a case-control study involving 30 participants: 15 PCD patients with genetically confirmed RSPH4A mutations and 15 age- and sex-matched healthy controls. All participants completed the BSIT, and BSIT scores were compared by diagnosis, sex, and age. Results: PCD patients had significantly lower BSIT scores than controls (p = 0.0015). When stratified by sex, both male (p = 0.0289) and female (p = 0.0178) PCD patients demonstrated significantly lower BSIT scores compared to their respective healthy counterparts. Regression analysis showed a significant inverse correlation between age and BSIT score in the PCD group (r² = 0.2873, p = 0.0395), while no such relationship was observed in controls (r² = 0.0096, p = 0.7283). Among PCD patients, age-related decline in olfactory function was more pronounced in females (r² = 0.71, p = 0.005) than in males (r² = 0.31, p = 0.25). Conclusions: These findings demonstrate that the RSPH4A founder mutation is associated with measurable olfactory impairment in PCD patients, particularly in females and with advancing age. Routine assessment of olfactory function should be considered in the clinical evaluation of patients with PCD, as anosmia may represent a key phenotypic feature and contribute to disease burden.

Abstract: Objective: Various orbital conditions (trauma, autoimmune thyroid disease, tumors, infections, congenital malformations) may lead to retrobulbar hemorrhage (RBH) with a consecutive increase in orbital cavity pressure resulting in orbital compartment syndrome (OCS). OCS is associated with acute loss of visual function and a high risk of permanent damage to the optic nerve (compressive optic neuropathy). Orbital decompression surgery (ODS) is a time-critical procedure that reduces pressure on the optic nerve, thereby improving visual function. The surgical management protocol for orbital decompression is not standardized and varies. Surgical techniques differ in orbital fat decompression, lateral canthotomy, and decompression of the medial orbital wall and floor. This retrospective study aimed to evaluate surgery procedures and the outcome of visual function after orbital decompression surgery. Methods: In a retrospective study, we evaluated 28 patients (17 male, 11 female) with orbital compartment syndrome from May 2016 to October 2024. All patients underwent orbital decompression surgery as first-line treatment. Visual acuity (VA), diplopia, and ocular motility were analyzed pre- and postoperatively. Recovery was defined as postoperative improvement of vision, diplopia, and ocular motility. Linear and logistic regression analyses were used to assess the associations between clinically relevant risk factors and primary outcomes. Results: Orbital decompression surgery was performed with a median of 8.40 hours (Q1: 4.80, Q3: 24.00) upon occurrence of symptoms. The average preoperative measured vision was 0.23 (SD, 0.34). 46% of patients were preoperatively categorized as „blind“ according to the WHO visual impairment categories. 96% showed preoperative ocular motility impairment. Diplopia was preoperatively present in 46%. After orbital decompression surgery, postoperative visual acuity improved in 36% of the patients. Ocular motility improved by 67% and Diplopia by 62% after ODS. The primary surgery technique was 2-wall decompression in 68% (19/28) of cases, followed by 1-wall decompression (21%; 6/28) and 3-wall decompression (11%; 3/28). Lateral decompression (82%; 23/28) and medial wall decompression (93%; 26/28) were the primary procedures performed. Orbital floor wall decompression was performed in only 14% (4/28) of cases. Regression analysis revealed a statistically significant effect of preoperative measured vision on postoperative vision, while accounting for age, sex, and time to surgery. Conclusion: Orbital decompression surgery is the time-sensitive first-line treatment of acute visual function loss in OCS. Our data showed a postoperative improvement in visual acuity in 36% of patients, along with considerable improvement rates in diplopia and ocular motility. The primary surgery technique was a 2-wall-decompression approach with lateral wall decompression and medial wall decompression. Center-specific timeline optimisation of OCS patients is essential.

Abstract: Background/Objectives: The various head and neck squamous cell carcinoma (HNSCC) subtypes are among the most common cancers globally, with significant recurrence rates within the first two years post-treatment. Despite advancements in treatment, structured early follow-up remains crucial for timely diagnosis and effective salvage treatment. Methods: This retrospective study examines the impact of implementing a structured initial restaging between three and six months after the conclusion of initial treatment. The study population included 532 patients treated with curative intent at the University Medicine of Greifswald, Germany, between 2010 and 2019. Patients were divided into two groups: standard follow-up (SF) and adapted follow-up (AF). The AF group received standardized post-treatment restaging, including imaging and panendoscopy or PET-CT exams. Results: We found a trend towards earlier diagnosis and a reduction in recurrences, although these differences were not statistically significant. Secondary cancers were observed more frequently in the AF group, significantly affecting overall survival. Conclusions: A The study highlights the importance of structured early follow-up and suggests potential strategies and possible future improvements.

Abstract: Objectives: Observational studies have shown that chronic obstructive pulmonary disease (COPD) is associated with an increased risk of hearing impairment. However, causality remains unclear, including with respect to lung function. This study aimed to investigate the associations of lung function and COPD with hearing impairment in the UK Biobank and confirm potential causalities using Mendelian randomization (MR). Methods: Cross-sectional analyses were performed using logistic regression models in a subsample of the UK Biobank. Two-sample MR analyses were performed on summary statistics for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), COPD, and sensorineural hearing loss. Results: FEV1 and FVC were negatively associated with hearing impairment, with odds ratios (95% confidence intervals) of 0.80 (0.77, 0.84) and 0.80 (0.76, 0.83), respectively. COPD was positively associated with hearing impairment, with an odds ratio (95% confidence interval) of 1.10 (1.02, 1.18). In the MR analyses, a negative association was found between FVC and sensorineural hearing loss, with an odds ratio (95% confidence interval) of 0.91 (0.83, 0.99). For FVE1 and COPD, no significant associations were found. Conclusion: The results of this study showed that FVC was causally associated with hearing impairment, suggesting a potential protective effect of FVC on hearing impairment.

Abstract: In 2008, Hahn et al. presented a method for cultivating a 3D organ culture of the cochlea. Although this method is well established, it is currently only applied to early postnatal animals. Given the known differences in regeneration and repair abilities between early postnatal and adult mammalian cochleae, our goal was to further develop and optimize this method to extend it beyond early postnatal animals to include adult mammalian cochleae. After rapidly dissecting the cochlea, it is opened and placed in a neurotrophin-containing culture medium. The culture is then maintained at 32°C in a rotating bioreactor for 24 hours. The combination of mild hypothermia (32°C), quick cochlea dissection, and the addition of 10 ng/ml of BDNF and 5 ng/ml of NT-3 to the culture medium ensures complete cell survival of all cochlear cell types in 10-day-old mice. The modifications to the established method include the incorporation of neurotrophins (BDNF and NT-3) into the culture medium and cultivation under mild hypothermic conditions (32°C). By introducing neurotrophins and cultivating at 32°C, a 3D organ culture of the cochlea can also be established with 10-day-old mice. This in vitro model preserves all cochlear cell types under conditions similar to those found in vivo.

Abstract: Objectives: To determine if VEMP testing causes DPOAE level reduction. Methods: The changes of DPOAE levels after VEMP testing in 174 patients (80 males and 94 females; median age, 53 years [interquartile range, 39-67 years; range, 15-85 years]) who were examined in the vertigo outpatient clinic between June 2021 and December 2024 were retrospectively analyzed. Results: The DPOAE levels decreased significantly after VEMP testing at 1.4 kHz, 2 kHz, 2.8 kHz, sum all 1/2 octave, and average 1/2 octave (1-6 kHz). The decrease of the DPOAE levels was significantly correlated with age, but not sex or side. Conclusions: The strong sound stimulation used in VEMP testing can decrease DPOAE levels. VEMP testing can be an invasive test method and should be performed with detailed consideration of the risks and benefits. The age factor can influence the decrease of DPOAE levels in VEMP testing.

Abstract: Background/Objectives: Surgical removal is the treatment of choice for cholesteatoma control. Depending on the size, the surgery involves partial resection of the ossicular chain and, if necessary, the bony skull base. Titanium foreign materials (prostheses, meshes) can be used to restore sound transmission and to cover larger defects of the skull base. After the operation, recurrence and residual control are necessary. This can be done by means of second-look surgery or an MRI examination with a non-EPI DWI sequence. Similar to other metal implants, artifacts may occur in the image due to the titanium used. This study aimed to estimate MRI generated artifacts due to the titanium foreign material (prosthesis, mesh) to get insights in a possible limiting role for recurrent cholesteatoma detection. Methods: 28 MRI examinations (T1-, T2-, non-EPI DWI sequences) in 14 males and 14 females (5,2-92,4 years) after cholesteatoma surgery and single-staged implantation of a PORP, TORP, or titanium mesh were considered. The size of the respective artifacts was measured, and the mean artifact sizes of the respective prosthesis types were compared. A second look surgery was performed in all cases due to the MRI result or clinical findings. Both were also compared. Results: Artifacts occurred in all titanium foreign bodies depending on the used MRI sequence (PORP, TORP, Mesh). We found a positive association between size of prosthesis and size of artifact. All subsequent second-look surgeries confirmed the MRI examinations according to a positive control for the presence of a cholesteatoma. The detection rate was 82.1%. Conclusions: Titanium material-related artifacts might influence the MRI detectability of recurrent cholesteatoma. Small cholesteatoma might be missed by an MRI based follow up. Single or two staged reconstructive concepts after cholesteatoma surgery need to be discussed.

Abstract: Background: Augmented reality (AR) glasses can be used for different medical indications. Primarily, a visual overlay on the optic screen offers additional operational information. A transfer of acoustic information via speech-to-text transcript using AR glasses presents a new non-surgical option to support patients with different forms of hearing loss. This study aimed to evaluate different AR glasses for speech-to-text transcription. Methods: We compared four different AR glasses (G1, MYVU, AIR, and Moverio 40) systems with a speech-to-text transcription regarding speech capturing, design, and software. Speech capturing ability was tested by free field numbers, monosyllabics, and OLSA in quiet and in noise. Results: The AR systems achieved Freiburger monosyllabic speech recognition rates between 20 % and 45 % at 65 dB. OLSA in quiet results varies between 77 % and 100 % and +1.7 dB and +3.5 dB in noise. AR systems differ substantially in terms of design and software. Proposed indication criteria are given. Conclusion: AR glasses offer a new treatment option for patients with selected indications. The systems show limitations in difficult hearing situations.

Abstract:

Background/Objectives: Aural toilet using microsuction is a common procedure in ENT clinics, and vertigo is a frequent complaint during this procedure. This study aimed to investigate the characteristics and incidence of microsuction-induced nystagmus and vertigo based on the appearance of the tympanic membrane (TM). Methods: In 85 patients with various TM appearances, microsuction-induced vertigo and nystagmus were assessed. Results: Microsuction elicited nystagmus in 95% (81 of 85) of patients and vertigo in 36% (31 of 85). The nystagmus direction was towards the ipsilateral ear in a bowing position and towards the contralateral ear in a leaning position. The proportion of patients who complained of rotatory vertigo was significantly higher in those with TM perforation, open cavity mastoidectomy, and adhesive otitis media (74%, 26 of 35) compared to those without TM perforation group (10%, 5 of 50) (P < 0.001, X² test). Conclusions: Aural toilet using microsuction commonly induces due to convection in the lateral semicircular canal endolymph caused by the cooling effect. While microsuction-induced nystagmus was observed in most patients, the incidence of vertigo varied depending on the TM condition. Clinicians should closely monitor patients for vertigo during the procedure, and methods to prevent microsuction-induced vertigo should be explored.

Abstract: Background and Objectives: Tinnitus management in otosclerosis is a significant clinical challenge, especially in patients who are ineligible or unwilling to undergo surgical treatment. While otosclerosis surgery may alleviate tinnitus, alternative non-surgical treatments are still being explored. This study evaluates the effects of oral calcium and fluoride supplementation on tinnitus severity in otosclerosis patients who opted for non-surgical management. Materials and Methods: A total of 128 otosclerosis patients with tinnitus were included in this study, which was conducted over a five-year period. Patients received Florical (Mericon Industries, Inc., USA), a calcium and fluoride supplement, and were monitored for three months. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI) before and after supplementation. Results: Assessing patients by degree of tinnitus, we achieved a clinically significant reduction in THI scores (≥10 points) in patients with mild tinnitus, the moderate and severe degrees of tinnitus having a lower degree in tinnitus reduction. Conclusions: Oral calcium and fluoride supplementation appears to be a promising and safe non-surgical approach for tinnitus management in mild otosclerosis-related tinnitus. However, its efficacy diminishes as tinnitus severity increases.

Abstract:

The inner ear is a relatively isolated organ, protected by the blood-labyrinth barrier (BLB). This barrier creates a unique lymphatic fluid environment within the inner ear, maintaining a stable physiological state essential for the mechano-electrical transduction process in the inner ear hair cells while simultaneously restricting most drugs from entering the lymphatic fluid. Under pathological conditions, dysfunction of the stria vascularis and disruption in barrier structure can lead to temporary or permanent hearing impairment. This review describes the structure and function of the BLB, along with recent advancements in modeling and protective studies related to the BLB. The review emphasizes some newly developed non-invasive inner ear drug delivery strategies, including sound therapy, ultrasound therapy assisted by microbubbles, inner ear-targeting peptides and route of administration cerebrospinal fluid conduit. We argue that some intrinsic properties of the BLB can be strategically utilized for effective inner ear drug delivery.

Abstract:

Primary Sjogren's Syndrome (PSS) is an autoimmune disease caused by chronic inflammation of the exocrine glands. We aimed to determine the immunohistochemical parameters that may help the diagnosis of PSS and to determine the histopathological markers for the early diagnosis of the patients. Hematoxylin-Eosin-stained preparations of salivary gland tissue samples of the control group consisting of 9 healthy patients without autoimmune disease and 12 patients diagnosed with non-specific chronic sialadenitis (NCS) and the diseased group consisting of 39 patients diagnosed with PSS were evaluated. SSA/Ro (TRIM21), SSB/la, BAFF, enolase (ENO1), and MMP-9 antibodies were applied to the samples to assess the presence of staining in the ductal, acini, and inflammation regions. Mild staining was detected in the ductal areas with the SSA/Ro (TRIM21) antibody in all cases with PSS, and no staining was found in patients with healthy salivary gland biopsy and NCS (p<0.01). ENO1 and MMP-9 antibodies also had (statistically significant) higher and more intense staining in the ductal areas in NCS and PSS compared to the patients with normal salivary glands (p<0.01). Our study suggests that SSA/Ro (TRIM21), ENO1, MMP9, and BAFF can be used to confirm the diagnosis in cases of suspicion.

Abstract:

Background: The use of intraoperative facial nerve monitoring (IFNM) is becoming more and more frequent, an established intraoperative aid in parotid gland surgery. To date, there are no scientific studies in the literature on the post-operative outcomes of submandibular gland surgery, in particular on post-operative injury of the marginalis mandibulae branch (MMB) that represents the most frequent and feared complication of this surgery, with an incidence of 1-7% of cases. Objective: In this retrospective study, the authors evaluated the incidence of postoperative paralysis of the MMB of the facial nerve (FN )in patients undergoing submandibular sialodenectomy for benign diseases, such as benign tumors and sialolithiasis, from 2014 to 2023, with particular attention to the role of IFNM in this context. Materials and Methods: The retrospective study was conducted at the Maxillo-Facial Department of Magna Graecia University of Catanzaro. The patients were divided into two groups: Group 1 (G1) consisted of subjects who underwent surgery without the use of IFNM and identification and clamping of facial vessels (1 January 2014 to 31 Dicember 2018); Group 2 (G2), consisted of subjects who underwent surgery with IFNM and without identification and clamping of facial vessels (1 January 2019 al 31 Dicember 2023). In G2 employed the Nerve Integrity Monitor (NIMR di Medtronic) and to classify the FN function we used the modified House-Brackmann classification. A descriptive analysis was performed, and univariate and multivariate logistic regression were used to examine the impact of IFNM on surgical timing and the association between deficit of G2 (vs. G1) adjusted for age, sex, smoking status for age, sex, smoking status. The level of statistical significance was set at p value<0.05. Results: A total of 101 patients were included in the study: 50 subjects were assigned to G1 (49.5%, comprising 24 female and 26 male, and 51 subjects were assigned to G2 (50.5%), comprising 21 men and 30 women, the mean age was 55 ± 16 years in the entire patient cohort. In 77% of the cases (n. 78, precisely 38 in G1 and 40 in G2), no facial nerve injury occurred. In 23% of the cases (n. 23, specifically 12 in G1 and 11 in G2), postoperative paralysis of MMB was observed. Of these subjects, nobody had permanent paralysis but only transient dysfuction (of the 12 patients of G1 four demonstrated grade I dysfunction while eight exhibited grade II dysfunction, of the 11 subjects of G2, eight exhibited grade I dysfunction, while three demonstrated grade II dysfunction). After six months the dysfuction of grade II persisted only in five patients of G1. The results of univariate and multivariable linear regression demonstrated that the surgical timing was found to be 99 ± 44 minutes considering the entire cohort of patients, 110 ± 43 minutes for G1 and 92 ± 42 minutes for G2 (Beta = -19, 95% CI -37 to -0.16 and p = 0.048). A longer surgical timing was observed compared to non-smokers (always statistically significant with a p-value of 0.008), suggesting that smoking status may influence the duration of the intervention (Beta = -0,32, 95% CI -0,08 to -0.55 and p = 0.008). Discussion and Conclusions: MMB paralysis represents one of the most frequent complications that can occur also in submandibular gland surgery and IFNM offers to the surgeon a valuable support in identifying the MMB in submandibular sialadenectomy. The use of IFNM can be a valid aid, but its effectiveness always depends on the competence but its effectiveness always depends on the competence of the surgeon.

Abstract: Autosomal dominant non-syndromic hearing loss (ADNSHL) is a genetically heterogenic condition. The transformation/transcription domain associated protein (TRRAP) gene has been recently associated with ADNSHL and only four variants of the gene have so far been reported in this disease. (1) Here, we report on a Hungarian ADNSHL family, in which the affected individuals exhibited sensorineural hearing loss with similar clinical symptoms, including initial impaired high frequencies that subsequently affected speech and lower frequencies. (2) Whole exome sequencing and screening of the shared genetic variants of the affected individuals was performed. (3) Our results revealed a novel heterozygous missense variant (NM_001244580.2, c.5360A&gt;G, p.Lys1787Arg) in the TRRAP gene. This variant is completely co-segregated with hearing impairment. It is present in a heterozygous form in the affected mother and daughter, but not carried by any unaffected family members. (4) This study highlights the importance of elucidating the germline genetic background of ADNSHL, which may help to predict individual risk and the risk of family members. This will improve prevention, screening and therapeutic measures for each patient and hearing loss-prone families.

Abstract: Background/Objectives: Laryngeal squamous cell carcinoma (LSCC) is a common malignancy with unsatisfactory survival rates, highlighting the need for reliable biomarkers to improve diagnosis and prognosis. Growth differentiation factor 15 (GDF15), a protein implicated in various cancers, has not been thoroughly investigated in LSCC. This study aimed to evaluate the significance of GDF15 expression in LSCC and its potential clinical implications. Methods: We analyzed archival tissue samples from 65 LSCC patients using immunohistochemistry and evaluated GDF15 expression profiles from the Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets. Statistical analyses included Kaplan-Meier survival analysis and Cox proportional hazards regression to assess the correlation between GDF15 expression, clinicopathological variables, and survival outcomes. Results: GDF15 expression showed no significant difference between tumor and adjacent normal tissues. However, in the tissue macroarray (TMA) cohort, high GDF15 expression was significantly associated with lower TNM stage and less advanced pT status. Kaplan-Meier analysis revealed that high GDF15 expression correlated with poorer overall survival in the TMA cohort but not in the TCGA or GEO datasets. Multivariable analysis identified GDF15 as an independent prognostic factor for disease-free survival in LSCC. Conclusions: Our findings suggest that GDF15 may serve as a prognostic biomarker in LSCC, particularly in early-stage disease. Further research is warranted to validate these results and explore GDF15's potential as a therapeutic target, contributing to improved patient management.

Abstract: Laryngeal papillomatosis and recurrent respiratory papillomatosis are caused by the human papillomavirus. It is characterized by papillomatous growths and is the most common benign disease of the larynx. Juvenile onset RRP is characterized by more aggressive disease compared to adult onset RRP. Patients often require frequent surgical procedures, with an increasing shift towards office-based treatment. A variety of surgical and adjuvant medical therapies are available with mixed responses. New targeted therapies and vaccines are currently under investigation as potential adjuncts in the management.