Abstract: Background: Epstein-Barr virus related acute pharyngotonsillitis is common in children and adolescents, and is generally managed successfully with positive outcomes by both ENT specialists and the pediatricians. However, a variety of acute, life-threating complications can occur, including upper airway obstruction and infectious or dysimmune sequelae. Methods: This paper describes our recent experience with four pediatric patients presenting with severe ENT manifestations of infectious mononucleosis (IM) that led to life-threating complications, all managed over the past three years at our tertiary pediatric hospital. Results: We report four cases (two boys and two girls) aged 5 to 16 years, hospitalized with complicated EBV-related pharyngotonsillitis. Presentations included respiratory distress (cases 1 and 2), fatal hemophagocytic lymphoistiocitytosis (case 3), and a retropharyngeal abscess (case 4). Conclusions: The prognosis of IM in the pediatric population is generally favourable. However, acute life-threating complications may arise. In such cases, timely and coordinated multidisciplinary management involving ENT specialists, pediatricians, and anesthesiologists is critical.

Abstract: Introduction: Obstructive sleep apnea (OSA) is a prevalent disorder in the adult population characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, sympathetic activation, and sleep fragmentation. It is linked to significant cardiovascular, metabolic, neurocognitive, and psychosocial morbidity. There is increasing evidence that continuous positive airway pressure (CPAP) adherence remains suboptimal in many patients and in those patients, surgery is often indicated. Methods: This review presents an updated, protocol-driven surgical approach grounded in clinical evidence and experience, highlighting the role of drug-induced sleep endoscopy (DISE) and personalized multi-level interventions for adult patient with OSA. Integration of anatomical phenotyping and DISE-directed planning enables precise surgical targeting. The protocol emphasizes patient selection, individualized treatment based on obstruction patterns, and perioperative optimization. This surgical algorithm improves success rates and long-term outcomes in patient’s intolerant of CPAP therapy. Results: A DISE guided, and multilevel surgical approach include: uvulopalatoplasty, septoplasty, tongue base reduction, palatoplasty and maxillomandibular advancement (MMA). Preoperative assessments include BMI and the STOP BANG along with Epworth Sleepiness scale, while postoperative care emphasizes follow up polysomnography and adjunctive therapies only when necessary. Regional experiences in Saudi Arabia and Canada underscore the importance of standardized, evidence-based surgical care. Conclusion: The purpose of this article is to establish a clear protocol for managing patients diagnosed with OSA, drawing from a review of existing literature and the insights of experienced surgeons in the field of sleep apnea, and updating current protocols with modern evidence.

Abstract: Background: A group of patients with untreated unilateral vestibular schwannoma (UVS) was observed in previous clinical trials, and the results indicated a reduction in the vestibulo-ocular reflex (VOR) on the ipsilateral (tumor) site of the lesion. However, in a subset of patients, a loss of VOR gain was also observed on the contralateral (non-tumor) side, suggesting the presence of contralateral neural crosstalk. Methods: To understand our previous clinical findings, the present study has expanded its population to investi-gate whether these unexpected findings are recognized in a significantly larger population of patients with UVS (n=640). Retrospectively, mean VOR gains of all semicircular canals (SCC) were obtained using video head impulse tests (vHIT) and compared between ipsi- and contralateral side of lesion. To eliminate any potential bias resulting from procedural effects, vHIT data was also obtained from a group of 72 healthy subjects. Results: As ex-pected, a VOR gain reduction was identified on the side of lesion in a substantial propor-tion of patients with UVS, varying ranging from 19.4% (anterior SCC) to 39.7% (posterior SCC). More interesting was the observation of a significant number of patients (21.9%) ex-hibiting a significant VOR reduction in posterior semicircular canal on the contralateral side, with a strong correlation with the ipsilateral side (r = 0.69). In relation to this phe-nomenon, our data further demonstrates that the influence of the superior branch of the vestibular nerve is less pronounced on the contralateral side compared to that of the infe-rior branch. Conclusion: Current data from a significant group of patients with UVS sup-ports bilateral commissural connectivity of inhibitory neural pathways between vestibular nuclei, as evidenced by a considerable VOR gain reduction in the posterior SCCs, facili-tating compensatory mechanisms. This suggests that in a significant proportion of UVS patients the contralateral side may also exhibit partial impairment, albeit undetected.

Abstract: Background: Traditional demonstrations are a common way to teach clinical skills, but they often feel unstructured and inconsistent. Peyton's four-step approach provides a more organized, student-focused method that might help learners pick up skills better. This study compared the standard demonstration method with Peyton's approach for teaching ENT procedures to interns. Methods: We did a prospective study at a single center with two groups: Group A got the conventional demonstration, and Group B learned using Peyton's method. Both groups were trained on three ENT skills—anterior rhinoscopy, Trotter's method, and anterior nasal packing—then tested using OSCE checklists. We also asked students for their feedback through a simple questionnaire. Results: For anterior rhinoscopy, both groups performed similarly. But students taught with Peyton's method did significantly better on Trotter's method and nasal packing (p = 0.0098 and 0.004). Overall, they preferred Peyton's approach, remembered the steps better, and wanted to use it for future training (p < 0.005). Conclusions: While traditional demonstrations are straightforward, Peyton's structured, hands-on four-step method leads to better skill learning and retention for medical students. Conclusions: While traditional demonstrations are straightforward, Peyton's structured, hands-on four-step method leads to better skill learning and retention for medical students.

Abstract: Background: Benign paroxysmal positional vertigo (BPPV) is the most common pe-ripheral vestibular disorder and most frequently involves the posterior semicircular canal (PSC). Atypical apogeotropic variants of PSC-BPPV may present with pure down-beating positional nystagmus, mimicking contralateral anterior semicircular ca-nal involvement and resulting in diagnostic and therapeutic uncertainty. Objective: To assess the effectiveness of the Bascule/Pendular maneuver in managing patients with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. Methods: A total of 178 consecutive patients presenting with pure down-beating posi-tional nystagmus without a torsional component were evaluated using a standardized diagnostic protocol under video-Frenzel goggle monitoring. All patients underwent the Bascule/Pendular maneuver, a modification of the classical Semont maneuver designed to mobilize otoconial debris along the vertical canal planes (Left Anterior–Right Poste-rior and Right Anterior–Left Posterior), regardless of precise lateralization. Conversion of nystagmus from the apogeotropic to the geotropic variant was considered the pri-mary outcome. Results: The maneuver was well tolerated, with no procedural inter-ruptions or complications. Immediate conversion to the geotropic variant was achieved in 86 patients (48.3%) after a single maneuver. In the remaining patients, successful conversion was obtained after additional maneuvers, most commonly following a second application on the contralateral plane. Once geotropization was achieved, all patients were successfully treated using a standard posterior canal repositioning ma-neuver. Conclusions: The Bascule/Pendular maneuver is a practical and effective ap-proach for patients presenting with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. By facilitating conversion to the geotropic form, it allows prompt treatment with conventional repositioning maneuvers and may repre-sent a useful first-line strategy in atypical BPPV presentations.

Abstract: Background: Voice analysis combined with artificial intelligence (AI) is rapidly becoming a vital tool for disease diagnosis and monitoring. A key issue is the identification of vocal biomarkers, that are quantifiable features extracted from voice to assess a person’s health status or predict the likelihood of certain diseases. Currently, the biomarkers are extracted using pitch-asynchronized methods that need improvement. Methods: Based on the timbron theory of voice production, a pitch-synchronous method of vocal biomarker extraction is proposed and demonstrated on standard voice databases, especially the ARCTIC speech databases published by Carnegie Melon University. A complete set of formant parameters and timbre vectors for all US English monophthong vowels are presented. The timbre distances among all US English monophthong vowels are presented, showing the richness and accuracy of information contained in those biomarkers. Results: The methods are then applied on the voice recordings of the Saarbrücken voice database for voice diagnostics. Accurate and reproducible measurements of timbre vectors, jitter, shimmer, and spectral irregularity are generated, showing the usefulness to diagnostics-oriented voice signals. Conclusions: The biomarkers extracted using pitch-synchronous methods might have significant advantages for voice-based diagnostics over the traditional biomarkers. To quantify its effectiveness and accuracy, the pitch-synchronous methods should be tested on large-scale databases for diagnostics tasks to compare with the traditional biomarkers. Furthermore, the method of finding glottal closing instants from voice signals should be tested on voice databases for diagnostics tasks and live voice signals.

Abstract: Objectives: This prospective study aimed to assess noise levels in otolaryngology operating rooms (OR), explore noise variation across subspecialties, and examine the correlation between noise, verbal communication, and surgery complexity. Study Design: Prospective trial. Setting: Single academic institution. Methods: Noise levels and surgeon feedback from 60 otolaryngology surgeries at a Tertiary Academic Medical Center were collected between May 2023 and March 2024. Cases were randomly selected based on staff availability, excluding emergency surgeries. The cohort included 13 general ENT, 13 facial plastics, 8 head and neck, 13 laryngology, and 13 rhinology surgeries. Noise data was recorded with a Curconsa Sound Level Meter SL720. Surgeons reported communication ease and case complexity via survey, with communication deemed impaired with the incidence of repeated information in the OR. Case complexity was rated from grade 1 (lowest) to grade 4 (highest). Results: Noise differences between subspecialties’ ORs were statistically significant (p < 0.001), but the Effect size was small (η² ≈ 0.04). The Rhinology OR showed higher average noise levels compared to Facial Plastic (Rhinology louder by ~2.2 dB) and Head-Neck (Rhinology louder by ~2.6 dB). Noise did not significantly impair communication in the OR (p=0.526). Higher noise in the OR did not significantly influence surgical complexity (p=0.547). Conclusion: Noise levels in otolaryngology operating rooms varied modestly across subspecialties. No significant association between noise levels and either communication impairment or surgical complexity was observed.

Abstract: Background: Chronic rhinosinusitis (CRS) and obstructive sleep apnea (OSA) frequently coexist, sharing inflammatory and anatomical pathways consistent with the "United Airway" This review examines the synergistic dysfunction linking these conditions. Methods: We conducted a comprehensive review synthesizing literature on the epidemiology, pathophysiology—including cytokine cascades and microbiome dysbiosis—and therapeutic outcomes of surgical and medical interventions for comorbid CRS and OSA. Results: Large-scale datasets confirm CRS as an independent risk factor for OSA. Pathophysiologically, the disorders are linked by mechanical obstruction, systemic cytokine spillover (IL-6, TNF-a), and nasopharyngeal microbiome dysbiosis (e.g., S. aureus biofilms). Therapeutically, Endoscopic Sinus Surgery (ESS) significantly improves subjective sleep quality (SNOT-22) and reduces CPAP pressure requirements, although it yields only trivial reductions in the Apnea-Hypopnea Index (AHI). Biologics like Dupilumab demonstrate rapid efficacy in improving sleep domains for CRS with nasal polyps. Conclusion: CRS and OSA are inextricably linked via mechanical and inflammatory mechanisms. A holistic "United Airway" management approach—optimizing nasal patency to facilitate CPAP adherence and reduce systemic inflammatory burden—is critical for improving patient outcomes.

Abstract: Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disorder of motile cilia that leads to impaired mucociliary clearance and recurrent airway infections. Children with PCD often present with ear and sinus disease resembling common pediatric conditions, yet the true burden and management remain incompletely defined. To address this gap, a systematic search for pediatric cohort studies published between 2020 and 2025 reporting otologic and sinonasal features of PCD was performed. Searches of PubMed, Embase, Scopus, and Web of Science identified 12 eligible studies, encompassing 524 children with confirmed PCD. Data extracted focused on demographics, otologic and sinonasal manifestations, vestibular findings, radiographic imaging, and interventions. Across studies, 60.3% had a history of otitis media and 39.1% had hearing loss, predominantly conductive. Tympanostomy tubes were utilized in more than half of patients, with many requiring multiple sets over time due to recurrent effusions or tube occlusion. Sinonasal disease was nearly universal, with 78.5% demonstrating chronic rhinosinusitis and most reporting nasal congestion and rhinorrhea; nasal polyps were uncommonly noted. Vestibular symptoms were also infrequently assessed but present in some patient cohorts. In conclusion, otologic and sinonasal disease are highly co-prevalent in pediatric PCD, highlighting the need for early recognition, regular surveillance, and standardized outcome reporting to guide long-term management of this complex chronic disease.

Abstract:

Voice generation and modulation depend both on the geometry and the passive mechanical properties of the soft phonation anatomic structures (mainly the vocal folds), and on the active contribution of upper airway muscles involved in phonation. Treatment for voice dysfunctions includes performing rehabilitation exercises when the phonation system is mechanically loaded to positively modify its function. Here we present a novel device to apply either positive or negative airway pressure to facilitate voice recovery. The device is based on the ability of a type of blower specially designed to generate a pressure drop caused by their blades rotation. Application of constant positive/negative pressure at the patient’s airway through a nasobuccal mask is achieved by Arduino-controlling the blower speed from the pressure signal measured by a sensor. A set of 3-way electrovalves configurates the blower as a positive or negative pressure generator (ranging from -50 cmH₂O to +50 cmH₂O). The device feasibility was assessed in 10 voluntary subjects, who reported easy use and subjective improvements in perceived vocal comfort. As the device is easy to build, low-cost, small and portable, it is potentially applicable for voice rehabilitation both at healthcare facilities and at the patient’s home.

Abstract: Computed tomography (CT) of the paranasal sinuses is essential in diagnosing odontogenic chronic rhinosinusitis. Treatment primarily targets the dental focus, with endoscopic sinus surgery (ESS) indicated when necessary. Assessing CT findings using the Lund–Mackay score (LMS) may guide therapeutic decisions. This study retrospectively compared LMS, dental pathology type, and reported symptoms with treatment choices in patients treated for odontogenic chronic rhinosinusitis between 2012 and 2022 at a tertiary otorhinolaryngology center. From 2067 chronic rhinosinusitis patients, 61 had an odontogenic cause. LMS was determined in 57 patients and correlated with treatment strategy. Dental pathology subtypes and presenting symptoms were also analyzed. A control group of 25 patients with localized, non-odontogenic chronic rhinosinusitis was included. Fifteen patients not undergoing ESS had lower LMS values (median 1), while 42 surgical patients had higher scores (median 6). Periapical pathology (47.4%) and oroantral fistula (26.3%) were the most common causes. Nasal discharge and pain were the most frequent symptoms. Neither dental pathology type nor symptoms significantly influenced treatment decisions.The extent of CT-detected pathology, reflected by LMS, can serve as a key criterion in determining treatment for odontogenic chronic rhinosinusitis, independent of symptoms or specific dental pathology type.

Abstract: Background: Overprescription of antibiotics for pharyngitis—driven by diagnostic uncertainty and physician disagreement on ambiguous presentations—contributes significantly to antimicrobial resistance. Existing AI diagnostic models report aggregate accuracy metrics that obscure performance variability across cases with different levels of diagnostic certainty, limiting their clinical utility. Objective: To develop and validate a consensus-based evaluation framework for deep learning models in pharyngitis diagnosis, stratifying performance by physician agreement levels (High vs. Low Consensus), and to compare image-only, symptom-only, and multimodal fusion strategies for smartphone-based diagnosis. Methods: We curated a dataset of 742 multimodal cases (symptoms and throat images) independently evaluated by 4–9 physicians. After excluding 102 cases where physicians could not reach a clear majority, 640 cases were used for model training and evaluation. We compared six architectures: Image-Only (CNN, Vision Transformer), Symptoms-Only, and Multimodal Fusion (Late Fusion, Gated Fusion, Cross-Attention). Models were evaluated using 5-fold stratified cross-validation, with separate analysis for High-Consensus (N=199) and Low-Consensus (N=441) cases. Results: On High-Consensus cases, all image-based models achieved excellent accuracy (95–96%) with high specificity (>96%). On Low-Consensus cases, accuracy dropped to 76–78%, matching the inter-physician agreement rate. Vision Transformer demonstrated the best overall performance (84.84% accuracy, 70.5% AUC). Multimodal fusion provided minimal benefit over image-only approaches. All models maintained high specificity (>96%) but exhibited low sensitivity (2–15%) for bacterial pharyngitis, reflecting conservative prediction patterns suitable for rule-out screening but requiring human oversight for suspected bacterial cases. Conclusions: Our consensus-based evaluation framework reveals that AI models, like human physicians, perform reliably only on diagnostically clear pharyngitis cases. The high specificity (96–98%) suggests strong potential for reducing unnecessary antibiotic prescriptions through AI-assisted triage, while the low sensitivity (2–15%) necessitates physician review for suspected bacterial infections. This stratified approach provides clinically meaningful insights for safe AI deployment in antibiotic stewardship programs.

Abstract: The present exploratory, uncontrolled, open-label study investigated the effect of Ginkgo biloba extract EGb 761® in the management of chronic tinnitus, and whether comorbidities have an impact on the treatment outcome. The full analysis set comprised 170 patients with chronic tinnitus who took 120 mg EGb 761® twice daily for 24 weeks. Outcomes were assessed using the Tinnitus Questionnaire, Tinnitus Handicap Inventory, and 11-Point Box Scales for loudness and annoyance. Comorbidities were recorded with audiometry, the Hospital Anxiety and Depression Scale, and the Perceived Stress Questionnaire. The effectiveness was further examined in responder analyses (at least 30% score reduction in 3 out of 4 outcomes) and in subgroups defined by baseline anxiety, hearing impairment, stress and depression. At week 24, significant improvements were observed in all tinnitus-related outcomes compared to baseline (all p&lt;0.0001). In subgroup analyses, patients with high baseline anxiety or stress as well as those with normacusis improved more whereas baseline depression had no influence. The overall response rate was 18.8%. The results of this exploratory study indicate that EGb 761® improved complaints in patients with chronic tinnitus. The therapy appears to be particularly beneficial for patients with normal hearing and/or concomitant anxiety and/or stress. Trial registration: The study was registered at ISRCTN (ISRCTN83863387, registration date October 14, 2016).

Abstract: Aim of this work is to deduce the position of the otoconial debris in lateral cupulo/canalolithiasis, as a function of two parameters: 1) the direction of the nystagmus that appears when the patient lies down (if present); 2) the positional nystagmus evoked by the supine roll test. The theoretical results are then compared with a population of 170 patients observed in the last ten years for vertigo due to paroxysmal positional vertigo of the horizontal canal. From the comparison between lying down and positional nystagmus, it is probably possible to identify the initial position of the fragments inside the lateral canal. This may be a useful clue for performing the correct liberatory maneuver. Instead, it is believed that to distinguish a jam located on the canal side of the cupula from a jam on the utricular side, one can only rely on the effective side of the liberatory maneuver. Background/Objectives: Aim of this work is to deduce the position of the otoconial debris in lateral cupulolithiasis or canalolithiasis based on two parameters: the direction of the nystagmus that appears when the patient lies down (if present) and the positional nystagmus evoked by the supine roll test. Methods: The theoretical results are then compared with a population of 170 patients observed in the last ten years for vertigo due to paroxysmal positional vertigo of the horizontal canal. Results: The study analyzed 170 cases of paroxysmal positional vertigo due to lateral canalolithiasis, comprising 141 geotropic and 29 apogeotropic forms. Among the geotropic cases, 80 showed no nystagmus in the supine position (GT0), 51 had supine nystagmus directed toward the healthy side (GT+, congruent), and 10 toward the affected side (GT−, incongruent). In the apogeotropic group, 10 had no supine nystagmus (AGT0), 16 exhibited nystagmus toward the affected side (AGT+, congruent), and only 1 toward the healthy side (AGT−, incongruent). Additionally, 2 cases showed monopositional apogeotropic nystagmus (mAGT), consistent with a “sieve-type” canal jam. Overall, 90 out of 170 patients (approximately 53%) had no nystagmus in the supine position: 80 out of 141 (≈57%) among geotropic forms and 10 out of 29 (≈34%) among apogeotropic forms. This difference was statistically significant (p = 0.0474, Yates correction), indicating that supine nystagmus is more frequent in geotropic than in apogeotropic variants. Conclusions: From the comparison between lying down and positional nystagmus, it is probably possible to identify the initial position of the fragments inside the lateral canal. This may be a useful clue for performing the correct liberatory maneuver. Instead, it is believed that to distinguish a jam located on the canal side of the cupula from a jam on the utricular side, one can only rely on the effective side of the liberatory maneuver.

Abstract: Cochlear homeostasis is critical for the preservation of hearing sensitivity by maintaining optimal cochlear fluid composition, sustaining electrochemical gradients, and supporting the function of sensory and supporting cells in the cochlea. Sensorineural hearing loss, resulting from the damage or loss of sensory hair cells, auditory neurons and other cochlear cells and structures, is intimately linked to disruptions in the homeostatic environment. In this narrative review, we explore the cellular and molecular pathways underpinning cochlear homeostasis in health and disease and examine the mechanisms by which failed homeostasis leads to sensorineural hearing loss. We further discuss current research avenues and emerging therapeutic strategies to restore or compensate for the loss of homeostatic balance. These interventions suggest a future where regenerative healing is possible, ultimately leading to permanent repair and functional recovery.

Abstract: Background. Differentiating Ménière’s disease (MD) from vestibular migraine (VM) remains difficult because current diagnostic frameworks are predominantly clinical and incorporate pure-tone thresholds, risking incorporation bias. We asked whether speech discrimination scores (SDS) alone can separate MD from VM at the patient level and whether adding a prespecified vestibular marker, the caloric–vHIT dissociation, pattern A (abnormal calorics with normal horizontal vHIT), improves performance. Methods. In a retrospective cohort (2015–2018) including definite MD (n=60) and definite VM (n=40) by Bárány/ICHD criteria, we trained patient-level logistic regression models with 5-fold out-of-fold validation and in-fold preprocessing. To avoid incorporation bias, PTA was excluded from all models. Predefined feature sets were: (1) SDS-only (bilateral SDS), (2) CalHiT-A-only (Yes/No; canal paresis ≥22% with horizontal-canal vHIT gain ≥0.80 in either ear), and (3) SDS+CalHiT-A. Discrimination was assessed by ROC–AUC with bootstrap 95% CIs; calibration and decision-curve analysis (DCA) are reported. An exploratory model encoded SDS as “affected/healthy.” Results. The SDS-only model achieved AUC 0.866 (95% CI 0.787–0.937). CalHiT-A-only yielded AUC 0.674 (0.561–0.778). Adding CalHiT-A to SDS did not improve discrimination (SDS+CalHiT-A AUC 0.844 [0.760–0.913]). The exploratory “affected/healthy” SDS encoding underperformed (AUC 0.801 [0.706–0.882]). CalHiT-A was significantly more prevalent in MD than in VM (56.7% [34/60] vs 17.5% [7/40]; Fisher’s exact p = 1.49×10⁻⁴). Calibration favored SDS-only, and DCA showed the highest net benefit for SDS-only across thresholds p=0.05–0.40. Conclusions. Bilateral SDS alone provides robust, well-calibrated discrimination between MD and VM and outperforms CalHiT-A and the affected/healthy SDS encoding. In this cohort, vestibular tests dissociation did not add diagnostic value beyond SDS at the patient level, supporting SDS-centered diagnostic workflows while reserving CalHiT-A for adjudication and phenotyping rather than primary classification.

Abstract: Background: Olfactory and taste disorders are associated with a variety of conditions, not only those directly affecting the nasal or oral cavity mucosa. In clinical practice, the acuity of the sense of smell is investigated subjectively using a variety of olfactory tests, both screening and diagnostic. The aim of this study was to develop an application that allows a patient to self-administer an olfactory and taste test at home. Methods: In the first stage, a literature review was carried out on the olfactory and taste tests available on the market. In the second stage, the best conditions for storing ST and TT were investigated. The third stage looked at how well patients of different ages and electronic literacy levels could per-form ST and TT independently. In the fourth stage, the feasibility of using STT for olfactory and taste screening was assessed. Results: The study used an olfactory test based on the ST and TT used in the Sensory Testing Capsule (STC), which can be used for olfactory and taste screening. Development of the app involved steps of registration, ordering, perform-ing the STT, and read-out of results. Simple instructions for performing the STT were cre-ated using graphics to illustrate the steps involved. Conclusions: The app could also be useful in the assessment of smell and taste by speech therapists before implementing multisensory therapy and used in occupational medicine to monitor the state of the sense of smell and taste in people who are occupationally exposed to toxic substances.

Abstract: Background: Parotid gland tumors pose diagnostic and surgical challenges due to their histological heterogeneity and proximity to the facial nerve. This study aimed to evaluate clinicopathological features and postoperative outcomes in a large cohort undergoing parotidectomy. Methods: This retrospective study included 314 patients who underwent parotidectomy between 2008 and 2024 at a tertiary center. Demographic data, tumor histology, and postoperative complications—particularly facial nerve paralysis—were analyzed. Histopathological features such as capsular, perineural, and lymphovascular invasion were also assessed. Results: Of all cases, 79% were benign, 14.6% malignant, and 6.4% non-neoplastic. Pleomorphic adenoma and Warthin tumor were the most common benign entities, while mucoepidermoid carcinoma was the most frequent malignancy. Malignant tumors were associated with higher rates of positive surgical margins (44.2%), capsular invasion (25%), and tumor necrosis (22%). Facial paralysis occurred in 4.4% of patients, more frequently among those with malignant tumors and extensive lymph node dissection. Capsular invasion and necrosis were rare in benign lesions but still observed, especially in pleomorphic adenoma. No significant differences in pathology were found based on place of birth. Conclusion: Most parotid tumors are benign, but certain histopathological features—such as necrosis, capsular and perineural invasion—are strong indicators of malignancy and should guide surgical planning and postoperative surveillance. These findings highlight the need for individualized, risk-adapted management strategies in parotid surgery to balance oncological safety with preservation of function.

Abstract: Background: In the present study, we focused on the periostin expression in Warthin’s tumor and malignant lymphomas, which require differentiation from these tumors. Objectives: we investigated the expression and the roles of periostin in the formation of parotid gland mass. Methods: Twenty-eight samples of parotid gland mass were investigate histopathologically and immunohistochemically. Result: Pathologically, tumors were diagnosed as Warthin’s tumors in 15 specimens and malignant lymphomas in 13 specimens. Increased periostin expression was observed in the stroma of Warthin's tumor and malignant lymphoma in 24 of 28 samples (12 Warthin's tumor, 12 malignant lymphoma) (85.7%). Periostin expression was observed in three different patterns: negative, superficial, and infiltrative. Statistically significant differences were found between the histological classification of the tumors　and periostin expression patterns. When periostin expression was examined in the same 28 specimens, increased periostin expression was observed in the tumor capsule in 13 specimens (46.4%). A statistically significant association was found between the presence or absence of periostin expression within the tumor capsule and the histology of parotid tumors. Conclusion and significance: Periostin may be involved in the development of Warthin's tumor and malignant lymphoma. Periostin may serve as a new biomarker for these diseases.

Abstract:

Background. Loss of smell can impair quality of life. Olfactory disorders (ODs) are often caused by viral infections, such as coronavirus disease 2019 (COVID-19). The aim of the study was to evaluate the effectiveness of olfactory training in patients with post-COVID OD. Materials and methods. The entire group consisted of 75 subjects (15 men and 60 women). They were randomly divided into two groups. Patients in both groups received pharmacological treatment (intranasal corticosteroids and vitamin A), salt irrigations, and elements of speech therapy olfactory training (SOT). Participants in the study group additionally carried out classical olfactory training (OT) using applicators with 4 scents twice a day. Olfactory function was assessed using the Sniffin Sticks' Test (SST). Results. For total SST score, the mean change before and after intervention in the study group was 7.9 points (p < 0.001). In the control group, the mean change was 2.8 points (p = 0.006). Conclusions. Classical OT appears to improve the recovery from post-COVID OD compared to pharmacological therapy with SOT elements alone. The use of intranasal corticosteroids, topical vitamin A, and saline nasal irrigation in our therapy seemed to help in improving olfaction. It is thought that the multidisciplinary team used here – doctor, speech therapist, and psychologist – may have also contributed to the effectiveness of the therapy.