ACTA Otorhinolaryngologica Italica

The nature of nasal discharge in chronic rhinosinusitis: a systematic review and meta-analysis using patientreported outcomes

Ethan M. Kallenberger — 2025-11-28

Objective. The objective of this study is to answer the question “What is the most common and severe type of nasal discharge in patients with chronic rhinosinusitis (CRS) at baseline as measured by patient-reported outcomes?”.
Methodology. Two independent reviewers evaluated studies for inclusion, extracted data from included studies, and performed critical appraisal of studies. Data on the four Sino-Nasal Outcome Test 22 (SNOT22) discharge questions, demographic, and comorbidity data was collected. Meta-analysis of single means and proportions was performed for demographic, comorbidity, severity, and prevalence data.
Results. A total of 53 studies (n = 6584) were included for analysis. Postnasal drip (PND) was the most severe symptom (2.6, 95%CI: 2.2-3) and most prevalent (80.7%, 95%CI: 53.0-97.7). Patients without nasal polyps had a higher PND score than those with polyps (2.56 vs 2.40, 95%CI: 0.1-0.2). However, patients with polyps reported higher symptom scores for need to blow nose, runny nose, and thick nasal discharge (all p < 0.0001).
Conclusions. CRS patients experience PND at a higher prevalence and severity at baseline than the other three forms of nasal discharge captured by the SNOT22. Polyp status influences differing symptoms of nasal drainage. Comorbid asthma or allergies are associated with more severe PND and total SNOT22 scores.

Neurovascular compression and vestibular compromises in idiopathic sudden sensorineural hearing loss

Yingzhao Liu — 2025-11-28

Objective. This study aimed to investigate the association between vestibular impairment and neurovascular compression at cerebellopontine angle (CPA) and internal auditory canal (IAC) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).
Methods. Seventy-one ISSNHL patients underwent audio-vestibular tests and magnetic resonance imaging (MRI) of CPA-IAC. The MRI findings of both ears were graded by Chavda, Gorrie and Kazawa systems.
Results. No significant association was found between different neurovascular types and the results of caloric test, vestibular evoked myogenic potentials and video head impulse test (vHIT). Chavda type II was more common in ISSNHL patients with vertigo. Tinnitus, initial and outcome hearing threshold showed no significant differences among different neurovascular types. ISSNHL patients with Gorrie type C had worse hearing prognosis than those with type B. ISSNHL patients with pathological vHIT results in the posterior semicircular canal were more prone to poor hearing recovery.
Conclusions. Vestibular testing results and radiological neurovascular compression signs in CPA-IAC region may not be associated in ISSNHL patients. Vestibular impairment is more closely related to hearing outcomes than neurovascular compression.

Novel approach for assessing nasal valve obstruction: a study of nasal valve patency using peak nasal inspiratory flow and flowmetry

Zdeněk Knížek — 2025-11-28

Objective. The aim of this paper is to compare the results of uing two methods designed to objectify nasal patency in patients with external and internal nasal valve obstruction.
Methods. Nasal flow was measured by a flowmeter (behind the nasal valve area) and peak nasal inspiratory flow (PNIF; in front of the nasal valve area) separately for each side of the nasal cavity.
Results. Data included information from a total of 38 sides of the nasal cavity – 19 sides of the nasal cavity with an obstruction in the area of the nasal valve and 19 sides of the nasal cavity without an obstruction. There were no statistically significant differences in terms of age (p = 0.299), gender (p = 1.000) and flowmetry values (4.28 vs 4.26; p = 0.462) between the two groups. Statistically significant differences between groups were found for visual analogue scale (VAS) of nasal patency (4.99 vs 8.64; p < 0.001) and PNIF scores (36.1 vs 91.6; p = 0.002).
Conclusions. To determine the contribution of obstruction to the clinical condition in the nasal valve area, it is appropriate to use a combination of methods measuring in the area in front of and behind the nasal valve. According to our observations, the combination of PNIF and flowmetry may be advantageous in the evaluation of these patients.

Italian multicentre study to validate the Swallowing Outcome After Laryngectomy (SOAL) questionnaire

Pietro De Luca — 2025-11-28

Objective. To report the data obtained by translating the Swallowing Outcomes After Laryngectomy (SOAL) questionnaire in Italian to validate it and offer a valid tool for Italian-speaking patients and clinicians.
Methods. A multicentre case-control study was performed between January 1st 2024 and October 1st 2024. In all, 494 patients consecutively treated for laryngeal squamous cell carcinoma were included in the study (group 1). Healthy controls and patients who underwent radiotherapy (group 2) or chemotherapy (group 3) of the head and neck district were the two control groups.
Results. Statistically significant differences were observed comparing SOAL scores among the three groups (ANOVA: p < 0.0001); significant differences were observed between group 1 (mean 0.89 +/- 1.31; 95% CI: 0-3) and group 2 (mean 6.78 +/- 4.59; 95% CI: 1-24) (Bonferroni-Holmes [BH] p < 0.01), and group 1 and group 3 (mean 11 +/- 7.47; 95% CI: 0-38) (BH: p 0 < 0.01). Statistically significant differences in the SOAL scores were also identified between group 2 and 3 (BH: p < 0.01).
Conclusions. The SOAL questionnaire may be a useful tool to correctly understand patients’ concerns for swallowing to promptly and rapidly manage them and improve patient’s quality of life.

Metastastic potential of middle ear neuroendocrine tumours

Michelle Sophia Dominique Engel — 2025-11-28

Objective. Middle ear neuroendocrine tumours (MeNETs) are rare neoplasms of the temporal bone. Although the clinical behaviour of MeNETs is often indolent, a subset demonstrates aggressive progression with locally invasive and metastatic disease. This study aims to describe the clinical presentation, progression, and outcomes of middle ear neuroendocrine tumours in 3 patients with particularly unfavourable clinical courses.
Methods. We retrospectively reviewed 3 patients diagnosed with MeNETs who developed locally invasive tumours and distant metastases. Data on clinical features, diagnostic findings, management and long-term outcomes were reviewed.
Results. All 3 patients described in this report developed distant metastases over a period of 6 to 16 years after initial diagnosis. Two of the 3 patients eventually died from their disease. No distinct clinical features could be identified that were predictive of an unfavourable course.
Conclusions. A subset of MeNETs can follow an aggressive clinical course with metastatic spread and, in some cases, tumour-related death, even after an initial period of seemingly benign behaviour. Comprehensive diagnostic work-up and prolonged follow-up are essential for patients with MeNETs.

Prognosis of patients with carotid blowout syndrome in the era of endovascular interventions

Aiman Elmograbi — 2025-11-28

Objective. To analyse the prognosis of carotid blowout syndrome (CBS) after endovascular interventions in patients with head and neck cancer.
Methods. We conducted a retrospective study at a tertiary centre (2000-2019), including demographics, medical history, treatment details, and outcomes of CBS.
Results. Among 44 patients with CBS (32 males, 12 females; mean age 65 ± 14 years), squamous cell carcinoma histotype and laryngeal localisation were most common, with 84% having advancedstaged disease. Significant risk factors included prior surgery (70%), neck dissection (48%), radiation (55%), and chemotherapy (66%). Pharyngocutaneous fistula and tracheostomy were present in 32% and 57% of cases, respectively. Radiological findings showed threatened bleeding (62%), sentinel bleeding (11%), and acute rupture (27%). Endovascular treatment achieved haemostasis in 95% of cases, with an 11% rate of acute ischaemic complications. Six-month survival was 28%, with 66% of deaths due to disease progression. Recurrent bleeding occurred in 16% of cases.
Conclusions. CBS is a severe complication with a high risk of rebleeding. Endovascular interventions effectively manage bleeding with low rates of complication.

Optimising oncologic outcomes in pT3 glottic cancers treated by transoral laser microsurgery: the impact of adjuvant treatment

Aurora Pinacoli — 2025-11-28

Objective. The treatment strategy for cT3 glottic squamous cell carcinoma (SCC) is far from being standardised, and the role of adjuvant treatment(s) is not clearly defined. This study assessed the impact of adjuvant (chemo-)radiotherapy ([C]RT) for patients with pT3 glottic SCC treated by transoral carbon dioxide laser microsurgery (CO2 TOLMS) presenting adverse pathological features.
Methods. A multicentric retrospective study was conducted at 3 referral hospitals, including patients with pT3 glottic SCC treated from January 2010 to October 2023. Demographic, clinical, and histopathological data were collected, together with data on surgery, postoperative functional performance, adjuvant treatment(s) with (C)RT, and complications. Five- and 10-year overall (OS), disease-specific (DSS), disease-free (DFS), and total laryngectomy free survivals (TLFS) were estimated by Kaplan-Meier curves. Uni- and multivariate Cox proportional hazards regression models were used to determine independent risk factors for survivals.
Results. One hundred and forty-one patients treated with CO₂ TOLMS for pT3 glottic SCC were included in the study. Twenty-six (18.4%) patients received adjuvant treatment(s): 19 (13.5%) received RT alone, and the remaining 7 (5%) received CRT. Five-year OS, DSS, DFS, and TLFS were 78.1%, 91.5%, 49.7%, and 64.8%, respectively. Age independently correlated with worse OS, DFS, and TLFS at both uni- and multivariate Cox analysis. Adjuvant therapy was an independent protective factor for recurrence or death (DFS) at univariate (hazard ratio [HR] 0.46, p = 0.03) and multivariate (HR 0.38, p = 0.01) Cox analysis.
Conclusions. This study suggests that adjuvant treatment with (C)RT has a positive impact on DFS for pT3 glottic SCC treated by CO2 TOLMS. The similar OS, DSS, and TLFS observed in pT3 SCC treated by CO2 TOLMS alone and a selected group of unfavourable lesions needing adjuvant (C)RT show that adding such a treatment on top of conservative surgery may ensure good oncologic outcomes even in a selected subgroup of more aggressive glottic pT3. Further prospective studies should be conducted to validate these findings and confirm the relevance of adjuvant treatment(s) in this setting.

Role of fine needle aspiration biopsy in the diagnosis of pleomorphic adenoma

Paolo Tropiano — 2025-11-28

Objective. The aim of the present study is to assess the reliability of fine needle aspiration biopsy (FNAB), an acknowledged diagnostic tool for head and neck lumps, in the diagnosis of pleomorphic adenoma (PA), a common benign salivary tumour.
Methods. We retrieved the FNABs performed at the Otolaryngology Division of a referral centre from September 2017 to September 2023. FNABs were ultrasound (US) guided and followed by rapid on-site evaluation (ROSE). Before surgery, cytological findings were integrated with clinical information to obtain a multiparametric diagnosis (MD).
Results. Of 633 FNAB reports, 413 involved major salivary glands. Among these, 214 patients underwent surgery, and final histopathology confirmed PA in 76 cases. FNAB and multiparametric evaluation yielded specificities of 97% each, and sensitivities of 89.5% and 93.4%, respectively.
Conclusions. US-guided FNAB, performed by head and neck surgeons, associated with ROSE, performed by anatomical pathologist, and MD, is highly reliable for diagnosing PA, thus improving clinical management and prioritisation of cases for surgery. This is particularly relevant considering that PA, even if benign, has a significant rate of malignant transformation and multifocal recurrences, creating notable concerns under both an oncological and functional (facial nerve sparing) points of view.

Acknowledgements to our reviewers - 2025

The Editor in Chief — 2025-11-28

The Editor-in-Chief and the Editorial Board of Acta Otorhinolaryngologica Italica are extremely grateful to the Scientific Committee and all the colleagues who kindly reviewed the scientific papers submitted for publication during 2025, contributing to a meticulous selection and appropriate re-elaboration of the manuscripts:

Download the list of the reviewers