ACTA Otorhinolaryngologica Italica

Medico-legal implications of functional septorhinoplasty according to Sulsenti: distinction from aesthetic surgery

Filippo Ricciardiello — 2026-09-07

Evaluation of neural transmission in implanted patients with Meniere’s disease

Ashley Baguant — 2026-09-07

Introduction. Meniere’s disease (MD) is characterised by fluctuating hearing loss. When hearing loss is severe or profound, rehabilitation requires cochlear implantation. The aim of this retrospective study was to compare cochlear implant (CI) fittings and electrode impedances between patients implanted because of MD and those with other aetiologies.
Materials and methods. This study involved patients who received cochlear implantation with MED-EL CI at our centre between 2005 and 2022. We first compared speech recognition in a quiet environment at one year after cochlear implantation. We then performed a comparative study of the electrode impedances and most comfortable levels at activation, 2, 3, 6, and 12 months after activation.
Results. Out of the 218 patients included in our study, 21 were diagnosed with MD. There was no significant difference in speech intelligibility in a quiet environment between the 2 groups. Electrode impedances were statistically comparable in both groups. However, MCLs for the 2 most apical electrodes were higher in the MD group during the first 2 months after surgery.
Conclusions. This study found a need for electrical stimulation at higher intensities in low-frequency electrodes during the early months after cochlear implantation in MD.

The effect of hearing loss above 2 kHz on temporal resolution and speech understanding in noise

Büşra Gökçe — 2026-09-07

Objective. This study aimed to evaluate temporal resolution, speech understanding in noise, and daily communication difficulties in individuals with sensorineural hearing loss above 2 kHz.
Method. Thirty adults aged 38-59 years with high-frequency sensorineural hearing loss (HF-SNHL) were included as the study group, and 30 individuals aged 37-59 years with normal hearing as the control group. Participants completed the Gap Detection, Random Gap Detection, Turkish Matrix Test (TMT), and the Speech, Spatial Perception, and Hearing Quality (SSQ) scale. Statistical comparisons and decision-tree analyses were conducted.
Results. Significant differences between groups were observed in temporal resolution tests, speech recognition thresholds (SRT), and speech intelligibility percentages in -5 dB signal to noise ratio condition of the TMT, as well as in SSQ results. Decision-tree analysis indicated that the Speech Perception subscale of the SSQ and the TMT SRT in noise procedure were considered useful for identifying HF-SNHL.
Conclusions. Temporal resolution was found to be reduced, and speech comprehension in noise impaired in individuals with HF-SNHL. The SSQ played a decisive role in identifying individuals with HF-SNHL.

Comprehensive description of clinical features of laryngeal dystonia and dystonic vocal tremor

Maria Raffaella Marchese — 2026-09-07

Objective. This study aimed to characterise laryngeal dystonia (LD) phenotypes using combined classification criteria and to evaluate treatment outcomes with botulinum neurotoxin type A (BoNT-A).
Methods. The study retrospectively reviewed patient medical records from our clinic over 5 years to identify cases of LD. We classified LD subtypes (adductor, abductor, mixed) and dystonic vocal tremor (DVT) based on updated criteria.
Results. We analysed 75 cases, predominantly adductor LD (60%) and DVT (28%). In all, 84% of patients were females, diagnosed around 68 years of age. The DVT group had late-onset dysphonia that worsened over time and was associated with essential tremor in almost half of cases. Subjects with mixed LD had the greatest increase in Voice Handicap Index (VHI) over time and the longest duration of disease in all cases associated with DVT. Abductor LD cases had the most severe dysphonia (VHI: 73.3). Two-thirds of cases received BoNT-A therapy; most had adductor LD and had received treatment for longer times and had the lowest rate of treatment refusal.
Conclusions. Correct LD classification aids in diagnosis, prognosis and treatment; it should be dynamic and evolve with the patient’s history. However, there is a lack of data in the literature on certain aspects of LD, emphasising the need for further research to improve clinical practice.

Italian Quebec Sleep Questionnaire for assessing quality of life in obstructive sleep apnoea

Federico Leone — 2026-09-07

Objective. To develop and validate the Italian version of the Quebec Sleep Questionnaire (I-QSQ) for assessing quality of life (QoL) in patients with obstructive sleep apnoea (OSA).
Methods. The questionnaire was translated, culturally adapted, and back-translated. Internal consistency and test-retest reliability were evaluated in patients with moderate OSA. Normative values were obtained in healthy subjects. Construct and criterion validity were assessed by comparing scores of patients and controls, and by correlating I-QSQ with the Epworth Sleepiness Scale. Responsiveness was examined in patients undergoing sleep surgery.
Results. One hundred-six patients and 173 control subjects completed the I-QSQ without assistance. Internal consistency was acceptable to excellent across domains (Cronbach’s α = 0.71-0.9), and test-retest reliability was high (ICC = 0.88-0.96). Patients scored significantly lower than controls in all domains (p < 0.001). A negative correlation was observed between I-QSQ and Epworth Sleepiness Scale scores (r = –0.54). Post-surgical patients showed significant improvement in I-QSQ total score.
Conclusions. I-QSQ is a reliable, valid, and responsive tool for evaluating QoL in Italian-speaking patients with sleep apnoea and can be effectively used in clinical practice and research.

Estimating nasoseptal flap length for sellar reconstruction: a surgical and radiological study

Fabio Portella Gazmenga — 2026-09-07

Objective. To assess whether computed tomography (CT) can predict the nasoseptal flap length necessary for reconstruction after endoscopic approaches to the sellar region.
Methods. Twenty consecutive patients who underwent endoscopic resection of pituitary adenoma were included, and data were obtained prospectively in 2 stages, one radiological and one surgical. The length of the flap as estimated by CT (CT-Est) was compared with the flap length considered optimal (Ideal Flap), after intraoperative measurements. Correlation between the 2 values was assessed with the Spearman correlation test.
Results. The mean length estimated on CT scans was 63.8 ± 2.3 mm, and the mean Ideal Flap was 59.1 ± 2.3 mm. The mean difference (Δ CT-Est – Ideal Flap) between these 2 values was 4.7 ± 0.7 mm. The Spearman coefficient of correlation between Ideal Flap and CT-Est was 0.938 (95% CI = 0.843 to 0.976), with p = 0.001, denoting a very strong and statistically significant correlation.
Conclusions. CT-based estimates closely approximated the nasoseptal flap length required for reconstruction of a sellar approach defect. CT has the potential to be a useful tool for preoperative planning of tailored flaps.

Probe-based confocal laser endomicroscopy for optical biopsy of basal cell carcinoma of the auricle

Flurin Mueller-Diesing — 2026-09-07

Objective. The resection of skin tumours of the auricle is confronted with the challenge of keeping the resection defect as small as possible and at the same time achieving a complete resection. Probe-based confocal laser endomicroscopy (CLE) is an optical procedure that enables real-time, non-invasive assessment of the epithelium with up to 1000x magnification in vivo. The aim is to evaluate the feasibility of CLE in basal cell carcinoma (BCC) of the auricle.
Methods. Sixty-four video sequences (4,872 images) of CLE images of 8 different patients with BCC on the auricle were analysed. Each video sequence was assigned a histologic diagnosis. The sequences were presented to 4 physicians with experience in CLE in a blinded fashion. Dignity was assessed dichotomously using criteria such as cell size, tissue homogeneity and fibrosis.
Results. BCC is characterised by inhomogeneous tissue with enlarged, poorly demarcated cells, partly interrupted by cell-free fibrosis. The assessment of dignity based on the CLE sequences achieved an average sensitivity of 86.7% and a specificity of 94.5%. The interrater reliability (Fleiss Kappa) showed substantial agreement (κ = 0.76).
Conclusions. The results demonstrate the initial feasibility of intraoperative CLE for optical biopsy of facial skin tumours. The technique has the potential to serve as a non-invasive diagnostic tool in intraoperative decision making. Further studies are needed to evaluate its use as an adjunct to optimise or reduce the use of invasive frozen section pathology in the treatment of BCC.

Association between tracheo-oesophageal fistula and anti-angiogenic therapy in locally advanced/ metastatic tumours. A narrative review

Fatima Ezzahra Nassih — 2026-06-30

Anti-angiogenic therapies (AAT), including monoclonal antibodies (MAB) and tyrosine kinase inhibitors (TKI), have become a cornerstone in the management of advanced or treatment-refractory malignancies. Despite their proven efficacy, these agents can cause significant adverse effects related to impaired vascular repair and wound healing. Among the rare but serious complications, tracheo-oesophageal fistula (TEF) has emerged as a clinically-relevant and potentially fatal event. This review analyses the existing literature to explore the association between AAT and TEF formation, emphasising the underlying mechanisms, risk factors, and clinical implications. Evidence suggests that inhibition of vascular endothelial growth factor signalling compromises endothelial regeneration, particularly in tissues previously exposed to radiotherapy, inflammation, or surgical manipulation. Bevacizumab-related TEFs have been primarily reported in patients with lung cancer undergoing multimodal treatment, while TKI-associated cases, most often linked to lenvatinib or cabozantinib, have occurred in thyroid cancer with tracheo-oesophageal invasion or rapid tumour regression. No TEF has been described in treatment-naïve or neoadjuvant settings, indicating a safer profile in the absence of pre-existing local iatrogenic damage. Overall, TEF should be regarded as an extreme manifestation of wound-healing impairment rather than a random event. Careful patient selection, multidisciplinary assessment, and vigilant clinical monitoring are essential to balance therapeutic efficacy with patient safety. Further research is warranted to elucidate the biological mechanisms underlying this complication and optimise treatment strategies for high-risk patients.

Prediction of difficult laryngeal exposure in microlaryngoscopy: a scoping review

Claudia Valenziano — 2026-09-07

Objective. To conduct a scoping review on difficult laryngeal exposure (DLE) prediction in microlaryngoscopy (MLS). The aim was to identify effective predictive scoring systems or parameters for predicting transoral exposure.
Methods. A comprehensive search was conducted in PubMed and Scopus, with the final search performed on December 19^th, 2024. Studies assessing preoperative predictors of DLE in MLS were included if they reported accuracy measures. Studies not in English, with insufficient data, and with sample size < 5 patients were excluded.
Results. Sixteen studies were analysed. Common predictors included body mass index, neck circumference, inter-incisor gap, thyromental distance, dental status, and the modified Mallampati index. Scoring systems like the Laryngoscore and the mini-Laryngoscore showed promise but varied in external validation.
Conclusions. DLE prediction for MLS remains underdeveloped. Validated predictive tools could improve patient selection, reduce operative times, and optimise oncological outcomes by ensuring effective exposure. Further research is needed to establish robust predictive models.

Radiologic and cadaveric spatial relation between nasopalatine canal and the middle turbinate axilla

Octavio Garaycochea — 2026-09-07

Objective. This study aims to describe the spatial relation (SR) between the nasopalatine canal (NPC) and the septal projection of the middle turbinate axilla (MTA-SP), 2 anatomical landmarks used in rhinology.
Methods. A retrospective study was conducted in patients who underwent a cone bean computed tomography. Two radiological measurements were assessed by 2 examiners: the distance between the perpendicular line corresponding to the MTA-SP to the posterior border of the NPC and the distance between the anterior and posterior border of the NPC. Also, an anatomical dissection was performed on a cadaveric head and NPC was cannulated to visually assess the SR through a radiological reconstruction.
Results. Among 30 patients, 14 females and 16 males with a mean age of 46.6 (SD 18.8) years, the mean distance between the perpendicular line corresponding to the MTA-SP to the posterior border of the NPC was -0.08 mm (SD 2.4 mm) and the mean distance between the anterior and posterior border of the NSP was 2.7 mm (SD 1.4 mm).
Conclusions. The septal projection of the middle turbinate axilla is above and slightly in front to the NPC, at a mean distance of 0.08 mm. Understanding this relationship provides essential information about structure and spatial orientation of the nasal cavity.

Comparative outcomes of nasalisation vs functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyposis: a 10-year retrospective study

Dubravko Manestar — 2026-09-07

Objective. To compare outcomes of functional endoscopic sinus surgery (FESS) and nasalisation (radical ethmoidectomy) in chronic rhinosinusitis with nasal polyposis (CRSwNP), and to identify subgroups benefiting most from nasalisation.
Methods. We retrospectively analysed 480 surgeries (374 FESS, 106 nasalisation) from 2012 to 2022. Nasalisation patients had more severe baseline disease than FESS patients (mean Nasal Obstruction Symptom Evaluation [NOSE] score: 76.88 ± 6.18 vs 73.55 ± 7.25; mean Visual Analogue Scale [VAS] olfaction score: 6.53 ± 1.1 vs 8.8 ± 1.15; mean Lildholdt score: 2.09 ± 0.76 vs 1.57 ± 0.83; all p < 0.001). Subjective (NOSE, VAS) and objective (Lildholdt) scores were recorded preoperatively and at one, 3, 6, 12, and 24 months postoperatively.
Results. Despite worse baseline status, nasalisation showed greater improvements in subjective and objective measures, and was particularly effective in diffuse extensive polyposis. Paired t-tests confirmed significant postoperative enhancements (all p < 0.001; Cohen’s d > 0.8). At 24 months, nasalisation showed superior outcomes: NOSE (24.5 ± 5.5 vs 41 ± 6), VAS olfaction (1.95 ± 1.05 vs 3.95 ± 1.15) (both p < 0.001); Lildholdt scores were similar (0.5 ± 0.6 vs 0.53 ± 0.65; p = 0.68).
Conclusions. The preliminary results of this retrospective study showed that nasalisation in more severe cases of CRSwNP yielded better long-term clinical outcomes. These results motivate for further investigation through a prospective study that will include comprehensive olfactory testing, quality of life measures, and a more complete methodology with refined variables to address the limitations of the current data set.