ACTA Otorhinolaryngologica Italica

Exploring asymmetry of electrical compound action potential latencies in sequential cochlear implants as a possible effect of the lateral olivocochlear bundle

Sandro Burdo — 2026-10-28

Objective. Electrophysiological evaluations of the second cochlear implant (CI) in sequentially implanted patients usually consider the brainstem with electrically evoked auditory brainstem responses and the auditory cortex with slow responses. To further understand auditory electrophysiological behaviour after the second implantation, the present study investigated auditory nerve activity using electrical compound action potential (ECAP).
Methods. Of 167 bilaterally implanted patients, 73 were evaluated and divided into 2 groups: patients with simultaneous (33 children and 8 adults) and sequential (21 children and 11 adults) surgeries. The sequential surgeries were further grouped into “short delay” (< 4 years) and “long delay” (> 4 years), considering the time spent between procedures. Every patient was assessed by evaluating the N1 wave of ECAP, focusing on the latencies in both ears.
Results. The ECAP’s interaural latencies were not statistically different in simultaneous patients and sequential progressive/acquired deaf adults. In contrast, in sequential congenital deaf children, the latencies of the second implant were temporally earlier than those of the first implant, but symmetry recovered within 2 years after surgery.
Conclusions. The results revealed that late-sequential CI stimulation generates asymmetric interaural activity at the first neuron in congenitally deaf children. Such an asymmetry is due to the anticipation of the sequential N1 wave ECAP, rather than the expected delay. The hypothesis attributes it to a temporary lack of efferent system tuning, particularly the lateral olivocochlear bundle, which should still be active in implantees. These findings could enhance the benefits of sequential CI mapping by implementing a stimulation delay with a temporal duration similar to N1 anticipation until binaural processing normalises.

Review of fixation techniques in double-barrel fibula flap and introduction of a new technique

Resi Pucci — 2026-10-28

Objective. The fibula flap is the preferred choice for mandibular reconstruction, especially with recent technological advancements. This study presents and evaluates a novel EASY-WEAR-OFF CAD/CAM patient-specific implant (PSI) double-barrel double-plate designed to improve stabilisation and outcomes.
Methods. A custom CAD/CAM plate with 2 parts, a long-bar and a short-bar plate, connected by vertical rods, was developed. Implant placement was performed under local anaesthesia alongside the removal of the short-bar plate at 6 months postoperatively. Literature on fixation techniques and CAD/CAM designs was reviewed to contextualise this approach.
Results. The double-barrel technique provides greater vertical bone height than the single-bar, reducing the bone gap and improving implant conditions. This PSI shows potential for better patient satisfaction and functional outcomes, supporting easier implant placement and postoperative management.
Conclusions. This CAD/CAM PSI may enhance mandibular reconstruction using the double-barrel fibula flap. Further studies with larger cohorts are needed to confirm its clinical benefits and longterm outcomes.

Absent cervical VEMP responses in iron deficiency anaemia: saccular hypofunction or insufficient sternocleidomastoid activation?

Ahmet Faruk Erdem — 2026-10-28

En bloc temporo-parotid resection for malignant tumours of the parotid: surgical technique

Elisabetta Zanoletti — 2026-10-28

Objective. Advanced malignant tumours of the parotid gland often extend to the skull base and adjacent soft tissues. Conventional extended parotidectomy has shown limitations in achieving radical margins. Temporo-parotid resection (TPR) was developed to ensure oncological continuity of the specimen in an en bloc fashion and to achieve reliable surgical margins. A detailed description of the surgical technique has not been reported in the literature to date and is the aim of the present work.
Methods. Thirty-four patients with malignant parotid tumours were treated with TPR between 2019 and 2025. The surgical technique is detailed step-by-step herein. The procedure begins with a combined cervico-parotid incision, followed by total parotidectomy with preservation or sacrifice of the facial nerve according to tumour involvement. A selective or modified radical neck dissection is carried out en bloc. Temporal bone resection is then performed according to 3 reproducible osteotomy patterns: type 1 (partial tympano-mastoidectomy running lateral to fallopian canal); type 2 (partial mastoidectomy, radical tympanectomy medial to fallopian canal and lateral to the labyrinth); type 3 (radical tympano-mastoidectomy, medial to fallopian canal and variably extending to the spheno-temporal bone, labyrinth, jugular fossa, carotid canal). The parotid, neck and temporal bone components are removed in continuity, without specimen disruption, thereby ensuring accurate deep margin assessment.
Results. TPR type 1 was performed in 10 cases (29.4%), type 2 in 20 cases (58.8%), and type 3 in 4 cases (11.8%). Outcome analysis was beyond the scope of the present study and will be reported separately.
Conclusions. TPR provides a reproducible en bloc approach to parotid malignancies with skull base extension, optimises oncological radicality, facilitates processing and assessment of surgical specimens, and enables standardisation of bone resections.

Are 3D-printed temporal bone models the future of otologic surgical training? A national multicentre validation study

Pietro Canzi — 2026-10-28

Objective. To validate a novel 3D-printed temporal bone model as an acceptable substitute for cadaveric human temporal bones in otosurgical training.
Methods. A 3D-printed healthy temporal bone model was evaluated by 54 otosurgeons (27 experienced and 27 trainees) from Italian universities. Participants performed dissections on the model and completed a 27-question survey comparing the synthetic model with the cadaveric one. The primary outcome was the percentage of average total scores exceeding 3, with acceptability set at > 70%.
Results. Overall, 80.9% (p < 0.001) of participants rated the model as comparable to the cadaveric temporal bone (average total score exceeding 3). High scores were observed for “usefulness as a training tool”, “task-based usefulness” and “overall reactions” domains with an average total score exceeding 3 in 95.8% (p < 0.001), 83.2% (p < 0.001), and 79% (p = 0.004) of questionnaires respectively. No significant differences were found between experienced and trainee surgeons’ evaluations.
Conclusions. 3D-printed temporal bone models are a viable, cost-effective, and customisable training tool comparable to cadavers. The realism of the soft tissues still needs to be refined in order to better mimic cadaveric specimens.

Clinical utility and advances of liquid biopsy in hypopharyngeal carcinoma: a systematic review and meta-analysis

Jing Liang — 2026-06-30

Background. Hypopharyngeal carcinoma (HPC) is an aggressive malignancy with poor prognosis due to difficult early diagnosis, frequent recurrence, and distant metastasis. Although surgery, radiotherapy, chemotherapy, and immunotherapy have progressed, accurate prognostic assessment and real-time monitoring remain limited. Liquid biopsy, a minimally invasive method detecting circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), and microRNAs (miRNAs), shows promise in solid tumours, but its role in HPC is underexplored.
Methods. A systematic search of PubMed, Embase, and Web of Science was conducted to September 2025 following PRISMA guidelines. Eligible studies evaluated ctDNA, CTCs, or miRNAs for diagnosis, treatment monitoring, or prognosis of HPC, reporting sensitivity, specificity, diagnostic odds ratio, or hazard ratio for meta-analysis.
Results. Twenty-four studies with 933 patients were included. Pooled estimates showed sensitivity 88.3% (95% CI: 84.7-91.6) and specificity 95.9% (95% CI: 93.3-97.9), with predictive intervals sensitivity 0.74–0.98 and specificity 0.85-1.00. Heterogeneity was moderate (I² sensitivity = 52.3%; specificity = 48.5%), and no publication bias was observed. Subgroup analyses indicated ctDNA was advantageous for treatment monitoring, CTCs were consistent in prognosis, and miRNAs were strong candidates due to stability and detection sensitivity. Sensitivity analyses confirmed robustness.
Conclusions. Liquid biopsy shows strong potential for diagnosis, monitoring, and prognosis in HPC. Large-scale, multicentre studies are required to validate its clinical application and integration into patient-management pathways.

Corticosteroid nasal irrigations vs sprays in chronic rhinosinusitis: a systematic review

Linger Sim — 2026-10-28

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition often treated with topical corticosteroids. While nasal sprays are standard, corticosteroid nasal irrigations may improve drug delivery and outcomes. Enhanced drug delivery in CRS is important because it promotes effective deposition of medication into the paranasal sinuses, thereby strengthening anti-inflammatory effects. This systematic review and meta- analysis, conducted per PRISMA guidelines and registered in PROSPERO (CRD420251053183), evaluated randomised controlled trials comparing corticosteroid nasal irrigations to sprays in adults with CRS. Six randomised controlled trials (RCTs) involving 370 participants were included. Irrigations significantly improved health-related quality of life compared to sprays (standardized mean difference [SMD] -0.62; 95% confidence interval [CI] -1.09 to -0.15; p = 0.01), particularly in patients with nasal polyps and those without prior endoscopic sinus surgery. Significant reductions were also observed in nasal polyp scores (MD -0.58; p < 0.0001) and Lund-Mackay radiologic scores (MD -1.79; p = 0.01). No significant differences were found in nasal endoscopy scores or adverse events. In conclusion, corticosteroid nasal irrigations are a safe and effective alternative to sprays for CRS management, offering better symptom control and objective improvements. Further studies are needed to refine delivery protocols, assess the cost-effectiveness of corticosteroid nasal irrigations versus sprays, and evaluate their relative efficacy in both nonsurgical and postsurgical patients, as well as in those with or without nasal polyps.

Notiziario SIO 2026

Redazione . — 2026-10-28

CONSIGLIO DIRETTIVO SIO (2026-2027)

See full text:

https://www.actaitalica.it/article/view/2973/1341

Comparison of thyroglossal duct cysts in adults and children: 11 years of clinical experience

Ömer Faruk Zengin — 2026-10-28

Objective. The aim of this study is to analyse the diagnostic, therapeutic, and follow-up characteristics of patients with thyroglossal duct cysts (TGDC) focusing on clinical differences between paediatric and adult cases.
Methods. Between January 2006 and December 2016, patients who underwent surgical treatment in our clinic with the diagnosis of TGDC were included. Patients were divided into paediatric (under 18 years) and adult groups. Age, gender, presenting symptoms, duration of symptoms, cyst size and location, imaging methods, histopathological findings and recurrence information were compared.
Results. A total of 36 patients were included (17 paediatric, 19 adult). In both groups, the most common complaint was neck swelling, and cysts were most frequently infrahyoid (77.8%). Adults had significantly larger cysts than children (p = 0.02), and sinus tract discharge occurred only in paediatric patients (p = 0.04). TGDC carcinoma was identified in only 3 adults.
Conclusions. TGDCs are the most common congenital neck masses in both age groups. The gold standard surgical treatment for this condition is the Sistrunk procedure, which significantly reduces the risk of recurrence. Clinicians should remain vigilant, as carcinoma may coexist with TGDCs, particularly in adults.

Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society

Cesare Piazza — 2026-10-28

Objective. Tracheal (TRA) and crico-tracheal resection and anastomosis (CTRA) are highly effective surgical procedures for managing selected cases of laryngo-tracheal stenosis, although the absence of a standardised classification limits the use of a common language within the scientific community and hinders multicentre comparisons. We present the European Laryngological Society (ELS) proposal, categorising (C)TRA into 6 Types (A1, A2, B, C, D, and E) mainly based on their anatomical extension and type of anastomosis performed.
Methods. The classification was validated through a preliminary multicentre cohort of 390 patients treated between September 1996 and March 2026 in 4 European referral airway centres sharing a common protocol for definitions of (C)TRA. Primary outcomes included postoperative complications and airway patency in terms of tracheostomy-free rate.
Results. The cohort was distributed across (C)TRA Type A1 (24.9%), A2 (21%), B (19%), C (31%), D (1.5%), and E (2.6%). Overall and anastomosis-specific complication rates increased from Type A1 to Type C, reflecting the technical burden of the procedure, while planned temporary tracheotomy in Types D and E effectively mitigated acute airway morbidity. Long-term functional success remained high across all (C)TRA Types, with tracheostomy-free rates ranging from 95.1% to 100% for all different kinds of (C)TRA procedures.
Conclusions. The proposed ELS classification provides a standardised framework that correlates well with surgical complexity and complication profiles, enhancing data comparability and serving as a valuable didactic resource for the international airway community.

Steroid-eluting sinus implants in endoscopic sinus surgery: results of an Italian Nationwide Survey

Mario Turri-Zanoni — 2026-10-28

Objective. To investigate current clinical practice patterns and perceptions regarding steroid-eluting sinus implants (SESIs) among Italian rhinologists.
Methods. A nationwide survey on SESIs use in endoscopic sinus surgery (ESS) was developed by an advisory board of 5 Italian experts from tertiary referral centres and distributed to rhinology surgeons across Italy. Of 145 invited physicians, 103 responded (71%). Three respondents without experience or interest in SESIs were excluded, leaving 100 participants for analysis.
Results. Among respondents, 46% were SESI Users and 54% Non-Users. SESIs were mainly used in revision ESS, frontal sinus surgery, and in patients with contraindications to systemic corticosteroids. Users valued SESIs for reducing restenosis and promoting controlled healing. In frontal sinus surgery, SESIs were commonly recommended in revision cases, especially for scarring-related restenosis. In ethmoid surgery, middle turbinate preservation influenced recommendations. Nonusers cited high costs, lack of reimbursement, and limited guideline clarity as the main barriers.
Conclusions. This survey shows marked variability in SESI adoption in Italy. While benefits are acknowledged in selected cases, economic and guideline-related issues limit wider use, highlighting the need for cost-effectiveness studies and national guidelines to better define the role of SESIs in ESS.