ACTA Otorhinolaryngologica Italica

Subtotal and total glossectomies with or without total laryngectomy – Does laryngeal preservation impact oncological and functional outcomes?

Mon, 27 Apr 2026 00:00:00 +0000

Objective. Subtotal (SG) and total glossectomies (TG) represent surgical options for advanced oral and oropharyngeal squamous cell carcinomas (SCC). Associated laryngeal preservation maintains phonation but increases the risks of aspiration pneumonia and, potentially, local recurrence in the vallecular/supraglottic area. To mitigate these risks, SG/TG with total laryngectomy (TL) may be performed. This study evaluates functional and oncological outcomes of SG/TG with/without TL, focusing on the clinical impact of laryngeal preservation.
Methods. This monocentric retrospective study analysed patients treated by SG/TG with/without TL between January 2013 and July 2024 in a referral, high-volume, academic institution. Oncological outcomes were assessed by overall (OS) and disease-free survival (DFS). Functional outcomes were evaluated in terms of gastrostomy- and tracheotomy-dependency.
Results. Among 67 patients analysed, 56 (83.6%) underwent SG/TG without TL and 11 (16.4%) with TL. Gastrostomy-dependency at discharge was 83.6%, with minimal differences between laryngeal preservation (83.9%) and TL (81.8%). Tracheotomy-dependency in case of laryngeal preservation was 16.7% at 12 months. Five-year OS was 23.1%. No significant differences in terms of OS or DFS were observed between SG/TG with or without TL.
Conclusions. Laryngeal preservation in SG/TG, when oncologically safe, does not worsen survival outcomes and offers better functional recovery. Gastrostomy dependency remains high across both groups, suggesting that laryngeal sacrifice does not confer significant nutritional advantages. State of the art reconstructive techniques using microvascular flaps facilitate laryngeal preservation without compromising survival.

Survival and prognostic factors of parotid malignancies in Northern Italy: a multicentric study

Mon, 27 Apr 2026 00:00:00 +0000

Objective. The aim of this study is to report oncological outcomes of a multicentric cohort of surgically- treated parotid gland malignancies (PGMs) and compare them with other Italian Institutions.
Methods. This is a retrospective multicentric study on surgically-treated patients with PGM. Overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) at 5 years were calculated. The Cox proportional hazard model was used for uni- and multivariate analyses. A qualitative review of the Italian literature was performed.
Results. One-hundred and six patients were included. Negative prognostic factors included deep lobe involvement, size > 4 cm, advanced stage, margin status, histological grade, nodal involvement and extranodal disease. Parotidectomy extent did not influence DSS or DFS for T1-T2 superficial tumours. The occult lymph node metastasis rate was 30.8%. Neither elective neck dissection (END) nor elective neck irradiation (ENI) influenced DFS or DSS.
Conclusions. Deep lobe removal in pT1-T2 superficial tumours may not always be necessary. END and ENI did not show a significant impact on prognosis, despite a high incidence of occult nodal metastasis. Further studies are needed to fully evaluate the impact of these therapeutic options in subgroups of patients with PGMs.

Dose-dependent IL-29 activation of TLR4 signaling drives eosinophil infiltration in chronic rhinosinusitis with nasal polyps

Yu Zhong, Huijuan Yan, Yuren Zhou, Nanlan Huang, Jingkun Li — Mon, 27 Apr 2026 00:00:00 +0000

Objective. Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) features extensive eosinophil infiltration, yet the molecular mechanisms driving this process are not fully elucidated. IL- 29 and TLR4 are known inflammatory modulators, but their dose-dependent interplay in ECRSwNP remains uncharted. This study aimed to explore how IL-29 activates TLR4 signalling to promote eosinophil infiltration in ECRSwNP.
Methods. Thirty patients with ECRSwNP and 30 controls post-nasal septum correction were recruited. Eosinophil infiltration was assessed via haematoxylin-eosin staining, while IL-29 and TLR4 expression and correlation were analysed using qPCR and immunohistochemistry. In vitro, eosinophils were stimulated with IL-29 (10-100 ng/mL) ± TLR4 inhibitor TAK-242, with migration measured by Transwell assay, cytokine secretion by ELISA, and NF-κB/MAPK signalling by western blot.
Results. Patients with ECRSwNP exhibited significantly elevated eosinophil infiltration and IL-29/ TLR4 expression (p < 0.05), with a robust correlation (r = 0.6018, p < 0.0001). IL-29 dose-dependently enhanced eosinophil migration and cytokine production, and the effects were reversed by TLR4 blockade, accompanied by decreased NF-κB and MAPK phosphorylation, indicating TLR4-mediated regulation.
Conclusions. Dose-dependent IL-29 activation of TLR4 signalling drives eosinophil infiltration in ECRSwNP, offering novel mechanistic insights and potential therapeutic targets for this condition.

Endoscopic transnasal craniectomy: impact on staging and prognosis of sinonasal adenocarcinoma

Joackim Mahdjoub, Laurent Tavernier, Olivier Mauvais — Mon, 27 Apr 2026 00:00:00 +0000

Objectives. Postoperative prognosis of sinonasal adenocarcinoma (SNAC) is closely related to local recurrence. Our objective was to identify subclinical anterior skull base (ASB) invasion, and to evaluate the impact of endoscopic transnasal craniectomy on SNAC staging and prognosis.
Methods. Retrospective study conducted from 2010 to 2023, including 33 patients, comparing 2 groups: conservative endoscopic sinus surgery (ESS) and complementary endoscopic resection with transnasal anterior skull base craniectomy (ERTC). Histopathology, overall survival (OS), recurrence-free survival (RFS), complication rates, surgery time and hospital stay were analysed.
Results. Histopathology revealed malignant invasion in 36.8% of ASB surgical specimens, despite the absence of pre- or intraoperative evidence of skull base invasion. All were low-grade tumours, with 57.1% previously classified as cT2. ERTC was associated with an improvement in RFS, although not statistically significant, with a greater incidence of complications, but no impact on OS.
Conclusions. This study provides the first significant evidence of frequent subclinical invasion of the ASB in cT2 cases. These findings raise important questions regarding the management of cT2 lesions. Should systematic biopsies of the anterior skull base be taken? Should a skull base resection be discussed in selected patients? Further studies with larger samples are necessary to better define the risk-benefit ratio of ERTC in low-stage SNAC prognosis.

Vestibular evoked myogenic potentials in patients with iron deficiency anaemia

Fatma Atalay, Murat Yaşar, Tuba Uyanık, Sezai Sacid Anbar — Thu, 12 Mar 2026 00:00:00 +0000

Objective. The aim of this study was to evaluate vestibular functions using cervical vestibular evoked myogenic potentials (cVEMP) in patients with iron deficiency anemia (IDA) and investigate the early detection of potential vestibular hypofunction.
Methods. In this prospective study, the cVEMP results of 34 adult patients diagnosed with IDA and with no vestibular symptoms were compared with those of 34 audiologically healthy controls. P1-N1 latency times, interpeak amplitudes, and amplitude asymmetry rates were analysed and compared between the groups.
Results. One hundred thirty-six ears of 68 participants, 34 patients with IDA and 34 healthy controls, were included in the study. There was no significant difference in age or gender between groups (p = 0.180, p = 0.726, respectively). The absent VEMP response rate was significantly higher in the IDA group than in the control group (p < 0.05). No significant differences were determined between the IDA and control groups in terms of P1 latency, N1 latency, interpeak amplitude, or threshold values (p = 0.903, p = 0.407, p = 0.761, p = 0.729, respectively). The asymmetry rate was significantly higher in the IDA group than in the control group (p < 0.05).
Conclusions. The increase in absent VEMP response and asymmetry rates in patients with IDA indicates that peripheral vestibular hypofunction has developed in these patients.

Assessment of language development in children with prelingual single-sided deafness

Dorota Pastuszak, Anita Obrycka, Henryk Skarżyński, Piotr Henryk Skarżyński — Mon, 27 Apr 2026 00:00:00 +0000

Objectives. To assess the development of receptive and expressive language skills in children who had prelingual single-sided deafness (SSD).
Materials and methods. Fifty children diagnosed with SSD at the Institute of Physiology and Pathology of Hearing in Warsaw/Kajetany, Poland were included in the study. Receptive and expressive language skills were examined using a norm-referenced test, the Child Speech Therapy Assessment Cards (CSTAC).
Results. In the test of receptive language skills, 46% of children with SSD received low scores, while 48% recorded low scores in the test of expressive language skills. Among children with normal hearing, the expected percentage of low scores is 30.8% for both receptive and expressive skills. Children with SSD demonstrated a significantly higher proportion of low scores in both receptive (χ2 [2, n = 50] = 19.66; p < .001; V = 0.63) and expressive (χ2 [2, n = 50] = 22.64; p < 0.001; V = 0.67) language skills compared to their normal-hearing peers.
Conclusions. The results showed that children with SSD are at risk of language delays. To minimise the potential consequences of such delays, appropriate early intervention – together with parental education, speech-language therapy, auditory training, and monitoring of language development – should be implemented.

Acoustic analysis of tracheo-oesophageal voice: cepstral and voicing measures

Mon, 27 Apr 2026 00:00:00 +0000

Objectives. To develop an acoustic analysis protocol examining the correlations between acoustic and perceptual parameters in tracheo-oesophageal (TE) voices.
Methods. Forty-nine laryngectomised patients with TE voice (42 M, 7 F; mean age 68 ± 9.3 years) were enrolled. Voice samples holding the sustained vowel /a/ and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) sentences were recorded and analysed to extract the fundamental frequency (F0), the fraction of locally unvoiced frames (FLUF) and the cepstral peak prominence smoothed (CPPS). A perceptual evaluation was performed with the Impression, Noise, Fluency and quality of Voice (INFVo) scale.
Results. CPPS and FLUF did not significantly correlate with F0. Average F0 on connected speech showed moderate correlations with I and Vo parameters (INFVo). Strong correlations between CPPS and FLUF were observed on both sustained vowel and connected speech. FLUF and CPPS moderately correlated with the I and Vo parameters; FLUF showed also a moderate correlation with the N parameter.
Conclusions. CPPS and FLUF are evaluable on both sustained vowel and connected speech and are easy to analyse. The intercorrelation between them and the correlations with perceptual evaluation suggest their validity for TE voice assessment.

Effectiveness of tinnitus retraining therapy in alleviating tinnitus symptoms: a systematic review and meta-analysis

Mon, 27 Apr 2026 00:00:00 +0000

Objective. This study systematically evaluated and analysed existing evidence regarding the effectiveness of tinnitus retraining therapy (TRT) in treating tinnitus at different follow-up periods and the factors that influence the choice of treatment.
Databases reviewed. Medline, OpenAIRE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Springer Nature Journals, Science Citation Index Expanded, and PubMed.
Methods. Data were collected from multiple sources. Studies on adults with tinnitus, experiencing stable, bothersome, and chronic symptoms were included. Participants with significant comorbid conditions potentially influencing TRT outcomes and traumatic injuries were excluded.
Results and discussion. A total of 18 articles were included in the qualitative assessment. The studies included encompassed various geographical locations and study settings, with a total of 1712 participants, of whom 1011 underwent TRT and 701 were in the comparison group who were receiving alternative treatments. Gender distribution among participants revealed 1097 males and 596 females. The analysis consistently demonstrated improvements in tinnitus severity and quality of life following TRT, as assessed by Tinnitus Handicap Index, Tinnitus Questionnaire, and Visual Analogue Scale. The meta-analysis revealed significant heterogeneity among studies; however, sensitivity analyses demonstrated consistent results. Additionally, publication bias assessment indicated no systematic bias in effect sizes across studies.
Conclusions. These findings suggest that TRT holds promise as an effective intervention for managing tinnitus. Further well-designed randomised controlled trials are warranted to confirm these findings and advance our understanding of TRT’s efficacy in treating tinnitus.

Sinonasal giant cell tumour. Report of four cases and review of the literature

Mon, 27 Apr 2026 00:00:00 +0000

Objective. Sinonasal giant cell tumour (SnGCT) is very rarely reported. The aim of the study is to present a series of SnGCT treated with an endoscopic or combined approach and to carry out a review of the literature on this topic.
Methods. This case series encompassed the clinical data of all the SnGCT surgically treated with curative intent at two different referral centres, between 2001 and 2024. The information was extrapolated to report epidemiologic and clinical data, surgical approach and follow up. A comprehensive clinical review of the literature was also carried out.
Results. Among 4 patients included, 3 were treated with a pure endoscopic resection and remained disease-free at the last follow up, while one was managed with a combined approach, who is alive with disease. From the review we found only 32 cases of SnGCT reported, mostly treated with an open approach. Local recurrence was documented in 12.5% of cases, while distant metastasis in 3%.
Conclusions. SnGTC is a benign but locally aggressive neoplasm that can present as a lytic lesion. The clinical behaviour of GCT is unpredictable, and it tends to recur locally and may even metastasise. In the nose and paranasal sinuses it is an exceedingly rare entity, but should be considered in the differential diagnosis with a large variety of histologies. Surgery is the treatment of choice for resectable lesions.