J. Otorhinolaryngol. Hear. Balanc. Med., Volume 7, Issue 2 (December 2026) – 10 articles

Background/Objectives: Primary thyroid lymphoma accounts for approximately 0.2–2% of thyroid malignancies. Plasmablastic lymphoma (PBL), an aggressive large B-cell neoplasm with plasma-cell differentiation and frequent loss of conventional B-cell markers, is a rare thyroid presentation. We report a thyroid PBL presenting as an acute surgical airway emergency in an immunocompetent patient and highlight the diagnostic and management pitfalls that distinguish this from anaplastic thyroid carcinoma. Case Presentation: A 75-year-old man without any significant past medical history presented with rapidly progressive right-sided neck swelling, dysphagia, inspiratory stridor, and respiratory failure. Imaging demonstrated a large, thyroid-centered mass with tracheal involvement, initially raising concern for anaplastic thyroid carcinoma. Histopathology revealed a diffuse infiltrate of large, atypical cells with immunoblastic and plasmablastic morphology. The neoplastic cells were CD20- and CD138-negative but strongly MUM1-positive, with lambda light-chain restriction, bright CD38 by flow cytometry, a Ki-67 proliferation index exceeding 95%, aberrant cytoplasmic CD3 expression, and a MYC::IGH rearrangement, supporting a diagnosis of PBL. Staging identified extranodal perinephric disease and mesenteric lymphadenopathy, consistent with disseminated extranodal Ann Arbor stage IV disease. The patient underwent systemic treatment and initially had an excellent response; however, one month after the last treatment cycle they presented to the hospital with a mass consistent with recurrence. Discussion: Rapid growth, fixation, and tracheal invasion strongly suggest anaplastic thyroid carcinoma in routine clinical practice. However, plasmablastic lymphomas can present similarly and require fundamentally different treatment. In this case, loss of conventional B-cell markers, CD138 negativity, and aberrant cytoplasmic CD3 expression created substantial diagnostic challenges. Light-chain restriction, plasma-cell-associated markers, flow cytometry, and MYC cytogenetics were vitally important. Conclusions: Thyroid-presenting PBL is exceptionally rare and may closely mimic anaplastic thyroid carcinoma, including presentation with life-threatening airway compromise and tracheal involvement. This case highlights several diagnostic pitfalls: CD138 negativity despite plasma-cell differentiation, and aberrant cytoplasmic CD3 expression. Prompt airway stabilization, adequate tissue acquisition, broad immunophenotyping, light-chain assessment, flow cytometry, EBV/HHV8/ALK testing, and MYC cytogenetics are essential for accurate diagnosis and lymphoma-directed treatment. Full article

Patulous Eustachian Tube (PET) is a rare otologic disorder, which is caused by abnormal patency of the Eustachian tube. Rapid weight loss is a recognized predisposing factor for PET potentially because of the reduction in peritubal adipose tissue that contributes to normal tubal closure. Although there is increasing awareness of this association, the best treatment of PET is still debated with several conservative, medical and surgical operations reported in the literature. This narrative review summarizes the available evidence regarding conservative, medical, minimally invasive, and surgical management of PET, with particular consideration of PET associated with rapid weight loss. Relevant literature was identified through searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library, with attention to studies using standardized diagnostic criteria and outcome measures. Conservative approaches, including hydration, nasal saline instillation, and behavioral modifications such as cessation of habitual sniffing, have been associated with symptomatic improvement and considered as initial options because of their accessibility and low procedural burden. Medical therapies, such as topical irritants, estrogen-based preparations, and mucosal-thickening agents, may provide temporary symptom relief, although their long-term effects require further evaluation. Among interventional strategies, silicone (Kobayashi) plug insertion has demonstrated encouraging symptom improvement and reductions in symptom scores in selected patients with refractory PET. Minimally invasive techniques, including autologous fat injection, cartilage augmentation, and soft tissue bulking procedures, have also demonstrated encouraging outcomes. Trans-tympanic interventions, including ventilation-tube insertion and catheter-based techniques, provided additional options with variable reported outcomes. Management of PET remains heterogeneous and largely individualized. Conservative and medical therapies are considered reasonable first-line options, while surgical and minimally invasive approaches may be considered for selected patients with persistent symptoms. Full article

Background/Objectives: Tinnitus can have an adverse impact on some patients’ lives, affecting the daily functioning for a proportion of patients. In recent years, audiologists in Singapore who are specialised in tinnitus and hyperacusis rehabilitation have increasingly been providing tinnitus and/or hyperacusis management. The aim of this study was to evaluate the outcome of audiologist-delivered tinnitus management at a public hospital in Singapore. Methods: Retrospective data from patients seen between 2016 and 2019 were extracted from the hospital’s electronic medical record system. Outcomes were analysed using pre-treatment and three-month post-treatment Tinnitus Handicap Inventory (THI) scores among patients referred to the audiologist-led tinnitus clinic. Results: A total of 201 patients aged 18 to 86 years received tinnitus management. Among patients who returned for follow-up, 93% showed a reduction in THI score three months after treatment. Mean THI scores decreased significantly from 46.9 to 24.3, with a corrected effect size of 1.16, indicating a large treatment effect. Among patients with moderate or greater tinnitus handicap at baseline, 81% improved by at least one severity grade. Conclusions: This is one of the first studies to report outcomes of an audiologist-led tinnitus management service in Singapore. The findings are consistent with a potential role for structured, audiologist-led tinnitus services in Asian healthcare settings, although controlled studies are needed to confirm treatment effectiveness. General practitioners, otolaryngologists and other healthcare providers can play an important role in recognising tinnitus-related distress, offering early reassurance and directing patients to appropriate audiological and supportive care. Full article

Objectives: To describe a rare case of delayed diagnosis of a subglottic foreign body (FB) in an adult, resulting in subglottic stenosis, and to evaluate the effectiveness of Suspension Microlaryngoscopy (SML) as a minimally invasive technique for its management. Case presentation: An adult patient presented with persistent respiratory symptoms and was ultimately diagnosed with a retained subglottic FB after a delayed clinical course. The FB was managed using endotracheal intubation and SML, which allowed precise visualization and extraction. Associated granulation tissue and mucosal overgrowth were treated with targeted resection and controlled cauterization. Discussion: The delayed presentation and nonspecific clinical manifestations posed significant diagnostic challenges, contributing to the persistence of the FB and the development of subglottic stenosis. SML provided excellent exposure of the subglottic region, enabling safe FB removal while minimizing trauma to surrounding tissues. Postoperative follow-up demonstrated complete symptom resolution and restoration of airway patency without complications. Conclusions: Subglottic FB impaction is an exceptionally rare condition in adults and may be overlooked because of its nonspecific presentation, leading to delayed diagnosis and airway complications. This case highlights the importance of maintaining a high index of suspicion for retained airway FBs in patients with persistent respiratory symptoms or unexplained subglottic stenosis. SML represents a safe and effective therapeutic option, offering precise visualization, atraumatic FB extraction, and successful management of associated granulation tissue, with favorable clinical outcomes. Full article

Background/Objectives: As patients increasingly rely on large language models (LLMs) for Chronic Rhinosinusitis (CRS) diagnosis, surgical candidacy, and perioperative care, evaluating the accuracy of LLM-generated information against established clinical practice guidelines for surgical management of CRS is essential. Methods: ChatGPT, Google AI, Google Gemini, and Grok were queried using a 21-question guideline-mapped prompt set (long) and a single patient-focused prompt (short). Two physician reviewers independently scored responses using a 3-point rubric across 21 fields. Primary outcomes were guideline-concordant scores; secondary outcomes included readability measured with the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Inter-rater reliability (IRR) was assessed using the intraclass correlation coefficient (ICC). Analyses were performed in SPSSv31. Results: Guideline concordance ranged from 55.36% to 77.98% (p > 0.05), highest for Grok (77.98%, 95% CI 63.67–92.28), followed by Google Gemini (66.67%, 95% CI 35.42–97.91), ChatGPT (55.95%, 95% CI 29.25–82.65), and Google AI (55.36%, 95% CI 29.97–80.75), with Grok significantly outperforming both ChatGPT and Google AI. Prompt structure significantly affected scores. Long-form prompting resulted in higher guideline concordance scores than short-form prompting (+26.19, p < 0.001). The CPG demonstrated a more readable structure, with a higher FRE (44.1), exceeding scores generated by Grok (31.7), ChatGPT (39.9), Gemini (39.2), and Google AI (32.5). In contrast, the CPG was a higher reading grade level (FKGL score of 11.7) than Grok (11.4), Gemini (10.5), and ChatGPT (10.3), but was lower in reading grade compared to Google AI, which produced the highest FKGL score (12.5). IRR was high (ICC = 0.961). Conclusions: LLMs demonstrated similar guideline concordance, suggesting patients can expect comparable accuracy across platforms. While LLMs generally improved FKGL scores compared to the AAO-HNS CPG, they demonstrated lower FRE scores, indicating mixed results on overall readability. However, longer prompt structure meaningfully influenced output quality, highlighting how a user’s ability to frame precise prompts is critical to obtaining accurate information. Full article

Background: The management of pediatric microtia and congenital hearing loss typically necessitates coordinated multidisciplinary input. Traditional fragmented care pathways across multiple specialties may contribute to delayed diagnosis and treatment intervention, inconsistent counselling, increased logistical burden, and suboptimal care integration. Objectives: We aimed to evaluate family-reported outcomes following implementation of a multidisciplinary Hearing Disorder and Microtia (HDM) clinic, focusing on family satisfaction, perceived care efficiency, understanding of disease and treatment, and early uptake of hearing rehabilitation. Methods: A prospective observational study was conducted on families attending the HDM clinic at a tertiary pediatric center between 2022 and 2024. A structured post-visit survey assessed satisfaction, perceived efficiency, understanding of disease and treatment options, and overall experience. Quantitative data were analyzed descriptively, while qualitative responses underwent thematic analysis. Results: Twenty families were included. Overall satisfaction was high, with 95% rating the clinic experience as very good to excellent and expressing willingness to recommend the service. Improved care coordination and clarification of counselling were reported by the majority of respondents, alongside reduced logistical burden. Notably, 65% of families initiated hearing rehabilitation at the first visit. Thematic analysis identified convenience, unified specialist communication, and clarity of management planning as key strengths of the multidisciplinary model. Conclusions: A structured multidisciplinary HDM clinic significantly improves caregiver experience and facilitates earlier hearing rehabilitation in children with microtia and congenital hearing loss. Integrated care delivery enhances communication, reduces fragmentation, and supports timely, family-centered decision-making. This model may serve as a framework for other complex pediatric otologic conditions requiring longitudinal multidisciplinary management. Full article

Background/Objectives: Nasopharyngeal cancer generally has a good survival rate with chemoradiotherapy, but a significant side effect is irreversible hearing loss, for which there is currently no preventive intervention. Given that dexamethasone (Dex) and D-methionine (dMet) have individually shown potential to prevent hearing loss in in vitro and animal studies, we hypothesized that combining Dex and dMet may offer greater protection against cytotoxicity induced by cisplatin and radiation treatments. Methods: Organ-of-Corti-derived OC-k3 cells exposed to cisplatin and/or radiation were used as an in vitro model of treatment-induced cytotoxicity to investigate the protective mechanisms of Dex and dMet. Results: Dex was associated with reduced apoptosis, accompanied by decreased p53 phosphorylation and increased Bcl-XL expression. Dex also reduced COX2 expression and showed trends toward attenuation of ERK1/2 and NFκB signaling. Conversely, dMet effectively blocked cisplatin-induced apoptosis but did not protect against radiation-induced cytotoxicity. Conclusions: The combination of Dex and dMet provided greater protection against cisplatin- and radiation-induced cytotoxicity in the OC-k3 cells than either agent alone. These findings support further investigation of combined Dex and dMet as a potential strategy to mitigate treatment-induced ototoxicity. Full article

Background: The current literature suggests that screening for symptoms of pediatric obstructive sleep-disordered breathing (SDB) is low despite guidelines from the American Academy of Pediatrics to screen all children at well visits. Specific factors that affect screening rates for snoring have not been well delineated. Materials and Methods: This study is a retrospective chart review of children ages 2–12 who presented for well-child visits at an academic hospital network. Multivariable logistic regression was used to identify factors associated with documentation for SDB screening. Results: Of 1001 charts reviewed, 809 children met inclusion criteria (median age 5 IQR [3–8] years, 50.3% female). Less than half (45.4%) of the children were screened for snoring, and 16.1% of those screened had symptoms of SDB. Adjusted multivariable regression showed that screening was significantly higher in older children (OR: 2.19 [1.46–3.29]; p < 0.001 for 5- to less than 8-year-old children; OR: 2.37 [1.57–3.57]; p < 0.001 for 8- to less than 12-year-old children). Children of the Other race group were also found to have significantly lower screening rates than Black and White children (OR 0.44 [0.23–0.84]; p = 0.014). The odds of being screened were 94% lower in visits in which a medical trainee was involved (p < 0.001). The odds of being screened at a well-child visit were 3.7 times higher in encounters in which a templated note was used (p < 0.001). Conclusions: Less than half of the children presenting for well visits were screened for snoring in this cohort. Differences in screening were attenuated by trainee involvement and the use of templated notes, which presents further avenues to explore meeting guideline recommendations for SDB screening. Full article

The work of anesthesiologists–intensivists, critical care specialists, and medical emergency teams is multifaceted and complex, with airway management representing a cornerstone and a common denominator of many procedures and interventions. Tracheal intubation has represented and still represents today the gold standard for airway control. This narrative review, conducted through a comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Library from database inception to December 2025 and supplemented by manual reference searches and retrieval of key historical sources, aims to trace the evolution of laryngoscopy for airway management and tracheal intubation—from its nineteenth-century origins to the current state of the art—while simultaneously addressing the clinical, educational, and safety implications of this evolution. Laryngoscopy evolution progressed in parallel with technological development and innovation, resulting in the expansion of clinical possibilities and in the improvement of patient safety. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, culminating in the widespread adoption of the Macintosh laryngoscope. Almost 50 years later, a pivotal turning point occurred around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that succeeded one another introduced new problems, driving the search for new solutions. At present, tracheal intubation with videolaryngoscopy has achieved success and safety standards substantially superior to those of the early days of the technique. In this review we retrace the historical milestones of laryngoscopy, analyze the problems that emerged over time with various devices and the solutions adopted, examine the evolution of videolaryngoscopes and the impact of these devices on both technical and non-technical skills, discuss the ongoing debate surrounding their routine use (universal videolaryngoscopy) and the selection of optimal adjunct devices, and outline the emerging role of artificial intelligence in improving success rates and facilitating the learning curve. This journey, after 150 years of evolution, has reached a high level of maturity in terms of safety and efficacy. Full article

Positional obstructive sleep apnea (POSA) is a subtype of obstructive sleep apnea in which the apnea–hypopnea index (AHI) is significantly greater in the supine position than in non-supine positions. However, POSA remains underrecognized and lacks a universally accepted clinical definition. POSA’s prevalence can exceed 50% of OSA patients and occurs most frequently in patients with mild/moderate disease. In the supine position, gravity-dependent posterior displacement of the tongue and soft palate can increase upper airway collapsibility and drive the pathophysiology of POSA. These disturbances can carry meaningful cardiovascular consequences, including acute blood pressure surges that correlate with oxygen desaturation severity. As OSA is increasingly understood as a heterogeneous disorder shaped by variable anatomical and physiological traits, POSA offers a clinically actionable framework for precision sleep medicine. Current therapeutic strategies demonstrate that targeting the specific mechanisms of POSA can improve outcomes beyond what standardized CPAP treatment achieves alone. Racial and ethnic disparities in both POSA prevalence and treatment adherence further highlight the importance of individualized, culturally informed care. This review synthesizes the current understanding of the mechanisms, epidemiology, and therapeutic implications of POSA and evaluates its role as a model for individualized therapy in obstructive sleep apnea treatment. Full article