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

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