J. Otorhinolaryngol. Hear. Balance Med., Volume 6, Issue 2 (December 2025) – 11 articles

Background/Objectives: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by calcification and ossification of ligaments and tendons, primarily affecting the spine. While often asymptomatic, DISH in the cervical spine can cause dysphagia and, more rarely, vocal cord paralysis due to compression of the recurrent laryngeal nerve at the cricothyroid joint. Here, we report cases of unilateral vocal fold paresis in two patients with DISH. Case Presentation: Our first case is an 80-year-old male presented with two months of dysphonia. Strobovideolaryngoscopy found left vocal fold paresis with glottic insufficiency. Computed Tomography (CT) imaging showed DISH with large anteriorly projecting osteophytes in the cervical spine causing rightward deviation of the laryngeal structures and compressing the cricothyroid joint. Second, a 30-year-old female with Turner Syndrome and subglottic stenosis who developed progressively worsening dysphonia over 6 months, characterized by diminished voice projection and clarity. Strobovideolaryngoscopy revealed a mild-to-moderate right vocal fold paresis. CT of the neck demonstrated multiple right-sided osteophytes projecting into the right tracheoesophageal groove, along the course of the right recurrent laryngeal nerve, in the absence of significant disc degeneration. Discussion and Conclusions: On our review of the literature, no other similar instances of unilateral vocal fold paresis were found. We present these cases to emphasize the need for early recognition and treatment to prevent symptom progression of DISH. Full article

Background/Objectives: Head and neck cancers significantly affect patients’ functional and psychosocial well-being. Multidisciplinary tumor boards have a central role in optimizing treatment strategies, but the relationship between tumor characteristics, comorbidities, and quality of life (QoL) remains insufficiently explored. Methods: We conducted a retrospective study of 94 patients with head and neck cancers evaluated by the oncology committee of Coltea Clinical Hospital in 2024. QoL was assessed post-surgery using the EORTC QLQ-C30 and H&N35 questionnaires. Descriptive statistics, non-parametric tests, correlations, and multivariate regression analyses were performed to examine associations between clinical variables and QoL outcomes. Results: The cohort comprised 82 men (87.2%) and 12 women (12.8%), with a mean age of 61.5 ± 9.8 years. The most common tumor site was the larynx (43.6%). Global QoL was low (mean = 42.3, SD = 11.7), and fatigue scores were high (mean = 61.5, SD = 13.5). All EORTC domains showed non-normal distributions (Shapiro–Wilk, p < 0.05). Kruskal–Wallis analysis revealed significantly lower QoL scores in patients with metastatic adenopathy with aunknown primary (p = 0.03). Spearman’s correlation indicated a moderate negative association between Charlson Comorbidity Index and QoL (r = −0.38, p = 0.01). Multivariate regression confirmed comorbidities (β = −2.5, p = 0.02) and tumor type (metastatic adenopathy, β = −8.0, p = 0.04) as independent predictors of reduced QoL. Conclusions: Patients with advanced disease and higher comorbidity burden experience significantly poorer QoL after head and neck cancer surgery. Tumor board decisions facilitate individualized treatment planning; however, systematic integration of QoL metrics is essential to optimize both oncological and functional outcomes. Full article

Background/Objectives: Hearing loss is a disorder that develops because of being exposed to high noise levels affecting the quality of life among affected individuals. A review of the literature was conducted to explore the prevalence of hearing loss and its associated factors among workers in the metal industry. Methods: The literature search was conducted on ScienceDirect, Google Scholar, Pub Med, ResearchGate and African Journals Online databases to identify articles according to the Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines. The studies published in scientific journals between January 2014 and December 2024 describing hearing loss and its associated factors among workers in the metal industry were considered for inclusion in the review. The articles were screened by the author. The Critical Appraisal Skills Programme (CASP) quality assessment tool with modified checklist questions was used to evaluate the quality of studies. Results: Following the literature search and using the relevant inclusion criteria, a total of 127 articles were identified, and 8 articles with a total of 2605 participants were included in the review. The sample sizes ranged from 93 to 606. The participants’ age ranged from 19 to 65 years. A review of studies showed varying prevalence of hearing loss ranging from 13.8% to 59%. Furthermore, the studies have found working experience, advanced age, cigarette smoking, tinnitus, working in areas of high noise levels and not using hearing protective devices to be associated with a risk of developing hearing loss. Conclusions: The review found that workers in the metal industry are at risk of developing hearing loss and, therefore, implementation of control measures to prevent the occurrence of hearing loss is necessary. Full article

Background/Objectives: Maxillofacial volumetric deficits are often treated using structural fat grafting with autologous free fat grafts. The buccal fat pad (BFP) is commonly used as a pedicled flap for limited oral cavity applications. This study explores its use as a free graft for reconstructing deformities in the upper and lower lips caused by trauma or tumor resections. Methods: Five patients underwent soft tissue defect reconstruction using a free fat graft from the BFP, following standard surgical procedures. Techniques for harvesting, transferring, and evaluating aesthetic and functional outcomes up to three months post-surgery are detailed, with long-term follow-up extending to an average of 20 months (range 12–24 months). Results: Initial post-operative assessments showed lip asymmetry due to edema and excessive graft volume. Partial necrosis was observed within 1–2 weeks, typical of tissue healing. By 4–5 weeks, mucosal revascularization occurred, with desired lip volume and functionality achieved between 8–12 weeks. Long-term follow-up averaging 20 months demonstrated excellent graft stability with no volume regression beyond the vermilion border in all patients. Conclusions: The BFP as a free graft offers advantages such as high survival rates and easy harvesting. It effectively restores lip function, volume, and aesthetics. Challenges include graft manipulation, retention, potential fibrosis, and volume unpredictability. Future refinements in technique and follow-up are necessary to overcome these issues, enhancing the reliability of BFP for lip reconstruction. Full article

Background/Objectives: Conductive hearing loss (CHL) recurrence or persistence after stapes surgery is often due to prosthesis displacement or malfunction, with malleus fixation being a less common cause. While persistent CHL linked to malleus fixation can be managed with appropriate diagnosis and surgical intervention, recurrent CHL cases remain poorly documented. This report describes a rare case of recurrent CHL due to malleus neck fixation, likely secondary to surgical trauma. Case Presentation: A 49-year-old woman underwent bilateral stapedectomy. CHL worsened after two years. CT showed right incus erosion and a left bony bridge. Revision surgery corrected the right side. Left tympanotomy revealed malleus fixation from a prior atticotomy. Removing the bony bridge restored ossicular mobility and hearing, stable at 6 and 12 months. Discussion: Malleus fixation after stapedectomy is rare and often related to congenital anomalies, chronic otitis media, tympanosclerosis, or surgical trauma. Bone dust or fragments from surgery may promote new bone formation, causing delayed fixation. Ossicular fixation can develop postoperatively and may be missed during primary surgery. High-resolution CT aids in diagnosis, especially in revision cases, while intraoperative palpation is key to detecting subtle abnormalities. Treatment options include ossicular mobilization, prosthesis revision, or chain reconstruction, tailored to the fixation’s location and severity. Conclusions: Surgical trauma should be considered a potential cause of recurrent CHL post-stapedectomy. Thorough removal of bone debris through aspiration and irrigation during surgery is essential to minimize this risk and optimize long-term hearing outcomes. Full article

Background: The posterior labyrinth is particularly vulnerable to ischemic injury. Vertigo can occasionally be the only presenting symptom of acute myocardial infarction (AMI). Acute Bilateral Vestibular Neuropathy (ABVN) is an extremely rare condition, with only three cases previously reported in the literature. Its exact pathophysiological mechanisms remain unclear. Case Presentation: We present the case of a 76-year-old male who presented to the emergency department (ED) with vertigo and severe postural unsteadiness. Subsequently, a silent AMI was diagnosed, prompting cardiac stenting. Vestibular function assessments over the following eight months confirmed the diagnosis of ABVN. A cycle of vestibular rehabilitation yielded limited objective benefit, although the patient reported subjective improvement as measured by the Dizziness Handicap Inventory (DHI). Discussion and Conclusions: This case suggests a potential association between peripheral vestibular dysfunction and acute hemodynamic impairment due to myocardial infarction. Notably, it represents the first reported case of ABVN following a silent AMI, presenting solely with vestibular symptoms. Full article

The aim of this study article is to better understand patient outcomes following simple nasal fracture realignment, comparing outcomes when performed under LA versus GA. A systematic search of the evidence base is conducted. Data extraction and documentation are performed in keeping with PRISMA guidance. Critical appraisal tools are applied to aid quality assessment and assessment of bias. Twelve articles were selected for inclusion in this review, accumulating 2405 participants in total. No significant difference in patient outcomes between the LA and GA groups was observed. There was high variation in article quality, with some assessed as having a high risk of bias. Although some methodological limitations and outcome heterogeneity between studies hamper our ability for direct comparison, it seems likely that patient outcomes after nasal fracture correction under LA versus GA are comparable. Further large-scale studies with an agreed set of outcome measures are required to understand this relationship more fully. Full article

Background/Objectives: Leishmania spp. are protozoan parasites transmitted by female sandflies (Phlebotomus or Lutzomyia). Clinical manifestations depend on species and host immunity. While cutaneous and visceral forms prevail, mucocutaneous involvement—particularly isolated nasal septum leishmaniasis—is rare and frequently misdiagnosed as an inflammatory, infectious, or neoplastic condition. Risk factors associated with mucocutaneous leishmaniasis include systemic or local immunodeficiency, prior renal transplantation, treatment with chronic inhaled steroids, residence in endemic areas or travel to such regions, and previous Leishmania infections. Immunosuppressed patients are at higher risk for atypical presentations and delayed diagnosis, which can result in extensive tissue destruction. Early clinical suspicion, histopathological confirmation, and prompt therapy are essential to prevent permanent mucosal damage. Therefore, a multidisciplinary approach is needed for adequate evaluation and effective treatment. Methods: A 67-year-old man with rheumatoid arthritis on methotrexate reported a two-year history of right-sided nasal obstruction and ulceration that failed to respond to antibiotics. He did not present systemic symptoms. Results: Facial CT revealed a septal deviation; the patient underwent septoplasty, and biopsy confirmed Leishmania amastigotes. Serology (rK39 immunochromatographic test) was positive. He was treated with liposomal amphotericin B at 4 mg/kg/day for five days, followed by miltefosine at 100 mg/day orally for 14 days. At an eight-week follow-up, the nasal mucosa was fully healed, obstruction was resolved, and there was no evidence of recurrence. Conclusions: Although nasal septum leishmaniasis is uncommon, it should be considered in the differential diagnosis of chronic nasal lesions, especially in immunocompromised patients or those from endemic regions. Definitive diagnosis requires biopsy with histological or molecular confirmation. Combined liposomal amphotericin B and miltefosine therapy yields high cure rates and prevents mucosal destruction. Early recognition is critical to avoid diagnostic delays and long-term sequelae. Full article

Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the nasal and paranasal mucosa that significantly impacts the quality of life. Postoperative inflammation and polyp recurrence remain common despite advances in endoscopic sinus surgery (ESS), prompting interest in localized corticosteroid delivery systems. This review analyzes bioresorbable steroid-releasing implants and corticosteroid-impregnated nasal dressings, focusing on their pharmacologic mechanisms, safety, and clinical outcomes. A synthesis of findings from randomized trials and observational studies was performed, with emphasis on devices such as Propel™, NasoPore, Merocel, SinuBand FP, and gel-based dressings. The Propel implant demonstrated robust evidence for reducing adhesions and inflammation with negligible systemic absorption. NasoPore and Merocel provided structural support and localized steroid delivery but lacked controlled-release kinetics. Gel-based dressings and SinuBand FP offered anatomic adaptability, with limited systemic effects. Some methods showed systemic steroid exposure in cortisol monitoring. Corticosteroid-releasing devices enhance ESS outcomes through localized therapy. While Propel is the most validated, other devices remain viable alternatives in specific clinical contexts. Comprehensive safety monitoring and standardized trials are essential to optimize their integration into postoperative care. Full article

Background: Interdigitating dendritic cell sarcoma (IDCS) is a very rare haematologic malignant tumour that arises from antigen-presenting cells. While it primarily affects the lymph nodes, extranodal manifestations have been observed, and there is a slight male predominance. Due to its rarity, diagnosing IDCS can be challenging, as illustrated in our case report of a 61-year-old woman. Methods: In this case presentation, the oncological management of a patient suspected of having malignant melanoma metastasis in the neck lymph nodes is discussed. This includes otorhinolaryngological examinations, fine needle aspiration biopsy, PET CT imaging, and histological analysis with immunohistochemistry. Results: The patient’s medical history included the excision of a pigmented lesion from the left ala of her nose, which was diagnosed as malignant melanoma. After surgical treatment, she experienced a tumour-free period of one year; however, during a follow-up ultrasonography three pathological lymph nodes were detected on the left side of her neck. Initially, a nodal metastasis of melanoma was suspected. Yet, fine needle aspiration cytology revealed myofibroblastic tumour invasion, and a re-biopsy showed no signs of malignancy. To further investigate, PET-CT scans were conducted, and a modified radical neck dissection was performed based on the findings. The histological analysis of the lymph nodes revealed an IDCS, a second independent tumour distinct from the initially diagnosed malignant melanoma, originating from the submandibular, upper jugular, and mid-jugular lymph nodes. Conclusions: This case highlights the diagnostic difficulties associated with IDCS. Initially, the clinical suspicion of malignant melanoma was considered, necessitating further examinations and a multidisciplinary approach to reach a final diagnosis and provide the patient with appropriate treatment. Full article