Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background/Objectives: Despite the high prevalence (around 4.1–37.2%) and highly debilitating adverse impact, there has been inconclusive evidence regarding the efficacy of treatment for tinnitus management, especially for those patients with tinnitus who do not have a specific or treatable origin. The aim of this updated network meta-analysis (NMA) was to estimate the efficacy and safety of the different non-invasive brain stimulation (NIBS) interventions in tinnitus management in patients with chronic tinnitus without a specific or treatable origin. Methods: This NMA included randomized controlled trials (RCTs) of NIBS interventions in patients with chronic tinnitus. The current NMA was conducted using the frequentist model. The primary outcome was a change in tinnitus severity after the NIBS intervention. Results: We identified 45 eligible RCTs with a total of 2042 participants. The results of the current NMA showed that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, or response rate. While several protocols showed a signal, the top-ranked intervention was preliminary and derived from a single, small study. All the NIBS interventions had fair acceptability compared to the controls. Conclusions: This NMA highlighted that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, and/or response rate. Future well-designed RCTs with electroencephalogram applications are needed for replication over the proclamation of efficacy. Full article

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life. Full article

Background/Objectives: The vestibular labyrinth is classically viewed as a sensor of low-frequency head motion—linear acceleration for the otoliths and angular velocity/acceleration for the semicircular canals. However, there is now substantial evidence that air-conducted sound (ACS) can also activate vestibular receptors and afferents in mammals and other vertebrates. This sound sensitivity underlies sound-evoked vestibular-evoked myogenic potentials (VEMPs), sound-induced eye movements, and several clinical phenomena in third-window pathologies. The cellular and biophysical mechanisms by which a pressure wave in the cochlear fluids is transformed into a vestibular neural signal remain incompletely integrated into a single framework. This study aimed to provide a narrative synthesis of how ACS activates the vestibular labyrinth, with emphasis on (1) the anatomical and biophysical specializations of the maculae and cristae, (2) the dual-channel organization of vestibular hair cells and afferents, and (3) the encoding of fast, jerk-rich acoustic transients by irregular, striolar/central afferents. Methods: We integrate experimental evidence from single-unit recordings in animals, in vitro hair cell and calyx physiology, anatomical studies of macular structure, and human clinical data on sound-evoked VEMPs and sound-induced eye movements. Key concepts from vestibular cellular neurophysiology and from the physics of sinusoidal motion (displacement, velocity, acceleration, jerk) are combined into a unified interpretative scheme. Results: ACS transmitted through the middle ear generates pressure waves in the perilymph and endolymph not only in the cochlea but also in vestibular compartments. These waves produce local fluid particle motions and pressure gradients that can deflect hair bundles in selected regions of the otolith maculae and canal cristae. Irregular afferents innervating type I hair cells in the striola (maculae) and central zones (cristae) exhibit phase locking to ACS up to at least 1–2 kHz, with much lower thresholds than regular afferents. Cellular and synaptic specializations—transducer adaptation, low-voltage-activated K⁺ conductances (K_LV), fast quantal and non-quantal transmission, and afferent spike-generator properties—implement effective high-pass filtering and phase lead, making these pathways particularly sensitive to rapid changes in acceleration, i.e., mechanical jerk, rather than to slowly varying displacement or acceleration. Clinically, short-rise-time ACS stimuli (clicks and brief tone bursts) elicit robust cervical and ocular VEMPs with clear thresholds and input–output relationships, reflecting the recruitment of these jerk-sensitive utricular and saccular pathways. Sound-induced eye movements and nystagmus in third-window syndromes similarly reflect abnormally enhanced access of ACS-generated pressure waves to canal and otolith receptors. Conclusions: The vestibular labyrinth does not merely “tolerate” air-conducted sound as a spill-over from cochlear mechanics; it contains a dedicated high-frequency, transient-sensitive channel—dominated by type I hair cells and irregular afferents—that is well suited to encoding jerk-rich acoustic events. We propose that ACS-evoked vestibular responses, including VEMPs, are best interpreted within a dual-channel framework in which (1) regular, extrastriolar/peripheral pathways encode sustained head motion and low-frequency acceleration, while (2) irregular, striolar/central pathways encode fast, sound-driven transients distinguished by high jerk, steep onset, and precise spike timing. Full article

Background: Paragangliomas of the head and neck are rare, benign and indolent to slow-growing tumors. Not all tumors require immediate active intervention, and surveillance is a viable management strategy in a large proportion of cases. Treatment decisions are based on several tumor- and patient-related factors, with the tumor progression rate being a predominant determinant. Accurate prediction of tumor progression has the potential to significantly improve treatment decisions by helping to identify patients who are likely to require active treatment in the future. It furthermore enables better-informed timing for follow-up, allowing early intervention for those who will ultimately need it, and optimization of the use of resources (such as MRI scans). Crucial to this is having reliable estimates of the uncertainty associated with a future growth forecast, so that this can be taken into account in the decision-making process. Methods: For various tumor growth prediction models, two methods for uncertainty estimation were compared: a historical-based one and a Bayesian one. We also investigated how incorporating either tumor-specific or general estimates of auto-segmentation uncertainty impacts the results of growth prediction. The performance of the uncertainty estimates was examined both from a technical and a practical perspective. Study design: Method comparison study. Results: Data of 208 patients were used, comprising 311 paragangliomas and 1501 volume measurements, resulting in 2547 tumor growth predictions (a median of 10 predictions per tumor). As expected, the uncertainty increased with the length of the prediction horizon and decreased with the inclusion of more tumor measurement data in the prediction model. The historical method resulted in estimated confidence intervals where the actual value fell within the estimated 95% confidence interval 94% of the time. However, this method resulted in confidence intervals that were too wide to be clinically useful (often over 200% of the predicted volume), and showed poor ability to differentiate growing and stable tumors. The estimated confidence intervals of the Bayesian method were much narrower. However, the 95% credible intervals were too narrow, with the true tumor volume falling within them only 78% of the time, indicating underestimation of uncertainty and insufficient calibration. Despite this, the Bayesian method showed markedly better ability to distinguishing between growing and stable tumors, which has arguably the most practical value. When combining all growth models, the Bayesian method using tumor-specific auto-segmentation uncertainties resulted in an 86% correct classification of growing and non-growing tumors. Conclusions: Of the methods evaluated for predicting paraganglioma progression, the Bayesian method is the most useful in the considered context, because it shows the best ability to discriminate between growing and non-growing tumors. To determine how these methods could be used and what their value is for patients, they should be further evaluated in a clinical setting. Full article

Background: Narrow duplicated internal auditory canal (IAC) is a rare congenital malformation frequently associated with severe-to-profound sensorineural hearing loss. Case Presentation: We present a one-year-old girl with bilateral narrow duplicated IAC and profound hearing loss evaluated through CT/MRI and electrically evoked auditory brainstem response (EABR). Methods: We conducted a systematic review (1990–2023), identifying 59 published cases of which 24 were bilateral. The mean age at diagnosis was 10.34 years, and 25 cases presented additional inner ear malformations. Only seven patients underwent cochlear implantation, and EABR was performed in four cases. Outcomes of cochlear implantation were heterogeneous. Discussion: In our case, EABR showed a reproducible wave V on the right side, supporting candidacy for cochlear implantation which led to positive early auditory responses. Conclusions: This case and review highlight the role of EABR in identifying residual cochlear nerve functionality and guiding candidacy for cochlear implantation in narrow duplicated IAC. Full article

Objective: This study aims to examine the frequency of emergency department (ED) visits and the occurrence of postoperative nasal symptoms (PNSs) following endonasal skull base surgery (EESBS). Methods: A retrospective cohort study of patients who underwent EESBS at a tertiary referral center. The primary outcome was the frequency of ED visits within 30 days following surgery. Secondary outcomes included the incidence of PNS, readmissions, reoperations, and mortality. Results: A total of 307 patients (143 [46.6%] males, mean age: 58.03 years [interquartile range: 47–70.5]) were included in this analysis. Within 30 days following surgery, 89 patients (29%) presented to the ED, and 32 (10.4%) were readmitted. PNSs were the primary complaint in 60 (67.4%) patients, including nasal discharge in 42 (70%), epistaxis in 14 (23.3%), and obstruction in 4 (6.7%). Twenty-four (26.9%) patients had more than one PNS. Among patients presenting with nasal discharge, two were confirmed to have cerebrospinal fluid rhinorrhea. In both univariate and multivariable analyses, PNSs were not associated with nasoseptal flap harvesting, extended (beyond sella) approach, skull base reconstruction, readmissions, or reoperation. The 30-day mortality rate was 0.6%, with no association with PNS. Results remained consistent whether PNSs were analyzed as a composite outcome or as individual symptoms. Conclusions: Nearly one-third of patients visited the ED after EESBS, with two-thirds due to PNS. Most PNSs are self-limited but cause morbidity and prompt medical visits. Full article

Background: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an abrupt unilateral hearing loss of unknown origin. Combination therapy with hyperbaric oxygen (HBO), systemic steroids (SS), and prostaglandin E1 (PGE1) has been used in Japan; however, its prognostic factors remain unclear. Objective: To evaluate the efficacy of HBO combined with SS and PGE1 and to identify prognostic factors for hearing recovery in patients with ISSNHL. Methods: This retrospective study included 116 patients treated within 14 days of ISSNHL onset. Sixty patients received HBO, SS, and PGE1 (HBO group), and 56 received SS and PGE1 alone (No-HBO group). Hearing outcomes were assessed using PTA (arithmetic mean hearing at 250–4000 Hz) and graded by Siegel’s criteria. Prognostic factors were analyzed by multivariate logistic regression. Results: The HBO group showed significantly better hearing grade outcomes (p = 0.007) and greater PTA improvement (p = 0.003) than the No-HBO group. Vertigo and higher initial PTA were identified as independent predictors of poor hearing outcomes. Patients without vertigo showed significantly greater improvement at 2000 Hz (p = 0.009). Receiver operating characteristic analysis revealed an optimal initial PTA cutoff of ≥90.5 dB for predicting poor hearing outcome. Conclusions: HBO combined with SS and PGE1 significantly improves hearing outcomes in ISSNHL. However, the presence of vertigo and severe initial hearing loss remain poor prognostic indicators. These findings suggest that while the addition of HBO may enhance hearing outcomes, prognosis remains limited in severe cases. Further prospective studies are needed to confirm these results. Full article

Background/Objectives: This narrative review aims to evaluate the use of pupillometry as an objective measure of auditory perception and listening effort across the lifespan. Specifically, it synthesizes research examining pupillary responses in individuals with and without hearing impairment across pediatric, adult, and older adult populations. The review addresses methodological practices and clinical implications for integrating pupillometry into routine audiological assessment. Methods: 12 peer-reviewed studies published between 2010 and 2025 were selected through a systematic search of databases including PubMed, Scopus, Web of Science, and Google Scholar. Inclusion criteria required empirical use of pupillometry in auditory tasks involving human participants with normal hearing or hearing impairment. Studies were analyzed for population characteristics, experimental paradigms, pupillometric metrics (e.g., peak pupil dilation), level of evidence, and relevance to clinical audiology. This article uses a narrative review approach to organize and interpret findings. Results: Across age groups and hearing conditions, pupillometry consistently demonstrated sensitivity to cognitive load and listening effort, particularly in noisy environments or during complex auditory tasks. Pediatric studies revealed its potential as a non-invasive tool for preverbal children. Adult and older adult studies confirmed that pupillary responses reflect device performance (e.g., hearing aids, cochlear implants) and cognitive–linguistic demands. Methodological variability and individual differences in pupil response patterns were noted as limitations. Conclusions: The findings support the use of pupillometry as a valuable adjunct to behavioral audiometry, offering objective insight into auditory–cognitive load. Its application holds promise for pediatric diagnostics, hearing technology evaluation, and geriatric audiology. Standardization of measurement protocols and development of normative data are necessary to enhance clinical applicability and generalizability. Full article

Background/Objectives: The high prevalence of benign paroxysmal positional vertigo (BPPV) poses a considerable burden on healthcare systems, with an estimated annual cost of 2 billion dollars per year in the United States. The results of previous network meta-analyses (NMAs) have been inconclusive regarding the efficacy of different treatment strategies for managing BPPV. This study aimed to provide updated evidence of the comparative efficacy and safety of different treatment strategies in patients with BPPV. Methods: The present study was divided into two subgroups. The first part was the posterior canal BPPV, and the second was the horizontal canal BPPV. This frequentist model-based NMA included randomized controlled trials (RCTs) of treatments for BPPV, either in the posterior or horizontal canal. Results: This NMA of 82 RCTs revealed that, regarding posterior canal BPPV, most maneuvers plus postmaneuver rehabilitation/self-treatments were ranked superior to the traditional maneuver with/without medication in terms of the resolution rate. Among them, the modified Epley maneuver + self-treatment at home [odds ratio (OR) = 33.70, 95% confidence intervals (95%CIs) = 6.45–176.13] was ranked to be associated with the highest resolution rate. Regarding horizontal canal BPPV, only the Gufoni maneuver was associated with a significantly better resolution rate (OR = 4.40, 95%CIs = 1.13–17.12) and a higher transition/conversion rate (OR = 3.55, 95%CIs = 1.20–10.57) than that of sham/control groups. Conclusions: This study provides evidence that treatment strategies consisting of maneuvers in combination with postmaneuver rehabilitation/self-treatment may be preferred for managing BPPV affecting the posterior canal. However, no effective treatment strategy for horizontal canal involvement has been identified. Full article

Background and Objectives: Speech-in-noise testing is essential for evaluating functional hearing abilities in clinical practice. Although the Quick Speech-in-Noise test (QuickSIN) is widely used, no equivalent tool existed for European Portuguese. This study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), linguistically adapted and calibrated for native speakers, to support clinical assessment of speech perception in realistic listening environments. Materials and Methods: The SiN-EP was developed through a multi-stage process. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical accuracy. Selected sentences were recorded by a female native speaker in a controlled acoustic environment and mixed with multi-talker babble at signal-to-noise ratios (SNR (dB)) from 25 to 0 SNR (dB). A pre-test in a free-field setting at 65 dB SPL was conducted with fifteen normal-hearing young adults. Participants repeated each sentence, and their responses were analyzed to refine list composition, adjust difficulty, and ensure phonetic balance. Results: Intelligibility decreased systematically as SNR (dB) worsened, with ceiling effects at 25 and 20 SNR (dB). At 5 SNR (dB), high variability was observed, with set 5 showing disproportionate difficulty and set 14 containing an incomplete sentence; both were removed. At 0 SNR (dB), all sets demonstrated expected low intelligibility. The final test comprises thirteen lists of six sentences, each maintaining stable intelligibility, phonetic representativeness, and consistent difficulty across SNRs (dB). Conclusions: The SiN-EP provides a linguistically appropriate, phonetically balanced, and SNR (dB) calibrated instrument for assessing speech-in-noise perception in European Portuguese. The refinement process improved reliability and list equivalence, supporting the test’s clinical and research applicability. The SiN-EP fills a critical gap in assessing speech-in-noise perception in European Portuguese speakers, providing a reliable tool for both clinical and research applications. Full article

Background and Clinical Significance: Otitis media with effusion (OME) is characterized by persistent middle ear effusion without acute infection. Type 2 inflammation, mediated by IL-4 and IL-13 signaling via the IL-4Rα receptor, has been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP), asthma, and possibly OME. Refractory OME in adults remains a therapeutic challenge, as conventional treatments often fail to achieve long-term resolution. Targeted biologic therapies that modulate type 2 inflammation may offer a novel treatment option. Case Presentation: We report the case of a 60-year-old man with a 15-year history of allergic rhinitis and CRSwNP, complicated by recurrent asthma exacerbations, who presented with bilateral aural fullness, hearing loss, and tinnitus. His symptoms persisted despite repeated tympanic punctures, Eustachian tube insufflation, and corticosteroid therapy. Otoscopy revealed dull tympanic membranes with effusion, and audiometry showed conductive hearing loss with a B-type tympanogram on the left. Laboratory findings demonstrated mild peripheral eosinophilia. The patient was diagnosed with OME, likely secondary to type 2 inflammation. After nine biweekly injections of Stapokibart (CM310)—a humanized monoclonal antibody targeting IL-4Rα—aural fullness completely resolved. Otoscopic findings and tympanograms normalized, and hearing thresholds improved significantly. Retrospective evaluation using Iino’s diagnostic framework suggested that the patient did not meet the full criteria for eosinophilic otitis media (EOM); nevertheless, marked symptomatic and functional improvement was achieved. No recurrence or adverse effects were observed during follow-up. Conclusions: This case suggests that IL-4Rα blockade with Stapokibart may be effective in treating refractory OME associated with type 2 inflammation, even in patients who do not fulfill the diagnostic criteria for EOM. These findings highlight the potential of anti-IL-4Rα biologics as a novel therapeutic option for middle ear diseases driven by type 2 inflammation. Full article

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