This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.

Management of vestibular schwannoma (VS) is a complex process aimed at identifying a clinical indication for fractionated stereotactic radiotherapy (sRT) or microsurgical resection or wait and scan (WS). The aim of the review was to clarify which patient and tumor parameters may lead to different therapeutic choices, with a view to a personalized VS approach. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between February and March 2022. The authors defined six parameters that seemed to influence decision-making in VS management: 1-incidental VS; 2-tumor size; 3-tumor regrowth after sRT; 4-subtotal resection; 5-patients’ age; 6-symptoms. The initial search yielded 3532 articles, and finally, 812 articles were included. Through a qualitative synthesis of the included studies, management strategies were evaluated and discussed. An individualized proposal of procedures is preferable as compared to a single gold-standard approach in VS decision-making. The most significant factors that need to be considered when dealing with a VS diagnosis are age, tumor size and hearing preservation issues.

Sinonasal neoplasms are uncommon diseases, characterized by heterogeneous biological behavior, which frequently results in challenges in differential diagnosis and treatment choice. The aim of this review was to examine the pathogenesis and molecular mechanisms underlying the regulation of tumor initiation and growth, in order to better define diagnostic and therapeutic strategies as well as the prognostic impact of these rare neoplasms. A systematic review according to Preferred Reporting Items for Systematic Review and Meta-Analysis criteria was conducted between September and November 2022. The authors considered the three main histological patterns of sinonasal tumors, namely Squamous Cell Carcinoma, Intestinal-Type Adenocarcinoma, and Olfactory Neuroblastoma. In total, 246 articles were eventually included in the analysis. The genetic and epigenetic changes underlying the oncogenic process were discussed, through a qualitative synthesis of the included studies. The identification of a comprehensive model of carcinogenesis for each sinonasal cancer subtype is needed, in order to pave the way toward tailored treatment approaches and improve survival for this rare and challenging group of cancers.

Objective: Diffusion of endoscopic techniques for the resection of ethmoid bone malignancies through a transcribriform approach (TA) has raised new challenges regarding reconstruction options to reduce post‐operative complications. Although there is consensus on the advantages of vascularized flaps over free grafts for large defects, no standard protocol exists on reconstruction procedures. In addition, although the pedicled nasoseptal flap has been extensively discussed, few studies have been published on extranasal pedicled flaps. The aim of this manuscript is to provide a detailed description of a reconstruction technique for large anterior skull base defects with the pericranial flap as part of a multilayered reconstruction. Moreover, patients treated with this approach were retrospectively assessed for post‐operative complications.Methods: A detailed description of the reconstruction procedure as performed in our departments is provided. Pictures depicting the main surgical steps are also included. In addition, preliminary functional results from a retrospective series of patients who underwent a TA and subsequent pericranial flap‐based multilayer reconstruction for ethmoid roof malignancies between 2016 and 2022 at two institutional centers are reported.Results: 16 patients were included in the study. Nine patients (56.3%) underwent adjuvant radiotherapy. Two patients had a biochemically‐confirmed postoperative CSF leak. Only one of the two patients required surgical revision. During follow‐up (mean 13 months), no other early nor delayed complications were observed.Conclusion: A standardized surgical technique with pericranial flap as part of a multilayered reconstruction for large anterior skull base defects following resection of sinonasal malignancies is proposed, which appears to be a safe choice when endonasal flaps are not available.Level of Evidence: Level 4 Laryngoscope, 133:2942–2947, 2023

This study aimed to assess how the extent of parenchymal removal impacts on postoperative complications after benign parotid surgery. A multicentric retrospective study on parotidectomies for benign lesions performed between 2014 and 2020 was carried out. Demographics, tumor characteristics, surgical details, and postoperative outcomes were analyzed. In total, 591 patients were included. Multivariable logistic regression analysis revealed that partial superficial parotidectomy (PSP) was associated with a lower risk of postoperative facial nerve (FN) palsy, great auricular nerve (GAN) hypoanesthesia, and Frey syndrome (FS) than superficial parotidectomy (SP), irrespective of tumor size. Extracapsular dissection (ECD) was found to be protective for FS compared with SP, irrespective of tumor size. ECD was associated with a higher risk of FN palsy and GAN hypoanesthesia than PSP. Minimally invasive parotidectomy procedures, such as ECD and PSP, are associated with similar or even decreased rates of postoperative complications when compared with more traditional procedures, such as SP.

Prior to the introduction of biologic drugs, the natural history of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) was characterized by multiple recurrences, thus necessitating multiple surgical interventions. To understand whether Dupilumab efficacy in recurrent CRSwNP varies based on number of previous surgeries. This is a multicentric retrospective study on patients with CRSwNP under Dupilumab, who underwent at least one previous surgery. Correlations between number of previous surgeries and clinical outcomes at baseline and during treatment were investigated. 141 patients were included. Mean number of prior surgeries was 2.19 (median 2; range 1-13). For all patients, significant improvements were observed across all time points. Poorer results were observed in patients subjected to more than one prior surgery in terms of NPS at T2 (p .04), SNOT-22 at T4 (p .03), VAS for olfactory dysfunction at T3 (p .01) and T5 (p .009), VAS for nasal obstruction at T4 (p .047), VAS for rhinorrhea at T4 (p .02), VAS for craniofacial pain at T1 (p .02) and T2 (p .04) and of VAS for sleep disturbances at T1 (p .04). Patients subjected to multiple surgeries have worse outcomes during treatment with Dupilumab, particularly for what concerns craniofacial pain and olfactory dysfunction.