Background: To compare the functional and anatomical results of two different types of grafts in type 1 tympanoplasty (TPL I). Methods: A retrospective comparative bicentric study was conducted on patients treated with TPL I using temporal fascia or tragal cartilage. We evaluated the functional and anatomical results with intergroup and intragroup analyses. Variables predicting long-term success were also evaluated. Results: A total of 142 patients (98 fascia graft vs. 44 cartilage) were initially assessed, with a mean follow-up of 67.1 ± 3.2 months. No significant differences were observed between the two groups on the intergroup analysis of age, gender, ear side, or pre-operative hearing data (all p > 0.05). At the intragroup analysis of auditory outcomes, both groups demonstrated a significant improvement in post-operative air conduction, with greater gain for the fascia group at 6 months follow-up (p < 0.001 for both); however, at long-term follow-up, cartilage demonstrated better stability results (p < 0.001). When comparing the pre-and post-operative air-bone-gap (ABG), both groups showed a significant gain (p < 0.001); the fascia group showed that at 6 months, a greater ABG increase was found, but the difference was not statistically significant (4.9 ± 0.9 dB vs. 5.3 ± 1.2 dB; p = 0.04). On the contrary, the cartilage group at long-term follow-up at 5 years maintained greater outcomes (10 ± 1.6 dB vs. 6.4 ± 2 dB; p < 0.001). Lower age (F = 4.591; p = 0.036) and higher size of perforation (F = 4.820; p = 0.030) were predictors of long-term functional success. Conclusions: The graft material selection should consider several factors influencing the surgical outcome. At long-term follow-up, the use of a cartilage graft could result in more stable audiological outcomes, especially in younger patients or in case of wider perforations.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are mutually correlated with Type-2 inflammation. Dupilumab is effective in uncontrolled and relapsing CRSwNP. However, the precise characterization of Type-2 inflammation and the impact of previous surgery on clinical outcomes need clarification. Methods: We present a prospective observational study on a 38 CRSwNP-patient cohort, whose Type-2 endotype was confirmed after a multidisciplinary approach shared among ENTs, pneumologists and allergologists. Patients were treated with dupilumab and evaluated at 15 days and 1-3-6-12-18-24-30 months, focusing on clinical (VAS, nasal polyp score—NPS), radiological (Lund-Mackay) and quality of life (SNOT-22) parameters, as well olfactory function, asthma control, variation of Type-2 markers and number and extent (ACCESS score) of previous surgeries. Results: We confirmed the efficacy of dupilumab in total and sub-items VAS, NPS, SNOT-22 and sniffing score, as well as Lund–Mackay score improvements, observable and significant after 2 weeks of treatment (p < 0.0001) and long-lasting over 30 months. Good to excellent response criteria to biologic treatment at 6 months was observed in 30/32 patients. Comorbid asthma reached rapid control (p < 0.0001) and exhaled nitric oxide normalization was achieved. One single “not adequate” surgery showed a trend to milder improvement, as well as a higher ACCESS score to better olfactory outcome. Conclusions: The accurate selection of uncontrolled relapsing CRSwNP in terms of Type-2 endotyping by multidisciplinary approach can maximize dupilumab efficacy. The number and extent of previous surgeries may differentiate the response, although this effect is difficult to catch in real life. “Adequate” ESS surgery before dupilumab may drive mostly effective disease control.

Cholesterol granuloma is an uncommon inflammatory lesion whose etiology is still unclear. It is thought to originate from blood accumulation in a pneumatized space, probably after bleeding. The most frequent site is the petrous apex of the temporal bone, whilst it is very uncommon in the paranasal sinuses. We present a clinical case of an 80-year-old female patient with intense frontal headache and diplopia who underwent a neuro-navigated endoscopic sinus surgery. The histological diagnosis was a cholesterol granuloma of the frontal sinus, contaminated by Aspergillus Fumigatus hyphae. Cholesterol granuloma of the frontal sinus is a rare finding in clinical practice, but it should be taken into account in the diagnostic path in presence of rapidly increasing sight alterations and headache, even without rhinological symptoms.

Background: Sphenoiditis poses diagnostic and treatment challenges due to its complex anatomy and potential for serious complications. Anatomic variations, such as Onodi cells, could play a role in the onset and spreading of inflammation. The diagnosis and treatment of sphenoiditis can be more difficult if Onodi cells are present, especially due to their proximity to delicate vital tissues. Objectives: The purpose of this study was to look at the frequency, features, and relationship between Onodi cells and sphenoiditis. Methods: This multicentric study comprised 550 people who received sinonasal CT imaging. The Thimmaiah classification was used to assess the presence and features of Onodi cells, and radiographic results were used to diagnose sphenoiditis. We conducted univariate and multivariate logistic regression to evaluate the relationships between sphenoiditis and Onodi cells. Results: The prevalence of Onodi cells was 32.40%, with a higher prevalence on the right side (18.40%) compared to the left side (8.40%). The multivariable analysis revealed a significant correlation between right-side Type II Onodi cells and a higher incidence of sphenoiditis (OR = 6.81, 95% CI: 1.14–38.97, p = 0.029). In the univariable analysis (OR = 3.00, 95% CI: 1.15–6.96, p = 0.015), but not in the multivariable analysis, the presence of Type I Onodi cells on the left side was significantly associated with sphenoiditis. Conclusions: There may be a link between a higher incidence of sphenoiditis and the presence of Type II Onodi cells on the right side. In order to validate these findings and clarify the underlying processes of this connection, more prospective research is required.

We report the case of a 16-year-old girl presenting with a painless, clinically stable subcutaneous swelling of the nasal dorsum with a three-year history. Despite an extensive multidisciplinary diagnostic work-up—including dermatological, otorhinolaryngological, and radiological evaluations (ultrasound, CT, and MRI)—the nature of the lesion remained indeterminate. In order to achieve a definitive diagnosis while preserving the nasal profile aesthetics, the mass was entirely excised via an endoscope-assisted closed rhinoseptoplasty approach. Histopathological analysis revealed a spindle cell lipoma characterized by CD34 positivity and a Ki-67 proliferation index of less than 1%. This finding is extremely rare in terms of both anatomical location and patient age. The present case highlights the crucial role of histopathological examination in establishing the correct diagnosis, supported by a multidisciplinary assessment.

Background and Clinical Significance: Frontal sinus disease remains one of the most challenging conditions in rhinology due to its complex and variable anatomy and high tendency toward postoperative stenosis. Paranasal sinus mucoceles are uncommon, delayed complications following functional endoscopic sinus surgery (FESS), most often involving the frontal or anterior ethmoidal sinuses. They may arise from obstruction or scarring of natural drainage pathways, producing recurrent sinusitis or headache; Case Presentation: A 21-year-old male presented with persistent left-sided frontal headache and nasal obstruction after two previous FESS procedures. Radiologically, CT and MRI demonstrated chronic left-sided sinonasal inflammatory disease and two frontal-ethmoidal mucoceles. Revision endoscopic sinus surgery was performed with an image-guided (neuronavigation-assisted) technique, including Draf IIb frontal sinusotomy, mucocele marsupialization, and corrective septoplasty. The postoperative course was uneventful with rapid clinical improvement; Conclusions: Double postoperative mucoceles following ESS are rare. Neuronavigation-assisted revision surgery can be used for effective management in scarred, anatomically distorted sinus regions. However, this single case cannot establish superiority over conventional endoscopic guidance or demonstrate an effect on safety, efficacy, or recurrence.