Objective: To discuss indications (unfavorable conditions), surgical steps, complications, and follow-up of subtotal petrosectomy (STP) in cochlear implantation based on our experience of 348 cases. Anatomical variations associated with or without cochlear malformations and differences between electrode insertions were included in our analysis. Materials and methods: A retrospective case study was done in Gruppo Otologico (Piacenza, Italy), a quaternary referral center. Among 1002 cases that underwent subtotal petrosectomy, 348 were selected for cochlear implantation in the same setting. The study period was from 2004 to 2019. These patients’ clinical and radiological follow-up ranged from 2 months to 180 months. Data were inspected, cleaned, and analyzed by SPSS software. Results: The selected group’s mean age was 57.236 years, including 178 male and 170 female patients. The follow-up period lasted up to 108.65 months. Out of 348 cases, 8 were children (under the age of 18 years old). Inclusion criteria to be eligible for cochlear implantation in the same setting of subtotal petrosectomy was a preoperative pure tone average (PTA) of more than 90 decibels associated with low speech discrimination ranging from 0% in most cases up to 50% in the minority. 329 patients had a complete electrode insertion intra-operatively. Minor complications were observed in 6 cases. These include one case of implant extrusion due to a middle ear infection leading to labyrinthitis, three cases of post-auricular fistula causing one device failure, one subcutaneous CSF collection, and one subcutaneous seroma collection. Conclusion: Although in most cases, standardized trans mastoid facial recess technique for cochlear implantation is ideal as the surgical risks are minimal, in complicated cases such as concomitant chronic otitis media, prior canal wall-down cases, radical cavities, or inner ear abnormalities with high risk of cerebrospinal fluid leak subtotal petrosectomy should be the first choice of management with complete disease clearance. Close clinical and radiological follow-up is therefore mandatory. Single-stage implantation is preferred to staging the procedure unless one is unsure of disease clearance.

Late radiation-associated dysphagia (late-RAD) remains a challenge in head and neck cancer (HNC) survivorship, despite advancements in treatment methods. Although Fiberoptic Endoscopic Evaluation of Swallowing (FEES) stands as the preferred diagnostic approach for oropharyngeal dysphagia assessment in the HNC population, current studies lack a FEES-derived swallowing parameter characterization and phenotypic classification within this specific cohort. This study sought to employ FEES-based assessment to characterize swallowing safety and efficacy profiles, identify distinct phenotypes in HNC patients suffering from late-RAD, and examine potential correlations between safety and efficacy parameters. A retrospective analysis included twenty-four post-radiotherapy HNC patients evaluated using standardized FEES protocols across three bolus consistencies (liquid, semisolid, and solid). Swallowing safety was quantified using the Penetration–Aspiration Scale (PAS), while efficacy was measured via the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Additionally, six distinct dysphagia phenotypes were characterized within the cohort. Propulsion deficit was the predominant phenotype (92%), followed by delayed pharyngeal phase (37.5%) and protective deficit (25%), with 46% of patients exhibiting multiple phenotypes. Unsafe swallowing occurred most frequently with liquid consistency (62.5%), while residue was most prevalent with semisolid (82.6% valleculae, 52.2% pyriform sinuses) and solid consistencies (92.3% valleculae, 53.8% pyriform sinuses). Significant correlations were found between penetration–aspiration and pharyngeal residue scores across consistencies (p < 0.05). FEES examination revealed distinct phenotypes in late radiation-associated dysphagia, with a predominance of propulsion deficit and significant interdependence between safety and efficacy parameters.

Objective: Report a case of localized necrotizing meningoencephalitis as the cause of functional hearing loss after cochlear implant (CI) surgery. Case report: A 12-year-old with bilateral CI presented to our quaternary center due to severe functional hearing loss after 11 years since left ear CI surgery. CT with contrast was conducted showing a CPA tumor-like mass. Pre-operative computed tomography (CT) scans and magnetic resonance imaging (MRI) performed at the age of 1 year showed no inner ear abnormalities and in particular no evidence of a tumor in the cerebellopontine angle (CPA). Conclusion: Following removal of the CI and the mass, histopathological, immunohistochemical and cultural examinations revealed a necrotizing meningoencephalitis, with the CI electrode as the focus.

BACKGROUND AND OBJECTIVES: Jugular foramen schwannoma is a rare benign tumor arising from the lower cranial nerves. After reviewing their experience with microsurgical management of jugular foramen schwannomas through lateral skull base and transcervical approaches, the authors recommend a management algorithm to direct simplified surgical management. METHODS: Cases of jugular foramen schwannomas treated by the senior author between 1983 and 2024 were analyzed retrospectively. Sociodemographic data, clinical presentation, radiological and intraoperative tumor characteristics, histopathological results, surgical approaches, and postoperative course until the last visit were thoroughly documented and analyzed. RESULTS: A total of 53 cases of jugular foramen tumors were treated over a 40-year period. Age at presentation ranged from 13 to 76 years, with a mean age of 42.84 years. Women comprised 53% (n = 28) of the total patients operated on, whereas the rest, 47% (n = 25), were men. The most common presenting symptoms were hearing loss and dysphagia. Tumors were classified according to the Kaye and Pellet classification system into classes A (11.32%), B (39.62%), C (15.09%), and D (33.96%). The most commonly used surgical approach was the petro-occipital trans-sigmoid approach, either alone or combined with other approaches, and gross total removal was achieved in 98% of patients. New postoperative paralysis in previously normal lower cranial nerve function was evident in 44% (n = 8) of patients who had normal lower cranial nerve function before surgery. The duration of follow-up ranged from 12 to 144 months, with a mean follow-up period of 63.46 months. Three patients (5.6%) had tumor recurrence. CONCLUSION: Based on their experience, the authors have proposed a treatment algorithm that guides the best surgical strategy. Even if gross total tumor removal of jugular foramen area lesions can safely be achieved nowadays, an extensive understanding of microsurgical anatomy of the area and surgical training is mandatory.

Background: Meals are central to daily life, health, and social participation, yet their safety and enjoyment can be compromised in people with oropharyngeal dysphagia (OD). Despite the broad impact of OD on physical and psychosocial well-being and daily functioning, structured guidance for comprehensive mealtime management in clinical practice is lacking. To address this gap, a set of expert consensus-based “Do’s and Don’ts” covering four meal-related domains was developed. Methods: A modified Delphi consensus study promoted by the Italian Society of Deglutology involved a multidisciplinary panel of 53 experts in OD and related disciplines. Experts developed “Do” and “Don’t” statements across four domains: nutrition-focused diet prescription, meal preparation, mealtime experience, and patient and caregiver education. After panel conveners’ review, 61 statements underwent two rounds of online voting using a 3-point ordinal scale plus an additional option ‘unable to express an opinion’. Consensus was predefined as ≥75% agreement. Statements were revised between rounds based on participants’ comments to ensure clinical accuracy and practical applicability. Results: The response rate was 85% for Round 1 and 97.8% for Round 2. After Round 2, 57 of 61 statements (93.4%) reached the consensus threshold (≥75% agreement). Conclusions: Mealtime management in OD should be individualized and person-centered, balancing swallowing safety, nutritional requirements, quality of life, and enjoyment of eating. Management should extend beyond compensatory strategies alone to include the social and relational dimensions of meals. Active involvement and education of patients and caregivers are essential to support therapeutic adherence and daily implementation of recommendations. Interprofessional collaboration and multimodal educational strategies are crucial to ensuring a coordinated, safe, and effective nutritional approach to OD care.