Introduction: Pharyngeal closure is a critical step in total laryngectomy influencing postoperative recovery. While manual suturing is traditional, stapler-assisted closure offers potential advantages. This study provides an updated meta-analysis comparing stapler versus manual closure, stratifying by surgical indication, laryngectomy type and stapler technique. Methodology: Following PRISMA guidelines, a systematic search of four databases, up to November 2025, was conducted. Randomized controlled trials (RCTs) and observational studies comparing stapler versus manual closure in total laryngectomy were included. The primary outcome was pharyngocutaneous fistula (PCF) incidence. Secondary outcomes mainly included operative time and hospital stay. Risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Results: Twenty studies (4 RCTs, 16 observational) involving 1,545 patients were included. Stapler closure was associated with a significantly lower risk of PCF (RR = 0.54, 95% CI [0.38, 0.76], p < 0.001), shorter operative time (MD = -52.60, 95% CI [-74.33, -30.86], p < 0.001), and reduced hospital stay (MD = -3.62, 95% CI [-5.49, -1.76], p < 0.001). Subgroup analysis demonstrated a significant PCF reduction in primary laryngectomy (RR = 0.40, 95% CI [0.24, 0.69], p > 0.001), but this benefit was not statistically significant in salvage laryngectomy alone. Closed and semi-closed stapler techniques showed the most significant protective effects. Conclusion: Stapler-assisted pharyngeal closure significantly reduces PCF incidence, operative time, and hospitalization compared to manual suturing in primary laryngectomy. While efficient, its superiority in preventing PCF in high-risk salvage settings is not established, warranting careful patient selection.

Background: Laryngospasm is defined as glottis closure due to reflex constriction of the laryngeal muscles. It is one of the most common complications following pediatric anesthesia that can lead to hypoxemia, bradycardia, or aspiration. Laryngospasm following tracheal extubation has different reasons: presence of secretions, foreign body in the airway, or pain at the site of surgery. Propofol is usually used as an induction or maintenance agent. However, its use with the subhypnotic dose (0.5 mg/kg) is increasing nowadays for reducing the incidence of laryngospasm. This systematic review and meta-analysis aim to assess the efficacy of subhypnotic propofol in reducing the incidence of laryngospasm and respiratory complications in children following tonsillectomy or adenotonsillectomy and before extubation. Methods: We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they used propofol with a low dose (0.5 mg/kg) following tonsillectomy and before extubation. Both Randomized Controlled Trials (RCTs) and cohort studies published up until 27 December 2025 were included. We used the R software for statistical analysis. We employed a random-effects model for the analysis. Continuous outcomes were analyzed as mean differences (MD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics. Results: Our review included four RCTs and one prospective cohort study with 593 participants. Our analysis showed that propofol was significantly associated with a low incidence of laryngospasm (RR = 0.25, 95% CI 0.13–0.49), cough (RR = 0.08, 95% CI 0.01–0.62), and agitation (RR = 0.15, 95% CI 0.03–0.72) compared with the control group. However, there were no significant differences regarding laryngeal occlusion (RR = 0.70, 95% CI 0.20–2.46), cyanosis (RR = 1.13, 95% CI 0.14–9.43), stridor (RR = 1.38, 95% CI 0.76–2.50), and the duration of surgery (MD = 1.81, 95% CI −0.74 to 4.36). Conclusions: Our findings state that propofol had a lower significant incidence of laryngospasm than the control. Trial sequential analysis for laryngospasm indicated that evidence is conclusive. However, regarding the other outcomes, the evidence is still inconclusive, which suggests the need for future large-scale RCTs with larger sample sizes to validate these findings.

Background: Pathological scars result from aberrant wound healing and remain challenging to treat. Intralesional triamcinolone acetonide is the current mainstay of therapy. Recently, adjuvant laser therapy has emerged as a promising strategy to enhance drug penetration and modulate scar vasculature and collagen remodeling. This meta‐analysis assesses the clinical efficacy of laser‐assisted intralesional triamcinolone in the treatment of pathological scars. Methods: In March 2026, we conducted a systematic search of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and non‐randomized studies directly assessing laser plus intralesional triamcinolone. For the meta‐analysis, we used R 4.5.0 with R Studio 2024.12.1 + 563. Results: Our review included five RCTs and three non‐randomized comparative studies. Six studies encompassing 248 patients were included in the meta‐analysis. Compared with intralesional triamcinolone alone, laser combination therapy showed no significant difference in VSS/mVSS reduction (SMD = 0.28, 95% CI: −0.53 to 1.10, p = 0.496), with substantial heterogeneity (I ² = 83.1%). However, when compared with laser monotherapy, the combination significantly improved VSS/mVSS (SMD = −1.16, 95% CI: −1.85 to −0.48, p = 0.0008; I ² = 16.9%). Patient satisfaction appeared higher with combination therapy, but certainty was low, and the comparison with laser monotherapy was based on a single study. For VSS subscales vs. laser alone, combination therapy significantly improved vascularity, pliability, and height, but not pigmentation. Recurrence rates did not differ significantly between groups. Conclusion: Laser plus intralesional triamcinolone may improve scar scores and patient satisfaction compared with laser monotherapy, but current evidence does not demonstrate superiority over intralesional triamcinolone alone. Recurrence benefit remains uncertain. However, our findings are limited by the small number of RCTs and substantial heterogeneity. Future adequately powered RCTs with longer follow‐up periods are warranted.

Background: Adult hearing loss is common, yet hearing-aid uptake remains inadequate due to systemic and financial barriers in traditional audiologist-based fitting models. Over-the-counter (OTC) and self-fitting strategies have emerged to improve accessibility, allowing users to select and adjust their devices independently. However, concerns remain that reducing professional involvement may compromise electroacoustic accuracy, speech-in-noise outcomes, and overall patient satisfaction. Methods: A comprehensive literature search across PubMed, Web of Science, CENTRAL, Scopus, and Embase was conducted up to 1 June 2026. Parallel-group and crossover randomized controlled trials (RCTs) comparing self-fitting with professional-fitting were included. The primary outcome was patient-reported hearing benefit. Standardized mean differences (SMDs) and risk ratios (RRs) were pooled using a random-effects model. Results: Seven RCTs involving 1092 participants were included. The analysis revealed no statistically significant difference between self-fitting and professional-fitting strategies regarding patient-reported hearing benefit (SMD: 0.01, 95% CI [−0.44, 0.46], p = 0.97, I² = 89.2%, very low certainty of evidence). Similarly, no significant differences were observed across secondary outcomes, including speech-in-noise performance (SMD: 0.11, 95% CI [−0.25, 0.47]; p = 0.55), hearing loss (p = 0.12), hearing-aid satisfaction (p = 0.31), device adherence (p = 0.65), or the need for follow-up adjustment (RR: 0.46, 95% CI [0.12, 1.71]; p = 0.25). Safety outcomes were sparse and did not demonstrate a statistically significant difference between the fitting approaches; however, the evidence was imprecise and inconclusive. Conclusions: Self-fitting hearing aids showed no clear differences from professional best-practice fitting across several patient-reported and functional outcomes in adults with uncomplicated mild-to-moderate hearing loss. However, the certainty of evidence was very low because of risk of bias, substantial heterogeneity, imprecision, and the small number of trials. These findings are therefore hypothesis-generating and suggest that well-designed self-fitting pathways may have potential as an accessible alternative for selected users, but larger, rigorous, and longer-term trials are needed before broader clinical implementation can be recommended.