Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing loss undergoing cochlear implant assessment. Methods: An analysis included 389 sensorineural hearing loss (SNHL) patients who underwent cochlear implantation at a tertiary university hospital, of which 177 were congenital SNHL. Computed tomography (CT) and magnetic resonance imaging (MRI) data were meticulously assessed for diverse congenital pathologies, focusing on congenital malformations. Results: In the congenital SNHL group, comprising 177 patients (80 females and 97 males), congenital cochleovestibular malformations were evident in 56 ears of 29 cases. Different congenital cochleovestibular malformations, ranging from labyrinthine aplasia to isolated large vestibular aqueducts, were detected. Among the various anomalies, incomplete partitions and cochlear hypoplasia emerged as more frequent patterns. Conclusions: This study offers a comprehensive radiological analysis of congenital SNHL patients undergoing cochlear implantation, revealing a spectrum of anomalies. It demonstrates the diverse nature of anomalies affecting the external auditory canal, middle ear structures, and cochleovestibular system. These insights provide a deeper understanding of congenital SNHL and contribute to developing informed treatment strategies.

Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing loss undergoing cochlear implant assessment. Methods: An analysis included 389 sensorineural hearing loss (SNHL) patients who underwent cochlear implantation at a tertiary university hospital, of whose 177 were congenital SNHL. Computed tomography (CT) and magnetic resonance imaging (MRI) data were meticulously assessed for diverse congenital pathologies, focusing on congenital malformations. Results: In the congenital SNHL group, comprising 177 patients (80 females and 97 males), congenital malformations were evident in 56 ears of 29 cases. Among the various anomalies, incomplete partitions and cochlear hypoplasia emerged as significant patterns. Different congenital cochleovestibular malformations, ranging from labyrinthine aplasia to isolated large vestibular aqueducts, were detected. Conclusion: This study offers a comprehensive radiological analysis of congenital SNHL patients undergoing cochlear implantation, revealing a spectrum of anomalies. It demonstrates the diverse nature of anomalies affecting the external auditory canal, middle ear structures, and cochleovestibular system. These insights provide a deeper understanding of congenital SNHL and contribute to developing informed treatment strategies.

Background: Radiotracer- and magnetic seed-based targeted axillary staging techniques are increasingly used after neoadjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer who convert to clinical node-negative (ycN0) status. However, these technologies remain unavailable in many centres worldwide. We evaluated the effectiveness of radiotracer-free axillary staging using dual-tracer sentinel lymph node biopsy (SLNB) with indocyanine green (ICG) and methylene blue, with particular focus on the clinical implications of clipped node non-retrieval. Methods: This retrospective single-centre cohort study included 49 patients with biopsy-proven cN1 breast cancer who achieved ycN0 status following NAC and underwent dual-tracer SLNB using ICG and methylene blue between 2021 and 2024. Clipped node retrieval rates, tracer-specific detection patterns, recurrence outcomes, and disease-free survival (DFS) were analysed. Clinical outcomes, including recurrence and disease-free survival, were compared between patients with successful and unsuccessful clipped node retrieval. Results: Clipped node retrieval was achieved in 41 of 49 patients (83.7%). ICG outperformed methylene blue for clipped node identification (80.5% vs. 61.0%) and was the sole detecting tracer in 39.0% of cases. Using methylene blue alone would have reduced the retrieval rate to 51.0% (p = 0.001). ICG identified the clipped node in all six patients with axillary micrometastases (ypN1mi). Clipped node non-retrieval occurred in eight patients, all of whom had negative SLNB findings and did not undergo completion axillary lymph node dissection. Recurrence rates were similar between the retrieval and non-retrieval groups (17.1% vs. 12.5%, p = 1.000), and no isolated axillary recurrences were observed. Baseline tumour size was the only independent predictor of disease-free survival in multivariable analysis (HR 2.05, 95% CI 1.20–3.51; p = 0.008). Conclusions: Radiotracer-free axillary staging using ICG and methylene blue achieved a high clipped node retrieval rate in patients with ycN0 breast cancer after neoadjuvant chemotherapy. ICG significantly improved clipped node identification compared with methylene blue alone and identified the clipped node in all patients with residual nodal micrometastatic disease. Among patients with negative SLNB findings, clipped node non-retrieval was not associated with higher recurrence rates or worse disease-free survival during follow-up. However, given the small number of clipped node non-retrieval cases (n = 8) and recurrence events (n = 8), these findings should be interpreted with caution and require confirmation in larger prospective studies. These findings support the feasibility of a radiotracer-free dual-tracer approach in settings where radiotracer-based techniques are not available. Prospective multicentre studies are warranted to validate both the oncological performance of radiotracer-free axillary staging and the clinical implications of clipped node non-retrieval.

Objective: While advancements in radiotherapy and systemic agents have significantly improved survival rates in head and neck squamous cell carcinoma (HNSCC), managing long-term, treatment-induced toxicities remains a critical clinical challenge. This study aimed to develop a personalized, supervised machine learning-driven predictive model for multiple chronic toxicities by integrating clinical, dosimetric, and genetic data specifically evaluating the impact of the NBN gene rs1805794 (c.553G>C) polymorphism. Methods: This study enrolled 125 patients with HNSCC who received curative-intent radiotherapy and remained disease-free during follow-up with a median of 98 months. Comprehensive clinical and dosimetric data were collected, and chronic toxicities were recorded. Peripheral blood samples were analyzed for the NBN rs1805794 polymorphism using allele-specific PCR (AS-PCR). Following feature selection, four supervised machine learning classifiers were trained and evaluated to identify the optimal model for predicting multiple chronic toxicities. Results: The XGBoost algorithm emerged as the highest performing model. Baseline clinico-dosimetric predictors of multiple chronic toxicities included PTV70 volume, the addition of concurrent chemotherapy, advanced T and N stages, and continued smoking. Integrating the NBN rs1805794 genotype into the XGBoost architecture enhances its predictive capability. The final model accurately identified patients at high risk for multiple chronic toxicities, achieving an area under the curve (AUC) of 0.78, an accuracy of 0.77, a sensitivity of 0.74, and a specificity of 0.79. Conclusions: Integrating clinical, dosimetric, and genetic data within a machine learning framework effectively predicts multiple chronic toxicities in HNSCC. This approach enabled early risk stratification, providing the potential for personalized therapy.

Background: Carotid blow‐out syndrome (CBS) is a life‐threatening complication of head and neck cancer, often occurring after prior treatment and locoregional recurrence. Data on the timing of carotid rupture after local tissue compromise remain limited. We aimed to present our institutional experience with recurrence‐associated type III CBS, focusing on timing patterns and associated local factors. Methods: In this retrospective single‐center study, medical records of head and neck cancer patients who developed type III CBS between 2016 and 2025 were reviewed. Among 11 CBS cases, eight occurred in association with locoregional recurrence and constituted the study cohort. Locoregional recurrence was defined by clinical and radiologic evidence of recurrent disease and was histologically confirmed when feasible. All patients presented with acute carotid rupture and underwent emergent open carotid artery ligation. Demographic, tumor‐related, treatment‐related, local predisposing factors, rupture site, and relevant time intervals were analyzed. Results: Eight patients with recurrence‐associated type III CBS were included. The mean time to locoregional recurrence after primary treatment was 8.3 ± 5.1 months (range, 6–19). Tumor infiltration was present in all patients; three had mucocutaneous fistula, five had wound infection, and six had soft‐tissue necrosis at the rupture site. The mean interval between detection of recurrence or soft‐tissue exposure and carotid rupture was 5.4 ± 3.1 months (range, 2–12). Rupture appeared to occur earlier among patients with mucocutaneous fistula and/or necrosis; however, this finding should be interpreted cautiously because of the small subgroup size. Major neurologic morbidity occurred in two patients, and seven patients died during follow‐up due to disease progression. Conclusion: In recurrent head and neck cancer with local tissue compromise, carotid rupture may occur within a short interval, particularly in the presence of necrosis or mucocutaneous fistula. These hypothesis‐generating findings highlight the need for close surveillance, timely multidisciplinary planning, and early goals‐of‐care discussions. Level of Evidence: 4.