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Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a typical type‐2 inflammation involving T‐helper type‐2 cells and impairing quality of life due to nasal obstruction, discharge and reduced sense of smell. Recently, the anti‐IL4Rα antibody dupilumab was approved for CRSwNP. While dermatologic side effects in patients treated with dupilumab for atopic dermatitis are frequently observed, there is limited knowledge about these effects in patients with CRSwNP. We aimed to investigate frequency and characteristics of dermatologic side effects following initiation of dupilumab treatment in a cohort of Austrian CRSwNP patients. Therefore, CRSwNP patients presenting at the Department of Otorhinolaryngology, Head and Neck Surgery at the Vienna General Hospital were retrospectively evaluated for newly developed skin eruptions while under dupilumab treatment. Incidence was calculated and details on clinical symptoms were collected. One hundred and ninety‐two CRSwNP patients receiving dupilumab treatment were included, comprising a cumulative follow‐up of 89.65 years (median: 5.5, IQR: 5.9). We observed dermatologic side effects in four patients starting at a median time of 15.5 (range 4–23) weeks after dupilumab initiation corresponding to an incidence‐rate of 4.46 (95%‐confidence interval 1.39–11.23) events per 100 patient‐years follow‐up. The majority (75%, 3/4) of affected patients developed psoriasis‐like dermatitis, whereas one individual experienced rosacea‐like folliculitis and alopecia areata. While dupilumab dosing was reduced in 3/4 CRSwNP patients, one patient completely stopped dupilumab therapy. Our study provides the first comprehensive evaluation of both frequency and characteristics of dermatologic side effects caused by dupilumab in CRSwNP patients. All affected patients developed Th1‐inflammatory associated skin disorders – previously observed only in individuals with prior affections of the skin (i.e. atopic dermatitis). Thus, individuals receiving dupilumab for CRSwNP may develop novel symptoms that require interdisciplinary management. Future studies on dupilumab in a real‐world setting will be required to further explore its spectrum of side effects. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether elective tracheostomy is justified after tumor resection and bilateral neck dissection (ND) and whether application of tracheostomy scoring systems is reliable for planning of postoperative airway management.Study Design: Retrospective cohort study.Methods: We retrospectively assessed airway management in 160 patients with head and neck squamous cell carcinomas. Additionally, we applied and analyzed the 1) Cameron, 2) TRACHY, and 3) CASST tracheostomy scoring systems on the tracheostomy recommendations.Results: Elective tracheostomies were performed in 51.3% of our patients, particularly in T3 to T4 tumors, cases with free flap reconstruction, and concurrent procedures. Among patients undergoing concurrent procedures, those who received tracheostomy showed significantly longer inpatient stays (27.8 ± 30.0 days vs. 13.3 ± 6.6 days; P < 0.001). Tracheostomy recommendation coincides with the performance of bilateral ND in 28.6% (CASST), 60.0% (Cameron), and 75.0% (TRACHY) of the cases, respectively. By applying corresponding criteria, tracheostomy would be recommended in 2.5% (CASST), 76.9% (Cameron), and 84.4% (TRACHY) of our cases. Bleeding episodes were the most common complication occurring in 10 patients (6.3%), but tracheostomy scores did not significantly differ between bleeders and nonbleeders.Conclusion: Bilateral ND on its own is not a reliable predictor for elective tracheostomy. Furthermore, given the significant heterogeneity of currently available scoring systems, they prove inadequate for decision making and predictive modeling of tracheostomy placement.Level Of Evidence: 4 Laryngoscope, 130:E580-E586, 2020. [ABSTRACT FROM AUTHOR]

Objective: To assess the audiological and long-term medical and technical follow-up outcomes of an active middle ear implant.Methods: This was a retrospective medical chart analysis of all patients provided with an active middle ear implant in a tertiary academic medical referral center between September 1, 1998, and July 31, 2015. Main outcome measures were medical and technical complications, revisions, reimplantations, explantations, coupling approaches, mean time of use, pre- and postoperative hearing thresholds, functional hearing gain across frequencies (250-4,000 Hz), and Freiburg monosyllablic word test at 65 dB.Results: One hundred and three patients were identified. Fifteen were implanted bilaterally (n = 118 Vibrant Soundbridge devices [MED-EL, Innsbruck, Austria]). Seventy-seven devices were implanted for sensorineural and 41 for mixed and conductive hearing loss. Patients used the implant for 6.7 years (range 0.7 months-17.9 years) on average. Ninety-one patients (77.12%) were using the device at the end of the observation period. An overall complication rate of 16.1% was observed. The revision and explantation rates were higher for devices implanted between 2004 and 2006. The device failure rate was 3.4%. Audiological evaluation showed significant hearing gains for both hearing loss patient groups.Conclusion: This long-term follow-up reveals the reliability of the active middle ear implant in a single center. Overall complication rate and device failure rate are acceptable. The complication rate was higher during implementation of alternative coupling approaches. The audiological benefit was satisfactory in patients with all hearing loss types. The majority of implanted patients used the implant at the end of the observation period.Level Of Evidence: 4 Laryngoscope, 129:477-481, 2019. [ABSTRACT FROM AUTHOR]

Objectives: Activated platelets might play an important role in tumor progression. Mean platelet volume (MPV) has been used as a surrogate marker for platelet activation, and therefore its value as a marker of tumor prognosis has attracted recent attention. In this study, we aimed to critically evaluate the prognostic significance of the perioperative platelet count (COP), MPV and the MPV/COP ratio in head and neck cancer patients. Additionally, we explored the individual postoperative trajectory of these indices and their association with overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively evaluated 122 head and neck squamous cell carcinoma patients receiving surgery with curative intent followed by postoperative radiotherapy. Platelet indices were measured preoperatively and on days 1 and 7 postoperatively. OS and DFS were analyzed using Kaplan–Meier estimators, the log-rank test and uni and multivariable Cox models. Cutoffs to dichotomize patients for Kaplan–Meier curves and log-rank tests were empirically chosen at the respective median. The median follow-up was 8.8 years. Results: The adjusted preoperative COP, MPV and MPV/COP ratio were not associated with disease outcome. A low postoperative COP and a high MPV/COP ratio on the first postoperative day were independently associated with worse OS and DFS. In comparison to the preoperative measurements, patients whose COP increased by day 1 post-op showed a better OS (hazard ratio (HR) per 50 G/L increase: 0.73, 95% confidence interval (CI): 0.58–0.93, p = 0.013) and DFS (HR per 50 G/L increase: 0.74, 95% CI: 0.58–0.94, p = 0.018) in multivariable analysis. Conclusions: Our results suggest that a low postoperative COP and a high MPV/COP ratio represent a negative prognostic factor for OS and DFS. Notably, patients with an increase in COP by day 1 post-op when compared to their preoperative value showed a significantly better OS and DFS. [ABSTRACT FROM AUTHOR]

Bone-conduction implants are a standard therapeutic option for patients with conductive, unilateral, or mixed hearing loss who either do not tolerate conventional hearing aids or can benefit from surgery. The aim of this study was to evaluate long-term medical and technical outcomes, and audiological results with the Bonebridge transcutaneous bone-conduction implant. This retrospective study included all patients implanted with a bone-conduction hearing implant at a tertiary medical referral center between March 2012 and October 2018. Medical and technical outcomes included the mean length of implant usage, medical and technical complications (skin and wound infection, lack of benefit, technical failure), explantations and revisions, coupling approaches, implant failure rate, implant survival and the implant loss for added follow-up years. Auditory results were measured by functional hearing gain and the Freiburger monosyllabic test at 65 dB sound pressure level. Sixty-four patients were included in the study; five of these were implanted bilaterally (69 devices). Five unilaterally implanted patients were lost to follow-up. The mean follow-up was 27.1 months (range: 0.2 months–6.3 years). The mean implant usage was 25.9 months (range: 0.2 months–6.3 years). Fifty-seven implants (89.1%) were in use at the end of the follow-up period. Complications occurred in six ears (9.4%). Five implants (7.8%) were explanted without reimplantation. Device failure occurred in one implant (1.6%), which was possibly caused by recurrent head trauma. The rate of implant loss due to technical device failure (damage to device) was 1 per 72 follow-up years. The mean improvement on the Freiburger monosyllabic test (52.1%, p = 0.0001), and in functional hearing gain across frequencies (26.5 dB, p = 0.0001) was significant. This single-center follow-up reveals the medical and technical reliability of a transcutaneous bone-conduction implant for hearing rehabilitation because complication and revision rates were low. The majority of patients still used the device at the end of the observation period. Implantation resulted in favorable hearing outcomes in comparison to that of unaided conditions. Cautious patient selection mainly regarding co-morbidities, the history of chronic otologic diseases and proper surgical technique seems to be crucial in reducing complications. [ABSTRACT FROM AUTHOR]

Objective: Despite multiple studies from high-income countries, reports from low- and middle-income countries on the impact of COVID-19 on head and neck cancer care remain sparse. This study aimed to assess the effects of the COVID-19 pandemic on head and neck cancer patients at a tertiary reference centre in Bosnia and Herzegovina., Methods: We included 228 patients with malignant head and neck tumours evaluated and treated between January 1, 2019, and December 31, 2021. Patient demographics, histological characteristics, and treatment modalities were retrospectively obtained and compared between the pre-pandemic period (pre-COVID-19 group) and the period after the implementation of COVID-19 restrictive measures (COVID-19 group)., Results: Patients were significantly older during the COVID-19 pandemic. In particular, 63 patients (44.7%) were under 65 and 78 (55.3%) were 65 or older, while in the pre-COVID-19 period, 53 patients (60.9%) were under 65 and 34 (39.1%) were 65 or older (p = 0.017). The pre-COVID-19 and COVID-19 groups did not significantly differ regarding other patient- and tumour characteristics, or primary treatment modalities., Conclusions: During the COVID-19 pandemic, significantly fewer patients were under 65 at the time of initial work-up, potentially reflecting the more enhanced disease-related anxiety of the younger population. Future studies are warranted to address this population's specific educational and psychological needs to ensure appropriate cancer care., (Copyright © 2024 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Background: Climate change is a global challenge that is resulting in an increased occurrence of extreme weather events. Extreme weather events have been shown to negatively impact various health conditions, leading to an overall increase in morbidity and mortality. Ear, nose, and throat (ENT) emergencies are among the most common reasons for emergency department visits (EV). Acute otitis externa (AOE), an inflammatory external auditory canal skin infection, is the second most common condition for ENT-related emergency admissions. Previously, AOE has been associated with higher temperatures during summer; However, no data exists on extreme weather events' immediate and delayed effects on AOE-related EVs. Identifying these relationships could help predict EVs, optimize health resources, and relieve its significant burden on healthcare systems., Objective: This study aimed to associate the effects of extreme weather events with the immediate and delayed risk of AOE-related EVs., Methods: A total of 1522 AOE-related EVs from the ENT outpatient clinic of the Vienna General Hospital between 2015 and 2018 were analyzed. Meteorological data for the same study period was obtained from the Austrian Central Institution for Meteorology and Geodynamics for Vienna and a distributed lag non-linear model used to associate extreme weather events with the total number of AOE-related EVs. Relative risk (RR) and cumulative RR were analyzed over a period of 14 days., Results: AOE-related EVs showed a pronounced seasonality, with the highest occurrence in summer. The RR for AOE-related EVs was significantly increased one day after high-temperature events for seven days, to a maximum of 1.95 [1.04-3.65]. Low and high relative humidity significantly reduced the same-day occurrence of AOE-related EVs to 0.65 [0.46-0.92] and 0.74 [0.58-0.95]. Increased precipitation and wind speed significantly decreased the RR of AOE-related EVs four and seven days after occurrence. After one day, low atmospheric pressure events showed an increased RR of 1.42 [1.02-1.98] in AOE-related EVs., Conclusions: Extreme weather events significantly impact AOE-related EVs. While high mean temperatures were positively correlated with AOE-related EVs, low humidity was found to have a negative same-day effect, supporting the idea of multiple factors being involved in increasing the susceptibility for AOE. Knowledge of the pattern of events could allow the implementation of time-optimized prevention strategies to reduce the incidence of AOE, the frequency of EVs, and the burden on health care systems., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interests regarding the publication of this manuscript., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: Climate change has been associated with a higher frequency of extreme weather events, resulting in an overall increase in morbidity and mortality. Acute otitis media (AOM) is one of the most common otolaryngological infections and accounts for 1.5% of emergency department visits. This study aimed to identify associations between extreme weather events and the immediate and delayed risks for AOM-related emergency department visits (EV)., Methods: A total of 1,465 AOM-related EVs were identified in the Vienna General Hospital between 2015 and 2018. A distributed lag non-linear model was applied to evaluate the relationship between extreme weather conditions and the total number of AOM-related EVs per day. The relative risk (RR) and cumulative RR (cRR) of single-day events and extended weather events over three days were analyzed over a lag period of 14 days., Results: AOM-related EVs showed a pronounced seasonality, with the highest occurrence during winter. Single-day weather events affected AOM-related EVs only at high relative humidity. Prolonged extreme weather conditions over three days, however, significantly increased the cRR for AOM-related EVs to 3.15 [1.26-7.88; p = 0.014] and 2.14 [1.14-4.04; p = 0.018] at mean temperatures of -4°C (1 st -percentile - p 1 ) and 0°C (p 5 ) on the same day. Relative humidity of 37% (p 1 ) decreased RR to 0.94 [0.88-0.99; p = 0.032] on day 7, while extremely high humidity of 89% (p 99 ) led to an increased cRR of 1.43 [1.03-2.00; p = 0.034] on day 7. Heavy prolonged precipitation of 24mm (p 95 ) reduced cRR beginning day 4 up until day 14 to 0.52 [0.31-0.86; p = 0.012]. Prolonged low atmospheric pressure events of 985hPa (p 5 ) reduced the RR to 0.95 [0.91-1.00; p = 0.03], whereas extremely high atmospheric pressure events of 1013hPa (p 99 ) increased the RR to 1.11 [1.03-1.20; p = 0.008]. Extremely low wind speeds significantly diminished the RR of AOM-related EVs., Conclusions: While single-day extreme weather events had little impact on the occurrence of AOM-related EVs, extended periods of extreme temperatures, relative humidity, precipitation, wind speeds and atmospheric pressure significantly impacted the RR for AOM-related EVs. These findings could help improve healthcare resource allocation in similar climates and aid in educating patients about the role of environmental factors in AOM., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nieratschker, Haas, Lucic, Pichler, Brkic, Parzefall, Riss and Liu.)