24th Czech-German ENT Days

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Introduction: Retraction pocket is the pre-stadium of the cholesteatoma disease, and there is still no consensus on its management. The course is usually much worse in cleft palate patients because of severe Eustachian tube malformation and functional changes. Material and methodics: We evaluated 80 patients with retraction pocket surgery, 23of them with cleft palate, followed for minimum 10 years after surgery. The parameters were type of the tympanoplasty according to the grade of retraction, extent of the sanation procedure according to the grade of retraction and incidence of the re-retraction. Audiometry outcomes were evaluated and compared cleft to non cleft patients. Results: Those with cleft palate had significantly lower audiometric improvement after the surgery. Sanation procedures in cleft palate patients were also more extensive, probably because of higher grade of retraction process. Conclusion: The course and prognosis of adhesive otitis is more severe in cleft palate patients. To prevent cholesteatoma development is according to our experience most important careful follow up with otomicroscopic monitoring and early indication to surgical treatment according to the severity of changes and process dynamics.

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Colloaural fistulas in children - diagnosis and treatment Introduction: Anomalies of the first branchial cleft are rare. Developmental disorders associated with the branchial apparatus most commonly involve the second branchial cleft. Only approximately 6% of cervical fistulas/cysts originate from the first branchial cleft. These are referred to as cystae/fistulae colloaurales. They essentially represent a duplication of the external auditory canal. Colloaural fistulas do not include small fistulas located at the anterior, and very rarely at the posterior, margin of the auricle, which result from incomplete fusion of the six auricular hillocks of the first and second branchial arches, from which the auricle develops (fistula auris congenita). Based on their structure, two types of colloaural fistulas are distinguished according to the presence of cartilage. Based on the presence of both openings, they are classified as complete or incomplete. The aim of this study is to present the experience of our department with this rare clinical entity, specifically in pediatric patients. Methods: This retrospective study is based on the experience of the Department of Otorhinolaryngology of the Second Faculty of Medicine, Charles University, and Motol University Hospital and Homolka Hospital between 2011 and 2025. The study included patients from birth to 18 years of age. The anomaly was unilateral in all cases; no bilateral lesions were recorded. Both male and female patients were included. All patients underwent surgical treatment. Results: In clinical practice, we encounter both types of fistulas. Clinically, first branchial cleft anomalies present as cystic swellings or fistulas around the ear or within the external auditory canal, while the external opening in the neck is often inflamed. This opening may remain unrecognized until the first episode of inflammation, after which inflammatory swelling develops. The cervical course of the fistula may also be palpable. The finding very often mimics abscess-forming lymphadenitis; less commonly, patients present with chronic otorrhea or merely with the presence of an internal fistula in the external auditory canal without discharge. Diagnosis is not difficult when the anomaly is known to the physician. Typical findings include the clinical presentation and the location of the external fistula opening in the neck, and less commonly the presence of an internal fistula within the external auditory canal. Among imaging modalities, magnetic resonance imaging is the method of choice, as it demonstrates the course of the fistula and its relationship to surrounding structures. Fistulography has now been almost completely abandoned. The definitive treatment is complete excision of the fistulous tract while preserving essential structures, particularly the facial nerve (CN VII), through a superficial parotidectomy approach. Most patients underwent at least one inadequate procedure before definitive excision, most commonly simple incision and drainage. Patients were subsequently followed regularly until 19 years of age. Conclusion: Failure of obliteration of the branchial clefts results in branchiogenic fistulas and cysts. The external opening is located along the medial border of the sternocleidomastoid muscle, while the internal opening is determined by the branchial origin. Clinically, these anomalies most commonly present as small openings near the sternocleidomastoid muscle. They frequently become inflamed. Fistulas are present from birth but may be overlooked. Cysts tend to appear at a later age. Magnetic resonance imaging is the principal imaging modality used in the diagnostic process. During the acute inflammatory phase, antibiotic treatment is appropriate to control the inflammation, followed by surgical excision as the treatment of choice. Identification and dissection of the facial nerve trunk and neuromonitoring of its function are fundamental components of surgery for first branchial cleft anomalies.

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Background: Otitis media with effusion (OME) is one of the most common diseases in children. It manifests with hearing loss, which could lead to delayed speech or poor school performance. In recent years, novel etiopathogenetic factors, such as changes of microbiome of the adenoids and the middle ear, have emerged. The aim of this study is to analyze and compare the composition of adenoidal and middle ear microbiome in children with and without OME. Methods: A total of 31 children with adenoids and OME (study group), and 30 children with adenoids without OME (control group) were enrolled in study. Children in study group underwent endoscopic adenoidectomy and myringostomy. Samples of both adenoids and middle ear effusion were collected. Children in control group underwent adenoidectomy with samples collection. Collected samples were examined using molecular methods for detection of the DNA of common respiratory pathogens – Streptococcus pneumoniae (SRPN), Streptococcus pyogenes, Haemophillus influenzae (HAIN), Staphylococcus aureus and Mycoplasma pneumoniae. The microbiome of samples was also analyzed using 16s rRNA sequencing. Results: At least one pathogen was detected in adenoid samples in almost 97% of children in each group. In both groups, the most common pathogens were HAIN (23 and 20 positive samples) and SRPN (24 positive samples in each group). The relative abundance was significantly higher in the study group. Furthermore, pathogens were detected in middle ear fluid in children with OME, positivity was recorded in a total of 17 children. The most common pathogen was HAIN (n=9), followed by SRPN (n=7). Conclusions: The adenoidal microbiome may influence the development of otitis media with effusion. The presence of HAIN, which was significantly more common in adenoid tissue of children with OME than in children without OME, appears to be significant. This pathogen was also the most frequently found in middle ear effusion.

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Tinnitus aurium is defined as an objecitv or a subjectiv sound of the inner ear and it's recognition within the central hearing region of the brain. It’s a clinical symptom, that still today isn’t really completely understood, cause it has multiple factors or causes to consider (e.g. sudden hearing loss, presbycusis, infections, trauma or a tumor on the acoustic nerve). Considering numbers named by the „Deutsche Tinnitus Liga“ (a german self-help group) there are at least 1,5 million patients yet in Germany alone, suffering from tinnitus aurium; the annual first diagnosis led by 250.000 patients with a chronic illness. Worldwide 740 million patients suffer from tinnitus aurium; yet alone 120 million patients who feel strongly restricted or limited to live there everyday life. The german guide line for acute tinnitus aurium is still under surveillance and is yet to be published within 2026. While the german guide line for chronic tinnitus aurium (meaning the tinnitus aurium has been lasting for more than 3 months) is still in charge. Considering chronic tinnitus aurium this guideline recommends “tinnitus retraining”, which mainly includes psycho-therapy with focus on behavioural therapy, hearing training and the learning of relaxation methods such like PMR or autogenic training. Due to changes within the german health care system, but also because of limited amount of specialists it’s difficult for german patients to find a clinical psychotherapist specialised on behavioural therapy and tinnitus aurium. So as a modern solution in a technological society, but also as an answer to the lack of health care specialists the “Digital health Applications” (DIGA) are on the rise. Still the question is, if there are still any other ways to treat patients with tinnitus aurium and if the “Autonomous sensory meridian response” might be another way to treat these patients more effectively.

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Endoscopic access to the middle ear has become a standard surgical approach in otologic surgery. It is particularly advantageous for the repair of tympanic membrane perforations, especially those located in the anterior quadrants. Owing to the excellent visualization of the retrotympanum, it also facilitates the management of mesotympanic retraction pockets. Furthermore, endoscopy enables the exclusive transcanal treatment of epitympanic pathologies extending to the aditus ad antrum. We present two case reports demonstrating the endoscopic management of two foreign bodies in the middle ear. The first case: The foreign body consisted of a fragment of mill scale that had entered through the external auditory canal, perforated the tympanic membrane, and become impacted in the bony portion of the Eustachian tube. Endoscopic tympanotomy was performed; however, the fragment of mill scale could not be identified within the middle ear. Therefore, a Eustachian tube balloon dilation catheter was introduced transnasally into the pharyngeal orifice of the Eustachian tube. The balloon was not inflated; instead, the catheter was used to gently displace the fragment of mill scale into the mesotympanum, where it was subsequently removed endoscopically. An underlay myringoplasty was performed simultaneously to repair the tympanic membrane perforation caused by the foreign body. The perforation healed uneventfully, and normal Eustachian tube function was preserved. The second case involved a pediatric patient with iatrogenic dislocation of the stapes following T-tube insertion. This case illustrates the importance of exploratory tympanotomy whenever a foreign body is visible beneath the posterosuperior quadrant of the tympanic membrane. The endoscopic approach provides excellent visualization of the incudostapedial joint and the retrotympanum, allowing safe assessment and management of pathology in this anatomically challenging region.

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Background & Aim Neurootologic challenges like vertigo, hearing loss and tinnitus have been attributed to hypoxemia. As hypoxemia in sleep by obstructive sleep apnea (OSA) recently has been defined with “Hypoxic burden” we looked at its relation to neurootologic challenges. Material & Methods Between 2021-20026 4000 patients underwent fully attended polysomnography with and without CPAP in the sleeplab of the Heilig-Geist Hospital, Bensheim Germany. Different neurologic and cardiorespiratoric parameters have been related. Results The severity of the cardiorespiratory parameters during sleep do not directly relate to any neurotologic symptoms. Conclusions Despite sleep in humans is one third of life and so the hypoxic burden in OSAS is expected to lead to neurotologic symptoms there has been not statistical evidence. References Hörmann, K.: Rheological effects of pharmacologic treatment of inner ear disorders. ScanAudiol:Suppl.26(1987)47-48 Karl Hörmann,Thomas Verse: Surgery of Sleep related Sleep disorders,2nd ed. Springer 2009, Azarbarzin A, Sands SA, Stone KL et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J. 2019;40:1149-57 Solelhac G, Sánchez-de-la-Torre M, Blanchard M et al. Pulse Wave Amplitude Drops Index: A Biomarker of Cardiovascular Risk in Obstructive Sleep Apnea. Am J Respir Crit Care Med. 2023;207:1620-32 Keywords Hypoxic burden OSA Neurootologic challenges

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Background/Introduction: Obstructive sleep apnea (OSA) affects nearly 1 billion people worldwide. Surgery is variably effective and patients should be indicated very selectively. This study summarizes and presents our personal experience with TORS (not only) for OSA treatment, with the aim to provide information regarding its safety, efficacy, postoperative complications and its role in the Health system in Czech Republic. Methods: Our experiences with TORS surgery started in 2023 obtaining DaVinci Xi system. TORS is nowadays considered a common surgical minimally approach for Base of Tongue (BOT) reduction in cases of OSA due to a lingual tonsil obstruction. Furthermore, this procedure can be combined with other techniques, such as tonsillectomy, pharyngoplasty and many others in cases of a multilevel obstruction. Our patients have followed the standart indication protocol in OSA treatment (Endoscopy, PG, DISE). Pediatric patients were excluded from TORS program. Results: From 9/2023, 85 patients underwent transoral robotic surgery at our departement, 61 (72%) patients underwent surgery for oropharyngeal carcinoma, 8 (10%) for benign lesions of oropharynx, 14 (16%) for OSA. 7 patients underwent BOT reduction, 4 patients BOTr together with epiglotopalsty, in 3 cases the multilevel surgery was performed (BOTr, UPPP). There was 68% decrease of AHI in average in the patients after TORS. No patient with OSA had postoperative bleeding. No readmission was experienced. Conclusion(s): TORS for OSA treatment is an effective and safe procedure for adequately selected patients. Considering other effective ways of surgery (upper airway stimulation), in the Czech Republic, TORS is still being in its golden era regarding the surgical treatment of retrolingual space.

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Transoral robotic surgery (TORS) has been established as a standard surgical approach in head and neck oncology for nearly 15 years. It has demonstrated clear superiority primarily in T1–T2 oropharyngeal carcinomas and carcinomas of unknown primary (CUP). In highly selected patients, its application extends to T3 oropharyngeal, as well as T1–T2 hypopharyngeal and supraglottic cancers. However, patients may also benefit from the advantages of this modality in several less conventional indications. First, parapharyngeal space tumors and the resection of an elongated styloid process represent ideal indications for TORS. Nonetheless, their low incidence and anatomical proximity to critical vascular structures—such as the internal carotid artery and branches of the external carotid artery—limit the widespread adoption of TORS for these pathologies in many centers. Furthermore, the inherent advantages of the robotic system, including enhanced 3D visualization and tremor reduction, can be successfully utilized in open neck indications. Due to the angled robotic arms, neck surgeries can be performed through distant incisions concealed in the hairline or the axilla. While robotic transaxillary or bilateral axillo-breast approach thyroidectomy is a standard procedure in the Far East, its adoption remains limited in European centers. Additionally, various neck procedures, including submandibulectomy, and elective neck dissection, can be safely executed through retroauricular or facelift incisions. In experienced hands, salvage surgery for persistent or recurrent oropharyngeal cancer represents another promising indication. In conclusion, advanced robotic surgery is driving a critical paradigm shift in head and neck oncology, expanding its scope from early-stage cancers to a significantly wider variety of complex indications.

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Comparative Evaluation of RobOtol, Otoarm, and Manual Electrode Insertion.

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Background Transoral robotic surgery (TORS) provides minimally invasive access to anatomically complex regions of the upper aerodigestive tract. Its principal indications include selected tumors of the palatine tonsil and base of tongue, as well as lesions of the parapharyngeal and retropharyngeal spaces. TORS may also be used in selected patients with obstructive sleep apnea. Objectives To present our institutional experience with TORS, describe the perioperative management of patients undergoing robotic surgery, and evaluate the clinical characteristics of patients treated between 2023 and 2026. Methods A retrospective descriptive analysis was performed of 85 patients who underwent TORS at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Králové, between 2023 and 2026. The evaluation included indications for surgery, diagnosis distribution, and clinical stage. The perioperative protocol comprised appropriate imaging and tumor staging, pre-anesthetic assessment, dental clearance and enteral access when indicated, antibiotic and venous thromboembolism prophylaxis, and postoperative intensive care monitoring. In oncological procedures, particular attention was paid to the prevention of oropharyngeal bleeding through external carotid artery ligation and intraoperative clipping of relevant vessels. Results TORS was used predominantly in patients with lesions involving the palatine tonsil and base of tongue, including selected T1 and T2 carcinomas. Additional indications included parapharyngeal and retropharyngeal tumors and procedures for obstructive sleep apnea. Robotic surgery enabled transoral access to anatomically challenging sites within a standardized multidisciplinary diagnostic and perioperative pathway. Specific attention to vascular control and postoperative monitoring formed an essential component of patient safety. Conclusions TORS represents an established minimally invasive option for selected oncological and non-oncological diseases in otorhinolaryngology. Appropriate patient selection, comprehensive staging, multidisciplinary management, meticulous intraoperative hemostasis, and structured postoperative monitoring are essential for its safe implementation. Further expansion of robotic surgery may include supraglottic laryngeal procedures, salvage surgery, and the use of single-port robotic systems.

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Adenotomy has long been the most frequently performed surgical procedure in children. Since the mid-19th century, when the relationship between adenoid tissue and ear diseases was first described and when the first adenotomy was performed, there has been an interesting development in surgical techniques. The blind spot was the conservative procedure, where radioactivity was applied to the nasopharynx. Over the course of about 30 years, more than 2.5 million patients were irradiated before the connection of this procedure with carcinogenicity was described in the 1960s. The introduction of general anesthesia was a milestone for the safety and quality of the procedure. Currently, adenotomy is performed under endoscopic control using several possible techniques. Each of them has advantages and disadvantages. However, there has been a significant decrease in bleeding complications in particular. Individual techniques (especially laser, shaver and plasma coblation) will be described and evaluated with regard to safety and benefit for the patient. According to our own sample of more than 700 patients operated on using plasma coblation, we have recorded less than 0.5% bleeding complications and less than 0.4% recurrences. The disadvantages are a shallow learning curve and a greater risk of prolonged healing requiring the use of antibiotics compared to classic adenoidectomy.

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Introduction The TOTO study (tonsillectomy or tonsillotomy) for recurrent acute tonsillitis (RAT) in children and adults is a controlled, multicentric, randomised, surgical non-inferiority trial aiming to evaluate whether tonsillotomy is as effective as a tonsillectomy in RAT. The objective is to proof the non-inferiority of tonsillotomy (DRKS00020823). Methods About 2200 patients were screened across 24 study centres, a total of 531 patients were recruited. The last patient was included 05/2025, hence data analysis regarding the outcome criteria can start 05/2027 (last patient out). The correction of baseline data has been completed. Results 353 women (66%) and 178 (34%) men aged 24±10 years underwent tonsil surgery based on the German S3 tonsillitis guideline. The amount of treated sore throat episodes was 6±2 per year. Leading symptoms were dysphagia (95%) and recurrent fever (71%)s. Quality of life was at baseline: TOI-14 score 50±18, TAHSI score 57±17, SF-12 PCS score 41.9±5.1 and SF-12 MCS score 44±7. In underage patients(< 16 years; 14%) neither symptoms nor quality of life differed from adult patients (>16 years) except for a higher rate of fever during the episodes. The amount of sore throat episodes did not correlate with the quality of life: TOI-14 score r=0.12; TAHSI score r=0.08; SF-12 PCS score r=0.01 and SF-12 MCS score r=0.04. Conclusion Patient cohort showed representative characteristics for patients with severe RAT. Quality of life was on average moderately reduced and did not correlate with the amount of sore throat episodes. Potentially, measuring tonsil-specific quality of life could be the better way of assessing the severity of RAT than counting sore throat episodes. The study was financially supported by the “Gemeinsamer Bundesausschusses (G-BA)” as a “Erprobungsstudie”.

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Positive airway pressure (PAP) therapy represents the gold standard treatment for patients with moderate or severe obstructive sleep apnea (OSA). Despite the high efficacy of this treatment modality, long-term complience remains one of its major limitations in a substantial proportion of patients. Surgical treatment may therefore represent a suitable alternative to PAP therapy in selected patients. Despite numerous advances in surgical techniques, early or delayed postoperative bleeding remains one of the most common postoperative complications, along with pain and swallowing difficulties. Objective: The aim of this presentation is to share our experience and outcomes with the use of self-assembling hemostatic peptides in the surgical treatment of obstructive sleep apnea (OSA) at the Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and Motol University Hospital. Materials and Methods: A single-center study was conducted between June-September 2024 and April - September 2026 at the Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol and Homolka. Postoperative pain and swallowing difficulties were assessed using patient-reported questionnaires. Results: During the 2024–2025 period, we observed a lower incidence of postoperative bleeding in the PuraStat group compared with the control group, although the difference did not reach statistical significance. In 2026, however, no reduction in postoperative bleeding was observed. The increased incidence of bleeding complications in both groups in 2026 may be related to the transition to a new surgical technique, Barbed Reposition Pharyngoplasty (BRP), and the associated learning curve. Limited experience with the newly introduced technique may therefore have contributed to the higher postoperative bleeding rate. Regarding postoperative pain and swallowing difficulties, questionnaire-based assessment showed no significant differences between the groups. Conclusion: Self-assembling hemostatic polypeptides represent an easy-to-apply and safe method with the potential to reduce postoperative bleeding in patients undergoing surgery for OSA. However, given the relatively small number of patients included in our study, it is currently not possible to confirm that the application of PuraStat leads to a reduction in postoperative bleeding complications.

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Introduction: Acute epiglottitis (AE) is a rapidly progressing, potentially life-threatening inflammation of the epiglottis. Once primarily a pediatric disease caused by Haemophilus influenzae type b, acute epiglottitis now occurs predominantly in adults due to the widespread vaccination of children. The onset is typically sudden and urgent airway intervention may be necessary. This study aimed to describe the clinical characteristics of patients, assess the occurrence of complications, and identify their potential risk factors. Methods: A single-center study included 41 patients with AE hospitalized between March 2018 and September 2023. Data on age, sex, month of diagnosis, microbiological cultures, antibiotic therapy, and the presence of complications (such as epiglottic abscess, need for airway management, and its duration) were analyzed. Results: The cohort comprised 31 men and 10 women, with a mean age of 46.7 years. Adults predominated (39 vs. 2 children). The most commonly identified pathogens were Streptococcus pyogenes, Haemophilus spp., and anaerobes. An epiglottic abscess occurred in 15 patients (36.6%), but neither age (p = 0.60) nor sex (p = 0.27) was a significant risk factor. Intubation was required in 6 cases (14.6%). A trend toward increased risk was observed in older patients and those with an abscess, though these associations did not reach statistical significance (p = 0.13 and 0.17, respectively). Conclusion: AE occurs more commonly in adults nowadays, with a shifted spectrum of causative pathogens. Airway management is necessary in a minority of patients; however, the prediction of complications remains challenging.

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Background/Introduction: VEXAS syndrome is caused by a somatic UBA1 mutation and typically presents in older men with skin/subcutaneous inflammation, chondritis, vasculitis, and coagulopathy, often coexisting with myelodysplastic syndrome (MDS). Diagnosis requires genetic confirmation, but genetically negative cases with a compatible phenotype are increasingly reported. Methods: Case report of a 72-year-old man with low-risk MDS (karyotype 47,XY,+add(5q)) and primary Sjögren's syndrome (ANA+++, anti-Ro52++). He presented repeatedly with massive, painful neck swelling clinically resembling deep neck phlegmon. CT showed no abscess; inflammatory markers were low or only mildly elevated. UBA1 (exons 3–27) was sequenced from lymph node tissue. Results: Antibiotic therapy had no effect. Surgical exploration and lymph node excision were performed on repeated occasions. No pus was found intraoperatively. Histology showed only reactive lymphadenopathy with parafollicular hyperplasia; no malignancy. Rosai-Dorfman disease was considered but ruled out immunohistochemically. Every procedure was followed by severe, poorly controllable wound bleeding related to coagulopathy, requiring repeated local hemostatic packing, blood product support, tracheotomy for airway compromise, and prolonged ICU stay. UBA1 sequencing was negative for pathogenic variants. Clonal hematopoiesis-related variants (IDH2, SRSF2) were found incidentally, consistent with the patient's MDS. Conclusion(s): The clinical picture — recurrent pseudo-phlegmonous neck swelling, coagulopathy, and impaired wound healing in a patient with MDS — was highly suggestive of VEXAS syndrome, despite a negative UBA1 result. Possible explanations include limited assay sensitivity, mosaicism, or an overlapping autoinflammatory phenotype in patients with MDS and coexisting autoimmune disease. This case highlights the risk of pathergy with repeated surgery in such patients and the need for early multidisciplinary involvement (ENT, hematology, rheumatology) before further invasive intervention.

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Introduction: Peritonsillar abscess (PTA) is the most common acute complication of tonsillitis. Comprehensive knowledge linking etiology, clinical presentation, and laboratory results is crucial for effective patient care. Methods: A retrospective study analyzed 577 hospitalized PTA surgical patients. Data included medical history, admission laboratory markers, operative findings, and postoperative outcomes. Statistical analysis comprised univariate methods (Fisher's exact test, Mann-Whitney U test), multivariable logistic regression (aOR), species co-occurrence, ROC curve analysis, and k-means cluster phenotyping. Results: Polymicrobial infection (≥ 2 pathogens) was present in 8.7% of patients (n = 50) and associated with significantly higher admission CRP (median 115.9 vs. 88.9 mg/L, p = 0.0299). A CRP threshold ≥ 160 mg/L optimally predicted polymicrobial etiology (specificity 76.7%, AUC = 0.595, p = 0.0299). Previous outpatient incision attempts (19.4%, n = 76) were associated with lower admission CRP (66.2 vs. 92.6 mg/L, p = 0.0276), reduced WBC count (12.7 vs. 14.3 × 10⁹/L, p = 0.0087), and shorter postoperative hospital stays (IQR 0.0 vs. 1.0, p = 0.0465). Multi-drug resistance (MDR) strain prevalence decreased with age (p = 0.0084), highest under 30 years (10.7%) versus over 50 years (1.1%; aOR = 0.955, p = 0.042). Significant microbial synergy was confirmed between Streptococcus anginosus group (SAG) and aerobes (p = 0.0001) and SAG with Prevotella spp. (p = 0.0469). K-means clustering identified three phenotypes: Low-reactive Monomicrobial (58.4%, n = 328), Complicated Polymicrobial with High MDR rate (8.4%, n = 47; 19.1% MDR rate), and Hyper-inflammatory Monomicrobial (33.3%, n = 187; median CRP 175.7 mg/L). Conclusion: Polymicrobial PTA accentuates acute inflammation, whereas outpatient incision attempts blunt admission inflammatory responses. MDR strains primarily affect young adults. Multi-parametric phenotyping enhances risk stratification and targeted empirical antibiotic selection.

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Despite the very good prognosis for HPV-positive oropharyngeal cancer treated with chemoradiation, approximately 10% of patients experience locoregional recurrence, which can be managed surgically. Salvage surgery presents a number of challenges. Recently, transoral treatment has been preferred whenever possible; however, more extensive surgical procedures are also performed, often requiring reconstruction. The prognosis for patients treated surgically for locoregional recurrence remains poor, and the 5-year survival rate is generally reported to be between 20 and 40%.

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Cancer of unknown primary (CUP) in the head and neck accounts for 1–5% of malignancies, and roughly half of primary tumors remain undetected despite standard workup (endoscopy, imaging, PET/CT). Transoral robotic surgery (TORS) base-of-tongue mucosectomy has been proposed since 2013 to improve detection by resecting the lingual tonsil lymphoid tissue. In a single-center series of 30 CUP patients (Oct 2021–Apr 2024) treated with TORS tonsillectomy and bilateral base-of-tongue mucosectomy, the primary tumor was identified in 19 cases (63.3%) — 6 tonsillar and 13 base-of-tongue carcinomas — with a low complication rate (3 postoperative bleeds, no permanent swallowing disorders) and no cases requiring treatment de-escalation compromise. These results support TORS mucosectomy as an effective, safe addition to the diagnostic algorithm for head and neck CUP.

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Reirradiation offers a potentially curative treatment option for selected patients with recurrent head and neck squamous cell carcinoma (HNSCC) after previous radiotherapy. Salvage surgery remains the preferred curative approach when feasible, while reirradiation may be considered for unresectable or medically inoperable disease. Careful patient selection based on tumour extent, disease-free interval, resectability, performance status and organ function is essential. Modern techniques including IMRT, SBRT and proton therapy allow more precise treatment and improved organ-at-risk sparing, but severe acute and late toxicity remains a major concern. Optimal outcomes therefore depend on careful patient selection, individualized treatment planning and a multidisciplinary approach.

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Chronic rhinosinusitis with nasal polyps (CRSwNP) is a highly prevalent disease that results in significant healthcare costs as well as societal costs in the form of lost productivity and time. Unfortunately, a significant proportion of patients suffering from this disease find no relief from either current standard medications or surgical intervention. Biological therapy can offer a more targeted approach by blocking specific cytokines and immune signaling pathways involved in type 2 inflammation. These therapies have fundamentally changed treatment options for patients with severe CRSwNP who do not respond to conventional treatment. Biological therapy represents a new therapeutic class in the treatment of CRSwNP that has the potential to be a “game changer” for patients. At the same time, however, it poses a major challenge for us as physicians, especially for surgeons. Biological agents have demonstrated efficacy in treating CRSwNP, but they are also very expensive and may require long-term use. In our department, we began treating patients with dupilumab in 2024. Today, we see many satisfied patients who are quickly benefiting from the treatment with minimal side effects. On the other hand, however, there is a clear increase in healthcare costs associated with this therapy. The question for the future is what impact the long-term use of biologic medications will have, compared to the current standard of care for CRSwNP - not only on patients, but also on the healthcare system and on us as physicians.

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Malignant tumors of the nasal cavity are rare, representing only less than 1% of all malignancies. In spite of this fact, it is crucial not to leave them out in the differential diagnosis of the nasal obstruction, even more importantly in one-sided nasal obstruction and epistaxis. The main topic of this presentation is to sum up the history of a 50 year old patient, who initially presented with one-sided nasal obstruction with occasional nosebleeds. Even though surgical intervention was initially recommended, the symptoms resolved spontaneously, and no surgery took place. After a short asymptomatic period, the issues along with worsened nasal breathing started occurring again. The biopsy of the mass found on the rhinoendoscopic inspection was performed and thus the diagnosis of non-keratinizing squamous cell carcinoma was made. Afterwards the patient was referred to our department, where a primary surgical removal was indicated and performed and adjuvant chemoradiotherapy in the Proton Centre was considered. The principal aim is to emphasize the importance not only of a thorough history taking when approaching a patient presenting with unilateral nasal obstruction, but also the risks associated with omiting a histopathological examination of one-sided nasal masses.

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Surgery of the external nose is among the most technically demanding procedures in otorhinolaryngology and plastic surgery. It encompasses a wide range of surgical approaches and techniques and continues to undergo dynamic development. This presentation provides a comprehensive overview of the philosophy of modern rhinoplasty, with particular emphasis on the preservation of tissues and anatomical structures. Using a series of the authors’ own patients, it demonstrates the practical application of preservation rhinoplasty principles and provides practical explanations of surgical techniques and tips that can be directly applied in the operating room.

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Background: Increasing evidence supports the use of surface functional electrical stimulation (FES) as a complementary therapy for treating patients with complete denervated facial paralysis. However, standardised studies using objective methods are needed to quantify its therapeutic effects. This pilot study examined the safety and feasibility of home-based FES for treating denervated muscle atrophy and improving facial symmetry, using ultrasound and automated image analysis. Methods: Ten patients (median age: 61 years; median duration of denervation: 130 days) with complete facial paralysis were enrolled in a prospective, monocentric feasibility study. They performed home-based FES with long (initially 100 to 250 ms phase duration), triangular biphasic impulses to evoke contractions of the zygomaticus muscle twice daily 20 minutes for up to one year. Monthly follow-ups included stimulation adjustments, sonography, and standardised photographs. To eliminate reinnervation bias, data points were excluded as soon as electromyography indicated voluntary muscular activity. Synkinesis as long-term sequel after 1 – 2 years after reinnervation were compared by blinded raters with photos of historic controls. Results: No serious adverse events occurred. The stimulation parameters were progressively adapted (reduction of phase duration from mean 150 to 50 ms after 20 weeks) while frequency could be increased (from mean 1 to 5 Hz), demonstrating effective muscle engagement. The cross-sectional area of the zygomaticus muscle increased significantly, in contrast to the decrease observed in non-stimulated muscles. Automated image analysis revealed a significant deterioration in the non-stimulated areas compared to the stimulated facial region. There was a trend to less synkinesis in the FES-group compared with no-stimulated historic controls. Conclusions: FES is a safe and feasible therapy model for patients with complete facial paralysis. Atrophy of the stimulated muscles could be reversed, as could facial asymmetry. These promising results justify conducting a future controlled, randomised, double-blind study to further investigate these initial findings. Sponsored by a research grant from MED-EL, Innsbruck, Austria, DFG GU-463/12-1 and IZKF

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To achieve glottal gap closure in unilateral vocal fold paralysis (UVFP) through complementary ansa cervicalis nerve muscle pedicle laryngeal reinnervation (ANMP-LR). INTRODUCTION: ANMP-LR is easy to learn and does not require recurrent laryngeal nerve (RLN) transection. MATERIALS AND METHODS: Twelve patients with unilateral vocal fold paralysis (UVFP) were included, who received ANMP-LR and could be followed up for at least 6-24 months. At baseline, after 3-6 (T1), 12 (T2) and 24 months (T3), Voice Handicap Index (VHI), perceived roughness (R) and breathiness (B), sound pressure level (SPLmax), maximum phonation time (MPT), Dysphonia Severity Index (DSI) and glottal gap (GG) were recorded. RESULTS: R and B were significantly reduced at T1, MPT and SPLmax increased significantly up to T1 (MPT to 15.8 s; SPLmax to 91.5 dB). Similarly, VHI dropped significantly and the residual glottal gap (GG) was significantly reduced between T0 and T1. All outcomes remained stable until T3. There was a non-significant tendency to further improvement until T3 in SPLmax and GG. DISCUSSION: The T1-T3 outcomes of the complementary ANMP-LR are comparable with the standard LR and also with thyroplasty. As with all LR techniques, younger patients and those with shorter paralysis benefit more. Patients with evidence of unfavorable laryngeal synkinesis are more likely to benefit from a standard LR with RLN transection. CONCLUSIONS: Younger patients with insufficient synkinetic reinnervation and persisting or progressive glottis closure insufficiency in UVFP benefit from early reinnervation. When the easy-to-learn ANMP technique is used, any partial rehabilitation that has already been achieved or any remaining chance of spontaneous reinnervation via the RLN is not compromised.

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Tumours of salivary glands form 3% of all neoplastic involvements. Majority of them is benign, parotid gland is most commonly involved. Risk of malignity is increasing with reduced size of involved gland. Clinical differentiation of salivary gland tumours is difficult. MRI is therefore important in their differential diagnosis. Ultrasound is first method of choice in diagnostics of pathological involvement of salivary glands. MRI is preferred for evaluation of foci involving deep lobe of parotid gland, sublingual gland, minor salivary glands, deeply placed soft tissue, involvement of lymphonodes and possible perineural spread. Pleomorphic adenoma is the most common tumour of salivary glands, mostly in superficial lobe with fibrous capsule. Carcinoma, usually multifocal, can develop later from adenoma. Inhomogeneity of parenchyma with solid and cystic portions, mild enhancement after contrast media application, higher wash out ratio and lower mean ADC value than in malignant tumours are characteristic for Warthin tumour, involving largely smokers. Mucoepidermoid carcinoma of lower grade can mimic pleomorphic adenoma, higher grade carcinoma often metastasizes to lymphatic nodes. Adenoid cystic carcinoma often spreads perineurally, makes recurrence in long delay after surgery. It has intermediate T2W signal, higher grade of tumour has even low T2W signal. Metastases into salivary gland are exceptional, commonly from lung and breast carcinoma, from skin squamous cell carcinoma or melanoma. Multiple small cystic structures in parenchyma of gland are characteristic for Sjögren syndrome. Lymphoma can involve lymphoid tissue of parotid gland or adjacent lymphatic nodes, either primary or secondary by systemic involvement.

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Introduction: Benign tumors of the parotid gland are the most common salivary gland tumors and are primarily treated surgically. Although parotid surgery is an established treatment, postoperative morbidity, particularly facial nerve dysfunction, remains a significant clinical concern. Population-based data on surgical treatment patterns and postoperative outcomes for benign parotid tumors are limited. Therefore, this study analyzed the inpatient surgery of benign parotid tumors in Thuringia between 2016 and 2020. Material and Methods: In this retrospective, multicentre, population-based cohort study, clinical routine data of 1,157 patients who underwent surgery for benign parotid tumors in Thuringian hospitals between January 2016 and December 2020 were analyzed. Patient characteristics, preoperative diagnostic procedures, surgical techniques, histopathological findings, postoperative complications, facial nerve function, recurrence, and surgery rates were evaluated. Univariate and multivariate analyses were performed to identify factors associated with postoperative complications, facial nerve palsy, and recurrence. Results: The cohort included 621 men and 536 women, with a mean age of 62.5 ± 13.9 years. Preoperative ultrasound was performed on 97.7% of patients. The most common procedures were partial parotidectomy (50.7%) and lateral parotidectomy (41.0%). Facial nerve monitoring was employed in 99.3% cases. Histologically, Warthin tumors were most common, accounting for 60.8% of cases, followed by pleomorphic adenomas in 31.9%. Complete tumor resection was achieved in 99.3% of patients. Postoperative complications occurred in 16.7% of cases. Facial nerve palsy was documented in 8.2%, including transient palsy in 7.2% and permanent palsy in 1.0%. The median follow-up time was 0,23 months (range, 0-75 months). Recurrence was observed in 3.6% of patients. In univariate analyses, postoperative complications were significantly associated with female sex and more surgical extent (p < 0,05). The surgery rate was highest in the 60- 75 age group with 99-138/100,000 population. Conclusion: In Thuringia, surgery for benign parotid tumors was associated with high rates of complete tumor resection and low rates of permanent facial nerve dysfunction. The extent of surgery was an important factor influencing postoperative morbidity. These population-based data provide a comprehensive overview of current surgical practices and outcomes in treatment of benign parotid tumor and could support future quality assessment and treatment standardization.

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Background/Introduction: Facial nerve function is routinely assessed using clinical examination and standardized grading systems. Other functions of the facial nerve, including taste testing and the Schirmer test, are not routinely performed in ENT practice. The aim was to assess the relationship between facial nerve motor function and taste in patients with different causes of peripheral facial palsy. Methods: Facial nerve function was assessed using clinical examination, the House–Brackmann classification, the Sunnybrook Facial Grading System and objective digital facial analysis using the Rehapple application. Lateralized taste testing was performed using TASENS taste strips. We present three cases: Bell's palsy, facial palsy after parotid surgery and one healthy control. Results: Objective facial asymmetry was detected in both patients with facial palsy, whereas symmetrical facial function was found in the healthy control. Taste impairment was not detected in any examined subject. Conclusion(s): These initial cases demonstrate the feasibility of combining objective facial nerve assessment with lateralized taste testing in routine clinical practice. Larger patient cohorts are needed to evaluate the relationship between facial nerve dysfunction and taste impairment.

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Keratoacanthoma is a distinctive skin tumor with a variable clinical course that often closely mimics malignant lesions, particularly squamous cell carcinoma. Its characteristic rapid growth, followed by the potential for spontaneous regression, makes accurate diagnosis and treatment selection challenging. This may lead to unnecessary radical surgical procedures, especially in functionally and aesthetically sensitive areas such as the nose. Careful clinical evaluation and close interdisciplinary collaboration are therefore essential for appropriate management. We present two case reports of patients with keratoacanthoma located in the nasal region, demonstrating different clinical courses and therapeutic approaches. Clinical presentation, disease progression, histological findings, treatment strategy, and final outcomes were assessed. In the first case, the lesion was initially suspected to be squamous cell carcinoma, and surgical excision was considered. However, due to spontaneous regression observed during follow-up, a watchful waiting strategy was chosen, resulting in complete regression without the need for surgery and leaving only minimal scarring. In the second case, a patient presented with a large keratoacanthoma of the nasal apex with rapid progression and central necrosis. Based on the clinical appearance and disease course, conservative treatment with intralesional methotrexate was initiated. Gradual tumor regression was achieved; however, residual nasal deformity remained and required subsequent reconstructive plastic surgery. Keratoacanthoma represents a significant diagnostic challenge because of its clinical and histological similarity to squamous cell carcinoma. An individualized interdisciplinary approach can enable more conservative management in selected patients, helping to avoid unnecessarily mutilating surgery while preserving both functional and aesthetic outcomes.

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Background: Retrograde cricopharyngeal dysfunction (RCPD) is an underrecognized disorder of upper esophageal sphincter (UES) relaxation. Clinical features include an inability to belch or vomit, chest gurgling, bloating, and abdominal pain. Botulinum toxin injection into the UES is the current gold standard treatment. The aim of this work is to present the first experience with treatment of RCPD at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava. Methods: Since the beginning of 2026, we have treated three consecutive patients. One patient had UES spasm demonstrated on high-resolution manometry, and two patients were diagnosed clinically. All patients received transoral Dysport injections (150 SU) into the cricopharyngeus muscle under general anesthesia. Clinical severity and treatment effect were assessed using the BURP questionnaire pre- and post-operatively. Results: All patients reported marked clinical improvement and better psychosocial functioning. The mean BURP score decreased from 90.3 preoperatively to 16.0 postoperatively, a mean reduction of 82.3%. Reported adverse effects included transient dysphagia, reflux symptoms, and reduced voluntary control of belching. These effects were transient and resolved spontaneously. Conclusion: RCPD is a somatic condition with a major impact on quality of life. Botulinum toxin injection into the cricopharyngeus muscle is a simple, safe and effective treatment that provides substantial benefit for patients.

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Introduction: Cervical lymphadenopathy represents a common and relatively nonspecific clinical manifestation of a broad spectrum of pathological conditions. In this context, malignancies of the head and neck region are of major consideration, though systemic malignancies, most notably lymphomas, should also be considered. Case report: In this retrospective study, we describe a rare presentation of a female patient with bilateral multilevel cervical lymphadenopathy with no other clinical symptoms, who was referred to our department with an initial clinical suspicion of lymphoma. However, subsequent biopsy and colonoscopy revealed the underlying etiology to be metastatic colorectal carcinoma. Discussion and conclusion: While otherwise asymptomatic colonic cancer presenting with cervical lymphadenopathy is almost unheard of, tumours especially from the upper GI tract are known to metastasize into cervical nodes via the well described pathway of the thoracic duct and presenting as Virchow’s node. While these are a small minority of cases, they always have to be considered. A proper diagnostic algorithm for cervical lymphadenopathy should lead to correct and timely diagnosis even in such rare cases.

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Introduction: Laryngomalacia is the most common congenital anomaly of the larynx and also the most common cause of inspiratory stridor in children. The condition usually requires only observation and resolves spontaneously within 1–2 years. Severe cases are indicated for endoscopy under general anaesthesia to rule out any associated pathology. Direct laryngoscopy also allows a surgical treatment depending on the type of obstruction. Methods: A retrospective study of 50 paediatric patients who underwent dissection of aryepiglottic folds between the 1st of January 2013 and the 30th of June 2024 at the Department of ENT, 2nd Faculty of Medicine Charles University and Motol and Homolka University Hospital, Prague based on information from surgical records, medical records, outpatient records and the UNIS hospital information system. Results: In the patient cohort studied, a high success rate of surgical treatment (94%) was recorded, with a low incidence of post-operative complications (6%). Conclusions: The results of surgical treatment of laryngomalacia at our department are consistent with those of leading paediatric endoscopic centres worldwide. Associated comorbidities have been shown to be a potentially significant factor that negatively affects not only the course of the disease itself, but also leads to a higher incidence of complications and treatment failure. The post-operative course was uncomplicated in the majority of patients, particularly those who were otherwise healthy, allowing discharge by the second post-operative day (70%) with subsequent rapid regression of symptoms.

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Myasthenia gravis (MG) is an autoimmune disorder that affects neuromuscular transmission. It is caused by autoantibodies directed against acetylcholine receptors, which impair the normal function of the neuromuscular junction. The initial symptoms frequently involve the head and neck muscles, and patients may present with voice, swallowing, and speech disorders. Consequently, otorhinolaryngologists (ENT specialists) are often the first physicians to evaluate these early manifestations before a formal neurological diagnosis is established. Dysphagia, dysphonia, and dysarthria may be the initial presenting symptoms. ENT specialists play an important role in the initial evaluation of patients with unexplained pharyngeal or vocal cord weakness, in the assessment and management of aspiration risk to prevent serious airway and swallowing complications, and in the timely referral of patients to a neurologist for confirmatory diagnostic testing, including antibody assays and electrophysiological studies. In this presentation, we will review the most common ENT manifestations of myasthenia gravis and present two illustrative case reports demonstrating its clinical presentation.

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Background survival of Thyroid cancer patients is around 90% after thyroidectomy mainly in papillary thyroid carcinoma. Early diagnosis is a important factor in good outcome. Relation of Quality of life with a generic focus has been undr reported among thyroid cancer survivors. Aim Aim of my study to examine and describe factors associated with quality of life after surgery in thyroid cancer patients. Methods: Patients who underwent thyroidectomy for cancer between January 1999 and June 2001 in a Dhaka city & Feni town were included in the study. Interviews was completed with 146 (67%) of those 218 eligible, asking about sociodemographic variables, disease/treatment characteristics and social support. Quality of life was measured by the Chinese version of the Quality of Life Index. Multivariate analyses were performed using multiple linear regressions. Result: Post operation patients at 12-36 months follow up result reveals lower quality of life in comparison with those within 18 months of operation. Symptoms of fatigue and chills were negatively associated with quality of life. Patients who rated the impact of operational scar on activities as 'high' had lower quality of life scores. Support from friends, families and relatives had a high positive impact on quality of life. Conclusions: Doctors & specially nurses could improve quality of life among patients with thyroid cancer. Nurses by strengthening their social support and educating them in self-management of uncomfortable symptoms. Surgeons should consider types of operation in which the scar would be less likely to influence the patients' activities.

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Background: The Ligasure sealing system is a bipolar diathermy sealing device using high current with low voltage for creating a consistent seal to up to 7mm diameter vessels with reduced thermal spread. The electrosurgical generator is responsible for the detection of the characteristics of the tissue closed between the instrument jaws so it can deliver the exact amount of energy needed to seal it permanently. The Ligasure sealing system has been in standard use in our ENT department in Mladá Boleslav since January 2016. Methods: Reflecting on the sample of 751 standard total thyroidectomy procedures performed since January 2003 we are going to evaluate the demographic features, the effect on the surgery length, complications and patient outcome. To compare the data objectively we included solely total thyroidectomies and excluded every procedure including collar mediastinotomy, lymph node resection or any other accompanying procedure. We use the Ligasure sealing system in 218 patients and traditional hemostatic procedures in the other 573, we also tested the harmonic scalpel technology, but it will not be part of this overview. Results: In the Ligasure group the surgery length average was 89,62 minutes, the median was 88 minutes. In the traditional group the average was 98,10 minutes and the median 95 minutes. Other demographics and safety data are yet to be determined, based on the data set we have collected. Conclusion: Ligasure is an effective tool for hemostasis control and it shows reduction in the operating time. It has now become a standard tool in total thyroidectomy and other major surgeries in the ENT department Mladá Boleslav.

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Introduction: Robototic head & neck surgery offers numerous benefits & is a better option for delicate and complex head & neck surgery. Reduced blood loss, shorter hospital stays, and improved postoperative outcomes are huge advantages, but its adoption and widespread implementation in Bangladesh present a unique set of challenges. Huge financial expenses& the lack of training among surgeons are 2 major challenges. This study explores the current state, barriers, successes, and facilitators of Robotic Surgery in Bangladesh. Furthermore, it highlights strategies that will help adoption Robotic surgery and the implementation of training. Methodology: We conducted a literature search using PubMed, Google Scholar, and Google search engine. We identified, reviewed, and extracted key information from relevant articles to ensure a comprehensive understanding of the practice of Robotic surgery and identify barriers, facilitators, and strategies for training in developing countries. Results: From different relevant articles the subject matter were identified, analyzed, and reviewed. The data reveals that training programs borne from collaborations with international institutions can help capacity building to implement robotic surgery training successfully. This review also identified the current barriers to robotic surgery training & other barriers and potential strategies to help overcome them. The barriers identified were inadequate financial resources, poor support from health care stakeholders, lack of adequate training equipment, limited training curriculum, and the lack of qualified personnel & reluctant to accept new technology out of fear are important. Conclusions: Despite the financial constraint & challenges in Robotic surgery training in Bangladesh, we hope help from some authorities can bring this technology close to us. Training programs and workshops have been recorded in different Asian countries. To further advance the progress made, joint efforts from the local surgical workforce, the government, (allocation of budget to purchase robots, subsidy & discount for Poor patients), the robotic companies (request for creating cheap robots), and health care stakeholders will be required.

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Background: Routine grading of facial palsy is largely subjective and overlooks functions that matter to patients – facial symmetry, eye protection during blinking, and emotional expression. We present four objective tools developed in Jena, covering facial asymmetry, blinking, and muscle activity. Methods: AI-based angle mapping quantified facial asymmetry automatically from clinical photographs using 478 landmarks in 405 datasets from 198 patients. Automated blinking analysis (JeFaPaTo) extracted facial features from smartphone video in patients with acute palsy, patients with synkinesis, and healthy controls. Bilateral high-resolution surface EMG (HR-sEMG; 58 electrodes, muscle-oriented Fridlund and symmetrical Kuramoto schemes) recorded muscle activity during 11 movements in 36 synkinesis patients and 36 healthy controls. A proof-of-concept model (EIFER) mapped facial geometry to muscle activity via a 3D morphable model, toward electrode-free EMG. Results: Angle-map scores correlated moderately to strongly with the clinical Stennert index score (r = 0.32–0.73, p < 0.001), were robust to head rotation, and produced reference-free maps. Blinking analysis separated acute palsy, synkinesis, and controls: in acute palsy the minimal Eye-Aspect-Ratio (incomplete closure) was higher on the affected side, while blink frequency was lower and duration longer in both patient groups; these differences were not reflected in patient-reported outcome measures. On HR-sEMG, each movement activated nearly the entire muscle network rather than isolated muscles. In synkinesis, off-target muscles were overactive on the synkinetic and often the clinically unaffected contralateral side — evidence of a bilateral disorder relevant for contralateral treatment; the Fridlund scheme gave more specific contrasts. The electrode-free model showed that muscle activity can be inferred from video alone. Conclusions: The tools quantify facial asymmetry and muscle activity objectively in both flaccid and synkinetic palsy. Within multidisciplinary ENT-led care, they complement physician-based grading and patient-reported outcome measures and help standardize recovery monitoring. * Orlando Guntinas-Lichius and Joachim Denzler acknowledge support by the Deutsche Forschungsgemeinschaft (DFG), grant GU-463/12-1 and DE-735/15-1

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Introduction: Accurate delineation of tumor margins is a persistent challenge in surgery of oropharyngeal squamous cell carcinoma (OPSCC). The rising incidence of OPSCC further highlights the need for reliable, real-time tissue characterization tools. Hyperspectral imaging (HSI) captures spatially resolved spectral information across a broad wavelength range, enabling label-free, non-contact differentiation of tissue types. This study aims to evaluate the feasibility of HSI combined with machine learning (ML) for distinguishing tumor from healthy tissue in patients with OPSCC. Methods: In the prospective feasibility study HSI-HEAD-NECK (DRKS00033009) in vivo HSI data were acquired in 35 patients with OPSCC (91% males, mean age 68 ± 11 years, 71% of stage IV) using a hyperspectral endoscopy camera system with100 spectral channels. For each patient, HSI datacubes were collected intraoperatively from tumor-bearing and adjacent healthy tissue regions. Regions of interest were annotated in cooperation with an independent surgeon. Mean spectral profiles were extracted per tissue class and used to train ML approaches, evaluation was realized using cross-validation. Results: Preliminary results demonstrate visually distinct spectral profiles between tumor and healthy tissue across all investigated anatomical sites. Classifiers achieved promising discrimination accuracy higher than 80%. Consistent spectral differences were observed over the whole measured wavelength region, suggesting tumor-associated changes in tissue oxygenation and structural composition. Analysis is ongoing with a larger patient cohort. Conclusion: HSI represents a promising non-invasive approach for intraoperative in vivo tissue characterization in OPSCC. The combination with ML classification has the potential to support surgical decision-making regarding tumor margin assessment. This feasibility study will provide a foundation for prospective clinical validation. This work was funded by BMFTR/DVI under the HyperTUM project (Grant Agreement No. 16SV9564) and by EU Horizon Programme under the CHARM project (Grant Agreement No. 101058004).

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Introduction Artificial intelligence (AI) is becoming an increasingly important tool in healthcare, supporting diagnosis, prognosis, treatment planning, and patient monitoring. In rehabilitation medicine, AI offers opportunities to transform subjective clinical assessments into objective, data-driven evaluations. However, successful implementation of AI requires access to high-quality clinical data and digital tools capable of collecting standardized patient information. Methods As a case study of AI integration into rehabilitation practice, we present Rehapple, a digital platform developed for patients with facial palsy. The platform supports rehabilitation exercises while collecting facial movement data during routine use. These data are subsequently analyzed using machine learning and deep learning approaches. Current research focuses on automated classification of facial nerve impairment according to the House–Brackmann (HB) grading system using convolutional neural networks, as well as detection of synkineses through machine learning models based on extracted movement features. Results The platform has enabled systematic collection of facial movement recordings from patients undergoing rehabilitation. Preliminary analyses indicate that AI models can identify clinically relevant patterns within the collected data and provide automated assessments of facial function. The continuously growing dataset supports further model development and validation. Conclusion AI has the potential to enhance rehabilitation by providing objective, reproducible, and scalable assessment methods. The Rehapple platform demonstrates how digital data collection and AI-based analysis can be combined in clinical practice to support evaluation of facial palsy. Such approaches may contribute to improved monitoring of patient progress, more standardized assessments, and future development of personalized rehabilitation strategies.

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Background: Human listener-based assessment of alaryngeal speech is clinically established but time-consuming and influenced by listener experience. We investigated whether automatic speech recognition (ASR) can provide a standardized adjunct for assessing speech intelligibility. Methods: Speech samples from 17 alaryngeal speakers (10 tracheoesophageal, 7 electrolaryngeal) were evaluated using 21 complete PLTT datasets. ENT physicians, speech professionals, and speech science students transcribed the recordings. The same samples were processed independently with the locally installed Whisper large-v3 model without fine-tuning and evaluated using identical reference texts and scoring rules. Analyses compared absolute PLTT scores, speaker-level correlations, rehabilitation methods, and exploratory classification of clearly well versus poorly intelligible speakers. Results: ASR produced substantially lower PLTT scores than human listeners (25.36% vs. 55.21–72.03%; all p < 0.001). Nevertheless, ASR scores strongly correlated with pooled human ratings at speaker level (Pearson r = 0.858; Spearman ρ= 0.898; both p < 0.001). Tracheoesophageal speakers achieved higher ASR scores than electrolaryngeal speakers (33.88% vs. 14.46%; p = 0.035). After excluding moderately intelligible speakers, ASR completely separated six well-intelligible from four poorly intelligible speakers in an exploratory analysis (AUC = 1.000; cutoff ≥ 37.5%). Conclusions: The evaluated ASR system underestimated speech intelligibility after laryngectomy and cannot yet replace human assessment. However, its ability to distinguish clearly well from poorly intelligible speakers suggests clinical relevance. External validation in larger cohorts and across languages is required.

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Introduction: Broadband stimulated Raman scattering (bSRS) microscopy provides label-free, chemically specific contrast reflecting intrinsic molecular composition of cells and tissues. Its capability to resolve biochemical heterogeneity in head and neck cancer specimens makes it a promising ex vivo biosensing approach for diagnostic tissue characterization. We present a clinically deployable multimodal bSRS imaging device, COherent Raman PLatform (CORAL), integrating 38 Raman channels with simultaneous second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) acquisition in a single platform. Methods: The system architecture was specifically engineered for operation under routine clinical laboratory conditions. To ensure compatibility with standard histopathological workflows, a robust and reproducible dewaxing protocol was established. Measurement parameters and calibration routines were optimized to balance data quality, acquisition time, and operational stability. Head and neck cancer specimens were analyzed using whole-section scans. A dedicated processing pipeline was developed for visualization and analysis of multimodal bSRS data and integrated into a user-friendly graphical user interface, enabling rapid quality control. Following bSRS imaging, all samples underwent conventional hematoxylin and eosin (H&E) staining. Digitized H&E sections were annotated by expert pathologists, providing systematic correlation of Raman-derived biochemical information with established histopathological features, including tumor cell density, stromal composition, and tissue architecture. Results: Measurement protocols were successfully optimized to achieve reproducible molecular contrast and stable multimodal image acquisition under routine laboratory conditions. Whole-section imaging of clinical tumor specimens generated consistent bSRS, SHG, and TPEF datasets across samples. Comparison with pathologist-annotated H&E sections revealed that the multimodal measurements captured tissue-specific biochemical and structural features corresponding to histopathological tissue organization. Conclusion Multimodal bSRS enables reproducible, label-free biochemical tissue characterization in head and neck cancer specimens and provides diagnostically interpretable contrast at the cell and tissue level. These findings support its potential as an ex vivo biosensing modality complementing conventional histopathology. Acknowledgements: This work was funded by the EU Horizon Programme under the CHARM project (Grant Agreement No. 101058004). Furthermore, we acknowledge funding from the German Cancer Aid (Deutsche Krebshilfe) under the ARBOR- Automated RoBOt Tumor Resection project (grant number: 70116061), TROPHY- ulTRafast holograPHic FTIR microscopY funded by the European and Innovation Council under the Horizon Europe program in the PATHFINDEROPEN-01 call. (HORIZON-EIC-2021 PATHFINDER-OPEN-01, grant number: 101047137), QUANCER- Quantum microscopy with non-detected light for chemical-selective imaging of tumor tissue in a clinical setting (BMFTR, grant number: 13N16444), and TOOLS- Tailored Optics fOr Life Sciences Engineering funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, grant number: 528591139– FIP 31).

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Introduction : Surgical resection is the primary treatment for head and neck squamous cell carcinoma (HNSCC), where complete tumor removal is critical for prognosis. However, current intraoperative margin assessment using frozen section analysis is time-consuming and subjective. Raman spectroscopy is a label-free biophotonic technique that provides a molecular fingerprint of tissue based on inelastic light scattering. It has shown potential for distinguishing tumors for discriminating between tumors and precancerous lesions or benign changes and inflammations. Methods: This prospective, monocentric feasibility trial (DRKS00028114) evaluated the applicability of in vivo Raman spectroscopy for the detection of tumours during surgery in patients with primary head and neck squamous cell carcinoma (HNSCC). The workflow was fully established by the time the 30th patient had been examined. Using a clinical Raman system (InvaScope), spectra were acquired intraoperatively from tumour and healthy tissue sites. Subsequent histopathological analysis served as the diagnostic gold standard. The protocol was designed to integrate seamlessly into the standard surgical workflow. The probe measures in the wavenumber range of 500 cm⁻¹ to 3300 cm⁻¹ (numerical aperture of individual fibres (NA) = 0.22; spectral resolution ≈ 20 cm⁻¹). Results: Following the establishment of the clinical protocol, measurement time was significantly reduced, decreasing from over 30 minutes initially to approximately two minutes. High-quality, interpretable data was obtained from 90% of patients, revealing consistent and clear spectral differences between malignant and healthy tissues in both the fingerprint and high-wavenumber spectral regions. Recruitment of the planned 100 HNSCC patients (intention-to-treat) was completed in May 2025. The final analysis is ongoing. Conclusions: This study demonstrates that Raman spectroscopy, performed in compliance with clinical regulatory standards, is a feasible and rapid technique for the in vivo discrimination of HNSCC. The results support its potential role as a real-time, adjunctive optical biopsy tool for real-time margin assessment during surgery.

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Introduction: Secondary malignancies occur in 10–25 % of patients with head and neck (HN) cancers. The most common locations include the lungs, other HN regions, and the esophagus. Methods: We retrospectively analyzed patients treated for laryngeal or hypopharyngeal carcinoma, focusing on synchronous and metachronous second primary tumors, their association with clinicopathological characteristics, and prognostic relevance. Patients and Results: The cohort included 225 patients (197 men, 28 women; mean age 65 years), including 171 with stage III–IV disease and 162 with T3–T4 tumors. Regional metastases were present in 93 patients and distant metastases in 7; 102 tumors were poorly differentiated. Treatment was surgical in 122 patients, non-surgical in 103. Synchronous or metachronous second primary tumors, or multiple malignancies, were identified in 31 patients, with 34 tumors- 7 synchronous and 27 metachronous. The most frequent secondary malignancies were bronchogenic (n= 11), skin (n= 4) and thyroid (n= 3) carcinomas. Tumors were diagnosed 0–262 months after completion of treatment (mean 52, median 34). Seven patients were symptomatic at diagnosis, while 27 tumors were detected incidentally during follow-up, predominantly by PET/CT (n = 20), CT (n = 2), ENT examination (n = 1), colonoscopy (n = 1), and histopathology after thyroidectomy (n = 3). Median overall survival (OS) was 63 months. Median disease-free interval (DFI) was 129 months. Second primary tumors had no significant impact on OS or DFI. None of the analyzed parameters (smoking, age, sex, tumor size, grade, stage, metastases, treatment modality) influenced their development. Conclusion: Second primary tumors did not affect prognosis in patients treated for laryngeal carcinoma. As no predictors for risk stratification were identified, uniform follow-up is recommended, including head and neck examination and whole-body PET/CT, or chest CT, as one-third originated in the lungs. Follow-up is essential for at least 3 years, when half were diagnosed. Supported by MH CZ – DRO (FNOl, 00098892) and internal research IGA_LF_2026_018.

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Introduction Transoral surgery is a primary treatment option for selected patients with early to moderately advanced oropharyngeal squamous cell carcinoma (OPSCC). Transoral robotic surgery (TORS) was introduced to potentially improve tumor resection precision and reduce treatment-related morbidity compared to conventional transoral surgery (CTS). This study compared oncologic outcomes, treatment burden, and functional surrogates between TORS and CTS. Material & Methods This retrospective cohort study included 74 TORS patients (Sept 2021–Oct 2023) and 48 CTS patients (Oct 2015–Oct 2023) with T1–T3, N0–N2 OPSCC. Variables analyzed included margin status, operative time, hospital stay, functional surrogates (tracheostomy, nasogastric tube dependence), need for adjuvant therapy, and recurrence. Results Mean operative time was significantly shorter for TORS (150,405 min) versus CTS (191,104 min). TORS demonstrated improved perioperative metrics: shorter median hospital stay (7,732 days vs 9,468 days), lower temporary tracheostomy rate (12,162 % vs 14,583 %), and faster nasogastric tube removal (4,142 days vs 6,137 days). The recurrence rate was lower in the TORS cohort (1,351 %) compared to the CTS cohort (10,417 %). However, TORS had a higher rate of positive surgical margins (16,216 % vs 12.5%). The need for adjuvant oncologic therapy was comparable between TORS (82,432 %) and CTS (81,250 %). Conclusions In this cohort, TORS was associated with superior perioperative and functional recovery metrics, including shorter operative time, faster return to oral intake, and lower recurrence, despite a higher rate of positive margins. These findings suggest TORS offers reduced treatment burden and may be beneficial for carefully selected OPSCC patients.

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Purpose: Differentiating benign branchial cleft cysts from cystic metastatic squamous cell carcinoma (SCC) remains challenging in adults, particularly because fine-needle aspiration biopsy (FNAB) may yield false-negative results in cystic lesions. This study aimed to evaluate diagnostic misclassification in adult lateral cystic neck masses operated on under a benign diagnosis and to assess its oncologic consequences. Methods: A retrospective cohort study (2016–2024) included adults undergoing surgery for a presumed branchial cleft cyst with unequivocally benign FNAB findings. Patients with equivocal cytology or any clinical, endoscopic, or radiologic suspicion of malignancy were excluded. Demographic, clinical, radiologic, pathologic, and survival data were analyzed. Outcomes were additionally compared with a cohort of surgically treated thyroglossal duct cysts managed at the same institution. Results: Among 72 patients operated on for a presumed branchial cleft cyst, definitive histology confirmed a benign cyst in 64 cases (88.9%) and metastatic SCC in 8 cases (11.1%). Advanced nodal disease (N1–N2b) was identified only after surgery, despite the absence of suspicious clinical or radiologic findings. Diagnostic misclassification delayed definitive oncologic treatment by a mean of 5.1 months. Two tumor-related deaths occurred, resulting in 2- and 5-year disease-specific survival rates of 75%. In contrast, all 49 patients with thyroglossal duct cysts had concordant preoperative and histopathologic diagnoses, and no malignancy was identified during follow-up. Conclusion: Even with benign FNAB findings and no clinical or radiologic suspicion, metastatic SCC may be present in adult lateral cystic neck masses. Early surgical intervention and routine frozen section analysis should therefore be considered in adult patients.

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Background Incidence of thyroid cancer is increasing worldwide specially for small size papillary thyroid carcinoma, while the mortality remains low. Thyroid cancers are the most common endocrine disorders. Bangladesh is one of the countries with the high prevalence of thyroid cancer. The actual burden of thyroid dysfunction in Bangladesh is unknown. Surgery is the mainstay of treatment for thyroid cancer. In addition, active surveillance is proven as a valid option in patients with low-risk papillary thyroid cancer. The aim of this study is to assess the possibility of implementation of active surveillance in Bangladesh by physicians and to identify potential barriers to its widespread adoption. Methods Me & my group surveyed participants, Endocrinologists, ENT & Head-Neck surgeons of Bangladesh by distributing questionnaires & talking to them over telephone. The questionnaire included dichotomous, multiple choice questions, and multiple answer questions. Results We got responses from 50 surgeons. Most of the respondents agreed that AS is a valid modality for low-risk papillary thyroid cancer but no one has patients on active surveillance. ENT surgeons, Endocrinologists with >15 years of experience, and & practicing in clinics, private hospitals & university hospitals were involved. We have started an active surveillance program with a very small group of patients & awareness activities among different groups of doctors. Conclusion Obstacles to implementing active surveillance were, patient noncompliance and lack of national awareness as well as acceptance among the Bangladeshi doctors. Still active surveillance is possible in Bangladesh with differences in health care system & health care organization and even outside academic centers. Efforts to decentralize knowledge and expertise to health-care practitioners and community hospitals would encourage its implementation.