Michael Soyka

Background: Navigation guided rhinoplasty allows detailed planning and guidance of osteotomies. We aimed to investigate whether the use of a CT navigation system is feasible and capable of performing more precise osteotomies at specific locations, thus improving accuracy. Methods: Bilateral electromagnetic‐navigated osteotomies ( n = 18) of the nasomaxillary suture were performed on nine cadaver heads, using a transnasal ( n = 4) or percutaneous ( n = 14) technique. After dissection, we manually assessed the distance between the osteotomy and the suture on ( n = 5) specimens. Additionally, at baseline and postoperatively, a cone beam computed tomography was performed to calculate the mean and median distance between the osteotomy and the suture line. Results: The manually measured mean distance from intended to actual osteotomy was 0.75 mm (mm) (95% confidence interval [CI] 0.06–1.44 mm) with a median distance of 0.00 mm (interquartile range [IQR] 0.00–1.19 mm). In 6 of 10 procedures, the osteotomy was created according to plan with no visible deviation. Overall, on imaging, the navigation‐guided osteotomies deviated from the suture by an average of 1.50 mm (95% CI 0.87–2.12 mm) with a standard deviation (SD) of 1.35 mm. The median distance was 0.73 mm (IQR 0.59–2.61 mm). The accuracies of transnasal and percutaneous osteotomies were similar ( p = 0.63). Conclusion: Navigation‐guided osteotomies demonstrated good feasibility with clinically useful sub‐millimeter accuracy for both percutaneous and transnasal techniques. A model for postoperative outcome analysis is described with clinically useful accuracy, though not as high as direct observation. Level of Evidence: N/A.

Background: The interrelationship between unemployment and substance use disorders, especially opioid use disorders, is complex, and basic epidemiological data are lacking both in Germany and elsewhere. This study aimed to evaluate the prevalence rates of opioid use disorder, work ability, and associated factors among unemployed individuals with opioid use disorder who underwent socio-medical assessment by the Medical Service (MS) of the Federal Employment Agency (FEA). Methods: All socio-medical assessments conducted between 2016 and 2021 ( N = 4,249,028) were extracted from the FEA database and analyzed with respect to relevant sociodemographic characteristics, opioid use disorder (ICD-10 F11.x diagnosis) and work ability. Descriptive statistics were used to summarize the data. Results: A total of 4,249,028 unemployed individuals were assessed. Of these, 22,683 clients (0.5%) met an F11.x diagnosis (primary or secondary); mostly opioid dependence ( N = 20,506; 94.3%). The number of diagnoses increased over time (2016–2021). Mean age was 40.7 ± 9.4 years. Overall, 15,065 (73.5%) were male and 5,441 (26.5%) were female. For individuals with a secondary diagnosis of F11.x, most frequent psychiatric comorbidities were alcohol dependence (27.8%), polysubstance use (17.6%), schizophrenia (8.8%), depression episode (8.3%) or recurrent depression (5.9%) and persistent pain disorder (6.1%). Regarding daily work capacity, 58.3% ( n = 11,962) of individuals were able to work less than 3 h per day, 10.0% ( n = 2,051) were able to work 3–6 h per day, and 17.4% ( n = 3,568) were able to work more than 6 h per day. Conclusions: The number of unemployed individuals with opioid dependence in Germany has increased over time, and most are unable to work more than three hours per day. The most frequent psychiatric comorbidities were other substance use disorders, particularly alcohol use disorder, schizophrenia, and depression. Somatic comorbidities, with the exception of chronic viral hepatitis, were recorded less frequently. Tailored interventions and closer collaboration between employment agencies and mental health care providers are needed to improve the psychosocial integration of this population.

Background: Inferior turbinate hypertrophy is a major cause of chronic nasal obstruction and can be treated with several surgical techniques. However, current surgical decision-making is often not personalized to the dominant anatomical and functional substrate of obstruction. No widely adopted structural classification of the inferior turbinate exists, and no standardized algorithm links individual anatomical phenotypes to targeted surgical strategies. Methods: A structured narrative review of PubMed and Scopus was performed from database inception to 1 February 2026, using predefined search terms and eligibility criteria. Studies were selected if they addressed inferior turbinate anatomy, histopathology, imaging morphology, endoscopic grading, nasal valve or septal anatomy, surgical techniques, postoperative outcomes, complications, or patient-reported outcomes. Randomized and prospective trials, histopathological studies, CT morphometric analyses, and validated endoscopic grading systems were considered. Four phenotypes of inferior turbinate hypertrophy were identified and linked to preferred surgical options within a clinically oriented decision algorithm integrating endoscopy, functional testing, and selective CT imaging. This framework was developed to support individualized treatment planning and shared decision-making. Results: Four structural phenotypes were defined: (i) predominantly cavernous/mucosal hypertrophy; (ii) predominantly bony hypertrophy; (iii) anterior nasal valve-turbinate conflict; and (iv) mixed hypertrophy. For mucosal-dominant disease, radiofrequency ablation and laser turbinoplasty are preferred first-line, mucosa-preserving options. For bony hypertrophy, mucosa-preserving powered inferior turbinoplasty is favored for the mid/posterior turbinate, whereas endoscopic pyriform aperture turbinoplasty is preferred for anterior valve-level conflict. Mixed phenotypes are best managed with combined skeletal and mucosal procedures. The algorithm aims to avoid mismatched treatments, such as mucosal-only techniques for rigid bony hypertrophy or extensive skeletal reduction in purely mucosal disease. Perioperative variables relevant to shared decision-making, including type of anesthesia, postoperative morbidity, recovery profile, and expected limitations, were summarized for each technique. Conclusions: This phenotype-guided algorithm provides a structured, evidence-informed framework for the personalized selection of inferior turbinate surgery, emphasizing mucosal preservation, anatomical specificity, patient-centered decision-making, and avoidance of mismatched procedures. It is intended to support, not replace, clinical judgment and to guide future prospective validation studies in personalized rhinologic surgery.

Background: In Western countries, Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) is predominantly associated with a type 2 inflammatory endotype. While nasal secretion analysis shows promise for disease endotyping, current biomarkers remain limited for accurate stratification, disease monitoring, and prediction of treatment response. Objective: This study aimed to investigate the inflammatory patterns in nasal secretions of patients with type 2 Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) undergoing treatment with dupilumab, an anti‐IL4Rα antibody. A second objective was to evaluate markers for therapy response and monitoring. Methods: Nasal secretions and blood samples were collected at four time points from 23 patients with histological type 2 CRSwNP undergoing dupilumab treatment and compared with 10 healthy controls. Samples were analysed using proximity extension assay method by Olink. Results: Proteomic analysis of nasal secretions revealed 50 differentially expressed proteins in type 2 CRSwNP compared to healthy controls. Nasal secretions of most patients revealed a mixed inflammatory endotype. Under dupilumab treatment, cytokines of all different endotypes decreased. The cytokines with the highest mean change (MCP‐4, CCL23, GDNF and CCL11) showed good associations with clinical variables and were effective predictors of dupilumab response and disease control. Conclusion: The inflammatory environment of the nasal mucosa in histological type 2 CRSwNP is most often characterized by a mixed type 1, 2, and 3 inflammatory endotype. Targeting type 2 inflammation with dupilumab reduces inflammation markers of all three types of inflammation. GDNF has emerged as a valuable marker for stratifying therapy and monitoring success in type 2 CRSwNP under dupilumab treatment.

Background: Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)‐EAACI guidelines, this manuscript presents the ARIA‐EAACI 2024–2025 recommendations for oral and ocular treatments. Methods: The ARIA‐EAACI 2024–2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence‐to‐decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. Results: Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. Conclusion: This ARIA‐EAACI 2024–2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.

Background/Objectives: Opioid use disorder (OUD) is a chronic relapsing condition associated with elevated mortality and substantial psychiatric and somatic comorbidity. Oral methadone and sublingual and depot buprenorphine are the undisputed gold standard in opioid agonist treatment (OAT). More recently, another oral buprenorphine formulation, buprenorphine lyophilisate (BUP-Lyo), has been introduced into clinical practice, offering potentially faster bioavailability and simplified administration. This review aims to summarize the available clinical and pharmacological data on BUP-Lyo and assess its potential role within current OAT strategies. Methods: A targeted Medline search was performed to identify publications reporting pharmacological characteristics, safety, efficacy, and clinical use of BUP-Lyo. Additional information was requested from the manufacturer. Relevant sources were reviewed narratively with a focus on OUD treatment, with particular attention to the pharmacological and clinical profile of the compound. Results: Few studies on BUP-Lyo have been published to date. As a rapid-dispersion formulation placed on the tongue, BUP-Lyo provides faster bioavailability and a quicker route of administration compared with conventional sublingual buprenorphine. These properties may reduce the need for post-administration supervision and could lessen risks of misuse or diversion. Available evidence supports its safety, efficacy, and feasibility within routine OAT, and the clinical implications of these characteristics are discussed. Conclusions: BUP-Lyo expands the range of available buprenorphine formulations and offers practical advantages through accelerated absorption and simplified administration. While initial data are encouraging, the limited evidence base underscores the need for further longitudinal and post-marketing studies to define its clinical position in the management of OUD.