Michele Cassano

A 43-year-old man presented with a giant retro-auricular osteoma of the right mastoid. The osteoma was removed through a retroauricular incision and removed by drilling the mastoid under continuous irrigation and using a hammer and chisel. The results from an aesthetic point of view were reported by the patient as very satisfactory. No recurrence was found in the subsequent 6-month follow-up. The experience shows that the management and surgical approach described in scientific literature can be considered effective and safe for the removal of the osteoma and to avoid recurrences.

Mast cells represent key regulators within type 2 inflammation and contribute significantly to the pathophysiology of chronic inflammatory airway diseases. Nasal cytology has enabled their consistent identification, highlighting how their interaction with eosinophils influences inflammatory persistence, tissue remodeling, and disease severity in chronic rhinosinusitis with nasal polyps (CRSwNP). In contrast, conventional hematoxylin–eosin histopathology does not reliably visualize mast cells, potentially limiting comprehensive cellular characterization. Through cytological assessment, distinct inflammatory endotypes have been defined, including nonallergic rhinitis with mast cells and nonallergic rhinitis with eosinophils and mast cells, which may represent stages along a continuum progressing toward CRSwNP. The Clinical–Cytological Grading integrates cellular patterns with clinical parameters, identifying eosinophil–mast cell coinfiltration as a marker associated with increased disease severity and recurrence risk. Evidence from both sinonasal and extra-nasal mucosae, including eosinophilic esophagitis, further supports the relevance of mast cells within the broader network of type 2 inflammation. As therapeutic strategies increasingly target specific inflammatory pathways, accurate cellular endotyping becomes essential for refining risk stratification and optimizing biologic therapy selection. Integrating nasal cytology with histological and molecular approaches offers a pragmatic framework for advancing precision medicine in type 2 inflammatory diseases.

Inner ear malformations (IEMs) present significant challenges for cochlear implantation (CI), particularly the common cavity deformity, in which the cochlea and vestibule merge into a single space. Surgical and audiological outcomes in such cases depend on accurate electrode placement, nerve integrity, and tailored surgical strategies. We report the case of a pediatric patient with bilateral common cavity deformities who underwent sequential bilateral CI using the double posterior transmastoid labyrinthotomy (TML) approach with custom‐made electrodes. The patient, diagnosed with profound bilateral sensorineural hearing loss at 1 year of age, showed bilateral common cavities with identifiable but reduced caliber seventh and eighth cranial nerves on radiological imaging and absent responses on auditory brainstem response testing. Based on preoperative imaging, a custom‐made MED‐EL FORM19 electrode (Innsbruck, Austria) was selected and adapted to match the patient’s anatomy, aiming to optimize placement and reduce intraoperative complications. A staged implantation was performed. Surgery was uneventful, with intraoperative neural response telemetry confirming responses in both ears. At four‐year follow‐up, aided thresholds were stable in the speech frequency range (right ear: 40–60 dB HL; left ear: 50–65 dB HL). Speech audiometry in quiet demonstrated good detection and recognition, and language development was appropriate for hearing age, with significant improvement from baseline. This case illustrates that double posterior TML with custom‐made electrodes is a safe and effective strategy for CI in complex IEMs such as common cavity deformities. The technique offers precise electrode placement, minimizes risks to the facial nerve, and ensures stable fixation. Early bilateral stimulation, active family involvement, multidisciplinary care in specialized centers, and tailored electrode design are critical to achieving favorable long‐term outcomes. Multicenter studies are needed to further validate these findings and refine patient selection.

Background: Mucins, particularly MUC1, are involved in the pathogenesis of chronic respiratory diseases. In chronic rhinosinusitis with nasal polyposis (CRSwNP), altered mucin expression may contribute to chronic inflammation and tissue remodeling. However, the specific role of MUC1 in CRSwNP and its correlation with clinical severity and inflammatory pathway remains unclear. Objective: We aimed to evaluate the MUC-1 expression in nasal polyps of patients with CRSwNP and to assess the correlation of MUC-1 expression and disease severity, according to Clinical-Cytological Grading (CCG). Methods: Eighteen consecutive patients with CRSwNP who underwent endoscopic sinus surgery (ESS) were enrolled. A double-label immunofluorescence was performed to evaluate the expression of MUC-1, CD15 and Tryptase and their eventual co-localization on histological samples. Double-positive MUC-1+CD15+ and MUC-1+Tryptase+ inflammatory cells were counted by confocal microscopy. Results: MUC1 was expressed in all samples, with a significantly increasing expression in relation to CCG (p < 0.001). A significant co-localization between MUC1 and CD15+ eosinophils was observed, with a progressive increase in the number of double-positive cells from low to high CCG (p < 0.001). On the contrary, the co-localization between MUC1 and Tryptase+ mast cells was not significant, although both markers showed a higher expression in cases with high CCG (p < 0.001). Conclusions: A strong correlation between CRSwNP severity and MUC-1 expression, mainly colocalized with infiltrating eosinophils, was shown. This offers a promising perspective for the use of MUC-1 as a biomarker of CRSwNP.

Background and Clinical Significance: Adenoid cystic carcinoma (ACC) is a rare neoplasm of salivary glands, accounting for approximately 2–4% of all ACCs of head and neck malignancies. Adenoid cystic carcinoma (ACC) of the larynx is exceedingly rare, accounting for only 0.07–0.25% of all laryngeal tumors. Within the larynx, ACC may arise in various locations; however, the subglottic region is most commonly affected, representing approximately 64% of cases. ACC typically manifests as a slow-growing tumor with a pronounced tendency for perineural invasion and local recurrence. Current treatment strategies primarily involve surgical resection followed by adjuvant radiotherapy. Chemotherapy demonstrates limited efficacy and is generally reserved for advanced, recurrent, or metastatic disease. Given the rarity of this malignancy and the limited number of cases reported in the literature, we aim to contribute to the existing body of knowledge by presenting a clinical case of laryngeal ACC. Case Presentation: A 77-year-old male with a significant smoking history (more than 20 cigarettes per day for over 40 years) presented to our department in October 2023 with persistent dysphonia lasting several months. Endoscopic evaluation of the upper aerodigestive tract revealed an extensive neoplastic lesion involving the larynx. Contrast-enhanced computed tomography (CT) confirmed the presence and extent of the lesion. The patient subsequently underwent surgical resection and was referred for adjuvant postoperative radiotherapy. Unfortunately, the patient died of a myocardial infarction a few days before radiotherapy could be initiated. Conclusions: Due to the rarity of laryngeal adenoid cystic carcinoma, further studies are necessary to define optimal management strategies. Sharing clinical experiences and outcomes is essential, as there is currently no universally accepted treatment consensus for this uncommon malignancy. At the same time, our aim is to highlight the importance of histological subtype and perineural invasion which have to be considered as important prognostic factors when dealing with ACC.

Allergic rhinitis (AR), traditionally considered as a childhood condition, is increasingly recognized among older adults, driven by rising life expectancy and environmental factors. Although allergic sensitization declines with age, AR prevalence in the elderly is underestimated, with 3–12% of geriatric patients affected. Diagnosis is challenging due to nonspecific symptoms and overlapping conditions, leading to underdiagnosis and inadequate treatment. AR significantly impacts the quality of life (QoL), often exacerbating respiratory comorbidities like asthma and COPD. Presbynasalis, encompassing age-related sinonasal changes, includes reduced allergic responses, increased chronic rhinosinusitis, altered nasal structure, and impaired mucociliary clearance. Non-allergic rhinitis, atrophic rhinitis, and overlapping rhinitis further complicate AR diagnosis in the elderly. Effective management involves personalized pharmacotherapy, allergen-specific immunotherapy (AIT), and addressing comorbidities and polypharmacy risks. Despite safety concerns, recent studies demonstrate AIT efficacy in elderly patients, reducing symptoms and medication use. Given AR’s impact on cognitive and respiratory health, accurate diagnosis and treatment can enhance QoL and mitigate health decline. Greater awareness and further research are essential to understand AR prevalence and improve outcomes for geriatric patients.

Over the years, halotherapy (HT) has shown promise in the treatment of respiratory and dermatological diseases. However, its widespread acceptance remains limited due to the absence of official guidelines and awareness among doctors and patients. Among the patented systems of administration of HT, Aerosal® is the only one consisting of 3 certified elements, all classified as Medical Devices Class 2A: a dry saline dispenser called Aerosalmed®, a 30 g salt dose named AeroNaCL®, and a confined environment in marine multilayered construction with walls coated in salt called Aerosal®. We conducted an online survey of subjects undergoing Aerosal® HT across 80 Italian centers. Participants provided demographic data, reasons for choosing HT, and perceptions of its effectiveness. Following 10 treatment sessions, they rated improvements in various aspects, such as skin condition, sleep quality, relaxation, and respiratory benefits. Most participants learned about HT through word of mouth rather than medical advice, suggesting a discrepancy between patient satisfaction and medical endorsement. Over 92% reported resolution of their health issues post-treatment, with significant improvements in sleep quality and relaxation, particularly in adults. The therapy showed promise in various conditions, including respiratory and skin disorders, possibly attributed to stress reduction and intrinsic therapeutic effects. Despite skepticism, HT administered through the Aerosal® system has shown therapeutic potential. The psycho-physical benefits observed in patients advocate for greater consideration of this therapy by clinicians, emphasizing its safety, tolerability, and absence of notable side effects. In this context, standardized systems like Aerosal® are crucial for ensuring treatment safety and efficacy.