Adina Zamfir-Chiru-Anton

Respiratory allergies are among the most prevalent chronic diseases worldwide, and seasonal allergic rhinitis and asthma place a substantial burden on patients and healthcare systems. Pollen from trees, grasses, and weeds contribute to a wide spectrum of clinical manifestations, while globalization, urban landscaping, biological invasions, and climate change are facilitating the spread of new allergenic plants across continents. Ailanthus altissima (tree of heaven) is a fast-growing deciduous tree native to China that has become widely distributed in North America and Europe, including Romania. Although initially introduced as an ornamental and shade tree, its rapid growth, tolerance of pollution and drought, and ability to colonize disturbed urban habitats have increased its relevance as a potential aeroallergen. This narrative clinical review synthesizes evidence from clinical case reports, sensitization studies, molecular allergen characterization, aerobiological monitoring, and Romanian distribution data. To improve clinical and public health applicability, the review includes summary tables comparing Ailanthus with other emerging allergens such as ragweed and Platanus, outlining Romanian ecological and pollen-monitoring evidence, summarizing diagnostic implications for ENT and allergy practice, identifying evidence gaps, and presenting future research priorities. Current evidence supports A. altissima pollen as an emerging but under-recognized respiratory allergen, particularly in urban areas where the tree is established. However, major limitations remain, including the lack of standardized diagnostic extracts, incomplete molecular allergen validation, limited routine pollen monitoring, and absence of Romanian clinical sensitization studies. Greater clinical awareness, species-specific aerobiological surveillance, standardized allergen characterization, and coordinated Romanian sensitization studies are needed to determine the extent to which A. altissima pollen contributes to allergic rhinitis and asthma. Future research should explicitly distinguish species occurrence, airborne pollen exposure, IgE sensitization, and clinically relevant respiratory disease when evaluating the emerging allergenic importance of A. altissima.

Laryngeal pathology requires individualized management because the larynx integrates airway protection, phonation, swallowing, and respiratory function within a compact and highly variable anatomical framework. This narrative review examines how laryngeal anatomy and morphometry support interdisciplinary collaboration and personalized care in oncologic, stenotic, functional, and reconstructive laryngeal disease. Evidence from morphometric studies, CT, MRI, endoscopy, ultrasonography, three-dimensional reconstruction, artificial intelligence, and multidisciplinary clinical workflows was synthesized qualitatively. Key parameters—including vocal fold length, glottic width, thyroid cartilage angle, cricoid diameter, subglottic diameter, anterior commissure thickness, and the status of paraglottic and pre-epiglottic spaces—provide actionable information for diagnosis, T-staging, airway assessment, surgical planning, reconstruction, and functional rehabilitation. Morphometry concretely informs clinical decisions: thyroid cartilage angle guides thyroplasty and phonosurgical planning; subglottic diameter supports stenosis surgery and airway instrumentation; and anterior commissure, conus elasticus, cartilage, and deep-space measurements refine oncologic staging and margin strategy. Technological accelerators, including AI segmentation, radiomics, 3D printing, photogrammetry, and ultrasonography, extend morphometry from static measurement toward predictive modeling and patient-specific simulation. However, implementation remains limited by heterogeneous CT protocols, inconsistent measurement planes, uneven access to advanced technologies, lack of global normative databases, and unresolved ethical issues surrounding AI validation and data governance. This review supports standardizing CT morphometry using parallel vocal fold planes, routinely measuring anterior commissure thickness in T1 glottic cancer, incorporating ultrasonography as a first-line morphometric tool in voice clinics, and validating AI segmentation against population-specific morphometric norms. Laryngeal morphometry should therefore become a routine decision-making framework for precision laryngology.

Objectives: Incomplete partition type III is a rare malformation of the inner ear characterized by the absence of the modiolus, fixation of the stapes, and significant communication between the cochlea and the internal auditory canal (IAC). During cochlear implant (CI) surgery, there is a risk that the electrode array may enter the IAC, resulting in non-specific stimulation of auditory neurons or other nerve fibers inside the IAC. In this study, we present our experience with CI surgery in patients with incomplete partition type III and report the types of devices utilized. Methods: A retrospective analysis was conducted on all our patients with cochlear incomplete partition type III who underwent surgical cochlear implantation in a tertiary referral unit over the past 16 years. Results: Of the perimodiolar electrodes used initially, four were correctly positioned within the cochlea from initial insertion, and no reinsertion was necessary. A lateral wall electrode array CI was selected to replace the last failed perimodiolar insertion, but it also required two insertion attempts due to its initial misplacement into the internal auditory canal. Conclusions: In this study, electrode array selection was influenced by surgeon preference and by intraoperative factors such as the severity of the gusher. Our observations suggest that perimodiolar CIs can be used in selected cases of incomplete partition type III and did not appear to increase the risk of IAC misplacement compared with the lateral wall array used in one patient. However, these findings should be interpreted cautiously as observations from the authors’ experience rather than as generalized conclusions regarding the relative safety of perimodiolar versus lateral wall electrode arrays. Lateral wall arrays may also be misplaced into the IAC, and their use may be considered in cases with severe and difficult-to-control gusher.

Background/Objectives: Cochlear implantation (CI) represents a well-established intervention for the management of severe to profound sensorineural hearing loss. The co-occurrence of severe hearing loss and Autism Spectrum Disorder (ASD) presents unique diagnostic and therapeutic challenges that significantly impact post-implantation outcomes. This review aims to synthesize the current literature on cochlear implantation in children with Autism Spectrum Disorder (ASD), including diagnostic, audiological, rehabilitative, and functional outcome considerations. Methods: A structured search of PubMed and Scopus was performed for English-language articles published between January 2000 and January 2026, focusing on audiological assessment, rehabilitation challenges, multidisciplinary management, and post-implant functional outcomes in this population. Results: The findings synthesized in this review suggest that cochlear implantation in children with Autism Spectrum Disorder must be interpreted within a broader communicative-ecological framework rather than through auditory metrics alone. These findings highlight a multidimensional model of post-implant outcomes, shaped by the dynamic interplay between auditory access, social engagement, family context, and language-learning environments. Conclusions: Most children with ASD and severe-to-profound hearing loss show improvements in speech perception and production after cochlear implantation, although outcomes are highly variable. A multidisciplinary approach, through coordinated collaboration among specialists, enhances family engagement, optimizes compliance with care plans, and ultimately contributes to improved clinical and developmental outcomes. ASD should not be considered a contraindication for CI; however, careful individual assessment, realistic parental counseling, and a multidisciplinary approach availability to evaluation and rehabilitation are essential.

Background: Accurate differentiation between benign and malignant cervical lymphadenopathy remains clinically important for diagnostic stratification and treatment planning. This study evaluated the diagnostic performance of conventional morphological magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) values in a mixed cohort of cervical lymphadenopathies. Methods: This retrospective lesion-based diagnostic study included 88 cervical lymph nodes from 39 patients who underwent head-and-neck MRI between September 2023 and December 2025. The cohort had malignant entities such as squamous cell carcinoma metastases, thyroid carcinoma, non-Hodgkin lymphoma, adenoid cystic carcinoma, and medullary thyroid carcinoma, as well as benign/reactive, inflammatory, CMV-related, tuberculous, Warthin tumor-associated, and cystic lymphangioma-related lymphadenopathies. MRI examinations were performed for heterogeneous indications, including the initial assessment of palpable cervical lymphadenopathy, oncological staging, post-biopsy follow-up, suspected recurrence, and benign/inflammatory lesion characterization; therefore, not all patients underwent MRI for the same clinical indication. Most examinations were performed during the initial diagnostic work-up, while six cases represented post-biopsy follow-up. Morphological features and ADC values were analyzed using Mann–Whitney U tests, chi-square tests, ROC analysis, DeLong testing, Firth penalized logistic regression, generalized estimating equations (GEE), patient-level bootstrap resampling, and calibration analysis. Statistical analyses were performed using Python (Version 3.12), with exploratory verification in JASP. Statistical significance was set at p < 0.05. Results: The cohort included 39 patients with a mean age of 54 years (range: 18–74 years), with 20 males and 19 females. Of the 88 lymph nodes, 33 were malignant and 55 benign. Malignant nodes demonstrated significantly lower ADC values than benign nodes (0.87 ± 0.23 vs. 1.25 ± 0.22 × 10⁻³ mm²/s; U = 207, p < 0.001). ADC alone showed good diagnostic performance, with an AUC of 0.886 (95% CI: 0.803–0.960). The optimal ADC cutoff was 0.900 × 10⁻³ mm²/s, yielding 75.8% sensitivity and 89.1% specificity. The final GEE model, including the ADC, nodal shape, and margin characteristics while accounting for intra-patient clustering, achieved an apparent AUC of 0.956. Leave-one-patient-out cross-validation yielded an AUC of 0.929, and the bootstrap optimism-corrected AUC was 0.949. DeLong testing confirmed that the combined model significantly outperformed the ADC alone (AUC improvement = 0.070; p = 0.006), and the inter- and intra-observer reproducibility for ADC was excellent. Conclusions: ADC values, nodal shape, and margin characteristics provide complementary diagnostic information for differentiating benign from malignant cervical lymph nodes. A structured multiparametric MRI approach demonstrated high diagnostic performance, although the findings should be interpreted in the context of the retrospective single-center design and histopathological heterogeneity.

Inflammation at the superior airway level has multiple manifestations, and allergic rhinitis and chronic rhinosinusitis with or without polyps are two of the most frequent and troublesome of them, with innate and adaptive immunity being implicated. Dendritic cells, epithelial cells, neutrophils, macrophages, mucosal mast cells, eosinophils, basophils, innate lymphoid cells (ILCs), and NK cells are the players in innate immunity, while regulatory T (Treg), TH1, TH2, TH17, T follicular helper, and B cells are components of the adaptative immune system. Th9 cells, a subset of T helper cells discovered in 2008 that produce interleukin-9 (IL-9), play a vital role in the adaptive immune response and have advantageous and harmful effects in different diseases due to the induction pattern. We queried international databases for current, up-to-date information regarding the interplay between interleukin 9 (IL-9) and helper T cells (especially Th9 cells), and by other immune cells. Interleukin-9 has multiple immunological functions, acting on various target cells through its specific receptor (IL-9R), such as the following: the regulation of allergic (Th2-type) immune responses; effects on epithelial and mucosal cells, mast cells, and eosinophils; chronic inflammation; and autoimmunity. Thus, there is a further need to translate laboratory findings into clinical practice regarding IL-9.

Cholesteatoma is a prevalent disease affecting both children and adults. In this review, we present the recent findings related to the molecular mechanisms involved in cholesteatoma and discuss how researchers can target new molecules to treat this disease. These new approaches illustrate the paradigm shift from a primarily surgical solution to a biological “control and prevent” strategy.

Background and Objectives: Cochlear implantation (CI) is a surgical procedure that offers significant benefits to individuals with sensorineural hearing loss, particularly in pediatric patients, as it can prevent long-term cognitive impairment. Despite the devices being designed for lifelong use, complications may necessitate explantation and subsequent reimplantation. Materials and Methods: Our retrospective study analyzes the incidence and causes of such procedures in pediatric CI patients over a period of 15 years, from May 2009 to June 2025. The study included patients aged between 8 months and 17 years, recording their age, the manufacturers of their first and second implants, the reasons for explantation and reimplantation, and the type of electrode array used during the second surgery. Results: During the study period, a total of 440 cochlear implantations were performed in our department. The primary causes of explantation in our study group were device hardware failures in 2.27% of cases, seromas over the implant body or antenna in 0.68% of cases, spontaneous extrusion in 0.22% of cases, and local trauma with electrode displacement in 0.22% of cases. The study confirmed that hardware failures were the most common reason for reimplantation, with an incidence influenced by the device manufacturer and the extent of trauma to the device. Surgical observations highlight the challenges regarding electrode reimplantation and available electrode choices for the surgeon. Conclusions: The use of superior materials and advanced research in manufacturing can enhance implant reliability and reduce the number of surgical procedures required in the long term for pediatric patients. Any type of electrode array can be utilized in reimplantations if meticulous surgical techniques are applied.

Purpose: This review aims to analyze the diagnostic methods used to evaluate inferior vestibular nerve neuritis. Methods: We performed an electronic search on the PubMed database for clinical studies investigating the diagnostic techniques used for inferior vestibular nerve neuritis. Results: We initially identified 114 records in our search. After applying the inclusion and exclusion criteria, we narrowed it down to 12 studies. These studies collectively examined a total of 642 patients diagnosed with vestibular nerve neuritis, 64 of whom had inferior vestibular neuritis. Conclusions: The inferior vestibular neuritis is an unfrequent form of vestibular neuritis, often misdiagnosed. The diagnosis of inferior vestibular neuritis (IVN) is based on clinical history and vestibular testing, specifically reduced posterior canal gain on video head impulse test (vHIT), absent cervical VEMP (cVEMP), normal caloric responses, and preserved ocular VEMP (oVEMP). This review highlights the gaps in current diagnostic strategies and emphasizes the need for integrating advanced vestibular testing methods to enhance diagnostic accuracy for inferior vestibular nerve neuritis. Future studies should address the standardization of diagnostic protocols to facilitate broader clinical application.

Starting from the metabolic profile of type 2 diabetes mellitus (T2DM), we hypothesized that the mechanisms of ¹³¹I-induced cardiotoxicity differ between patients diagnosed with differentiated thyroid cancer (DTC) with/without T2DM, with metformin potentially acting as a cardioprotective agent by mitigating inflammation in patients with T2DM. To address this hypothesis, we quantified, using ELISA, the serum concentration of several key biomarkers that reflect cardiac injury (NT-proBNP, NT-proANP, ST2/IL-33R, and cTn I) in 74 female patients with DTC/−T2DM and 25 with DTC/+T2DM treated with metformin. All patients received a cumulative oral dose of ¹³¹I exceeding 150 mCi (5.55 GBq) over approximately 53 months. Our results showed the following: (i) In DTC/−T2DM patients, high-cumulative ¹³¹I doses promote a pro-inflammatory state that accelerates the development of cardiotoxicity. Monitoring NT-proBNP, ST2/IL-33R, and cTn I in these patients may help identify those at risk of developing cardiac complications. (ii) In patients with DTC/+T2DM, high-cumulative ¹³¹I doses lead to the release of NT-proANP (r = 0.63), which signals that the atria are under significant stress. (iii) In patients with DTC/+T2DM, metformin suppresses inflammation, leading to a dose-dependent reduction in cTn I (r = −0.59). Monitoring cTn I and NT-proANP, and considering the use of metformin as part of the therapeutic strategy, could help manage cardiotoxicity in T2DM patients undergoing ¹³¹I therapy.