Razvan Hainarosie

Background: Otogenic lateral sinus thrombosis (OLST) is a rare but potentially life-threatening intracranial complication of middle-ear infection. Despite advances in imaging, antimicrobial therapy and otologic surgery, optimal management—particularly anticoagulation—remains controversial, and no standardized clinical guideline is available. Methods: A structured narrative review was conducted using PubMed for English-language human studies published between 1 January 2015 and 31 January 2025. The search was repeated and documented during revision on 12 May 2026. Four searches were run separately; retrieved records were manually merged, and duplicate record occurrences were removed using PMID. The searches retrieved 83 records before deduplication; after removal of 19 duplicates, 64 unique records remained for title and abstract screening. Single case reports and review articles were excluded from the primary descriptive synthesis. SANRA principles guided review quality and transparency. Seven eligible studies comprising 140 confirmed OLST patients were analyzed descriptively; selected clinically relevant but non-comparable publications were retained for contextual discussion. Results: Most included cohorts were pediatric; one study included both pediatric and adult patients. Clinical presentation was heterogeneous and often attenuated by prior antibiotic exposure. Contrast-enhanced CT was frequently used initially, whereas MRI/MRV was most informative for confirming thrombus extent and follow-up. Broad-spectrum intravenous antibiotics and surgical source control represented core treatment. Anticoagulation was reported in six studies, most often with low molecular weight heparin, but indications and duration varied substantially. Outcomes were generally favorable, although visual impairment, hearing loss, behavioral sequelae and incomplete radiological recanalization were reported. Conclusions: OLST management should be individualized according to disease severity, thrombus extent, septic status, and patient-specific risk factors. Antibiotics and source control are essential, while anticoagulation should be considered selectively. A practical management algorithm is proposed, but prospective multicenter data are needed.

Background and Objectives: Complicated cholesteatomatous otomastoiditis includes a spectrum of inflammatory, suppurative, and destructive lesions affecting the temporal bone and surrounding critical structures, including the dura mater, labyrinth, facial nerve, sigmoid sinus, and skull base. The selection of appropriate surgical techniques and closure materials is decisive for long-term outcomes, functional preservation, and prevention of life-threatening complications. This systematic review and meta-analysis evaluates the evidence base for surgical approaches, intraoperative technologies, and autologous and synthetic closure materials used in the management of iatrogenic and disease-related fistulas in otomastoid surgery. Materials and Methods: A PRISMA 2020-compliant search was conducted across PubMed, Cochrane Library, Embase, and Scopus (2000–2024). The review was registered in PROSPERO (CRD420261370406). After the systematic screening process, 56 eligible studies involving 4218 patients were selected for inclusion. The primary outcome measures analysed were infection rates, fistula recurrence, preservation of function, and long-term integrity of the closure. Limitations include the predominance of observational studies and the absence of prospective registration prior to data extraction. Results: Autologous materials demonstrated consistently low infection rates (<10%) in contaminated operative fields and therefore remain the preferred first-line option for the reconstruction of small to moderate defects. In contrast, synthetic materials exhibited superior mechanical durability in large sterile defects, achieving closure integrity rates of 85–92% at two-year follow-up. Hybrid reconstructive constructs provided the most favourable overall outcomes, with pooled closure integrity reaching 91.6%, suggesting a synergistic advantage when combining biologic and synthetic components. Furthermore, the adjunctive use of combined microscopic–endoscopic surgical techniques was associated with a significant reduction in residual cholesteatoma rates (OR 0.56, 95% CI 0.38–0.82), supporting the growing role of endoscopic assistance in middle ear and mastoid surgery. When biologic closure strategies were appropriately selected according to defect characteristics and contamination status, functional preservation rates exceeded 90–95%, underscoring the importance of tailored reconstructive approaches. Conclusions: The durability of long-term outcomes is most strongly influenced by complete pathological clearance and by the strategic alignment of biomaterial properties with defect dimensions, contamination status, and surrounding anatomical structures. In response to these findings, an evidence-based algorithmic framework is proposed to facilitate rational intraoperative material selection.

Background: Nasal valve dysfunction (NVD) is a common yet underrecognized cause of nasal airway obstruction, with a significant impact on quality of life. Despite its clinical relevance, no universally accepted diagnostic standard exists, and optimal management remains debated. Multiple diagnostic tools and surgical or minimally invasive treatments have been proposed. This systematic review and meta-analysis aimed to evaluate current evidence regarding diagnostic approaches and treatment outcomes in NVD. Methods: A systematic search of PubMed/MEDLINE, Embase, and Cochrane Library was performed for studies published between January 1990 and January 2026, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, non-randomized comparative studies, cohort studies, and case series (≥10 patients) assessing diagnostic methods or therapeutic interventions for NVD were included. Diagnostic data were synthesized narratively. The primary surgical outcome was change in the Nasal Obstruction Symptom Evaluation (NOSE) score. Risk of bias was assessed using RoB 2, ROBINS-I, and QUADAS-2 tools. Results: Seventy-two primary clinical studies were included (15 diagnostic, 57 treatment-focused). Objective airflow measurements, particularly rhinomanometry and peak nasal inspiratory flow, showed greater reliability than isolated clinical maneuvers. Imaging modalities provided anatomical detail but correlated inconsistently with symptoms. Meta-analysis of 12 studies (n = 1210 patients) suggests that both traditional surgical and minimally invasive interventions can substantially improve nasal breathing, with mean NOSE score reductions of 40–55 points, though heterogeneity precludes direct comparison of their relative effectiveness. Conclusions: Diagnosis of NVD requires a multimodal approach combining clinical assessment, validated symptom scores, and selective objective testing. Surgical and minimally invasive treatments provide substantial symptom improvement when appropriately indicated. Evidence is constrained by the predominance of observational data, emphasizing the need for standardized diagnostics and robust comparative trials.

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference −43.8, 95% CI: −46.1 to −41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air–bone gap (ABG) decreasing from 52.1 ± 5.3 dB preoperatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery yields robust QoL improvement, favourable hearing outcome, and recurrence rates similar to classic techniques at short-term evaluation.

Background and Objectives: To evaluate the surgical management and outcomes of lateral semicircular canal fistulas (LSCFs) in patients with middle ear cholesteatoma, focusing on hearing preservation and vestibular function. Materials and Methods: A retrospective study was conducted on nine adult patients diagnosed with LSCFs secondary to cholesteatoma who underwent surgery at a tertiary referral center between 2018 and 2024. The preoperative evaluation included otoscopy, audiometry, vestibular testing (HINTS), and high-resolution CT (HRCT) of the temporal bone. Surgical techniques included canal wall up (CWU) or canal wall down (CWD) mastoidectomy, depending on the disease extent. Cholesteatoma matrix removal from the fistula was performed carefully. Fistula closure involved layered grafts of temporalis fascia, temporalis muscle, and/or gelfoam. The postoperative follow-up included audiometry and vestibular assessments. Results: Nine patients with LSCFs were identified (one Type III, three Type IIb, and four Type I/IIa). Five patients were found to have additional disease complications intraoperatively, including facial nerve involvement and middle fossa dehiscence. Postoperatively, hearing outcomes varied, with some patients experiencing improvement, others demonstrating stable hearing, and some exhibiting further decline, particularly in cases with extensive disease. Vestibular symptoms, including vertigo, generally resolved postoperatively, although some patients required prolonged vestibular rehabilitation. Conclusions: LSCF management in cholesteatoma surgery requires a careful preoperative assessment, meticulous surgical technique, and individualized fistula closure based on the size and type. While hearing preservation remains a challenge, particularly in extensive cases, the “underwater technique” and layered grafting may contribute to minimizing further damage and promoting fistula closure. Vestibular rehabilitation plays a crucial role in managing postoperative balance issues. A long-term follow-up is essential to monitor for recurrence and assess both auditory and vestibular function.

Background: Stapes prostheses represent one of the earliest and most widely applied “biomedical actuators” designed to restore hearing in patients with otosclerosis. Unlike conventional actuators, which convert energy into motion, stapes prostheses function as passive or smart micro-actuators, transmitting and modulating acoustic energy through the ossicular chain. Objective: This paper provides a comprehensive analysis of stapes prostheses from an engineering and biomedical perspective, emphasizing design principles, materials science, and recent innovations in smart actuators based on shape-memory alloys combined with surgical applicability. Methods: A narrative review of the evolution of stapes prostheses was consolidated by institutional surgical experience. Comparative evaluation focused on materials (Teflon, Fluoroplastic, Titanium, Nitinol) and design solutions (manual crimping, clip-on, heat-activated prostheses). Special attention was given to endoscopic stapes surgery, which highlights the ergonomic and functional requirements of new device designs. Results: Traditional fluoroplastic and titanium pistons provide reliable sound conduction but require manual crimping, with a higher risk of incus necrosis and displacement. Innovative prostheses, particularly those manufactured from nitinol, act as self-crimping actuators activated by heat, improving coupling precision and reducing surgical trauma. Emerging designs, including bucket-handle and malleus pistons, expand applicability to complex or revision cases. Advances in additive manufacturing and middle ear cement fixation offer opportunities for customized, patient-specific actuators. Conclusions: Stapes prostheses have evolved from simple passive pistons to innovative biomedical actuators exploiting shape-memory and biocompatible materials. Future developments in stapes prosthesis design are closely linked to 3D printing technologies. These developments have the potential to enhance acoustic performance, durability, and patient outcomes, thereby bridging the gap between otologic surgery and biomedical engineering.

Background: Cholesteatoma is a destructive middle ear lesion that compromises hearing and quality of life, for which endoscopic ear surgery (EES) has emerged as a minimally invasive alternative to microscopic approaches. While recurrence and audiological outcomes are frequently reported, patient-centered evaluations using validated patient-reported outcome measures (PROMs) remain limited. Objective: This study aimed to assess postoperative quality of life in patients undergoing exclusive endoscopic cholesteatoma surgery, using validated patient-reported outcome measures. Methods: We conducted a prospective observational cohort study in a tertiary referral center, enrolling 41 patients who underwent exclusive endoscopic cholesteatoma surgery over 20 months. Pre- and postoperative QoL was assessed using the Chronic Otitis Media Questionnaire-12 (COMQ-12) and the Glasgow Benefit Inventory (GBI). Follow-up included assessments at 3, 6, and 12 months, complemented by non–echo–planar diffusion-weighted magnetic resonance imaging (DWI-MRI) to detect residual or recurrent disease. Results: COMQ-12 scores improved significantly from baseline (54.0 ± 4.2) to 12 months (10.2 ± 3.3; mean difference –43.8, 95% CI: –46.1 to –41.5; p < 0.001). GBI scores were consistently high, increasing from 82.6 ± 4.8 at 6 months to 84.1 ± 4.9 at 12 months (p < 0.001). Audiometric evaluation demonstrated a significant postoperative improvement, with the mean air–bone gap (ABG) decreasing from 52.1 ± 5.3 dB pre-operatively to 26.4 ± 4.7 dB postoperatively (p < 0.001), indicating substantial closure of the conductive gap. Conclusions: Exclusive endoscopic cholesteatoma surgery is associated with significant improvement in disease-specific and general QoL, favorable audiological outcomes, and low recurrence rates. These findings support EES as a safe, effective, and patient-centered alternative to microscopic techniques for the management of middle ear cholesteatoma.

Head and neck squamous cell carcinoma (HNSCC) is an aggressive cancer with a complex molecular landscape. Despite extensive research, our understanding of the molecular mechanisms remains incomplete, hindering the development of effective therapeutic strategies for this disease. Long non-coding RNAs (lncRNAs) have emerged as crucial factors in cancer biology, regulating key networks across various malignancies. These molecules exert their regulatory functions through interactions with nucleic acids or proteins, thereby influencing signaling pathways within tumor cells. Consequently, lncRNAs play a significant role in key processes like cell proliferation, metastasis, immune evasion, and treatment resistance. This review offers a comprehensive overview of current knowledge regarding lncRNA-mediated mechanisms in HNSCC. The first section explores how lncRNAs influence tumor processes through various modulation mechanisms, including transcriptional and post-transcriptional regulation, chromatin remodeling, and epigenetic modifications. We also highlight the impact of lncRNAs on specific signaling pathways that control essential cellular functions (e.g., proliferation, apoptosis, angiogenesis, invasion, metastasis). Ultimately, this underscores the promising potential of lncRNAs as diagnostic biomarkers and therapeutic targets capable of enhancing patient care in oncology. Gaining a deep understanding of how lncRNAs modulate carcinogenic mechanisms may yield innovative approaches for early detection, personalized treatment, and improved clinical outcomes for HNSCC patients.

Background: Optimizing sedative techniques for drug-induced sleep endoscopy (DISE) enhances accuracy and reproducibility in tailoring treatment for obstructive sleep apnea (OSA). The Schnider and Eleveld pharmacokinetic–pharmacodynamic (PK-PD) models, which predict propofol concentration in effect-site compartment based on patient-specific parameters, were utilized to guide intravenous sedation in this study. We compared the effectiveness of propofol sedation guided by the novel general-purpose Eleveld model versus the Schnider model using target-controlled infusion (TCI) systems. Methods: We investigated twenty-five adult OSA patients, randomized into two groups: the Schnider model group (n = 12) and the Eleveld model group (n = 13). DISE was conducted following standardized protocols, targeting effect-site concentration TCI mode. Data concerning sedation levels, effect-site concentration of propofol, procedural timing, propofol dosages, respiratory and cardiovascular parameters, and any procedural incidents were collected. Results: DISE was performed successfully in all enrolled patients from both groups. A significant difference was observed in the effect-site concentration of propofol (CeP) at the moment of endoscopy between the Eleveld and Schnider groups (2.1 ± 0.4 µg/mL vs. 3.3 ± 0.7 µg/mL, respectively; p < 0.001). The E group also demonstrated a shorter time to attain the optimal sedation plane compared to the S group (6.1 ± 1.7 vs. 9.8 ± 2.2 min, respectively; p < 0.001) and a reduced total procedural time (11.2 ± 1.4 vs. 15.0 ± 2.1 min, respectively; p < 0.001). The incidence of adverse events was comparable between groups. Conclusions: The Eleveld model demonstrated a shorter time to achieve the optimal sedation plane, a shorter total procedural time, and a significant difference in effect-site concentration at the time of endoscopy compared to the Schnider model. The incidence of adverse events was comparable between the two groups, suggesting that the Eleveld model may offer improved efficiency without compromising safety during DISE.

Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band imaging) in identifying malignant laryngeal lesions through a comparative analysis with histopathological examination. Methods: We conducted a systematic literature review, utilizing databases such as PubMed, the CNKI database, and Embase for our research. Results: We analyzed the articles by reviewing their titles and abstracts, selecting those we considered relevant based on determined criteria; in the final phase, we examined the relevant studies according to the specific eligibility criteria. Conclusions: Narrow-band imaging is an advanced endoscopic technology that demonstrates its efficacy as a tool for diagnosing malignant laryngeal lesions and comparing them to premalignant lesions. The European Society of Laryngology has implemented a standardized classification system for laryngeal lesions to enhance data correlation and organization.