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Objective: To investigate the accuracy of Chat‐Based Generative Pre‐trained Transformer (ChatGPT) in answering questions and solving clinical scenarios of head and neck surgery. Study Design: Observational and valuative study. Setting: Eighteen surgeons from 14 Italian head and neck surgery units. Methods: A total of 144 clinical questions encompassing different subspecialities of head and neck surgery and 15 comprehensive clinical scenarios were developed. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using accuracy (range 1‐6), completeness (range 1‐3), and references' quality Likert scales. Results: The overall median score of open‐ended questions was 6 (interquartile range[IQR]: 5‐6) for accuracy and 3 (IQR: 2‐3) for completeness. Overall, the reviewers rated the answer as entirely or nearly entirely correct in 87.2% of cases and as comprehensive and covering all aspects of the question in 73% of cases. The artificial intelligence (AI) model achieved a correct response in 84.7% of the closed‐ended questions (11 wrong answers). As for the clinical scenarios, ChatGPT provided a fully or nearly fully correct diagnosis in 81.7% of cases. The proposed diagnostic or therapeutic procedure was judged to be complete in 56.7% of cases. The overall quality of the bibliographic references was poor, and sources were nonexistent in 46.4% of the cases. Conclusion: The results generally demonstrate a good level of accuracy in the AI's answers. The AI's ability to resolve complex clinical scenarios is promising, but it still falls short of being considered a reliable support for the decision‐making process of specialists in head‐neck surgery. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine the impact of the involvement of the superior pharyngeal constrictor muscle (SPCM) evaluated by magnetic resonance imaging (MRI) on outcome in oropharyngeal squamous cell carcinomas (OPSCCs). Methods: A retrospective study including consecutive patients with OPSCC treated with curative intent. Results: A total of 82 consecutive patients with OPSCC met inclusion criteria. At multivariate analysis, patients with SPCM infiltration were at significantly higher risk of death (HR: 3.37, CI: 1.21–9.38) and progression (HR: 3.39, CI: 1.38–8.32). In a multivariate model conditioned on HPV status, a significantly higher risk of death and progression was observed by combining both SPCM and HPV status with patients harboring an HPV‐negative OPSCC with SPCM infiltration showing the poorest outcome. Conclusion: MRI evidence of SPCM involvement significantly and independently increases the risk of death and progression in subjects with OPSCC. Considering both MRI‐assessed SPCM infiltration and HPV status significantly improved risk stratification in these malignancies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of platelet‐rich plasma (PRP) injection into the olfactory clefts of coronavirus disease 2019 (COVID‐19) patients with persistent olfactory dysfunction (OD). Study Design: Controlled study. Setting: Multicenter study. Methods: From March 2022 to November 2022, COVID‐19 patients with persistent OD were recruited from three European hospitals to undergo PRP injections into the olfactory clefts. Olfactory function was evaluated at baseline and 10 weeks postinjection with the Olfactory Disorder Questionnaire (ODQ) and threshold, discrimination, and identification (TDI) test. Data were compared with a control group of untreated patients. Results: Eighty‐one patients who underwent PRP injection and 78 controls were included. Sixty‐five PRP patients (80.3%) experienced subjective smell improvement after a mean duration of 3.4 ± 1.9 weeks. The parosmia, life quality statement, and ODQ sub‐ and total scores significantly decreased from pre‐ to 10‐week postinjection in the PRP group. The TDI sub‐ and total scores significantly increased 10 weeks postinjection. In controls, the ODQ score did not change over time, while the discrimination, identification, and total TDI scores significantly increase after 10 weeks of follow‐up. The 10‐week TDI and ODQ scores were significantly better in the PRP group compared with the controls. Conclusion: Patients who underwent PRP injection reported better 10‐week subjective and objective smell outcomes than controls. Future randomized‐controlled studies using saline injection into the olfactory cleft of controls are needed to determine the superiority of PRP over placebo. [ABSTRACT FROM AUTHOR]

Objective: Review the effectiveness of surgical and non‐surgical management strategies for isolated pars flaccida and combined pars tensa and flaccida tympanic membrane retractions in preventing progression or recurrence, improving hearing and preventing development of cholesteatoma. Design: Narrative review. Setting: ENT and otology services worldwide. Participants: Patients with non‐cholesteatoma tympanic membrane retractions. Main Ouctome measure: Changes in retraction (progression or resolution, or development of a known sequela such as perforation). Results: Eight full text papers are included: three randomised controlled trials and five case series or cohort studies of more than five patients (a total of 238 ears). Data exists for the use of conservative management, ventilation tubes, laser tympanoplasty, cartilage and fascia tympanoplasty, lateral attic reconstruction as well as mastoid procedures. Conclusion: Few high‐quality studies on the management of isolated and combined pars flaccida retractions exist. For isolated pars flaccida retractions deemed to require surgical intervention, this review suggests that lateral attic reconstruction and cartilage tympanoplasty carries least risk of recurrence. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to psychophysically evaluate the prevalence of smell and taste dysfunction 2 years after mildly symptomatic severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) infection compared to that observed at 1‐year follow‐up and while considering the background of chemosensory dysfunction in the no‐coronavirus disease 2019 (COVID‐19) population. Method: This is a prospective case‐control study on 93 patients with polymerase chain reaction (PCR)‐positive SARS‐CoV‐2 infection and 93 matched controls. Self‐reported olfactory and gustatory dysfunction was assessed by 22‐item Sino‐Nasal‐Outcome Test (SNOT‐22), item "Sense of smell or taste." Psychophysical orthonasal and retronasal olfactory function and gustatory performance were estimated using the extended Sniffin' Sticks test battery, 20 powdered tasteless aromas, and taste strips test, respectively. Nasal trigeminal sensitivity was assessed by sniffing a 70% solution of acetic acid. Results: The two psychophysical assessments of chemosensory function took place after a median of 409 days (range, 366–461 days) and 765 days (range, 739–800 days) from the first SARS‐CoV‐2–positive swab, respectively. At 2‐year follow‐up, cases exhibited a decrease in the prevalence of olfactory (27.9% vs. 42.0%; absolute difference, −14.0%; 95% confidence interval [CI], −21.8% to −2.6%; p = 0.016) and gustatory dysfunction (14.0% vs. 25.8%; absolute difference, −11.8%; 95% CI, −24.2% to 0.6%; p = 0.098). Subjects with prior COVID‐19 were more likely than controls to have an olfactory dysfunction (27.9% vs. 10.8 %; absolute difference, 17.2%; 95% CI, 5.2% to 28.8%) but not gustatory dysfunction (14.0% vs. 9.7%; absolute difference, 4.3%; 95% CI, −5.8% to 14.4% p = 0.496) still 2 years after the infection. Overall, 3.2% of cases were still anosmic 2 years after the infection. Conclusions: Although a proportion of subjects recovered from long‐lasting smell/taste dysfunction more than 1 year after COVID‐19, cases still exhibited a significant excess of olfactory dysfunction 2 years after SARS‐CoV‐2 infection when compared to matched controls. [ABSTRACT FROM AUTHOR]

The aim of this study was to prospectively evaluate the olfactory function in a series of individuals infected with SARS‐CoV‐2 and who had undergone psychophysical olfactory assessment prior to infection. Individuals unexposed to SARS‐CoV‐2 infection underwent a psychophysical evaluation of smell with the Sniffin' Sticks test. The subjects were followed prospectively and included in the study if they developed SARS‐CoV‐2 infection with a second test 60 days after recovery. At the 60‐day follow‐up of the 41 included subjects, 2 (4.9%) self‐reported persistent olfactory dysfunction (OD). The differences between TDI scores before and after infection were statistically significant (37 [interquartile range (IQR), 34.25‐39.25] vs 34.75 [IQR, 32.25‐38]; p =.021). Analyzing the individual olfactory domains, the differences were significant for threshold (T) (9.75 [IQR, 9‐11.25] vs 8.25 [IQR, 7.25‐10.25]; p =.009) but not for odor discrimination (D) (p =.443) and identification (I) (p =.159). SARS‐CoV‐2 causes a significant reduction in the olfactory function, in particular affecting the olfactory threshold, even in subjects who do not self‐report an OD. [ABSTRACT FROM AUTHOR]

Objective: To psychophysically evaluate olfaction in patients with laryngopharyngeal reflux (LPR). Study Design: Prospective controlled study. Setting: Tertiary medical center. Methods: From January 2021 to January 2022, patients with LPR diagnosed with hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring underwent psychophysical evaluation of the sense of smell. Reflux symptoms and findings were assessed with the Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA). Nasal symptoms were assessed through the Sino‐Nasal Outcome Test 22 (SNOT‐22). From pre‐ to posttreatment, patients underwent identification Sniffin' Sticks test and olfactory cleft examination. Clinical outcomes were compared between LPR patients and healthy individuals. Results: In total, 107 patients and 76 healthy individuals completed the evaluations. LPR patients reported significant higher RSS, RSA, and SNOT‐22 scores. Psychophysical olfactory evaluations were significantly lower in reflux patients compared with controls, while there were no significant differences in olfactory cleft score. RSS and RSA significantly improved from baseline to 3 months posttreatment. SNOT‐22, olfactory cleft endoscopy scale, and psychophysical olfactory evaluations did not change throughout treatment. Patients with higher number of acid pharyngeal reflux events reported lower psychophysical olfactory scores (P =.025). Conclusion: LPR disease was associated with low odor identification results in patients without olfactory cleft abnormalities. The sense of smell did not improve after 3‐month therapy. Future controlled studies using threshold, discrimination, and identification testing are needed. [ABSTRACT FROM AUTHOR]

Keywords: COVID-19; olfactory disorders; olfactory test; parosmia; quality of Life; smell EN COVID-19 olfactory disorders olfactory test parosmia quality of Life smell 1570 1574 5 12/02/22 20221201 NES 221201 INTRODUCTION Olfactory dysfunction (OD) is one of the most common symptoms of acute and long COVID-19.[[1]] Qualitative OD frequently accompanies or follows quantitative olfactory loss.[3] Few studies to date have combined both qualitative and quantitative evaluation of OD.[4] The aim of this study was to estimate the prevalence of qualitative OD and evaluate its functional impact in post-COVID-19 patients by combining a validated questionnaire[5] and a comprehensive olfactory psychophysical evaluation. Patients were evaluated with a median follow-up of >12 months, at which point only one third of patients who developed parosmia had recovered. Among patients reporting parosmia or phantosmia at any time, more severe quantitatively measured OD was correlated with longer qualitative OD (r = -0.34, I p i < 0.001; Fig. In the present series, the prevalence of qualitative OD when assessed with a structured questionnaire was higher than the prevalence of quantitative OD, with 78% of patients classified as normosmic reporting qualitative OD. [Extracted from the article]

Background: The aim of this study was to estimate the prevalence of self‐reported chemosensory dysfunction in a study cohort of subjects who developed a mild‐to‐moderate coronavirus disease 2019 (COVID‐19) in the period from January 17, 2022, to February 4, 2022 (Omicron proxy period) and compared that with a historical series of patients testing positive for severe acute respiratory syndrome–coronavirus‐2 (SARS‐CoV‐2) infection between March and April, 2020 (comparator period). Methods: Prospective study based on the 22‐item Sino‐Nasal Outcome Tool (SNOT‐22), item "sense of smell or taste" and additional outcomes. Results: Patients' characteristics and clinical presentations of COVID‐19 were evaluated and compared in 779 patients, 338 of the study cohort and 441 of the historical series. The prevalence of self‐reported chemosensory dysfunction during the proxy Omicron period (32.5%; 95% confidence interval [CI], 27.6–37.8) was significantly lower from that during the comparator period (66.9%; 95% CI, 62.3–71.3) (p < 0.001). Nearly one‐quarter of patients (24.6%; 95% CI, 20.1–29.5) reported an altered sense of smell during the proxy Omicron period compared to 62.6% (95% CI, 57.9–67.1) during the comparator period (p < 0.001). Similarly, the prevalence of an altered sense of taste dropped to 26.9% (95% CI, 22.3–32.0) during the proxy Omicron period from 57.4% (95% CI, 52.6–62.0) during the comparator period (p < 0.001). The severity of chemosensory dysfunction was lower in the proxy Omicron period compared to the comparator period (p < 0.001). Conclusion: The prevalence and the severity of COVID‐19–associated smell and taste dysfunction has dropped significantly with the advent of the Omicron variant but it still remains above 30%. [ABSTRACT FROM AUTHOR]

Background: This systematic review and meta‐analysis aims to estimate the prevalence and prognostic impact of retropharyngeal lymph node metastases (RLNMs) in oropharyngeal squamous cell carcinoma (OPSCC). Methods: This meta‐analysis was conducted according to PRISMA guidelines. Inclusion criteria: studies with more than 20 patients reporting the prevalence or prognostic impact of RLNMs in OPSCC. Whenever available, data on HPV status and subsites were extracted. Results: Twenty‐two articles were included. The overall prevalence of RLNMs in OPSCC was 13%, with no significant differences depending on HPV status. The highest prevalence was observed for posterior pharyngeal wall SCC (24%), followed by soft palate (17%), palatine tonsil (15%), and base of tongue (8%). RLNMs were associated with a significantly higher risk of death (HR:2.54;IC95%1.89–3.41) and progression (HR:2.44;IC95%1.80–3.30). Conclusions: The prevalence of RLNMs in OPSCC was 13%, being higher in tumors of the posterior pharyngeal wall. RLNMs were associated with unfavorable outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this multicenter case-control study was to evaluate a group of patients at least 1 year after coronavirus disease 2019 (COVID-19) with Sniffin' Sticks tests and to compare the results with a control population to quantify the potential bias introduced by the underlying prevalence of olfactory dysfunction (OD) in the general population. The study included 170 cases and 170 controls. In the COVID-19 group, 26.5% of cases had OD (anosmia in 4.7%, hyposmia in 21.8%) versus 3.5% in the control group (6 cases of hyposmia). The TDI score (threshold, discrimination, and identification) in the COVID-19 group was significantly lower than in the control group (32.5 [interquartile range, 29-36.5] vs 36.75 [34-39.5], P < .001). The prevalence of OD was significantly higher in the COVID-19 group, confirming that this result is not due to the underlying prevalence of OD in the general population. [ABSTRACT FROM AUTHOR]

Objective: Mean corpuscular volume (MCV) has been shown in to be a reliable prognostic marker in other cancers; however, no evidence exists on its use in head and neck squamous cell carcinoma (HNSCC). This study aimed to investigate the association between MCV, hemoglobin, platelet count and albumin concentration, and survival in stage III/IVA-B HNSCC treated with concurrent chemoradiotherapy.Study Design: Retrospective cohort study.Methods: In this multicenter retrospective study, we analyzed MCV, platelet count, hemoglobin concentration, and albumin concentration in peripheral blood samples from 260 patients with HNSCC undergoing organ preservation treatment with curative intent at the time of diagnosis. We then analyzed survival outcomes after accounting for confounders using multivariate analysis.Results: After adjustment for potential confounders, patients with low hemoglobin had a 3.3-fold higher risk of death (95% confidence interval [CI]: 2.26-4.81) than those with normal hemoglobin. Patients with an elevated MCV had a 1.54-fold higher risk of death (95% CI: 1.06-2.24), independent of site, stage, and human papillomavirus status. Interestingly, the effect of MCV on overall and progression-free survival was limited to those with a normal pretreatment hemoglobin. We identified no associations between pretreatment platelet count or albumin concentration and survival.Conclusion: These findings suggest that pretreatment anemia and macrocytosis are independent predictors of lower overall and progression-free survival in HNSCC patients undergoing organ preservation treatment.Level Of Evidence: III Laryngoscope, 131:E836-E843, 2021. [ABSTRACT FROM AUTHOR]

Finally, a structured and validated questionnaire for the assessment of symptoms in COVID-19 patients is highly desirable to characterize the full clinical spectrum of long COVID and improve the reliability and reproducibility of clinical studies. Keywords: chronic COVID syndrome; COVID-19; long COVID; long haulers; SARS-CoV-2 EN chronic COVID syndrome COVID-19 long COVID long haulers SARS-CoV-2 1685 1688 4 12/06/21 20211201 NES 211201 INTRODUCTION Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can cause a wide array of symptoms ranging from mild to severe or fatal forms of coronavirus disease 2019 (COVID-19).1 Furthermore, it has been observed that in a proportion of patients a variable range of symptoms may persist for a long time.2 An increasing number of studies have been focused on long COVID, but they have mainly been concentrated on previously hospitalized severe COVID-19 patients reporting symptoms up to 6-months after illness.3,4 The main aim of this study was to evaluate the prevalence of COVID-related symptoms 12-months after the onset of mild-to-moderate disease. All patients completing the baseline interview were phoned from March 5, 2021 to March 22, 2021, so that all patients were re-contacted 12-months after the onset of symptoms; in case of a nonresponse, patients were re-contacted twice. [Extracted from the article]

Objective: Recently, a novel host‐related index, the Host‐index (H‐index), including both inflammatory and nutritional markers, has been described and observed to stratify prognosis in patients with squamous cell carcinoma (SCC) of the oral cavity more accurately than other host‐related indexes This study aimed to investigate the prognostic performance of the H‐index using pretreatment blood tests in patients receiving up‐front surgery for SCC of the larynx. Methods: This retrospective observational study included a multicenter series of consecutive patients with SCC of the larynx diagnosed between 1 January 2009 and 31 July 2018, whose pretreatment blood tests were available and included the parameters necessary for the calculation of neutrophil to lymphocyte ratio (NLR) and the H‐index. Their association with disease‐free survival (DFS) and overall survival (OS) was measured. Results: A total of 231 patients were eligible for the present analysis (median [range] age, 68 [37‐96] years; 191 [82.7%] men). The median follow‐up was 73 months. In multivariable Cox proportional hazards regression models, increasing age (adjusted hazard ratio [aHR], 1.07 per year; 95% CI, 1.04‐1.09), advanced pT stage (aHR = 1.71 95% CI: 1.07‐2.71), and having close or positive surgical margins (aHR = 2.01; 95% CI: 1.21‐3.33) were significantly associated with poor OS. Among blood parameters, a higher neutrophil count was a strong predictor of both worse DFS (aHR for recurrence/death = 2.34; 95% CI: 1.24‐4.40) and OS (aHR for death = 2.67; 95% CI: 1.51‐4.71). Among inflammatory blood indexes, while NLR was not significantly associated with DFS or OS, patients with H‐index ≥8.37 showed a higher aHR for both recurrence/death (2.82; 95% CI: 1.65‐4.79) and death (2.22; 95% CI: 1.26‐3.89). Conclusion: In conclusion, the present study confirms the prognostic value of pretreatment H‐index, an easily measurable inflammatory and nutritional index, in patients with SCC of the larynx. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Objective: Nose and nasopharyngeal swab is the preferred and worldwide‐accepted method to detect the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) within the nose and nasopharynx. This method may be linked with possible difficulties, such as patient's discomfort or complications. This article shows a pilot study of SARS‐CoV‐2 detection with nasal and nasopharyngeal lavage fluids (level of evidence: 3). Methods: Nasal lavage fluid was collected from patients who were submitted to SARS‐CoV‐2 screening test, due to a preceding positive rapid antigen test. A control group was enrolled among health care professionals whose nasopharyngeal swab tested negative. Nasal lavages were performed using isotonic saline solution injected through a nasal fossa. Both lavage fluid and traditional nasopharyngeal swab were analyzed by real‐time (RT) PCR and antigenic test. Results: A total of 49 positive subjects were enrolled in the study. Results of the analysis on lavages and nasopharyngeal swabs were concordant for 48 cases, regardless of the antigenic and molecular test performed. RT‐PCR resulted weakly positive at swab in one case and negative at lavage fluid. Among the control group (44 subjects), nasopharyngeal swab and lavage fluid analyses returned a negative result. Sensitivity of the molecular test based on nasal lavage fluid, compared to traditional nasal swab, was 97.7%, specificity was 100%, and accuracy was 98.9%, with high agreement (Cohen's κ, 0.978). Conclusion: Nasal and nasopharyngeal lavages resulted to be highly reliable and well tolerated. A larger series is needed to confirm these results. This approach may potentially represent a valid alternative to the traditional swab method in selected cases. Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The accurate diagnostic assessment of clinically relevant human papillomavirus (HPV) infections in patients with head and neck squamous cell carcinoma represents an urgent unmet medical need. The aim of this study was to determine feasibility, accuracy, and clinical significance of HPV16/18 E6 oncoprotein detection on cytological specimens from oropharyngeal squamous cell carcinoma (OPSCC) and neck lymph node metastasis of SCC from unknown primary tumor (CUP) via a protein immunochromatographic assay. Study Design: Cross‐sectional study. Methods: Cytological specimens from primary tumor and neck metastases were collected from 34 patients with OPSCC or CUP and applied to a lateral flow format test that detects HPV16 and HPV18 E6 oncoproteins. E6 oncoprotein positivity or negativity in these specimens was compared to the specimens' "HPV‐driven" reference status, defined by presence of HPV‐DNA in combination with p16INK4a overexpression and/or HPV E6 seropositivity. Results: Eighteen of 29 OPSCC (62%) and three of five CUP (60%) were HPV‐driven according to our reference method. The E6 oncoprotein lateral flow test had a sensitivity of 94% (95% CI: 70%–100%) and a specificity of 100% (95% CI: 66%–100%) on primary tumor, and a sensitivity of 88% (95% CI: 64%–99%) and a specificity of 100% (95% CI: 74%–100%) on neck metastases. Test agreement between the E6 lateral flow test and the clinical reference method, HPV‐DNA plus p16INK4a was excellent, both for primary lesion and neck metastases. Conclusions: We found the detection of HPV16/18 E6 oncoproteins to be a feasible, highly reliable, and low‐invasive method to assess "HPV‐driven" status in OPSCC and CUP. Level of Evidence: II Laryngoscope, 131:1042–1048, 2021 [ABSTRACT FROM AUTHOR]

Background: To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. Methods: Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta‐analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS‐E tool. Results: The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta‐analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta‐analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14‐0.30). Locally advanced or high‐grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I‐II‐III, and level II was the commonest site of occult nodal metastases. Conclusions: An occult metastasis rate of 0.22 (99% CI: 0.14‐0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas. [ABSTRACT FROM AUTHOR]

Reply to: It is necessary to assess olfactory and gustatory functions in post-COVID-19 patients due to the omicron variant infection We, therefore, agree with Machado et al. that a complete psychophysical evaluation is imperative to gauge the degree of chemosensory dysfunction during Omicron waves accurately, distinguish between smell and taste impairment, measure residual olfactory function, and identify individuals who may be unaware of a persistent olfactory impairment. Keywords: COVID-19; olfaction; olfactory loss; olfactory tests; omicron variant; smell EN COVID-19 olfaction olfactory loss olfactory tests omicron variant smell 1567 1568 2 07/26/23 20230801 NES 230801 We very much appreciated the letters from Machado et al. and are pleased to have inspired these interesting thoughts. [Extracted from the article]

The aim of this study is to investigate the clinical profile of patients who developed coronavirus disease 2019 (COVID‐19) after full vaccination. Demographic, epidemiological and clinical data were collected through medical records and online patient‐reported outcome questionnaire from patients who developed symptomatic SARS‐CoV‐2 infection, confirmed by nasopharyngeal swab, at least 2 weeks after completion of vaccination. A total of 153 subjects were included. The most frequent symptoms were: asthenia (82.4%), chemosensory dysfunction (63.4%), headache (59.5%), runny nose (58.2%), muscle pain (54.9%), loss of appetite (54.3%), and nasal obstruction (51.6%). Particularly, 62.3% and 53.6% of subjects reported olfactory and gustatory dysfunction, respectively. Symptom severity was mild or moderate in almost all cases. Chemosensory dysfunctions have been observed to be a frequent symptom even in subjects who contracted the infection after full vaccination. For this reason, the sudden loss of smell and taste could continue to represent a useful and specific diagnostic marker to raise the suspicion of COVID‐19 even in vaccinated subjects. In the future, it will be necessary to establish what the recovery rate is in these patients. Level of Evidence: 4 Laryngoscope, 132:419–421, 2022 [ABSTRACT FROM AUTHOR]

Summary: During the last decade, the worldwide incidence of keratinocyte carcinomas (KC) has increased significantly. They are now the most common malignancy, representing approximately 30% of all cancers. The role of ultraviolet (UV) radiation as a major environmental risk factor for skin cancers is well recognized. The aim of this review is to analyse the current understanding of the nature of beta‐human papillomavirus (HPV) and its association with KC and explore the implications for the management and prevention of these cancers. A comprehensive review of the literature on beta‐HPV and its association with KC was undertaken, the results reported in the form of a narrative review. A subgroup of HPV that infects the mucosal epithelia of the genital tract has been firmly associated with carcinogenesis. In addition, some HPV types with cutaneous tropism have been proposed to cooperate with UV in the development of KC. The first evidence for this association was reported in 1922 in patients with epidermodysplasia verruciformis (EV). Since then, epidemiological studies have highlighted the higher risk of skin cancer in patients with EV and certain cutaneous HPV types, and in vitro studies have elucidated molecular mechanisms and transforming properties of beta‐HPV. Furthermore, in vivo research conducted on transgenic mice models has shown the possible role of beta‐HPV in cutaneous carcinogenesis as a co‐factor with UV radiation and immunosuppression. There is good evidence supporting the role of beta‐HPV in the oncogenesis of KC. The high prevalence of beta‐HPV in human skin and the worldwide burden of KC makes the search for an effective vaccine relevant and worthwhile. [ABSTRACT FROM AUTHOR]

Introduction: Warthin's tumor (WT) is a common benign salivary gland neoplasm with a negligible risk of malignant transformation. However, there is a risk of malignant tumors being misdiagnosed as WT on cytology and inappropriately managed conservatively. Methods: Patients from nine centers in Italy and the United Kingdom undergoing parotid surgery for cytologically diagnosed WT were included in this multicenter retrospective series. Definitive histology was compared with preoperative cytological diagnoses. Surgical complications were recorded. Results: A total of 496 tumors were identified. In 88.9%, the final histological diagnosis was WT. In 21 cases (4.2%) a malignant neoplasm was diagnosed, which had been incorrectly labeled as WT on cytology. Conclusions: The risk of undiagnosed malignancy should be balanced against surgical risks when considering the management of WT. Although nonsurgical management remains an appropriate option, there may be a rationale for serial clinical or radiological evaluation if surgical excision is not performed. [ABSTRACT FROM AUTHOR]

There have been hints that nonviral cancer antigens are differentially expressed in human papillomavirus (HPV)‐positive and HPV‐negative head and neck squamous cell carcinoma (HNSCC). Antibody responses (AR) to cancer antigens may be used to indirectly determine cancer antigen expression in the tumor using a noninvasive and tissue‐saving liquid biopsy. Here, we set out to characterize AR to a panel of nonviral cancer antigens in HPV‐positive and HPV‐negative HNSCC patients. A fluorescent microbead multiplex serology to 29 cancer antigens (16 cancer‐testis antigens, 5 cancer‐retina antigens and 8 oncogenes) and 29 HPV‐antigens was performed in 382 HNSCC patients from five independent cohorts (153 HPV‐positive and 209 HPV‐negative). AR to any of the cancer antigens were found in 272/382 patients (72%). The ten most frequent AR were CT47, cTAGE5a, c‐myc, LAGE‐1, MAGE‐A1, ‐A3, ‐A4, NY‐ESO‐1, SpanX‐a1 and p53. AR to MAGE‐A3, MAGE‐A9 and p53 were found at significantly different prevalences by HPV status. An analysis of AR mean fluorescent intensity values uncovered remarkably different AR clusters by HPV status. To identify optimal antigen selections covering a maximum of patients with ≤10 AR, multiobjective optimization revealed distinct antigen selections by HPV status. We identified that AR to nonviral antigens differ by HPV status indicating differential antigen expression. Multiplex serology may be used to characterize antigen expression using serum or plasma as a tissue‐sparing liquid biopsy. Cancer antigen panels should address the distinct antigen repertoire of HPV‐positive and HPV‐negative HNSCC. What's new? Head and neck squamous cell carcinoma remains a deadly disease but new immunotherapeutic approaches are underexplored. Here the authors tested for antibody responses against human antigens to characterize the expression of such antigens in tumors positive or negative for human papillomavirus (HPV). Antibody responses were significantly different in prevalence and pattern based on HPV‐status in a large patient cohort. The authors urge independent confirmation of their results but point out that multiplex serology of tumor antigens could be a promising strategy to identify immunotherapeutic targets based on HPV status. [ABSTRACT FROM AUTHOR]

Background: To enforce the evidence for causality between high‐risk human papillomavirus (hrHPV) infections and neck squamous cell carcinoma from unknown primary (NSCCUP) and provide biological basis for treatment de‐intensification, we searched for TP53 mutations in association with HPV status. Methods: TP53 mutations were searched for by amplification of exons 4 to 10. Results: Of the 70 NSCCUP, 27 (39%) harbored HPV infection. TP53 sequencing resulted in the identification of 19 patients harboring single mutations including 16 disruptive alterations (84%). The association of TP53 mutations and HPV could be evaluated in 48 NSCCUP including those with disruptive mutation in any exon (n = 16) and those without mutations but with complete sequence of exons 4 to 9 (n = 32): no disruptive mutations were found in the 17 HPV‐driven NSCCUP but in 16 of the 31 non‐HPV‐driven NSCCUP (P =.0002). Conclusion: In a fraction of cases, NSCCUP is an HPV‐driven entity harboring wild‐type TP53 gene or nondisruptive TP53 mutations. HPV‐driven NSCCUP might benefit from treatment de‐intensification. [ABSTRACT FROM AUTHOR]

This is a commentary on the article by Hosseinpoor et al. Laryngoscope, 133:E29–E30, 2023 [ABSTRACT FROM AUTHOR]

Background: A consensus about the most appropriate diagnostic method(s) for head and neck human papillomavirus (HPV)‐induced carcinogenesis is still lacking because most of the commercially available assays have been designed for the cervix. Methods: This article summarizes current data and trends concerning HPV diagnostic strategies in oropharyngeal squamous cell carcinoma (OPSCC). Six main approaches are described. Results: The diagnostic gold standard for HPV‐related OPSCC, focusing on E6/E7 mRNA detection, requires fresh samples. Because most frequently available samples are formalin‐fixed paraffin‐embedded (FFPE), the pros and cons of the different approaches were analyzed. Conclusions: In the FFPE samples, the immunohistochemistry of p16, which is considered appropriate to assess HPV‐driven carcinogenesis in OPSCC according to the 8th American Joint Committee on Cancer TNM classification, may not be specific enough to become the diagnostic standard in the perspective of treatment deintensification. p16 may play a safer role in combination with another highly sensible assay. Other promising approaches are based on DNA detection through real‐time polymerase chain reaction and RNAscope. [ABSTRACT FROM AUTHOR]

We have read with interest the recent article by Mercier et al.1 which has the merit of investigating whether there are correlations between the presence of olfactory dysfunction (OD) and epidemiological, clinical, and prognostic parameters in patients affected by coronavirus disease 2019 (COVID-19). 2021; 28: 28 - 35. 7 Politi LS, Salsano E, Grimaldi M. Magnetic resonance imaging alteration of the brain in a patient with coronavirus disease 2019 (COVID-19) and anosmia. Interestingly, while acknowledging that the pathogenesis of OD is still controversial, the authors' starting hypothesis is that anosmia and hyposmia may have different pathogenesis. [Extracted from the article]

Keywords: anosmia; coronavirus; COVID-19; olfactory dysfunction; olfactory function; parosmia; SARS-CoV-2; smell EN anosmia coronavirus COVID-19 olfactory dysfunction olfactory function parosmia SARS-CoV-2 smell E28 E29 2 06/17/22 20220701 NES 220701 We have read with interest the recent article by Lerner et al.,1 which analyzed the clinical features of parosmia following coronavirus disease 2019 (COVID-19). Anosmia, COVID-19, olfactory function, SARS-CoV-2, smell, olfactory dysfunction, coronavirus, parosmia In Response to Clinical Features of Parosmia Associated with COVID-19 Infection. [Extracted from the article]

To determine the sensitivity and specificity of HPV16 serology as diagnostic marker for HPV16-driven oropharyngeal squamous cell carcinoma (OPSCC), 214 HNSCC patients from Germany and Italy with fresh-frozen tumor tissues and sera collected before treatment were included in this study. Hundred and twenty cancer cases were from the oropharynx and 94 were from head and neck cancer regions outside the oropharynx (45 oral cavity, 12 hypopharynx and 35 larynx). Serum antibodies to early (E1, E2, E6 and E7) and late (L1) HPV16 proteins were analyzed by multiplex serology and were compared to tumor HPV RNA status as the gold standard. A tumor was defined as HPV-driven in the presence of HPV16 DNA and HPV16 transformation-specific RNA transcript patterns (E6*I, E1∧E4 and E1C). Of 120 OPSCC, 66 (55%) were HPV16-driven. HPV16 E6 seropositivity was the best predictor of HPV16-driven OPSCC (diagnostic accuracy 97% [95%CI 92-99%], Cohen's kappa 0.93 [95%CI 0.8-1.0]). Of the 66 HPV-driven OPSCC, 63 were HPV16 E6 seropositive, compared to only one (1.8%) among the 54 non-HPV-driven OPSCC, resulting in a sensitivity of 96% (95%CI 88-98) and a specificity of 98% (95%CI 90-100). Of 94 HNSCC outside the oropharynx, six (6%) were HPV16-driven. In these patients, HPV16 E6 seropositivity had lower sensitivity (50%, 95%CI 19-81), but was highly specific (100%, 95%CI 96-100). In conclusion, HPV16 E6 seropositivity appears to be a highly reliable diagnostic marker for HPV16-driven OPSCC with very high sensitivity and specificity, but might be less sensitive for HPV16-driven HNSCC outside the oropharynx. [ABSTRACT FROM AUTHOR]

New onset of smell and taste loss are common findings also in patients with symptomatic COVID-19 after complete vaccination. 10 Lechien JR, Hopkins C, Vaira LA, Saussez S. SARS-CoV-2 vaccination may help patients with persistent COVID-19 smell dysfunction. We really appreciate the interest shown in our communication1 by Mungmunpuntipantip and Wiwanitkit.2 We agree with colleagues that the antibody response to vaccination may be an important factor in determining the predisposition to develop a symptomatic form of coronavirus disease 2019 (COVID-19) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. [Extracted from the article]

Objective: To compare the quality of life (QoL) of patients who underwent total laryngectomy with voice prosthesis insertion and postoperative radiotherapy (PORT) with those receiving concurrent chemoradiation for laryngeal preservation. Study Design: Retrospective, cross-sectional study in a tertiary academic center. Methods: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaires were used to assess long-term QoL in 67 patients treated for laryngeal cancer. Results: The scores of functional scales for physical ( P < .000), social ( P = .001), and role functioning ( P = .043) were more favorable in the chemoradiation group. The global QoL score was higher in the nonsurgical group ( P = .016). Surgical patients reported on sleep disturbance ( P < .000), dyspnea ( P = .001), and pain ( P = .003), with a higher scores and greater difficulties with the senses ( P < .000), social contact ( P = .002) and speech ( P = .010). The chemoradiation group reported greater problems with dry mouth ( P < .000) and sticky saliva ( P = .005). Conclusion: We found better long-term QoL scores in patients undergoing concurrent chemoradiation. This appears to be mainly because of better physical functioning, social functioning, and social contact and smaller problems with pain, respiration, speech, the senses, and sleep disturbances. [ABSTRACT FROM AUTHOR]

Objectives: To review cases of DNAs with special emphasis on contrast-enhanced computed tomography (CECT) findings and their implications for treatment planning. Study design and settings: Retrospective evaluation of adult patient records with diagnosis of DNAs on CECT at Treviso Regional Hospital. Results: Eighty patients were identified. In 30.0% of cases, an immediate surgical drainage was performed. In 22.5% of cases, a surgical drainage was necessary because of the lack of clinical response to medical therapy alone. Almost half of the patients were treated with antibiotics alone with complete remission. DM was predictive for lack of response to medical therapy alone (P = 0.014). Intraoperative findings confirmed the CECT diagnosis in 88.1%. Conclusions: Although the mainstay of treatment for deep neck abscesses remains surgical drainage, small abscesses can respond to antibiotics alone. CECT monitoring of DNAs was the essential steps in choosing the more appropriate treatment and, probably, the basis for the good prognosis of patients. [Copyright &y& Elsevier]