Objective: : This study aimed to evaluate the clinical efficacy and safety of systemic bevacizumab in recurrent respiratory papillomatosis (RRP) and to explore the potential predictive value of human papillomavirus (HPV) genotype in this condition.

Methods: : A total of 34 patients with confirmed HPV6- or HPV11-associated RRP who received at least three doses of systemic bevacizumab were enrolled. Disease burden and clinical response were evaluated based on the number of interventions, Derkay scores, and voice-related quality of life (assessed using the Voice Handicap Index-30 for adults or the pediatric Voice Handicap Index for children) before and after treatment. Adverse events were documented and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Additionally, vascular endothelial growth factor A (VEGFA) expression in RRP tissues was measured by immunohistochemistry.

Results: : The overall response rate (ORR) was 70.59%. The frequency of surgical interventions was significantly reduced following treatment (median reduction from 2 to 0; P < 0.0001), and Derkay scores also showed a significant reduction (median reduction from 7.0 to 1.5; P < 0.0001). Adverse events were observed in 38.24% of patients, all of which were grade 1-2 and manageable. In juvenile-onset recurrent respiratory papillomatosis (JORRP), patients infected with HPV11 exhibited an ORR of 76.92%, with 57.58% achieving a ≥ 50% reduction in Derkay scores. In contrast, among patients infected with HPV6, the ORR was 57.14%, and only 45.83% demonstrated a ≥ 50% improvement in Derkay scores. Although these differences did not reach statistical significance, HPV11-positive patients with JORRP appeared to have a more favorable prognosis. Conversely, in adult-onset RRP (AORRP), patients with HPV11 infection had an ORR of 40% and a 16.67% rate of ≥ 50% Derkay score reduction, while those infected with HPV6 demonstrated an ORR of 88.89% and a 77.78% rate of significant Derkay score improvement. Similarly, a statistically significant reduction in surgical frequency before and after treatment was observed only in HPV11-positive JORRP patients and HPV6-positive AORRP patients. All groups of RRP showed VEGFA expression, but there was no significant difference.

Conclusion: : Systemic bevacizumab is effective and well-tolerated in both JORRP and AORRP. HPV genotype may influence therapeutic response and clinical outcomes in RRP patients receiving bevacizumab treatment. Specifically, HPV11-positive JORRP patients and HPV6-positive AORRP patients appear to derive greater benefit.

Background: : Vestibular disorders are common yet diagnostically challenging in first-line and specialist settings, and delays or misclassification can alter management and outcomes. Structured symptom questionnaires and supervised machine learning (ML) have shown promise for triage, while recent large language models (LLMs) may reason over clinical descriptions without task-specific training.

Objective: : To evaluate zero-shot LLMs for five-class vestibular diagnosis from an electronic questionnaire, characterize error patterns across disorders, and compare the best-performing LLM with a trained gradient-boosted tree (LightGBM, LGBM).

Methods: : We used a seven-center prospective cohort with an electronic 23-item questionnaire and guideline-based reference diagnoses by experienced ENT specialists. The prediction task was a five-class classification among benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), Meniere disease (MD), sudden sensorineural hearing loss with vestibular dysfunction (SSNHL-V), and an aggregated “Others” category of individually rare vestibular conditions. After prespecified exclusions, 1,025 single-definite cases were analyzed; 912/113 patients formed the train/test split for a LightGBM baseline. Three LLMs (DeepSeek-R1, DeepSeek-V3, Doubao-1.6-thinking) were evaluated zero-shot on all 1,025 cases. We report Top-k, MRR, and NDCG@5 overall; one-vs-rest sensitivity, specificity, and accuracy per disorder (macro-averaged where applicable); 95% CIs via 1,000-patient bootstrap; paired bootstrap for model differences; and McNemar’s test for accuracy on the shared test set.

Results: : All LLMs outperformed a prevalence prior baseline (Top-1 38.6%). V3 and Doubao achieved Top-1 ≈ 65% and Top-3 ≥ 91%, with MRR ≈ 0.79–0.80. Disorder-wise, BPPV was reliably detected; vestibular migraine remained hardest; sensitivity–specificity trade-offs were model- and disorder-dependent. On the 113-case test set, LGBM slightly exceeded V3 on sensitivity (0.722 vs. 0.632), specificity (0.941 vs. 0.926), and accuracy (0.770 vs. 0.742), with no significant accuracy difference (McNemar p = 0.690). Findings support LLMs as a zero-shot front end that narrows diagnostic search space while approaching a specialized model’s performance.

Endoscopic transoral surgery constitutes a significant advancement in the management of complexpathologies involving the nasopharynx, parapharyngeal space, and ventral skull base. This minimally invasive approachutilizes natural orifices to access regions traditionally requiring extensive external dissection, thereby reducing morbiditywhile maintaining oncologic efficacy. Technological integration—including high-definition endoscopy, robotic assist-rhhzhyphen↲ance, and augmented navigation—has expanded the applications of endoscopic transoral surgery from initial diagnosticprocedures to sophisticated multiportal resections. Future advancements in flexible robotics and bioengineeredreconstruction promise to overcome current spatial constraints. This review synthesizes anatomical principles, technicalinnovations, clinical outcomes, and evolving paradigms, establishing endoscopic transoral surgery as the standard of carefor selected ventral skull base pathologies.