As a diagnostic tool for low-to-mid frequency vestibular function, the rotational chair test serves as a vital adjunct in the assessment of vestibular disorders and is currently recommended as a core supplementary examination for bilateral vestibulopathy and presbyvestibulopathy. This modality effectively bridges the frequency domain gap between caloric testing and the video head impulse test, while enabling the quantitative evaluation of the central velocity storage mechanism. Despite limitations such as high equipment costs and a lack of standardized normative data, the rotational chair test remains indispensable for elucidating vestibular pathophysiological mechanisms, facilitating dynamic disease monitoring, and evaluating vestibular function in specific populations, including those with inner ear malformations or cochlear implants. This review aims to delineate the physiological principles, procedural protocols, and evaluative parameters of the rotational chair test, while summarizing its clinical application in various vestibular disorders to provide a reference for the standardized implementation and promotion of this technology.

In recent years, driven by the continuous evolution of minimally invasive concepts and digital medicine technologies, laryngeal minimally invasive surgery has undergone substantial changes in surgical approaches, technical modalities, and therapeutic objectives. These advances have demonstrated distinct advantages in improving intraoperative visualization, enhancing procedural precision, and facilitating functional recovery. This narrative review provides an updated overview of minimally invasive laryngeal surgery, focusing on indication selection for emerging techniques, technical maturity, and the current evidence base. Additionally, we discuss future trends in multi-technology integration and intelligent assistance in this field. This article aims to provide a reference for clinical practice and subsequent research in minimally invasive laryngeal surgery.

Background: The mechanisms linking lifestyle to hearing impairment remain unclear. This study seeks to examine the associations of lifestyle factors with hearing impairment and to quantify the mediating effects of inflammatory and metabolic biomarkers in these associations.

Methods: In 441,844 UK Biobank participants, lifestyle was scored across seven behaviors. Biomarkers included an inflammatory score, metabolic score for insulin resistance (METS-IR) and their individual components. Cox proportional hazards regression was used to examine the independent associations of lifestyle and biomarkers with hearing impairment. Mediation analysis was then performed to evaluate the mediating role of these biomarkers.

Results: Over a median follow-up of 14.22 years, 20,743 incident hearing impairment cases were documented. Adherence to an ideal lifestyle was associated with a 14% lower risk (HR = 0.86, 95% CI: 0.82–0.90) compared with a poor lifestyle, while elevated inflammatory score (HR = 1.03, 95% CI: 1.02–1.04) and metabolic score for insulin resistance (HR = 1.08, 95% CI: 1.06–1.10) significantly increased risk. Mediation analyses showed that inflammatory and metabolic biomarkers collectively explained 1%–20% of the lifestyle-hearing impairment association, with metabolic factors (body mass index, high-density lipoprotein cholesterol) contributing most substantially.

Conclusion: Adherence to a healthy lifestyle was associated with lower hearing impairment risk, with inflammation and metabolic dysregulation acting as partial mediators. This offers mechanistic insights and supports lifestyle-based interventions for hearing impairment prevention.

Background: Age-related vestibular and auditory impairments are highly prevalent and frequently comorbid in older adults, particularly in resource-limited rural areas where reliance on subjective symptom reporting may underestimate the true disease burden. This study aimed to (1) quantify the prevalence and comorbidity of objectively measured vestibular and hearing dysfunction, and (2) assess the concordance between self-reported symptoms and objective assessments.

Methods: We conducted a cross-sectional study of 670 community-dwelling adults aged 55–65 years in rural Taizhou, China. Vestibular function was objectively evaluated using the video head impulse test (vHIT), and hearing function via pure-tone audiometry (PTA) performed in a sound-treated booth. Concurrently, participants completed an interviewer-administered standardized questionnaire assessing self-reported dizziness, hearing difficulties, tinnitus, and otologic history.

Results: Prevalence rates were 71.5% for hearing loss and 8.5% for vestibular dysfunction. Among participants with hearing loss, 10.2% exhibited concurrent vestibular dysfunction. In univariate analyses, symptom patterns involving hearing loss were associated with abnormal vHIT findings. Self-reported dizziness exhibited low sensitivity (7.9%) but high specificity (91.4%) for vestibular dysfunction. Subjective-objective agreement for hearing assessments was poor (κ = 0.173), with 39.7% underestimating their impairment severity.

Conclusion: Vestibular and auditory impairments are highly prevalent and frequently comorbid in rural aging populations. Objective testing is essential to overcome limitations of symptom-based screening. Integration of dual-modality sensory screening into rural primary care may optimize early detection and intervention for age-related decline.

Background: Intraoperative bleeding remains a challenge in sinonasal and skull base surgeries. Pre-occlusion of the maxillary artery can reduce bleeding, but its endoscopic application is not well-defined. This study evaluates the anatomical feasibility and clinical utility of endoscopic maxillary artery (MA) pre-occlusion.

Materials and methods: Three fresh-frozen, latex-injected cadaveric head specimens (6 sides) were used for gross anatomical dissection. Subsequently, endoscopic observations were performed via trans-buccal, trans-maxillary, and endonasal approaches to simulate intraoperative endoscopic views. Key anatomical landmarks were documented. Endoscopic MA pre-occlusion was attempted in 20 consecutive patients undergoing surgery for sinonasal or skull base tumors. The primary outcome was the difference between preoperative and postoperative hemoglobin.

Results: The MA was consistently localized in cadaveric specimens via trans-buccal, trans-maxillary, and endonasal approaches. The buccal nerve, inferior head of the lateral pterygoid muscle, and temporalis muscle served as reliable landmarks. In the clinical series (14 males, 6 females; mean age 49.8 ± 19.6 years), the mean preoperative hemoglobin level was 130.00 ± 22.37 g/L, which decreased to a postoperative level of 110.39 ± 21.05 g/L (mean gap: 19.67 ± 14.91 g/L). Only two patients (10%) required perioperative blood transfusion.

Discussion: Endoscopic pre-occlusion of the MA is anatomically feasible and reproducible. The observed hemoglobin drop is consistent with reduced intraoperative bleeding, potentially minimizing the need for transfusions.

Conclusion: This anatomical analysis-driven surgical technique was verified in a series of surgical cases, confirming that endoscopic pre-occlusion of the maxillary artery is feasible and appears safe in selected sinonasal and skull base procedures.

Introduction: Madelung’s disease (MD) is a rare metabolic disorder characterized by symmetric, non-encapsulated adipose tissue accumulation, predominantly involving the cervical regions. Extensive cervical lipomatosis may distort normal neck anatomy and complicate airway management. The coexistence of MD and hypopharyngeal squamous cell carcinoma (HPSCC) is exceedingly rare and poses unique clinical challenges.

Case presentation: A 62-year-old man with long-standing type I MD presented with progressive dyspnea and dysphagia. Fiberoptic laryngoscopy, narrow-band imaging, MRI, and contrast-enhanced CT demonstrated a right-sided HPSCC causing severe intraluminal airway narrowing together with extensive cervical lipomatosis resulting in extrinsic compression.

Results: Combined intraluminal tumor obstruction and extrinsic cervical compression led to critical dual airway compromise. Awake tracheal intubation with extracorporeal membrane oxygenation (ECMO) team standby was performed, followed by total laryngectomy, bilateral neck dissection, and excision of extensive cervical lipomatous tissue. Postoperative follow-up showed no evidence of recurrence or residual airway compression. Immunohistochemistry demonstrated positive UCP1 expression, but weak PRDM16 expression, in both tumor and adipose tissue.

Discussion: This case highlights the complexity of airway management in patients with concurrent MD and HPSCC. Awake tracheal intubation with ECMO standby may provide a safe strategy in selected high-risk patients. Furthermore, the choice between upfront surgery and chemoradiotherapy warrants careful consideration. The potential role of adipose tissue metabolic reprogramming in HPSCC progression requires further investigation.

Conclusions: The coexistence of MD and HPSCC may create a rare but life-threatening dual airway obstruction. Early recognition, multidisciplinary collaboration, and proactive airway planning are essential for safe management in patients with anatomically distorted necks.

Background: Neck injuries caused by foreign bodies seem common. However, reports of nail gun injuries involving multiple neck organs are extremely rare. Neck injuries are especially dangerous, since they might cause damage to the esophagus, trachea, spinal cord and important vessels, and may be potentially fatal. In particular, injuries to multiple foreign bodies in the neck may cause serious complications, such as hemorrhage, infection, and neck movement disorder. Nail gun injuries are prone to penetrating wounds and compound wounds, which can cause multi-organ structural injury, hemorrhage caused by direct injury to large blood vessels; injury to nerves, destruction of important organs and tissue structures in the neck, resulting in respiratory and articulatory disorders, shock and even death.

Case presentation: Here, we report a case of a youth from Xizang, China, who had multiple nail gun injuries to multiple neck organs. The Tibetan youth presented with neck pain, hoarseness, and swallowing pain, accompanied by forced neck position, pain and limited movement in the left upper limb.

Results: Through multidisciplinary team, we successfully removed three nails (thyroid gland, vertebral body and intervertebral space) from the neck with no complications on follow-up and review.

Discussion: This case highlights the diagnostic and therapeutic challenges of multiple penetrating foreign bodies in the neck involving the thyroid, vertebra, and spinal canal, and demonstrates the value of a multidisciplinary approach.

Conclusion: To our knowledge, this is a rare case of multiple nail gun injuries to the thyroid gland, cervical vertebra, and intervertebral space simultaneously. The successful management without complications underscores the importance of individualized surgical strategy and team collaboration.