Mastoiditis, a serious complication of acute otitis media, primarily affects the pediatric population and requires prompt diagnosis and treatment to prevent severe complications. This review explores the pathophysiology, clinical presentation, diagnostic techniques, and therapeutic approaches for mastoiditis, focusing on the role of amoxicillin in its management. The anatomical connection between the middle ear and mastoid air cells facilitates the spread of infection, which is further influenced by inflammatory processes, bacterial biofilms, and host immune responses. Diagnosis involves a combination of clinical findings, imaging studies such as computed tomography and magnetic resonance imaging, and microbiological cultures to guide targeted antibiotic therapy. Amoxicillin remains the first-line treatment for non-resistant cases owing to its effectiveness against common pathogens, safety profile, and cost efficiency. However, the increasing prevalence of β-lactamase-producing bacteria necessitates the use of amoxicillin-clavulanate in resistant cases. Antibiotic selection should be based on local resistance patterns and patient-specific factors, such as allergies and comorbidities. Surgical interventions, including mastoidectomy, are required in advanced or refractory cases. Future research should focus on developing novel diagnostic tools, optimizing antibiotic regimens, and implementing antimicrobial stewardship programs to combat drug resistance. Global collaboration is essential for establishing standardized guidelines and improving access to high-quality care in resource-limited settings.

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Mixed Medullary and Follicular Cell Carcinoma (MMFCC) is a rare thyroid cancer combining medullary and follicular (often papillary) elements. The lack of standard clinical signs and imaging characteristics makes it difficult to diagnose before surgery. At present, the main approach to treatment is surgical removal, and the outlook for patients is primarily influenced by how advanced the medullary carcinoma is. We report two cases of MMFCC confirmed by postoperative pathology. Case 1 involved a 46-year-old woman with bilateral thyroid nodules and left cervical lymph node metastasis. Preoperative ultrasound classified the nodules as TI-RADS 4c, and fine-needle aspiration cytology suggested papillary thyroid carcinoma. Total thyroidectomy with bilateral neck lymph node dissection was performed. Postoperative pathology revealed MMFCC, with a medullary component accounting for approximately 95% and extensive lymph node metastasis. Six weeks postoperatively, serum calcitonin was 73.00 pg/mL. Case 2 involved a 54-year-old man presenting with neck pain. Ultrasound showed a hypoechoic left thyroid nodule (TI-RADS 4b) with bilateral cervical lymphadenopathy. Fine-needle aspiration suggested medullary thyroid carcinoma, and serum calcitonin and carcinoembryonic antigen levels were markedly elevated. Following total thyroidectomy with bilateral neck lymph node dissection, pathology confirmed MMFCC with an approximately 80% medullary component. Postoperative tumor markers decreased significantly, and long-term follow-up was initiated. MMFCC is a rare thyroid carcinoma with considerable diagnostic difficulty. Fine-needle aspiration alone may be insufficient for accurate diagnosis, whereas preoperative serum calcitonin testing provides important diagnostic clues. Total thyroidectomy with systematic lymph node dissection is advised, plus long-term monitoring per both carcinoma guidelines.

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The diagnosis of vocal fold (VF) lesions relies on examinations such as laryngoscopy and voice analysis, which are highly dependent on clinicians' experience. This leads to a relatively higher risk of misdiagnosis and missed diagnosis among junior physicians. In recent years, with the rapid advancement of artificial intelligence (AI), numerous deep learning (DL)-based methods have emerged in this field. Early research primarily focused on single-modality image analysis, such as classifying white light or narrow-band images into benign or malignant lesions using convolutional neural networks (CNNs). However, such methods often fail to fully integrate complementary information from different modalities and fall to meet the clinical demands for multi-classification and risk stratification. Recently, DL and multimodal fusion have gradually become research hotspots. It enables the extraction of complementary multi-category feature information by integrating laryngoscopic images, videos, voice, and clinical text data (e.g., laryngoscopy reports and medical record information), to construct an end-to-end intelligent diagnostic system. This narrative review summarizes the research progress of DL and multimodal fusion in the diagnosis, classification, and severity grading of VF lesions over the past five years (2020–2025). Studies demonstrate that multimodal DL models outperform single-modality models across multiple tasks, which significantly improves the identification and classification accuracy of VF lesions. These models exhibit promising performance. However, DL and multimodal fusion still face numerous challenges, and their clinical translation remains difficult. 

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Nicotine is a stimulant that affects the ganglia. Similar to capsaicin, it also activates sensory nerves in the airways, which leads to secretion and coughing in human subjects. The nasal mucosa can be exposed to the drug through either nasal or oral administration. The study investigated the effects of nicotine on electrically stimulated contractions of human nasal mucosa, resting tension of human nasal mucosa, and contractions induced by 10⁻⁶ M norepinephrine (NE) or 10⁻⁶ M methoxamine, a sympathetic mimetic. The purpose was to assess the direct impact of nicotine on human nasal mucosa in an in vitro laboratory setting. The findings demonstrated that the nasal mucosa contracted in a dose-dependent manner upon the addition of methoxamine to the incubation medium. Addition of nicotine at doses of 10⁻⁴ M elicited a significant relaxation response to 10^–6 M methoxamine-induced mucosal strip contraction. Nicotine could inhibit electrical field stimulation-induced spike contraction and had a negligible effect on the basal tension of the nasal mucosa as the concentration increased. Adding 10⁻⁶ M nicotine to the 10⁻⁶ M NE-induced contraction, it initially induced a small reduction of the contraction, then it potentiated the contractions. This study demonstrated that high nicotine concentrations had a significant spasmolytic effect via antagonistically binding to α-adrenoceptors. Moreover, people with nasal allergies and stuffy noses who additionally utilize an α-adrenergic agonist nasal spray, oral or smoked nicotine, or both concurrently may not get relief from nasal obstruction.

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