Having been popularised in the 1950s, stapes surgery remains one of the most life-impacting operations in otology – but we know as a specialty that it carries at least a small degree of risk in even the best hands. As patient expectations around the care they receive evolves, there is a need to reframe how we train and support the next generation of stapes surgeons, and to be consistent in our messaging to patients.

This instructional session explores the multifaceted challenges and evolving strategies for modern stapes surgery, drawn from my own mentorship and experience of over 160 cases performed under local anaesthetic with sedation. Technical considerations such as sedation protocols, intraoperative stressors and decision-making in complex cases will be discussed with video case examples.

Crucial to this topic is the changing psychosocial context in which we practise. The proliferation of online reviews and patient forums means each surgical outcomes are under scrutiny—making trust, communication, and counselling skills more important than ever. I will explore a patient-centred, emotionally intelligent approach to pre-operative counselling that moves beyond paternalism to shared decision-making. Attendees will gain practical strategies for helping patients appreciate risk, understand functional deficits, and prepare for a range of outcomes.

This session is designed for trainees and young consultants in otology who want to build long-term confidence in offering stapes surgery and wish to be guided in a prudent way to achieve it.

Tinnitus is one of the most frequent and challenging complaints encountered in daily otorhinolaryngology practice. Although commonly perceived as a subjective symptom without a definitive cure, tinnitus represents a heterogeneous condition with multiple etiological pathways, variable clinical presentations, and markedly different therapeutic implications. The otorhinolaryngologist plays a central role in identifying treatable causes, guiding appropriate diagnostic work-up, and implementing realistic, individualized management strategies.

This Instruction Course is designed to provide a structured, step-by-step clinical approach to tinnitus from the perspective of the ENT specialist. The course emphasizes practical diagnostic algorithms, differentiation between tinnitus as a symptom and tinnitus as a disorder, and recognition of distinct tinnitus phenotypes, including cochlear, somatosensory, vascular, and central forms. Evidence-based principles of audiological assessment, imaging indications, and multidisciplinary collaboration are integrated within an otology-focused framework.

Therapeutic strategies discussed in this course include etiological treatment when available, sound-based interventions, hearing rehabilitation, counseling principles applicable in ENT practice, and the rational use of pharmacological options. Particular attention is given to avoiding ineffective or unnecessary therapies and to improving physician–patient communication in order to reduce distress and enhance treatment adherence.

Upon completion of this course, participants will be able to apply a systematic diagnostic pathway for tinnitus patients, identify cases requiring further investigation or referral, formulate personalized treatment plans based on tinnitus phenotype, and communicate realistic expectations to patients.

Background

Stress-related auditory complaints—particularly tinnitus, sound intolerance, and fluctuating hearing symptoms—are frequently reported in clinical practice. While central auditory and limbic mechanisms of stress have been extensively studied, the auditory periphery has long been considered a passive recipient of stress-related modulation. Emerging evidence challenges this assumption.

Acute activation of the hypothalamic–pituitary–adrenal (HPA) axis leads to rapid release of glucocorticoids, which are known to induce synaptic remodeling in the central nervous system. However, whether similar mechanisms operate at the inner hair cell–spiral ganglion neuron synapse, the first synapse of the auditory pathway, has remained largely unexplored. Moreover, sex-dependent differences in stress responsiveness are increasingly recognized across neuroscience, yet are rarely addressed in auditory research.

Recent experimental work demonstrates that stress hormones directly modulate synaptic architecture in the cochlea, revealing sex-specific patterns of plasticity mediated by glucocorticoid receptors. These findings provide a novel mechanistic framework linking stress physiology with peripheral auditory dysfunction.

Description

This keynote lecture will present and contextualize new experimental evidence demonstrating that acute exposure to stress hormones induces rapid, sex-dependent synaptic remodeling at the inner hair cell synapse. Using organotypic cochlear models, the lecture will illustrate how corticosterone alters presynaptic ribbon size, postsynaptic AMPA receptor organization, and synaptic colocalization without causing overt cellular damage.

The talk will integrate molecular, synaptic, and functional perspectives, bridging basic auditory neuroscience with clinically relevant phenomena, including tinnitus, hyperacusis, and stress-related hearing fluctuations. Particular emphasis will be placed on sex as a biological variable, receptor-specific mechanisms, and the concept of the cochlea as a stress-responsive organ.

The lecture will conclude by discussing translational implications for individualized auditory care and future research directions in stress-related otology

Outcome Objectives

After attending this keynote lecture, participants will be able to:

1. Recognize the auditory periphery as an active target of stress hormones, rather than a purely mechanically driven system.

2. Understand sex-dependent mechanisms of synaptic plasticity at the inner hair cell–spiral ganglion neuron synapse.

3. Explain the role of glucocorticoid receptors in cochlear synaptic remodeling under acute stress conditions.

4. Integrate stress biology into clinical reasoning for tinnitus and other stress-associated auditory disorders.

5. Identify emerging translational opportunities for sex-sensitive and stress-informed approaches in otology and audiology.