Exploring the role of extracellular vesicles in otorhinolaryngology: From diagnostics to therapeutic potential

Extracellular vesicles (EVs), including exosomes and microvesicles, have gained increasing attention as cell-free platforms for diagnostics and therapy across multiple medical disciplines, including otorhinolaryngology. This narrative review surveyed PubMed, Scopus, and Web of Science up to October 2025, with an emphasis on studies published within the past decade, to summarize and critically evaluate the mechanistic, diagnostic, and therapeutic roles of EVs in otorhinolaryngologic disorders. Current evidence, which is predominantly preclinical with a limited number of early-phase clinical studies, supports the potential utility of EVs in several disease contexts. In head and neck cancers, EVs show value as biomarkers for early detection, disease staging, and monitoring treatment response. In sensorineural hearing loss, EVs, particularly those derived from mesenchymal stem cells, demonstrate anti-inflammatory, antioxidant, and neuroprotective properties that support cochlear repair and neural regeneration. Similarly, EV-mediated modulation of chondrocyte function and extracellular matrix synthesis provides a preclinical foundation for cartilage and reconstructive applications. Emerging studies also suggests diagnostic and therapeutic roles for EVs in chronic rhinosinusitis and olfactory dysfunction, mainly through immune modulation and mucosal repair. Intranasal administration has shown promise as a non-invasive delivery route in experimental models, particularly for targeting neural and nasal tissues. Despite these encouraging findings, major challenges remain, including limited clinical validation, variability in EV isolation and characterisation methods, and the need for scalable, standardised production. Addressing these gaps through coordinated translational and clinical research will be critical for advancing EV-based applications in otorhinolaryngology.