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This study aims to evaluate the effect of botulin toxin A in patients with multiple sclerosis (MS) affected by spasmodic dysphonia (SD) and to show the safety and effectiveness of this treatment in long-term observation. This is a pilot study on three relapsing-remitting MS patients with SD and their response to botulin toxin A. None of the patients reported dysphagia or other adverse events. Significant improvement was observed in terms of both voice quality and laryngostroboscopy results. The treatment effect was durable for 6–8 months. Botulin toxin A is a safe treatment that can be successfully used to treat SD in patients with MS. Larger studies are necessary to confirm our results. [ABSTRACT FROM AUTHOR]

Objectives: Before the widespread use of antibiotics, most deep neck infections (DNIs) stemmed from complicated pharyngeal infections. Nowadays, they seem to be due mainly to dental infections. In 2010, our group reported that DNIs originated from a major salivary gland in 14% of cases. The main endpoint of the present investigation was to review our experience of the diagnosis and treatment of DNIs of salivary gland origin. We also compared the characteristics of DNIs originating from salivary glands with those originating elsewhere.Methods: Between 2000 and 2011, 44 patients were treated for DNIs of salivary origin at our institution. These patients were compared with 191 cases of DNI diagnosed as having other sites of origin.Results/conclusions: In the present series, DNIs originating from a major salivary gland accounted for 19% of all cases of DNI of known origin. Patients with DNI of salivary gland origin were more likely to be elderly than those whose DNI originated from elsewhere (p=0.000). Our multivariate statistical model showed that comorbidities (p=0.051, statistical trend) and the need for surgical treatment (p=0.028) independently predicted long-term hospitalization for DNIs originating from a major salivary gland. [ABSTRACT FROM AUTHOR]

Olfactory receptors were found to be expressed also in human sperm giving rise to the hypothesis that they might play a role in fertility and sexual behavior. For instance, bourgeonal was demonstrated to be an agonist of sperm cells olfactory receptor, OR1D2. OR1D2 has been found to be expressed in human olfactory epithelium and to play a critical role in human sperm chemotaxis. Recent preliminary evidence showed that olfaction sensitivity (determined by n-butanol olfactory threshold) and sexual desire were associated in young adult males. It is reasonable to hypothesize that bourgeonal olfactory threshold could be related with human sexual behavior and desire. In 37 healthy young adult male volunteers (age range 20–36 years), the bourgeonal odor threshold and the intensity of sexual desire [the latter using the International Index of Erectile Function (IIEF) scale] were examined. In addition, samples of DNA were collected. Allele and genotype frequency of the OR1D2 single nucleotide polymorphisms (SNPs) were then evaluated in order to study the relationship between sexual desire and OR1D2 SNPs expression. The olfactory threshold was categorized as <10, 10 ⩽ threshold < 15, 15 ⩽ threshold < 20, ⩾20. IIEF 1 and IIEF 2 scores were significantly associated. IIEF1 scores, but not IIEF2 scores were significantly associated with olfactory threshold. No statistically significant associations were found neither between genotypes frequency and sexual desire (IIEF1 and IIEF2), nor between genotypes frequency and olfactory threshold. Hypothesizing for the first time the relationship between bourgeonal olfactory sensitivity and sexual desire in a group of young adult males, the present study found a significant association between lower olfactory threshold for bourgeonal and stronger sexual desire, in terms of IIEF1. [ABSTRACT FROM AUTHOR]

Background: Adenosquamous carcinoma (ASC) of the head and neck is a rare malignancy characterized by loco-regional and distant aggressiveness. At histology, ASC reveals two distinct, juxtaposed components, squamous cell carcinoma (SCC), and true adenocarcinoma.Methods: The immunohistochemical expression of AE3, CK19 and CAM5.2, and HPV infection was tested in a case of laryngeal ASC.Results: The patient had no regional lymph node metastases, but developed a recurrence in neck soft tissues shortly after primary radical surgery. The laryngeal surgical specimen had the typical morphological features of ASC. The tumor's squamous and glandular components were both strongly and diffusely immunoreactive for AE3 and CK19, whereas CAM5.2 selectively stained only the gland-like part. We found no high- or low-risk HPV DNA (28 genotypes) in the specimens. The patient underwent salvage extended radical neck dissection and received postoperative radio-chemotherapy. At 4-month follow-up control, neck recurrence was found. Palliative chemotherapy was instituted.Conclusions: An accurate histological and immunohistochemical diagnosis is mandatory to differentiate ASC from conventional SCC. Radical surgical excision is recommended for laryngeal ASC. Adjuvant postoperative therapy is administered in most cases, but there are no widely accepted indications for these treatments. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Treatment options for dysphagia associated with multiple sclerosis (MS) are currently limited. In this study we investigated whether intraluminal electrical pharyngeal stimulation facilitates swallowing recovery in dysphagic MS patients. Patients and methods: Twenty dysphagic MS patients were randomized to receive 5 Hz “real” pharyngeal stimulation (10 patients) for 10 min or “sham” pharyngeal stimulation for 10 min (10 patients). Patients were evaluated by videofluoroscopic, and electromyographic examinations, and by the Penetration/Aspiration Scale (PAS) performed before (T 0) and immediately after the last session of 5 consecutive days of electrical pharyngeal stimulation (T 1), and then after two (T 2), and four (T 3) weeks of 5 consecutive days of pharyngeal electrical stimulation. Results: Patients who received “real” stimulation showed a significant improvement in all the swallowing outcome measures as compared with those receiving “sham” stimulation. Conclusions: No specific treatment for oro-pharyngeal dysphagia related to MS has been described to date. Our preliminary findings suggest a potential benefit of intraluminal electrical pharyngeal stimulation for the treatment of dysphagia caused by MS. [Copyright &y& Elsevier]

Purpose: Smoking is a self-destructive behavior that is known to induce remodeling of the lower airways, leading to squamous metaplasia, but little is known about its effects on the nose and paranasal sinuses. Nasal irrigations are often mentioned as measures for treating sinonasal inflammations. The purpose of our study was to compare the effects of nasal irrigations with sulfurous-arsenical-ferruginous thermal water or isotonic sodium chloride solution in smokers with nonallergic chronic rhinosinusitis, based on clinical and olfactory evidence. Materials and Methods: The present study was a prospective, randomized, double-blind study performed in a tertiary academic referral center. Seventy smokers with nonallergic chronic rhinitis were enrolled. Nasal endoscopy, rhinomanometry, nasal cytology, and odor threshold measurements were performed in subjects randomized to daily nasal irrigations with either thermal water or isotonic sodium chloride solution for 1 month. Results: Immediately after the treatment, the thermal water irrigations revealed a positive pharmacologic action, judging from a tendency toward lower nasal resistances (P = .07) and larger numbers of ciliated cells in the patients treated (P = .003). Endoscopic findings in the thermal water group were still better than in the control group a further 2 months later (P = .03). Conclusions: Our results indicate that nasal irrigations with thermal water had a good effect on endoscopic objective signs, nasal resistances, and epithelial trophism. [ABSTRACT FROM AUTHOR]

Objectives: Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]).Methods: In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month.Results: An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month.Conclusions: Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Sensorineural hearing loss after diving from a low height has been rarely reported especially in children. Methods: We present and discuss a new case of pediatric sudden sensorineural hearing loss after diving. Results and Conclusion: Medical and surgical approaches (indications and timing of explorative tympanotomy) to this occurrence are still controversial. [Copyright &y& Elsevier]

Summary: Laryngeal carcinoma is the 11th commonest form of cancer in men world-wide, with 121,000 new cases in 1985. More than 95% of all laryngeal malignancies are squamous cell carcinomas. Treatment indications in cancer of the larynx are often controversial, since there are few comparative studies of different available therapeutic approaches. Surgery and radiotherapy are both widely used, and the choice between these two procedures is the most common therapeutic decision which has to be taken. Laryngeal function preservation has gained more and more weight in the last decades and chemotherapy is also a significant component of several curative approaches. In the last decades, several organ-preserving surgical techniques have become available and consequently total laryngectomy results less applied. Regardless of the treatment modality, Tis, T1, T2 laryngeal carcinomas have an 80–90% probability of cure, whereas for more advanced tumours this is approximately 60%. The most effective approach to laryngeal cancer remains prevention and early diagnosis when this cancer is curable with function preserving treatments. [Copyright &y& Elsevier]

The aims of this study were to assess the efficacy and safety of botulinum toxin (BoTox) injection in the cricopharyngeus muscle (CP) and CP myotomy in patients with oropharyngeal dysphagia (OPD) and to identify factors predicting the outcome of these treatments. The study involved patients with persistent OPD despite 2–6 months of rehabilitation, who all underwent clinical evaluation, esophageal manometry, upper gastrointestinal endoscopy, and videofluoroscopy (VFS). Patients received 5–10 BoTox units injections in the CP, identified by electromyography. Surgical myotomy of the upper esophageal sphincter was performed when dysphagia persisted after two BoTox injections. After treatment, patients were reevaluated with clinical interviews and VFS. The study population included 21 patients (15 mean and 6 women; median age, 68 years), classified into three groups, based on the etiology of their OPD: eight (38%) had central nervous system abnormalities, five (24%) had peripheral nerve disease, and eight (38%) were classified as idiopathic. The median time since the onset of dysphagia was 18 months. Thirteen of 21 patients (62%) needed supplemental/total gastrostomy feeding, and 5 of 21 (24%) had tracheostomy. One patient died, on posttreatment day 7, due to massive aspiration. No other BoTox-related complications were observed. After BoTox injection, dysphagia improved in 9 of 21 (43%) patients. Severely altered VFS findings and CP incoordination or low activity predicted BoTox failure at multivariate analysis. Dysphagia improved in 8 of 11 (72.7%) patients who failed to respond to BoTox and underwent myotomy. A mild impairment of VFS findings and a higher pressure of pharyngeal contractions best predicted response to BoTox with or without myotomy. BoTox injection can be used as the first therapeutic option in patients with OPD: it is safe and simple and relieves dysphagia in 43% of cases. If BoTox fails, CP myotomy can be offered to patients with preserved oral and tongue activity at VFS and an intact bolus propulsion ability on manometry. [Copyright &y& Elsevier]

Summary: Necrotizing fasciitis is a soft-tissue infection characterized by progressive destruction of fascia and adipose tissue which may not involve the skin. Cervical necrotizing fascitis (CNF) is an uncommon clinical entity. The development of CNF is frequently related to synergistic infections of aerobic and anaerobic organisms of the upper aerodigestive tract. We describe the first case of CNF due to multi-drug resistant Burkholderia cepacia and Peptostreptococcus infection in an immuno-competent patient without cystic fibrosis. [Copyright &y& Elsevier]