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The diagnosis of GH deficiency (GHD) is based on the measurement of peak GH responses to pharmacological stimuli. Pharmacological stimuli, however, lack precision, accuracy, are not reproducible, are invasive, non-physiological and some may even be hazardous. Furthermore, different GH commercial assays used to measure GH in serum yield results that may differ considerably. In contrast to GH, IGF-I can be measured on a single, randomly-obtained blood sample. A review of the available data indicates that IGF-I measurement in the diagnosis of childhood-onset isolated GHD has a specificity of up to 100%, with a sensitivity ranging from about 70 to 90%. We suggest an algorithm in which circulating levels of IGF-I together with the evaluation of auxological data, such as growth rate and growth, may be used to assess the likelihood of GHD in pre-pubertal children.

Introduction: Smell and taste loss are characteristic symptoms of SARS-CoV-2 infection. The aim of this study is to investigate the prevalence and risk factors associated with olfactory and gustatory dysfunctions in coronavirus disease (COVID-19) patients. Methods: We conducted an observational, retrospective study on 376 patients with documented SARS-CoV-2 infection admitted to the San Gerardo Hospital in Monza, Italy, from March to July 2020. All patients answered a phone questionnaire providing information on age, sex, smoking status, and clinical characteristics. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated through logistic regression models including relevant covariates. Results: The prevalence of olfactory and gustatory dysfunctions in COVID-19 patients was 33.5 and 35.6%, respectively. Olfactory dysfunctions were significantly directly associated with current smoking and history of allergy, the multivariable ORs being 6.53 (95% CI 1.16–36.86) for current smokers versus never smokers, and 1.89 (95% CI 1.05–3.39) for those with an allergy compared to those without any allergy. Respiratory allergy in particular was significantly associated with olfactory dysfunctions (multivariable OR 2.30, 95% CI 1.02–5.17). Significant inverse associations were observed for patients aged 60 years or more (multivariable OR 0.33, 95% CI 0.19–0.57) and hospitalization (multivariable OR 0.22, 95% CI 0.06–0.89). Considering gustatory dysfunctions, after allowance of other variables a significant direct association was found for respiratory allergies (OR 2.24, 95% CI 1.03–4.86), and an inverse association was found only for hospitalization (OR 0.21, 95% CI 0.06–0.76). Conclusion: Our study indicates that current smoking and history of allergy (particularly respiratory) significantly increase the risk for smell loss in COVID-19 patients; the latter is also significantly associated to taste loss. Hospitalization has an inverse association with the risk of olfactory and gustatory dysfunctions, suggesting that these may be symptoms characteristics of less severe SARS-CoV-2 infection.

Objectives To determine the impact of adenotonsillectomy for treatment of severe obstructive sleep apnea (OSA) in children without comorbidities. Methods A systematic review was performed to identify studies regarding adenotonsillectomy for treatment of children with severe sleep apnea. Polysomnographic parameters were considered as metric of cure and the number of patients of persistent apnea was calculated. Quality of evidence was graded using OCEBM (Oxford Center for Evidence Based Medicine) and MINORS (Methodological Index for Nonrandomized Studies) scores. Results The systematic review included nine studies. Five studies were prospective and four retrospectives. No one was controlled. The number of subjects with severe OSA included was 499 with a prevalence of male. The mean age varied from 4.3 to 8.2. The follow-up period ranges from 1 to 23 months. The criteria for considering severe OSA ranges from AHI or RDI ≥10 to ≥30. All the trials have found a statistically significant reduction of postoperative AHI or RDI values in patients who had undergone adenotonsillectomy for severe OSA. The AHI and RDI improving varied from 57.7% to 93.3%. All the studies documented persistent OSA after adenotonsillectomy. The number of residual OSA considering AHI≥5 varied from 30 to 55.5%, in case of AHI ≥1 from 60 to 90.6%. Conclusion To the best of our knowledge, this is the first review regarding the effectiveness of adenotonsillectomy for severe OSA in otherwise healthy children. Adenotonsillectomy is partially effective in the treatment of severe OSA in children without comorbidities. However, it reduces the severity of OSA determining a significant reduction of polysomnographic parameters. These results suggest a clinical and polysomnographic follow-up after surgery in order to manage the residual mild and moderate OSA.

Purpose: To perform a comprehensive review of the literature regarding presbyphonia. Methods: We searched PUBMED through a combination of MeSH terms for articles published in the English language concerning presbyphonia. Results: Presbyphonia identifies vocal changes due to anatomical and physiological changes of the larynx occurring during the aging process. It affects about 10–20% of elderly and could negatively impact on their quality of life. The diagnosis of presbyphonia is typically a diagnosis of exclusion made in absence of other laryngeal disease with a characteristic clinic of aging voice and an instrumental pattern of presbylarynx. The treatme nt of choice for presbyphonia is speech therapy that significantly improves voice performances. In case of failure, surgical therapy should be proposed in selected patients although evidence of its benefit is scanty. Conclusions: The reviewed evidence regarding aging voice has shown that presbyphonia is considered a clinical entity that could impact the quality of life in elderly. Speech therapy is effective for improving voice performances.

Juvenile recurrent parotitis is a rare recurrent inflammation of the parotid glands occurring in children. The etiology remains obscure and the treatment is still debated. In the present study, we perform a systematic review of the literature with the purpose of identifying and discussing the treatment options emerged over the last 28 years in order to prevent recurrent episodes of parotitis. We ultimately included 24 studies. The definitions used for juvenile recurrent parotitis varied widely and none of the selected studies referred exactly to the same definition. Only one was a randomized controlled trial and it showed marked benefits with the use of Bear Bile and Huangqi, two traditional Chinese medicines. Two additional study on sialendoscopy included a control group but was not randomized. All the remaining contributions were case series or case reports. The vast majority (n = 19) of the selected studies reported on sialendoscopy. They all documented improvement of the condition following this intervention. An analysis grouping all these studies (corresponding to 336 children) showed that only 25.8% (95% Confidence Interval: 21.5–30.8) of the treated children had further recurrences. However, the only two controlled study on sialendoscopy showed a similar improvement in controls. The remaining four studies were on sialography (n = 2), on oral appliance in the specific group of children with concomitant dental malocclusion (n = 1) on ductal hydrocortisone infusion through catheter inserted in the parotid duct (n = 1). Improvements were documented in all four contributions. This systematic review of the literature did not consent us to draw definite conclusions on the most suitable treatment for juvenile recurrent parotitis. The available evidence is indeed weak and difficult to interpret because of the scarcity of randomized controlled trials, the heterogeneity of the definitions used and the high rate of spontaneous resolution. Future large and well-designed randomized controlled trials that will include children fulfilling a shared definition of the condition are warranted.

Objectives The main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved. Methods We performed a systematic review searching PubMed and MEDLINE databases including English-language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children. Results We included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0–20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0–8.0) compared with FESS 17.7% (95% CI: 12.8–23.4) or SP 50% (95% CI:15.7–84.3) (p .05). The analysis of the possible risk factors involved in recurrences are inconclusive. Conclusion Recurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.

Congenital bony nasal cavity stenosis is caused by alterations of the normal embryological development of the nasal cavity. Depending on the site of the obstruction, the most important types of stenosis are: choanal atresia and stenosis, congenital nasal pyriform aperture stenosis, congenital midnasal stenosis, arhinia and nasal septum deviation. Although they are uncommon, they could be potentially life-threatening conditions that require early diagnosis and proper treatment. In case of neonatal nasal obstruction, appropriate differential diagnosis with other causes, such as rhinitis and sinonasal masses, are performed by nasal endoscopy and radiological exams. Treatment strategy consisting of medical nasal therapies and endoscopic or open nasal surgery should be tailored according to the types and the degree of the stenosis. When indicated, endoscopic endonasal approach is considered the most effective technique in neonates warranting minimal surgical invasiveness and maximum effect. In order to promote the management of these rare yet clinically relevant neonatal nasal breath disorders, we review the current trends in diagnosis and treatment of congenital bony nasal cavity stenosis.

Objective: Dysphagia after uncomplicated thyroidectomy is commonly reported and it includes a broad spectrum of swallowing complaints. Though various causes have been hypothesized, it remains not completely understood. Methods: A systematic review was performed to identify studies concerning dysphagia post uncomplicated thyroid surgery. A qualitative analysis of data extracted was conducted. Results: We have included 16 studies of which 15 are prospective and one are retrospective. The number of subjects varied from 12 to 254, the mean age from 39 to 54 years with an overall prevalence of females. The duration of the follow-up ranges from 1 month to 4 years. All the included trials documented postoperative dysphagia, 12 of which have detected it in the early postoperative period. Considering long-term follow-up period, 12 studies reported an overall improvement of swallow symptoms. The instrumental findings revealed non-specific alterations of swallowing. Conclusions: Dysphagia after uncomplicated thyroidectomy can arise early in the postoperative period resolving spontaneously in the first year. Diagnostic methods failed to identify the physio pathological mechanism of swallow alteration leaving this condition still unclear. Since these symptoms can reduce patient’s quality of life, we suggest an appropriate education before thyroid surgery.

Following the severe acute respiratory syndrome coronavirus (SARS‐CoV) and Middle East respiratory syndrome coronavirus (MERS‐CoV), another highly pathogenic coronavirus named SARS‐CoV‐2 (previously known as 2019‐nCoV) emerged in December 2019 in Wuhan, China, and rapidly spreads around the world. This virus shares highly homological sequence with SARS‐CoV, and causes acute, highly lethal pneumonia coronavirus disease 2019 (COVID‐19) with clinical symptoms similar to those reported for SARS‐CoV and MERS‐CoV. The most characteristic symptom of patients with COVID‐19 is respiratory distress, and most of the patients admitted to the intensive care could not breathe spontaneously. Additionally, some patients with COVID‐19 also showed neurologic signs, such as headache, nausea, and vomiting. Increasing evidence shows that coronaviruses are not always confined to the respiratory tract and that they may also invade the central nervous system inducing neurological diseases. The infection of SARS‐CoV has been reported in the brains from both patients and experimental animals, where the brainstem was heavily infected. Furthermore, some coronaviruses have been demonstrated able to spread via a synapse‐connected route to the medullary cardiorespiratory center from the mechanoreceptors and chemoreceptors in the lung and lower respiratory airways. Considering the high similarity between SARS‐CoV and SARS‐CoV2, it remains to make clear whether the potential invasion of SARS‐CoV2 is partially responsible for the acute respiratory failure of patients with COVID‐19. Awareness of this may have a guiding significance for the prevention and treatment of the SARS‐CoV‐2‐induced respiratory failure., Research Highlights SARS‐CoV2 causes epidemic pneumonia characterized by acute respiratory distress.This novel coronavirus is similar to SARS‐CoV in sequence, pathogenesis, and cellular entry.Some coronaviruses can invade brainstem via a synapse‐connected route from the lung and airways.The potential invasion of SARS‐CoV2 may be one reason for the acute respiratory failure.Awareness of this will have guiding significance for the prevention and treatment.

Purpose To determine the rate of recurrence following surgical treatment of thyroglossal duct cysts (TDGCs) in children. Methods A search of electronic databases (Pubmed and MEDLINE) was performed in order to identify studies concerning surgical treatment of TGDCs in children published between 1980 and 2012. The following terms were used: "thyroglossal duct cysts", "recurrent", "recurrence", "children", "pediatric". Results Sixteen articles were selected with the majority published during the last decade. The total number of included subjects was 1233. The mean (95% confidence interval (CI)) rate of recurrences was 10.7% (9.1%–12.6%). Eleven studies involving 751 subjects reported the frequency of recurrences separately for primary cases. The mean (95% CI) rate of recurrences was 10.8% (8.7%–13.3%). Five studies reported separately results of surgery for secondary cases. The mean (95% CI) rate of recurrences was 20.0% (12.2%–30.8%). Eight of the sixteen studies reported data on risk factors for recurrence. The use of the Sistrunk technique is a protective factor, whereas children who experienced repeated episodes of infection prior to surgery are exposed to a higher risk of recurrence. Conclusion Recurrences after surgery for TDGCs remain a clinically relevant issue. One of ten operated children experiences a recurrence. Available data support the use of the Sistrunk technique but further studies aimed at improving the clinical management of TDGCs are required.

BACKGROUND: The efficacy of intratympanic steroid (ITS) treatment in sudden deafness (SD) remains controversial. To shed light on this issue, we performed a systematic review of randomized controlled trials to assess the overall efficacy of ITS therapy and to clarify whether it is more suitable as a first-line approach (primary treatment) or as a salvage treatment when traditional systemic agents have failed. METHODS: An electronic database search (MEDLINE and PubMed) was performed with the objective of identifying all studies published in the English language between January 1980 and November 2011 on the efficacy of ITS in the treatment of SD. All relevant articles were retrieved, and the related reference lists were reviewed systematically to identify other reports that could be included. Data were synthesized using the Mantel-Haenszel model. Results are expressed as odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 11 randomized studies including 472 subjects allocated to ITS and 453 controls were selected. Intratympanic steroid regimens used and treatments administered to controls varied widely across studies. When considering together trials investigating ITS therapy as a primary (n = 4) or salvage (n = 7) treatment, the common OR for recovery was 1.7 (95% CI, 1.3-2.3). When considering them separately, the common ORs for recovery were 0.9 (95% CI, 0.7-1.6) for primary and 2.9 (95% CI, 1.9-4.5) for salvage therapy. CONCLUSION: Intratympanic steroid therapy seems to confer a certain degree of benefit as a salvage but not as a primary treatment of SD. However, further evidence is needed to clarify some yet uncertain aspects, such as the optimal protocol of therapy.

Tonsillectomy and adenoidectomy (T&A) is currently recommended in children with Obstructive Sleep Apnea (OSA). However, the condition persists after surgery in about one third of cases. It has been suggested that Drug Induced Sleep Endoscopy (DISE) may be of help for planning a more targeted and effective surgical treatment but evidence is yet weak. The aim of this review is to draw recommendation on the use of DISE in children with OSA. More specifically, we aimed at determine the proportion of cases whose treatment may be influenced by DISE findings. A comprehensive search of articles published from February 1983 to January 2014 listed in the PubMed/MEDLINE databases was performed. The search terms used were: "endoscopy" or "nasoendoscopy" or "DISE" and "obstructive sleep apnea" and "children" or "child" or "pediatric." The main outcome was the rate of naive children with hypertrophic tonsils and/or adenoids. The assumptions are that clinical diagnosis of hypertrophic tonsils and/or adenoids is reliable and does not require DISE, and that exclusive T&A may solve OSA in the vast majority of cases even in the presence of other concomitant sites of obstruction. Five studies were ultimately selected and all were case series. The median (range) number of studied children was 39 (15-82). Mean age varied from 3.2 to 7.8 years. The combined estimate rate of OSA consequent to hypertrophic tonsils and/or adenoids was 71% (95%CI: 64-77%). In children with Down Syndrome, the combined estimated rate of hypertrophic tonsils and/or adenoids was 62% (95%CI: 44-79%). Our findings show that DISE may be of benefit in a minority of children with OSA since up to two thirds of naive cases presents with hypertrophic tonsils and/or adenoids. Its use should be limited to those whose clinical evaluation is unremarkable or when OSA persists after T&A.

The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR.

Keywords Menarchetiming.Menstrualcycle.Centralprecociouspuberty.GnRHaOur aim was to longitudinally investigate menarche timingand menstrual cycle (MC) pattern during the first fivegynaecological years in 101 girls with idiopathic centralprecocious puberty (CPP) who had been treated withgonadotropin-releasing hormone agonists (GnRHa) for atleast two years. Our girls received Decapeptyl Depot(60