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The authors reported a case of a 27‐year‐old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis.

Background The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. Purpose In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. Methods 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. Results Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. Conclusion In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.

Background/Objective The main end point of this investigation was to review our experience gained from 2009 to 2015 of treating chronic rhinosinusitis with nasal polyps (CRSwNP) in elderly patients (≥65 years old) with functional endoscopic sinus surgery. Secondary aims were to analyze the prognostic variables for CRSwNP in elderly patients and to compare the demographic, clinical, laboratory, histologic, and prognostic characteristics of CRSwNP in elderly versus young adult patients (20-40 years old). Methods Forty-three consecutive elderly patients and 71 consecutive young adult patients with CRSwNP were enrolled. Results Significant associations were found in the elderly group between CRSwNP recurrence and allergy (p = 0.037), CRSwNP recurrence and asthma (p = 0.017), and CRSwNP recurrence and acetyl salicylic acid (ASA) intolerance (p = 0.032) but not between recurrence and eosinophilic/noneosinophilic CRSwNP histology. Significant associations emerged in the young adult group between CRSwNP recurrence and asthma (p = 0.009), and ASA intolerance (p = 0.016), and serum eosinophil count (p = 0.02). The recurrence rate was also significantly higher for young adult patients with eosinophilic-type CRSwNP (p = 0.001). CRSwNP recurred less often in the elderly than in the young adult patients (p = 0.05). Conclusion The present preliminary investigation found a lower recurrence rate after functional endoscopic sinus surgery for CRSwNP in elderly patients than in young adult patients. Further investigations on larger, prospective series are mandatory to support the hypothesis that, although eosinophilic-type CRSwNP is generally considered a variant at high risk of recurrence and that probably warrants stricter postoperative follow-up and adjuvant postoperative medical treatment, these considerations could not be applied to elderly patients.

One of the biggest challenges for otolaryngologists is represented by the locally recurrent undifferentiated nasopharyngeal carcinoma (uNPC). Despite improvements in its treatment options, such as modern radiotherapy, chemotherapy, or external surgical approaches, the risk for severe complications, functional disabilities, and even death remains considerable. Over the years, advances in endoscopic surgery have led to a new alternative in the salvage surgery for recurrent uNPC: the nasopharyngeal endoscopic resection (NER). We retrospectively reviewed clinical records of 8 patients (6 men and 2 women), who underwent NER for recurrent T1 (rT1) locally recurrent uNPC between 2008 and 2011. Together with resections for subsequent recurrences, a total of 9 NERs were performed by a single surgeon with curative intent. Negative margins were obtained for the whole group of patients. After a mean follow-up period of 27 months (range, 16-54 mo), all the patients had no evidence of the disease. We had only 1 recurrence after 7 months. Two-year overall survival and disease-free survival rates were 100% and 88.9%, respectively. Only 1 patient presented with a complication, osteitis. Nasopharyngeal endoscopic resection can be considered a valid and promising treatment option for rT1 locally recurrent uNPC, showing encouraging short-term outcomes and complication rate. Long-term follow-up is needed to state the efficacy of NER, together with a larger number of patients.

The Silent Sinus Syndrome (SSS) is a rare condition that causes facial asymmetry, unilateral enophthalmos and diplopia. It is thought to be secondary to chronic maxillary sinus atelectasis (CMA) with reabsorbed bone and subsequent displacement of the orbital floor. Such anatomic modifications occur over time, and therefore it is possible to encounter different stages of the same disease with or without orbital displacement. Clinical findings can be unclear so it makes sense to recognize potentially evolving SSS while other disturbances have to be ruled out. Our purpose is to underline clinical findings for different diagnosis and proper management. We consider Functional Endoscopic Sinus Surgery (FESS) indicated in CMA and SSS to halt the progression of the disease. Nevertheless restitution treatment of enophtalmos due to orbital floor displacement involves plastic reconstruction of the floor of the orbit via transconjunctival approach. We report a case of SSS and discuss distinctive features of non-neoplastic lesions involving the maxillary sinus that should be considered for differential diagnosis.

Congenital cholesteatoma within the tympanic membrane is an uncommon entity, with only few cases being documented. The aetiopathogenesis of this lesion is still unknown; however, when cholesteatoma develops in subjects without any history of previous ear inflammation, as in the case we report here, an embryologic origin is deeply suspected. An acquired origin is hypothesized in patients with a previous history of an inflammatory process of the external or middle ear because of the proliferation of the basal cell layer of the tympanic membrane epithelium. We report a rare case of congenital cholesteatoma of the tympanic membrane in an adult patient and review the literature.

Purpose Despite advances in the diagnosis and treatment of chronic rhinosinusitis with nasal polyps (CRSwNP), their recurrence rate remains significant. There is a need for promptly-obtainable, inexpensive, minimally-invasive prognostic parameters to enable rhinologists to identify patients at higher risk of recurrent CRSwNP. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), previously discussed as potential markers of inflammation, has already been investigated in CRSwNP. The aim of the present study was to test the prognostic value of the NLR and ELR, and also of the basophil-to-lymphocyte ratio (BLR) (given the emerging role of basophils in CRSwNP) in a large series of CRSwNP. Materials and methods The study concerned 240 patients who underwent FESS for CRSwNP from 2009 to 2014 and had a postoperative follow-up longer than 12 months. We considered patients with recurrences as those with endoscopic evidence of at least grade I polyposis. Results In our series, the mean NLR, ELR and BLR were significantly higher in patients whose disease recurred than in those remaining recurrence-free (p = 0.03, p = 0.0001, and p = 0.0002, respectively), but the discriminatory power of the NLR, ELR, or BLR in terms of disease recurrence was unacceptable (AUCs = 0.600, 0.678, and 0.662, respectively). Conclusions The heterogeneous prognostic role of NLR, ELR and BLR identified in the clinically and pathologically different sub-cohorts of CRSwNP considered supports the hypothesis that CRSwNPs with a similar clinical picture may differ considerably in terms of the biological and pathogenic mechanisms of polyp formation and growth.

International journeys are increasing and more than 70 million people from industrialized countries cross the borders of tropical countries every year. More than 50% of them will suffer from some form of infectious illness, ranging from mild travelers' diarrhea to severe dengue fever to fatal malaria, with a wide spectrum of microbiological entities. Travel-related respiratory infections, including TB, and sexually transmitted infections are also increasingly reported. Awareness of travel-related risk is not always adequate among international travelers. Specific training on travel medicine-related issues, as well as better diagnostic facilities for imported diseases, is crucial for physicians and nurses in industrialized countries.

Although resistance to tigecycline has been reported in surveillance studies, very few reports have described the emergence of resistance in vivo . We report two cases of patients with infections due to SHV-12-producing Klebsiella pneumoniae and K. pneumoniae carbapenemase-3 (KPC-3)-producing Escherichia coli , which developed tigecycline resistance in vivo after treatment. The reported limited experience underlines the risk of occurrence of a tigecycline MIC increase under treatment pressure.

Figure 1. Intraoperatory view of the mass. DOI http://dx.doi.org/10.13070/rs.en.1.1016 Date 2014-09-10 Cite as Research 2014;1:1016 License CC-BY Benign fibrous histiocytoma of the nasal vestibule: report of a case and review of literature Ioannis Mylonakis1, 2 (ioannis dot mylonakis at unipd dot it) #, Enzo Emanuelli3, Barbara Pedruzzi1, 3, Filippo Marino4, Alessandro Martini1, 3 1 Department of Neurosciences, Univerity of Padua, Italy. 2 ENT Clinic, University Hospital of Padova, Italy. 3 Endoscopic Airways Surgery Unit, University Hospital of Padova, Italy. 4 Anatomical Pathology Unit, University Hospital of Padova, Italy # : corresponding author Benign fibrous histiocytoma (BFH) is a rare connective tissue tumor arising in skin (dermatofibroma), soft tissues and bone (“deep” fibrous histiocytoma). Few cases of soft tissue BFH have been reported in the head and neck and localizations in the nasal fossa are extremely rare. We report the presence of a soft tissue BFH in the right nasal vestibule of a 54 year old male, the first well defined report in the English literature of a tumor of this kind in this particular site. Introduction Benign benign fibrous histiocytoma (BFH) was first described as a separate clinical entity in the 1960s after a lengthy process aiming towards a precise identification of fibrohistiocytic lesions and the distinction between benign and malignant variants [1]. It is now considered a benign mesenchymal lesion composed of fibroblasts and histiocytes arising in the cutaneous and non-cutaneous soft tissues, although disputes still exist on whether this is a true tumor or a reactive mass at least as for the cutaneous form [2] [3]. Confusion on the nature of fibrohistiocytic lesions also accounts for the variety of names used to describe this tumor and its variants: Dermatofibroma, sclerosing hemangioma, adult xanthogranuloma, fibroxanthoma, and nodular subepidermal fibrosis are some of the terms more commonly used in the past to identify this tumors [1]. While cutaneous BFH (dermatofibroma) usually originates in sun-exposed skin, non-cutaneous soft tissue BFH usually presents itself in subcutaneous tissues of the extremities and more rarely in visceral spaces like the retroperitoneum and pelvis; localizations in tendons are rare and visceral presentations anecdotal [3]. The “deep” soft tissue variant of the tumor seems to be relatively more frequent in young children, especially in the head and neck region [4]. BFH arising in the orbital tissues represents the most frequent primary mesenchymal tumor of the orbit in adult patients and accounts for most of the head and neck localizations that would otherwise be rare [5]. In the ENT practice BFH has been more commonly encountered in the bone and soft tissues of the oral cavity such as in the tongue, gingival or alveolar ridge, mandible, maxilla, lips, soft palate, and floor of the mouth. The nasal cavity and paranasal sinuses, larynx, trachea, temporomandibular joint, and submandibular and parotid glands are more rarely involved [5]. A malignant subtype of fibrous histiocytoma has also been described [2] [3]. Tumors of the nasal vestibule are generally rare and reports of nonepithelial variants absolutely exceptional [6] ; no definite cases of fibrohistiocytic tumors in this site are present in literature so far. Case report In February 2012 a 54 year old Italian male presented in the outpatient ambulatory of the Endoscopic Upper Airways Surgery Unit of the University Hospital of Padua with a large, nontender mass of the right nasal vestibule which he had noticed 3 months earlier and had rapidly grown in size since then. The tumor caused local discomfort and unilateral nasal obstruction. The patient referred no specific personal or professional risk factors for nasal disease apart from persistent nasal picking. In his general history there were no other significant pathologies apart from hypertension under treatment with vasodilators. On direct examination the lesion appeared as a pedunculated mass without alterations of the overlying mucosal lining, originating from the alar region of the right nostril (Fig. 1). Complete upper aerodigestive tract endoscopic examination revealed no other lesions. Topics paranasal sinus neoplasms benign fibrous histiocytoma histiocytes

Described first in 1980s, allergic fungal sinusitis that is a chronic noninvasive fungal sinusitis is a relatively uncommon disease in adults. Nasal polyposis, peculiar imaging features, and allergic mucin are its main characteristics. Although case report and/or series about this disease have been reported, its occurrence in pediatric population remains rare. Pathogenesis of this illness is the same in both children and adults, but some clinical characteristics are different, especially at presentation. The clinical picture and treatment of this disorder in children are analyzed.

HIV RNA monitoring is not available in most antiretroviral treatment (ART) programs in sub-Saharan Africa; switch to second-line therapy is mostly guided by clinical/immunological criteria. This may lead to unnecessary disease progression and drug resistance accumulation. We investigated the prognostic value of virological and immunological status 6 months after ART initiation with respect to death, loss to follow-up, and treatment switch.We considered treatment-naive HIV-1-infected patients, starting ART with available 6-month visit and subsequent follow-up, enrolled in a prospective cohort comprising 5 ART sites in 3 sub-Saharan countries. Outcome measures included the time from 6-month visit to death for all causes, loss to follow-up, and switch to second line.Of 2539 patients, 62% were females, their median pre-ART CD4 count was 215 cells per microliter, median HIV RNA 4.6 Log10 copies per milliliter, 30% were on WHO stage 3/4. At 6 months, 85% had HIV RNA1000 copies per milliliter. During 3112 person-years follow-up after the 6-month visit, 91 patients died. Death was predicted by 6-month HIV RNA ≥10,000 copies per milliliter, adherence, and 6-month CD4200 cells per microliter. The 2-year estimated probability of surviving ranged from 0.69 (with 6-month HIV RNA ≥10,000 and CD4200) to 0.95 (with HIV RNA1000 and CD4 ≥200). Loss to follow-up (1.95 per 100 person-years follow-up) was predicted by the 6-month HIV RNA10,000 copies per milliliter and adherence but not by CD4. Switch to second line (6.94 per 100 person-years follow-up) was predicted by 6-month HIV RNA and CD4.In patients starting ART in sub-Saharan Africa, 6-month HIV RNA independently predicts subsequent survival, retention to care, and switch to second-line therapy. This measure warrants further evaluation as specific time point monitoring option.

Objective To review the importance and benefits of flexible bronchoscopy and rigid bronchoscopy in airway foreign body inhalation in children. Prompt diagnosis will lead to safer outcomes when both types of endoscopy are employed within the operating room setting. Methods Retrospective review of all cases of foreign body inhalation seen and treated in our Department between July 1986 and December 2010. Results Three-hundred and ten children were admitted to our Department from Pediatric Emergency Room for a suspected foreign body inhalation. All patients with suspected FB inhalation underwent bronchoscopy. Of 310 evaluations of tracheobronchial tree performed at our Department, 104 were negative, while an airway FB were observed and removed in 206 cases. Conclusions Rigid bronchoscopy under general anesthesia is an extremely accurate surgical technique to identify, localize and remove airway foreign body. In our experience, flexible bronchoscopy under total intravenous sedation and topical anesthesia is very useful in doubtful cases to absolutely exclude the presence of foreign body in upper airway tracheobronchial tree.

Acquired tracheal pouch known also as tracheocele is a rare air-filled diverticulum of tracheal pars membranacea. This disease may be due to esophageal or tracheal surgery, orotracheal intubation, or increased intralunimal pressure through a weak area of tracheal wall. When symptomatic and medical therapy is insufficient, this disorder must be treated surgically. Several surgical methods ranging from open neck or thoracic surgery to endoscopic managements have been reported. We report the case history of a 7-year-old boy affected by recurrent pneumonia due to tracheal pouch. The patient underwent successful brushing of tracheocele plus fibrin glue application by rigid tracheobroncoscopy. Furthermore, particular emphasis on endoscopic treatments of tracheal diverticulum is also presented.

Penetrating trauma to the neck is a rare observation. We report the first case of laryngeal myofibroblastic tumor due to a persistent splinter of glass in the preepiglottic space, which presented with recurrent mild hemoptysis and cough, and mimicked supraglottic carcinoma. The clinical and imaging evaluations are herein reported. Finally, medical and surgical options in the management of this unusual observation are discussed.

Allergic rhinitis (AR) is a chronic nasal disease that affects the upper respiratory tract. This disorder is characterized by inflammation of the mucous membranes and it manifests with several nasal symptoms accompanied sometimes by non-nasal symptoms. Best therapy aims to prevent and improve the AR-clinical picture. Steroids have an important role in the treatment of AR. The development of steroids administrated directly on nasal mucosa has much reduced the systemic adverse affects associated with oral steroids therapy. Mometasone furoate aqueous nasal spray is a synthetic steroid assessed for intranasal use in the therapy of adults and children affected by AR. Such topical nasal steroid is an effective molecule improving clinical picture of AR and it is also approved as prophylactic therapy. In this article, apart from a careful description of its successful clinical use the authors review pharmacokinetic/pharmacodynamic profile, mechanism of action, safety, and efficacy of such steroid molecule.