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The recurrent or chronic "non specific pharyngitis" is one of the most common complaints of adults treated in an outpatient setting and it is a disease without a certain aetiology, but with many probable causes which can be of bacterial or viral nature, but incidence of atypical microorganism infection, such as Chlamydia trachomatis (Ct), Mycoplasma hoininis (Mh) and Ureaplasina urealyticum (Uu) is believed to be on the rise. The increase is correlated above all to sexual behavior and to diffusion of new microbiological diagnostic methods, such as PCR. From 840 patients affected by recurrent episodes of chronic pharyngeal phlogosis and examined from 2006 to 2008, we selected 67 patients, 37 women and 30 men. On the basis of molecular and cultural analysis, 85.07% of patients were positive to Ct, and 89.55% were positive to Mollicutes (Mh+Uu), showing a vast overlapping of co-infections of Uu and Mh. Our data indicated a higher rate of infection by atypical microorganism in selected patients affected by chronic pharyngitis. It is important to suspect this aetiology during recurrent chronic pharingitis because patients with these oropharingeal infections, must be considered as carriers and the correct treatment, only possible after exact diagnosis, is above all necessary to prevent fearful complications in other body areas. [ABSTRACT FROM AUTHOR]

Deep learning-based approaches to delineating 3D structure depend on accurate annotations to train the networks. Yet in practice, people, no matter how conscientious, have trouble precisely delineating in 3D and on a large scale, in part because the data is often hard to interpret visually and in part because the 3D interfaces are awkward to use. In this paper, we introduce a method that explicitly accounts for annotation inaccuracies. To this end, we treat the annotations as active contour models that can deform themselves while preserving their topology. This enables us to jointly train the network and correct potential errors in the original annotations. The result is an approach that boosts performance of deep networks trained with potentially inaccurate annotations.

We propose a novel, connectivity-oriented loss function for training deep convolutional networks to reconstruct network-like structures, like roads and irrigation canals, from aerial images. The main idea behind our loss is to express the connectivity of roads, or canals, in terms of disconnections that they create between background regions of the image. In simple terms, a gap in the predicted road causes two background regions, that lie on the opposite sides of a ground truth road, to touch in prediction. Our loss function is designed to prevent such unwanted connections between background regions, and therefore close the gaps in predicted roads. It also prevents predicting false positive roads and canals by penalizing unwarranted disconnections of background regions. In order to capture even short, dead-ending road segments, we evaluate the loss in small image crops. We show, in experiments on two standard road benchmarks and a new data set of irrigation canals, that convnets trained with our loss function recover road connectivity so well that it suffices to skeletonize their output to produce state of the art maps. A distinct advantage of our approach is that the loss can be plugged in to any existing training setup without further modifications.

The maxillary sinus is the most common site of sinonasal inverted papilloma. Endoscopic sinus surgery, in particular endoscopic medial maxillectomy, is currently the gold standard for treatment of maxillary sinus papilloma. Although a common technique, complications such as stenosis of the lacrimal pathway and consequent development of epiphora are still possible. To avoid these problems, we propose a modification of this surgical technique that preserves the head of the inferior turbinate and the nasolacrimal duct. A retrospective analysis was performed on patients treated for maxillary inverted papilloma in three tertiary medical centres between 2006 and 2014. Pedicle-oriented endoscopic surgery principles were applied and, in select cases where the tumour pedicle was located on the anterior wall, a modified endoscopic medial maxillectomy was carried out as described in this paper. From 2006 to 2014 a total of 84 patients were treated. A standard endoscopic medial maxillectomy was performed in 55 patients (65.4%), while the remaining 29 (34.6%) had a modified technique performed. Three recurrences (3/84; 3.6%) were observed after a minimum follow-up of 24 months. A new surgical approach for select cases of maxillary sinus inverted papilloma is proposed in this paper. In this technique, the endoscopic medial maxillectomy was performed while preserving the head of the inferior turbinate and the nasolacrimal duct ("TuNa-saving"). This technique allowed for good visualization of the maxillary sinus, good oncological control and a reduction in the rate of complications.

Great auricular nerve (GAN) is frequently sacrificed during parotid surgery. GAN preservation during parotidectomy is advised to avoid complications such as sensitive disorders, but debate still exists. In this study, our experience is reported on the matter. From a cohort of 173 parotidectomies carried out in the period 2005-2010, we studied 60 patients: 20 patients in which we preserved only the posterior branch of GAN (group A), 20 patients in which we preserved also the lobular branch (group B) and 20 patients in which the main trunk of GAN was sectioned (group C); we evaluated tactile sensitivity in all the skin supplied by GAN at 1 week, 1 month, 6 months and 1 year after surgery. Group B is the best in terms of loss and recovery of sensitivity after 1-year post-surgery, followed closely by group A, on the contrary group C confirmed to be the worst. Results suggest that saving as many branches of the GAN as possible during parotid surgery could be useful for reducing hypo-dysesthesia. Preserving posterior and lobular branches of the GAN, when possible, improves the sensitivity of the preauricular area with better quality of life for the patient.

Objective: Primary objective of this study was to find a statistical link between the most worldwide comorbidities affecting the elderly population (hypertension, diabetes, osteoarthrosis, osteoporosis and depression) and recurrent episodes of BPPV. Secondary objective was defining possible "groups of risk" for people suffering recurrent positional vertigo related to the presence of a well documented comorbidity., Methods: This was an observational, cross-sectional, multicenter, spontaneous, non-pharmacological study. The data of 1092 patients suffering BPPV evaluated in 11 different Departments of Otolaryngology, Otoneurology and Neurology, referring Centers for positional vertigo evaluation, were retrospectively collected., Results: Regarding evaluated comorbidities (hypertension, diabetes, osteoarthrosis, osteoporosis and depression), data analysis showed the presence of at least one comorbid disorder in 216 subjects (19.8%) and 2 or more in 408 subjects (37.4%). Moreover there was a statistical significant difference between the number of comorbidities and the number of recurrences, otherwise said as comorbidity disorders increased the number of relapses increased too., Conclusion: The presence of a systemic disease may worsen the status of the posterior labyrinth causing a more frequent otolith detachment. This condition increases the risk for patients suffering BPPV to have recurrent episodes, even if correctly managed by repositioning maneuvers. The combination of two or more of aforementioned comorbidities further increases the risk of relapsing BPPV, worsened by the presence of osteoporosis. On the basis of this results it was possible to define "groups of risk" useful for predicting BPPV recurrence in patients with one or more comorbidity., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

Metatypical Basal Cell Carcinoma, also known as Basosquamous Carcinoma is a subtype of Basal Cell Carcinoma. It is similar to Basal Cell Carcinoma for the gross aspect and regional recurrences, but it has the capacity to spread and develop metastasis. This terrible characteristic endangers the life of the patient if it is not readily recognized by the physicians. Herein we present a report of two patients affected by BSC originating in the nasal region and external ear that after a series of devastating local recurrences metastasized to the lung and bones in one case. The true incidence of Basoquamous Carcinoma may be higher, with underreporting arising because of rarity of diagnosis and lack of awareness on the part of clinicians. Our experience suggests that a deep biopsy is often necessary to discover a BSC that appears as BCC but with local aggressive features., (Copyright © 2012 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.)

Problems/objectives: Malignant peripheral nerve sheath tumours are uncommon soft tissue tumours originating from Schwann cells or nerve sheath cells. Malignant epithelioid schwannoma is an aggressive variant of malignant peripheral nerve sheath tumour, and unfortunately is related with a high rate of recurrence and poor prognosis., Methodology: In this study we present a rare case of malignant epithelioid schwannoma of the parotid gland and we discuss its origin, unusual presentation, and possible treatments options., Results: Patient underwent total parotidectomy without neck dissection. Postoperative radiotherapy and chemotherapy management were not necessary., Conclusion: Patients with malignant epithelioid schwannomas typically present with pain and/or rapid enlargement of a pre-existing lesion but the diagnosis of these tumours remains difficult as it is based primarily on clinical suspicion. There is no recognized management for this tumour yet while the prognosis seems to correlate best with the extent of surgical resection (Fig. 4, Ref. 16).

Objectives: An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC., Methods: Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM--either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: group A, with postural restrictions, and group B, without postural restrictions. The statistical analysis was performed with X2 tests and t-tests., Results: No patients in either group showed positional nystagmus in the posttreatment evaluation under infrared videonystagmoscopy. No patients had symptoms of vertigo after the therapy. The results of follow-up vestibular tests were normal in both groups., Conclusions: In our experience, postural restrictions do not enhance the beneficial effect of the CRMs. They do not seem to have any protective role and therefore should not be recommended as an adjunct to the treatment of PSC BPPV.

Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and/or the subcondylar region. Over the last 5 years, we observed 22 fractures of the condylar neck and 10 fractures of the subcondylar region. In 13 patients (11 male, 2 female, age range 10-68 years, mean 33 years), 10 of whom had other mandibular and/or other maxillo-facial and skeleton fractures - 50% of these with dislocated condylar heads - and the other 3 for their free choice, regarding the different treatments, 18 transparotid approaches with partial parotidectomy (bilateral in 5 cases), were performed reducing and fixing 12 condylar neck fractures and 5 subcondylar region fractures with appropriate plates (2.0 mm) and screws. After surgery, no intermaxillary fixation was performed. Complications included 4 salivary fistulae (bilateral in 1 patient), which closed spontaneously after 4 or 5 weeks with a dressing, 1 case of Frey's syndrome, which healed after 2 treatments with botulin and 6 cases of transient facial palsy lasting 4-8 weeks (1 case bilateral) affecting zygomatic, buccal and marginal mandibular nerves. During follow-up, functional parameters considered were: restoration of original pre-injury occlusion; vertical, lateral and protrusion mandibular movements. All patients re-acquired the original pre-injury occlusion; the maximal post-operative intrinsical distance was at least 40 mm after a variable period of rehabilitation and lateral and protrusion movements also led to satisfactory final results. All patients were free of pain and had no deflection or clicking upon opening or chewing. None suffered from haematoma, miniplate fractures, bone resorption or condylar necrosis. In our experience, the Transparotid approaches with partial parotidectomy permits very good anatomical repositioning of the displaced condylar or subcondylar osseous segments in all cases, since isolation of the facial nerve branches and removal of a limited part of the parotid gland tissue overlying the lesion allow perfect exposure of the fracture site. The wide operation field allows the facial nerve to be preserved and permits easy internal rigid fixation with plates, as the drill, screws and screwdriver can be positioned exactly perpendicular to the bone surface instead of obliquely, as occurs with many different approaches.

The main problem arising from tinnitus is the disturbance it causes in day-to-day life and disturbance in sleep leading to fatigue and general discomfort. We attempted to study the effect of melatonin in conjunction with Sulodexide as a treatment method for tinnitus and evaluate its effectiveness. We studied 102 patients suffering from tinnitus with a Prospective Randomised Controlled Study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with melatonin and Sulodexide, another 34 were treated with melatonin alone, and the remaining 34 (control group) were managed without therapy in order to evaluate spontaneous variations in quality of tinnitus. Patients were assessed prospectively with Tinnitus Handicap Inventory and Acufenometry both pre-treatment and post-treatment. Among the patients we studied, we found better results with both Tinnitus Handicap Inventory and Acufenometry in the group who received melatonin and Sulodexide as against melatonin alone. Any improvement was noted in the control group. In conclusion, our opinion is that melatonin in combination with Sulodexide is a viable treatment option for patients suffering from central or sensorineural tinnitus.

Since very little is understood about the exact aetiology of tinnitus, this has made treatment of the condition difficult. Even though approximately 10-15% of the general population suffer from tinnitus, only 2% consider it serious enough to warrant any treatment. The main problem arising from tinnitus is the disturbance it causes not only in day to day life but also in sleep, leading to fatigue and general discomfort. The present study focused on the effect of Melatonin in conjunction with Sulodexide as a treatment method for tinnitus. Overall, 102 patients suffering from tinnitus were evaluated in a prospective randomised controlled study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with Melatonin and Sulodexide, another 34 were treated with Melatonin alone, while the remaining 34 (control group) were managed without treatment in order to evaluate spontaneous variations in the quality of tinnitus. Patients were assessed prospectively with the Tinnitus Handicap Inventory and Acufenometry, both pre- and post-treatment. Among the patients studied, better results with both Tinnitus Handicap Inventory and Acufenometry were found in the group who received Melatonin and Sulodexide compared to those receiving Melatonin alone. No improvement was observed in the control group. In conclusion, Melatonin in combination with Sulodexide is, in our opinion, a viable treatment option for patients suffering from central or sensorineural tinnitus.