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Pneumolabyrinth is a condition characterised by the presence of air within the inner ear and is a rare complication after cochlear implant surgery. One of the causes of pneumolabyrinth may be the increase in pressure in the middle ear. The use of continuous positive airway pressure (CPAP) is an effective treatment strategy for obstructive sleep apnoea. According to a recent study, the use of CPAP should be delayed by 1 or 2 weeks in subjects undergoing middle ear surgery; however, there is currently no indication to delay the CPAP in subjects undergoing cochlear implant surgery. We report the case of a patient on CPAP who underwent left cochlear implantation and, in the early postoperative period, reported severe vertigo and tinnitus. Cone-beam CT of the temporal bone revealed the presence of pneumolabyrynth. We believe that the use of CPAP should be delayed in subjects undergoing cochlear implantation to avoid the development of acute pneumolabyrinth.

Introduction: Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers. Results: Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the. Conclusions: Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

A prospective observational study was conducted to evaluate the presence of swallowing, speech and orofacial muscle imbalance (OMI) disorders in patients with adenotonsillar hypertrophy and their regression after surgery. ENT, speech therapist and dentistry examination were conducted before and 12 months after surgery in 78 children between the ages of 2 and 12 with dysphagia, speech disorders and OMI adenotonsillar hypertrophy related with sleep-disordered breathing. Of the 78 patients enrolled, 62 underwent adenotonsillectomy, 9 adenoidectomy and 7 volume reduction of the palatine tonsils with a 12-month post-operative increase in SWAL-QOL score, weight gain, correction of ogival palate, dental crowding and tongue posture and consequent resolution of phono-articulatory disorders. All patients show an improvement in swallowing, phono-articulatory disorders’ symptoms and OMI correction at 12-month evaluation.

Introduction: Nasal packing is a common procedure used to ensure haemostasis after nasal surgery. Materials and Methods: A prospective, randomized, controlled and double-blinded study was conducted on 80 consecutive subjects to investigate whether using Nasal Dressing Sponge® (NDS) instead of simple Merocel® might improve patients' postoperative experience of nasal packing. Results: During the stay of the tampons no differences were noticed between the two groups as regards the postoperative pain. When it comes to pain during the packing removal, patients complained of worse symptoms in the side packed with Merocel. There was no bleeding after the removal of Merocel, whereas 5,6% patients were subject to some bleeding when NDS was removed. Conclusion: Merocel and NDS gave similar results regarding haemostatic activity. Nasal Dressing Sponge could decrease pain during the removal of the nasal pack, while it could be associated to a bigger incidence of mild bleeding after removing the pack.

Meniere's disease (MD) is characterized by the triad of fluctuating hearing loss, episodic vertigo and tinnitus, and by endolymphatic hydrops found on postmortem examinations. Since the description of endolymphatic hydrops by Hallpike and Cairns, the physiopathology of Meniere's symptoms has been based on assumption that the pathologic lesion was the cause of the symptoms. Schuknecht proposed the theory of membranous rupture causing the mixing up of endolymph and perilymph leading to the occurrence of Meniere's symptoms. Lawrence confirmed this theory with research on experimental animals. In 1995 the AAO-HNS criteria defines "Possible MD (Grade D), Probable MD (Grade C), Definite MD (Grade B) and Certain MD (Grade A). In 1995 the Committee of Barany Society proposed a classification that is similar to the AAO-HNS criteria but includes only two categories: definite MD and probable MD. A variety of medical and surgical treatments has been developed to treat or control the symptoms. The treatment can be divided into non-destructive and destructive procedures. During the last 21st IFOS Congress in Paris in June 2017, an international consensus (ICON) Round Table joining six experts of MD from different continents was designed in trying to draw a minimal consensus, which could be summarized in an algorithm. This synthesis was highly challenging and only France and Japan have drawn a consensus or recommendation applicable in their countries. Scientific literature was assessed using the Level of Evidence classification (1 to 5) and recommendations were given following the grading of recommendations assessment, development and evaluation (GRADE) scoring system. In MD, the aim of the treatment is first to reduce the frequency, and secondarily the severity of the vertigo attack, with a minimal impairment of hearing function associated with a hearing and tinnitus improvement. The treatment is symptomatic and should always be related to the main complaint of the patient. At the beginning it should be conservative. The conservative treatments are used regardless of the hearing function, while destructive ones are preferentially used in patients with hearing loss. Concerning bilateral MD the treatment should always be conservative.

Meniere's disease (MD) is characterized by the triad of fluctuating hearing loss, episodic vertigo and tinnitus, and by endolymphatic hydrops found on postmortem examinations. Since the description of endolymphatic hydrops by Hallpike and Cairns all the physiopathology of Meniere's symptoms have been based on assumption that the pathologic lesion was the cause of the symptoms. Paparella came out term and concept towards understanding of a disease was, "pathogenesis," which applies to all otological diseases, in general and in particular within this context of MD, which allows us to better understand this disease. After Schuknecht proposed the theory of membranous rupture causing the mixing up of endo and perilymph leading to the appearance of Meniere's symptoms. Lawrence proved this theory with research on experimental animals. In 1995 the AAO-HNS criteria defines "Possible MD, Probable MD, Definite MD and Certain MD. In 1995 the Committee of Barany Society proposed a classification that is similar to the AAO-HNS criteria, it includes only two categories: definite MD and probable MD. A variety of medical and surgical treatments have been developed to treat or control the symptoms. The treatment can be divided into non-destructive and destructive procedures.

The Ewing's sarcoma Family of Tumors (EFT) includes classic Ewing's Sarcoma (ES) of bone, Extraskeletal Ewing's Sarcoma (EES) and malignant peripheral primitive Neuroectodermal Tumor (pNET) of bone and soft tissue. ES is an aggressive tumor with a high incidence of local recurrence and distant metastasis. The skeletal form is more common and typically occurs in the long bones of the extremities. The extra skeletal form occurs in the soft tissues of the lower extremities, paravertebral tissues, chest wall, retroperitoneum and rarely in the head and neck region in about 1-4% of cases. Involvement of the head and neck is usually identified in the nasal or oral cavities, sinuses or soft tissues of the neck.

Objective: Purpose: To investigate whether treatment with citicoline, in association with vitamin B6, ginger, melissa and ViNitrox, could improve Dizziness Handicap Inventory (DHI) scores in patients affected by dizziness and vertigo. Materials and methods: Fifty-five consecutive subjects (ranging from 49 to 71 years of age) who complained of dizziness and vertigo of unknown origins were treated with citicoline (500 mg) along with ginger (200 mg), vitamin B6 (2.1 mg), melissa (300 mg) and ViNitrox (150 mg) twice per day for a two-month period. Patients underwent pure tone audiometry (PTA) and a neurotological visit including spontaneous nystagmus testing, bedside examination and the Romberg Test. To evaluate the perceived severity of dizziness and vertigo, its impact on life and the efficacy of treatment, patients were assessed using the DHI before and after treatment. Results: The majority of patients did not report any family history of hearing impairment (94.54%), and 67.27% did not report any kind of hearing loss at the moment of the first examination; mean PTA0.5-4 kHz resulted in 32.5 dB HL and 31.9 dB HL for the left and right ear, respectively. DHI mean value before treatment was 55.85 ± 11.69, while it decreased to 19.85 ± 10.56 after completing therapy (p=0.0001); no significant association between the variables examined and post-treatment DHI values was found (p>0.05). Conclusion: Our results suggest that the use of citicoline should be taken into consideration when managing patients suffering from balance disorders.

The Ewing's sarcoma Family of Tumors (EFT) includes classic Ewing's Sarcoma (ES) of bone, Extraskeletal Ewing's Sarcoma (EES) and malignant peripheral primitive Neuroectodermal Tumor (pNET) of bone and soft tissue. ES is an aggressive tumor with a high incidence of local recurrence and distant metastasis. The skeletal form is more common and typically occurs in the long bones of the extremities. The extra skeletal form occurs in the soft tissues of the lower extremities, paravertebral tissues, chest wall, retroperitoneum and rarely in the head and neck region in about 1- 4% of cases. Involvement of the head and neck is usually identified in the nasal or oral cavities, sinuses or soft tissues of the neck. Primary Ewing's sarcoma of the base of tongue is exceedingly rare and here it is described its diagnosis and treatment.

Currently, surgical training of physicians in Italy has limited possibilities.Surgical training can be performed on dissection of human bodies as well as in animal laboratories, but experience is very poor. We conducted a survey through an anonymous questionnaire in order to evaluate the opinions of post-graduate physicians on their need for experience training on both human and animal bodies during their medical studies. A total of 165 young Sicilian physicians responded to the survey. Only 14 of them (8.5%) declared they had specific training on a live animal, while 46 (27.9%) reported they already attended cadaver labs. Over 70% assigned the maximum score to the utility of such courses as integration of medical academic offer. Our results showed that the majority of the subjects interviewed expressed a need for training using these practices and that it might be necessary to investigate patterns to promote the opportunity for direct practice on human and animal bodies.

Pleomorphic adenoma is the most common benign tumor of the salivary glands. It arises mainly from the parotid, less frequently from the minor salivary glands of the oral cavity and, exceptionally, from the accessory glands widespread in the upper aero-digestive tract. Intranasal localization is rare and mainly affects the glands sited in the nasal septal mucosa. There are isolated case reports in literature regarding adult patients. We report a rare case of a young 14-year-old girl with pleomorphic adenoma arising from the nasal septum.

Introduction: The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations. Materials and Methods: This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane. Results: Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (P

Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome. Objectives: Aim of this study is to verify the presence of neurocognitive, neurobehavioral or sleep disturbances in children affected by adenotonsillar hypertrophy (ATH) and Obstructive Sleep Apnea Syndrome (OSAS) and verify their improvement after Adeno-Tonsillectomy (AT). Methods: Eighty children suffering from adenotonsillar hypertrophy and OSAS were recruited for AT in the ENT Department of the University of Palermo. All the children underwent clinical evaluation, including rhinofibroscopy for grading the obstruction due to the adenotonsillar hypertrophy (before and 6 months after surgery), and polysomnography and 6 months after surgery. Two different rating scales were administered to the parents, the Sleep Disturbance Scale for Children (SDSC) for the evaluation of sleep disturbance and the subscales B and C of the Conners' Parent Rating Scale Revisited (CPRS-R) for the evaluation of behavioral disturbances (before and 6 months after surgery). Results: Children's mean age was 5.3 + 1.6 years with a percentage of 59.2% for male and 40.8% for female. All patients showed adenotonsillar hypertrophy grade III-IV. Polisomnography showed the presence of moderate OSAS in 72.6% of the children and severe in 27.2%. In the preoperative evaluation all the children had pathological values in the CPRS-R, regarding the cognitive and inattention subscale (B) and the hyperactivity subscale (C). In the SDSC results were also pathological, with variables depending on the subscales. After AT, CPRS-R evidenced a statistically significant improvement in scores for all children. Even SDSC scale postoperatively showed a statistically significant improvement in the scores of each subscale. Conclusion: Adenotonsillar hypertrophy is the most frequent cause of snoring and OSAS in children. OSAS in children is a frequent cause of sleep disorders and daytime behavioral changes. AT in children improve significantly both OSAS and behavioral disturbances.

Leptin is a peptide produced by peptidergic cells or those able to process and secrete peptides. Originally, this function was considered proper and exclusive of certain neurons of the magnocellular and parvicellular hypothalamus. These cells originated from a common precursor, namely neural crest cells, which have the ability to produce hormonal neuropeptides. From this primitive neuroectodermal site, cells migrate to other organs: the gastro-entero-pancreatic system (GEP), the lung, heart, reproductive and urinary systems. Leptin is considered the typical neuropeptide with an anorexic function, and is also called the “satiety hormone” because it plays a key role in the control of energy expenditure and food intake. Leptin was identified for the first time in white and brown adipocytes. Although initially thought to be exclusively expressed and secreted by adipocytes, leptin has been identified in other tissues related with nutritional homeostasis, such as gastric and salivary glands. In addition, leptin or its receptors have been observed in gastric, colorectal and breast cancers. It is believed to have a role in stimulating cell proliferation, and is associated with a risk of developing cancer as well as progression and invasiveness. To date, the role of leptin in the development of the carcinoma of the larynx has been poorly investigated. The principal endpoint of this chapter was to evidence the peptidergic immunohistochemical expression of leptin in laryngeal SCCs, its possible role in cell proliferation and the prognostic factor and predictor of locoregional recurrences.

The hyoid bone is the only â suspended boneâ in our body, and its suspension system has an important role in posture maintenance. We studied postural modification in a group of patients affected by Obstructive Sleep Apnea Syndromewho had undergone surgical treatment including hyoid suspension. The surgical procedure performed was section of supra- and infrahyoid muscle and mobilization of the hyoid bone through its suspension to the thyroid cartilage. We studied the postural changes with stabilometric tests. In the early post-operative (one week) follow-up, we performed a posturography test with closed eyes and occlusal disjunction, and saw a worsening of the average parameter of the centre of pressure with antero-posterior oscillations. However, we would like to highlight that by the time of the one year follow up, a compensatory mechanism had been established which allowed for a return to normal hyoid bone kinematics.

Labyrinthine fistula is a complication of ear cholesteatoma that increase the risk of sensorineural hearing loss. The management of the fistula must be done contextually with mastoidectomy by: leaving cholesteatoma matrix over the fistula, or remove the matrix reconstructing the defect. Objective: analysis of the two techniques to treat labyrinthine fistula. Methods: retrospective review with case series analysis. Results: a labyrinthine fistula was present in 14% of cholesteatoma patients; CT scan was pre-dictive in all cases; the hearing preservation was obtained with both techniques; a re-currence was detected only in one case; postoperative nystagmus incidence was higher in those cases with matrix left in situ and when the size of the fistula was lar-ger than 2 mm. Conclusions: the labyrinthine fistula have to be treated contextually with cholesteatoma removal, both techniques had good postoperative hearing preser-vation rate. The postoperative vertigo with nystagmus is more frequent in larger fistu-las.

Giovanni Filippo Ingrassia revisited and redefined some of Galeno's reports, and was recognized as one of the leading Italian Physicians of the 16th century. Ingrassia principally studied the skull, and gave very important contributions to otorhinolaryngology, including the discovery of the stapes. He also isolated the inferior nasal concha from the maxillary bone, described the frontal sinus, the pterygopalatine fossa and several foramina of the skull. Ingrassia firstly attributed a sensorial function to the middle ear bones, which he called fifth particular function. He also added some details to the description of the VIII cranial nerve, which introduces the concept of bone conducting sound. The most important discovery in Ingrassia's study about the hearing organ was the first description of the third bone of the ossicular chain that he called "stapes". Ingrassia should thus be reconsidered under a new light for his important discovery and for his intuitions about the stapes and its role in hearing. It is appropriate for a Sicilian physician to be placed at his rightful place side-by-side with Eustachio and Valsalva in the history of otology.Giovanni Filippo Ingrassia riconsiderò e ridefinì alcune descrizioni di Galeno e fu riconosciuto come uno dei principali Medici Italiani del XVI secolo. Ingrassia studiò principalmente il cranio e diede un contributo importante per la moderna otorinolaringoiatria, come la scoperta della staffa. Egli descrisse l'osso del turbinato inferiore isolandolo dall'osso mascellare; descrisse inoltre: il seno frontale, la fossa pterigopalatina e diversi tra i fori cranici. Per primo, Ingrassia attribuì una funzione sensoriale agli ossicini dell'orecchio medio, funzione che chiamò quinta funzione particolare. Aggiunse anche alcuni dettagli alla descrizione dell'VIII nervo cranico, introducendo il concetto di conduzione ossea del suono. La scoperta più importante di Ingrassia, durante lo studio della funzione uditiva, è stata la prima descrizione del terzo ossicino della catena che chiamò "staffa". Ingrassia deve quindi essere riconsiderato sotto una nuova ottica per le sue importanti scoperte e per la sua intuizione sulla staffa e sul suo ruolo nella funzione uditiva. Sarebbe appropriato per il medico Siciliano essere posto accanto ad Eustachio e Valsala nella storia dell'otologia.

Malformations of bony inner ear are rare anomalies occurring in approximately 20% of patients with congenital sensorineural hearing loss. Conductive hearing loss is usually associated with abnormalities of the external and middle ear. Recent reports of patients with lateral semicircular canal malformations indicate inner ear malformations to be associated with sensorineural or conductive hearing loss. Differential diagnosis of conductive hearing loss should include otosclerosis, isolated ossicular deformities, inner ear anomalies or a combination of these. In this report, a case is described with right vestibule-lateral semicircular canal dysplasia presenting at our centre with bilateral otosclerosis.

SUMMARY Aim of the present study was to evaluate the effects of obstructive sleep apnoea syndrome (OSAS) on the peripheral and central vestibular system, by means of a case series prospective study at the University referral centre of Otolaryngology Head and Neck Surgery; 45 consecutive patients suffering from OSAS were compared with a control group of 30 volunteer subjects selected from among the department employees. Severity of the disease was evaluated by means of cardio-respiratory function monitoring during sleep; the apnoea-hypopnoea index was calculated. Both groups underwent: 1) head and neck examination; 2) fibre-optic examination; 3) pure tone audiometry; 4) evaluation of eye movement disorders using oculomotility tests recorded with the help of video-nystagmography; 5) caloric vestibular responses recorded with video-nystagmography; 6) auditory brainstem response. Results, when evaluating our data, showed that the peripheral vestibular system may become asymmetric due to hypoxic damage while the central vestibular system corrects this disequilibrium.

The minimally invasive sinus technique, (MIST) is different from minimally invasive sinus surgery. MIST implies a treatment philosophy and surgical model that is quite different from functional endoscopic sinus surgery (FESS). The goals of this article are to discuss the origins of functional sinus surgery as it relates to the evolution of FESS and MIST, define MIST as a philosophy and surgical model, discuss treatment of surgical sinus disease, and challenge the rationale for our departure from Messerklinger's "functional" concepts into what will be referred to as "contemporary FESS. " Many authors address the reduced revision rate (compared with FESS) following initial intervention with MIST, the potential to markedly reduce the rate of intranasal synechiae, and the reduction in immediate postoperative morbidity.

The ability to maintain body balance and postural control is regulated by a central integration process of afferent inputs received from peripheral sensory components such as the somatosensory, visual, and vestibular apparatus, which control the tonic postural system by modulating efferent information. It is widely recognized that stimuli from the visual and the vestibular systems provide information on the position of the head relative to the trunk and contribute to the orientation and the movement of the body in the environment. For these reasons, the vestibular system plays a key role in controlling body balance. Indeed, several studies have shown the presence of imbalance, postural instability and, more generally, postural disorders in vestibular disorders such as in patients suffering from dizziness. Furthermore, in the eleventh revision of the International Classification of Diseases it was included a chronic vestibular disorder named persistent postural perceptual dizziness (PPPD) characterized by such symptoms as persistent dizziness, non-spinning vertigo, and unsteadiness that are exacerbated by standing position, movement, and visual stimuli. Since it was demonstrated that vestibular disorders are a predictor of increased postural instability and the latter condition increases the risk of falling and affects negatively the daily activities, the purpose of the present chapter is to report knowledge on the role of the vestibular system on body balance and postural control focusing on the relationship between vestibular dysfunctions and postural disorders.

Pleomorphic adenoma is the most common tumour of the salivary glands. However, it is extremely rare for these to originate in the nose and even when they do so, it is most commonly in the nasal septum. It is important to be aware of the paucity of presenting symptoms (nasal obstruction and epistaxis), as the lesion may not be recognized immediately. Growth is generally restricted locally and the tumour is not known to spread to the neighbouring structures. Surgical resection is the treatment of choice. Recurrences and evolution to malignancy are not frequent, but long-term follow-up is recommended. The case is presented of pleomorphic adenoma arising from the lateral wall of the right nasal cavity, in a 34-year-old male, which was resected completely, endoscopically. Histological and immunohistochemical evaluation revealed the presence of a pleomorphic adenoma.