Search

N/A.

Rhinosinusitis (RS) is a common disease and is currently classified into two main types: acute RS (ARS) and chronic RS (CRS), which in turn includes CRS with or without nasal polyps. Different guidelines consider this classification. However, in clinical practice, other phenotypes exist. The current article would propose new clinical-based phenotyping of RS, including the following clinical phenotypes: simple catarrhal RS, Acute RS, acute bacterial RS, severe (complicated) acute RS, chronic RS, and recurrent chronic RS. Treatment strategy should be tailored considering the clinical phenotype and could include phytomedicines, intranasal non-pharmacological remedies, and local bacteriotherapy. In conclusion, RS requires thorough diagnostic work-up, and the therapeutic approach should be mainly based on appropriate management.

Although several cochleo-vestibular symptoms are commonly associated with migraine, only a limited number of studies have been done in this regard. Some reported abnormalities in audiometry, auditory brainstem response and vestibular tests, considering these manifestations mainly related to central etiology. However, increasing evidence also suggests a peripheral involvement of the inner ear in migraine. The aim of this study was to investigate the peripheral auditory pathway in migraineurs using otoacoustic emissions (OAEs), to detect alteration of cochlear functioning and possible relationship with disease severity. Sixty-two migraineurs and sixty matched controls were enrolled in the study and underwent a routine neuro-otolaryngology examination, self-administered questionnaires were used to evaluate subjective perception of hearing disability. DPOAE and their suppression were lower in migraineurs compared to controls and significantly related to the disease duration. Altered DPOAE exposed migraineurs to the risk of affecting by migraine without aura, of presenting with ocular and/or auditory symptoms during attack and of using more painkillers. Concomitant dopaminergic symptoms and/or allodynia such as the acute non-consumption of triptans were significant determinants of decreased contralateral suppression of DPOAE among migraineurs. This potential subclinical cochlear impairment in migraine detected by OAEs may represent the earliest sign of sensorineural damage in these patients, providing a promising tool for the initial diagnosis and an opportunity to monitor disease course and treatment response over time.

BACKGROUND. Nose and paranasal sinus surgery requires an accurate anatomical knowledge and a fine systematic learning. Surgical practice on cadaveric specimens is very important for the ENT resident to allow for a step-by-step learning, but it is not easy in all countries to have access to this compound. MATERIAL AND METHODS. We propose 3D-printed anatomical bone model exercitations as an alternative method for anatomical study, morphological research and surgical learning RESULTS. We have achieved very satisfactory morphological results both for the colours and shapes. CONCLUSION. The use of 3D modelling simulation allows the young surgeon to improve their technical skills and to the expert surgeon to plan the preoperative strategy in complex situations.

Osteoma is a rare benign lesion of the skull, with an incidence of 0.6% of all benign tumours of paranasal sinuses. It is commonly asymptomatic, and mostly diagnosed incidentally at the imaging. The most frequent disturbs are: headache, nasal discharge and symptoms of inflammation. Osteoma is often associated with nasal polyposis and mucocele, which are usually considered as secondary lesions. Contrariwise, in our cases, we are prone to consider the osteoma as secondary to the inflammation associated with polyposis and mucocele. The physiopathology of these diseases was therefore reviewed to explain a possible relationship. We conducted a retrospective analysis in our ENT division from January 2010 to December 2016.

The aim of this research is to investigate penetration of Bromelain into sinonasal mucosa in patients with chronic rhinosinusitis (CRS) versus a control group. Bromelain is derived from pineapple (Ananas comosus) and has various pharmacological effects. 40 patients (20 patients and 20 controls) were enrolled in the study. Bromelain 500 mg tablet twice daily was administered for 30 days. We scored bromelain presence in turbinate and ethmoid mucosas and in the serum of both the groups. Bromelain has an excellent distribution from blood to rhinosinusal mucosa. Its diffusion ability may allow the use of bromelain as an anti-inflammatory agent in paranasal sinus pathologies.Farmacocinetica della Bromelina nel sangue e nella mucosa rinosinusale nei pazienti con rinosinusite cronica.Lo scopo di questa ricerca è quello di accertare la farmacocinetica di Bromelina nella mucosa rinosinusale e nel sangue in pazienti con rinosinusite cronica (CRS) ed in un gruppo di controllo. La Bromelina è un derivato dell’ananas (Ananas comosus) e dispone di vari effetti farmacologici. In questo studio sono stati arruolati 40 pazienti (20 pazienti e 20 controlli). Abbiamo somministrato Bromelina 500 mg in compresse due volte al giorno per 30 giorni. Abbiamo valutato la presenza di Bromelina nella mucosa dei turbinati e dell’etmoide e nel siero. La Bromelina risulta avere un’ottima distribuzione dal sangue alle mucose rinosinusali. In conclusione la capacità di diffusione può permettere l’uso di bromelina come farmaco anti-infiammatorio nelle patologie rinosinusali.

Introduction: Migraine and allergies are common occurrences. The aim of this study was to investigate the relationship between respiratory allergy and cephalalgic migraine in childhood.Materials and Methods: We screened 800 children for headache and its characteristics. After that we investigated the presence of allergy performing prick tests, rhinoscopy, endoscopy, rhinomanometry, nasal cytology and mucociliary clearance tests.Results: Out of 800 children screened, 96 suffered from headache. Among these, 67 resulted to suffered from both headache and allergy. We found a significant correlation between allergy and headache onset in the morning and headache onset in the evening in non-allergic subjects. The average duration of the a headache attack was independent from the presence of allergy, as well as the frequency of the cephalalgy attacks, and the localization of the pain. Prodromal symptoms connected with headache were reported to be: dizziness, aurea, sparkling scotoma, nausea and vomiting, and they were associated with absence of allergy. We also found a relationship between female gender and headache onset, but in teen-agers only. Paracetamol or FANS were used in the majority of cases, but antihistaminic therapy and/or nasal topical sprays were also reported.Discussion: For an effective diagnostic and therapeutic approach to migraine, the pediatrician should take into account atopy and its related allergic manifestations requiring a consultation with an otolaryngologist or allergist, if necessary. Our findings also stress the potential role of medicines that are not usually utilized for migraine attacks, such as antihistamines or decongestionant nasal sprays.

Atrophic rhinitis is defined as “a chronic debilitating disease of the nasal passages that is characterized by progressive nasal mucosa atrophy, nasal crusting, fetor, and enlargement of the nasal space with paradoxical nasal congestion.” In this case, the discrepancy between the subjective sensation, the objective parameters, and the endoscopic picture is so evident that the symptom is defined as “paradoxical congestion.” Recently, the use of four-phase rhinomanometry (4PR) has been recommended for the assessment of nasal obstruction. In this method, the nasal airway resistance is calculated using hundreds of resistances continuously recorded during the whole breathing cycle. RM has been used also to evaluate the effects of nasal treatments in patients with atrophic rhinitis. In a comprehensive review on the surgical procedures used for the empty nose treatment, authors concluded that given the complexity of the condition and the high degree of failure (up to 21% of patients may report only marginal improvement), before undertaking any surgical procedure in these patients, along with the subjective evaluation, an objective measurement of nasal resistances should also be performed in order to demonstrate the effects of the surgery. Regarding olfactive impairment in atrophic rhinitis, even if it is often described, very few studies were conducted, and fewer again have a well-designed protocol.

Empty nose syndrome is a rare post-surgical condition that arises from the iatrogenic nasal tissue loss, mainly the inferior turbinates. Despite the widely patent nasal passage, patients suffering from ENS complain about a paradoxical sensation of nasal obstruction, associated with nasal crusting or burning, dryness or excessive nasal discharge, headache and sometimes a sense of suffocation. These symptoms ultimately constitute a considerable burden affecting patients’ quality of life. The diagnosis of ENS in patients with a history of nasal surgery is primarily based on the clinical evaluation of symptoms, using subjective questionnaires like the SNOT-25 and the ENS6Q, combined with the endoscopic and radiologic evidence of an altered intranasal structure, whereas the inferior turbinates and sometimes the middle ones are completely or partially missing. In the last years, several surgical procedures of inferior turbinate augmentation have been proposed to treat this condition, with encouraging results in terms of symptoms and quality of life improvement. This chapter introduces a brand new endoscopic technique used to rebuild the inferior turbinate using an intranasal mucosal flap combined with the insertion of an autologous cartilaginous flap.

Nasal obstruction (NO) is a common symptom that affects from 10 to 20% of the worldwide population. NO may be evaluated using subjective assessment tools (visual analogue scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow), but there is no consensus on which is the best objective method of evaluation. The objective tests provide information with no statistical significance in data results, and moreover they are not adequate to evaluate patients suffering from empty nose syndrome. Computational fluid dynamics is a suitable instrument to generate three-dimensional visualization of nasal cavity and to study the flux distribution and variables like temperature, humidity, pressure, velocity, and wall shear stress in each point of nasal surface using mathematical methods. This tool is becoming more and more diffuse, despite the high costs and the time needed for the simulation. Using virtual surgery allows to obtain predictable data regarding surgical outcome or therapeutic goals. The use of computational fluid dynamics model is the next-generation tool to obtain large number of data to test new devices and new techniques in order to reach the so called custom-made surgery or target therapy.

The study analysed the presence of HPV in samples tissue from laryngeal chronic hyperplastic inflammation, with and without pre-neoplastic potential, and from squamous cell carcinoma of the larynx. The aim of this analysis was to evaluate the presence/absence of different types of HPV and their relationship to the clinical profile of the patients studied (habit of smoking and drinking).Sixty cases were randomly selected from patients undergoing surgical treatment of the larynx for inflammatory/ neoplastic lesions and of neck nodes. Patients underwent standard clinical workup, comprising medical history and physical examination, panendoscopy, whole-body CT scan (in cancer patients), diagnostic or therapeutic microlaryngoscopy with laryngeal biopsy, and HPV evaluation.The HPV analysis showed an increased risk for heavy smokers of HPV positivity, as well as precancer lesions and cancer. Type 6 and 16 seem to be prevalent in all types of laryngeal mucosa disease, but pre-neoplastic conditions versus cancer seem to show a wider variety of HPV infections while cancer patients are invariably affected by types 6 and 66. Heavy smoking is related to HPV infection likewise alcohol in association with smoking. Advanced T is more associated with HPV positivity.These data impose a closer follow-up of smokers and pre-neoplastic cases and the utility of the broadspectrum polymerase chain reaction assay in laryngeal dysplastic and cancer lesions. This study may allow to develop biomarkers for early detection or recurrence surveillance, to identify therapeutic targets, and to begin individualization of treatment based on the biology of these tumours.HPV infection, Larynx, Laryngeal chronic hyperplastic inflammation, Squamous cell carcinoma.Il seguente studio si è proposto di analizzare in campioni estratti da tessuto laringeo affetto da infiammazione cronica iperplastica, con e senza potenziale pre-neoplastico, e in campioni di carcinoma a cellule squamose laringeo, la presenza/assenza dei diversi genotipi di HPV e la loro relazione con il profilo clinico dei pazienti studiati (abitudine tabagica e abuso di alcol). Sessanta casi sono stati selezionati in modo randomizzato da pazienti sottoposti a trattamento chirurgico della laringe per patologie infiammatorie / neoplastiche e dei linfonodi del collo. I pazienti sono stati sottoposti a un esame clinico standard comprendente anamnesi ed esame fisico, endoscopia, TC total-body (in pazienti oncologici), microlaringoscopia diagnostica o terapeutica con biopsia laringea e valutazione dell’HPV. L’analisi HPV ha mostrato un aumento del rischio di positività all’HPV per i fumatori definiti “pesanti”, nonché di lesioni precancerose e carcinoma. I tipi 6 e 16 sembrano prevalere in tutti i tipi di malattia della mucosa laringea, ma le condizioni pre-neoplastiche rispetto al carcioma sembrano mostrare una più ampia varietà di infezioni da HPV mentre i pazienti oncologici sono invariabilmente affetti dai tipi 6 e 66. Allo stesso modo del fumo “pesante”, l’abuso di alcol in associazione con il fumo sono correlato ad un aumento del rischio di infezione da HPV. Carcinomi con T di alto grado sono maggiormente associati a positività di HPV. Questi dati impongono, pertanto, un follow-up più stretto dei fumatori e dei casi pre-neoplastici e l’utilità del test di reazione a catena del la polimerasi ad ampio spettro nelle lesioni displastiche e tumorali laringee. Questo studio potrebbe consentire di sviluppare biomarcatori per la rilevazione precoce o la sorveglianza di recidiva, per identificare bersagli terapeutici e per iniziare l’individualizzazione del trattamento basato sulla biologia di questi tumori.

Ossifying fibroma is a benign fibro-osseous tumour that rarely involves the ethmoid sinuses and orbit. It is classified as a benign fibroosseous lesion, a term that is synonymous with a variety of lesions reported in the literature. Recurrence rate with deleterious effects in cases of extramandibular ossifying fibroma is the impetus for open en bloc resection of the tumour. Continuously evolving techniques in endonasal endoscopic sinus surgery has rendered resection of large benign sinonasal and cephalonasal tumours possible. The authors report a case of ossifying fibroma involving the ethmoid sinus, orbit and anterior skull base in a 65-year-old previously healthy woman completely resected by endonasal endoscopic sinus surgery. The patient was free from postoperative complications and was dismissed from hospital on the sixth postoperative day. At present, the patient is disease-free at a regular five-year postoperative follow-up. Endonasal endoscopic resection of sinonasal ossifying fibromas is an excellent therapeutic option when performed by a surgeon experienced in endoscopic sinonasal surgery. The advantages of an endonasal endoscopic approach include direct visualization, enhanced visibility and magnification resulting in decreased intraoperative and postoperative morbidity. Aesthetic outcome is excellent in the absence of facial scars.

Inferior turbinate compensatory hypertrophy is a common condition found in post-traumatic septal deviation. In literature several approaches are described for treating turbinates enlargment. We conduct a retrospective study on two group of 43 and 48 patients mached for age and sex that underwent to rino-septo-turbinoplasty from January 2011 to January 2013. First group was treated by inferior turbinates submucous unipolar coblation and the second by submucous unipolar coblation plus lateral outfracture. Inclusion criteria were: isolated nasal occlusion non-sensitive to medical treatment with compensatory enlarged inferior turbinate/s and marked nasal pyramid-septal deviation evaluated by pre-operative nasal endoscopy; turbinates hypertrophic grade from I –III according to Friedman.

Cambi, Jacopo/0000-0002-5226-2278 WOS: 000379255600019 PubMed: 26742909 Chronic rhinosinusitis (CRS) is a very prevalent inflammatory disease. Treatments vary in different countries. In the present study, we explored the approaches of physicians in 50 countries. In this cross-sectional study, a rhinosinusitis survey (RSS) was completed by Honorary and Corresponding Members (otorhinolaryngologists) of the Italian Society of Rhinology. In 79.1 % of the 50 countries, the proportion of patients suffering from CRS was 15 %. Nasal symptoms were more intense in winter (46 % of countries), and spring and autumn (22 %). The most common symptoms were nasal obstruction (86 %), postnasal drip (82 %) and headache (52 %). The most common investigative modalities in the assessment of CRS are paranasal sinus CT, fiberoptic endoscopy, and anterior rhinoscopy. CRS patients were principally treated by otorhinolaryngologists (70 %). Medical treatments included nasal corticosteroids (90 %), nasal washes (68 %), and nasal decongestants (32 %). In 88 % of countries, more than 50 %, or "about 50 %", of all patients reported subjective symptom improvement after treatment. In most of the countries, surgery was required by 20-35 % of all CRS patients. During post-surgery follow-up, nasal washes (90 %), nasal corticosteroids (76 %), and systemic antibiotics (32 %) were prescribed. In 20-40 % of all patients, CRS was associated with nasal polyps. In such patients, the medical treatment options were nasal corticosteroids (90 %), systemic corticosteroids (50 %), nasal washes (46 %), and systemic antibiotics (34 %). Treatment of CRS patients varies in different countries. Paranasal sinus CT is the most common investigative modality in the assessment of CRS, and nasal corticosteroids are the first-line treatment, in the absence or presence of nasal polyps.

Cingi, Cemal/0000-0003-3934-5092 WOS: 000434471200007 PubMed: 29423374 Background: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. Objective: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. Methods: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions-Asia, Europe, the Americas, and Africa. Results: The prevalence of AR was reported to be 15%-25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H-1-antihistamines (82.69%). Conclusion: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

The purpose of this prospective study was to assess the effectiveness and safety of Streptococcus salivarius 24SMBc administered as a nasal spray in children affected by recurring infections of the upper airways, adenotonsillar hypertrophy, and sleep disordered breathing (SDB).Prospective study on 42 children with SDB. Anamnestic and general examination data were collected using the 'Sleep Clinical Record' (SCR) questionnaire during the first inspection and after three months of treatment with Streptococcus salivarius 24SMBc nasal spray. Quantitative variables were statistically compared.After three months, the enrolled patients showed lower SCR scores than during the first inspection (6.0 vs 7.5 p 0.000), with a significant reduction of nasal obstruction (p = 0.001) and oral breathing (p = 0.04), and a positive Brouillette Score (p = 0.001). The children and parents did not declare any adverse reactions during the three months of treatment.This series confirms the effectiveness and safety of Streptococcus salivarius 24SMBc treatment in children affected by recurring upper respiratory tract infections, adenotonsillar hypertrophy, and sleep disordered breathing.

This article analyzes the role played by the ear, nose and throat (ENT) specialist in the diagnosis and treatment of the Obstructive Sleep Apnea Syndrome (OSAS).The instrumental methods of investigation of otolaryngology expertise are fiberoptic rhinolaryngoscopy and sleep endoscopy. To better define and treat OSAS it is essential to define location, extension and degree of obstruction. The major limitation of rhinolaryngoscopy is that it is conducted while the patient is awake. Sleep endoscopy was introduced to address this issue: it is an endoscopic examination conducted during pharmacologically induced sleep (midazolam, propofol). Surgical treatment: The applicability of surgical treatment is limited: it is not efficient for every patient and not to the same extent. Surgical therapy is based on the detection and correction of the site of obstruction, although in most cases the obstruction sites are located at different levels. The surgical approach usually follows a path characterized by "subsequent steps". According to Stanford University Powell-Riley Protocol the first phase includes: nasal surgery, palate surgery (UPPP, LAUP Laser Assisted uvulopalatoplasty, UvuloPalatalFlap UPF) and tongue base surgery (tongue suspension, genioglossus advancement, hyoid suspension) that could either be executed individually or associated. Four-six months after surgery a physical and polysomnography examination should be performed. In case of symptoms persistence, the surgeon could move on to phase II surgery as recovery therapy. The phase II surgery includes: maxillo-mandibular advancement, tongue base resection and tracheotomy. In selected cases a Phase II surgery could be planned at the beginning of treatment.

Objectives: The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children. Methods: The study included 100 atopic children (52 boys, 48 girls) aged 5‒9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed. Results: The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus , 34 to grass pollen and 16 to Parietaria . Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference ( P

Aim The main aim of this study was to assess the presence of behavioural disturbances in child with OSAS before and after adenotonsillectomy (AT). Background In children adenotonsillar hypertrophy is associated with increased probability of OSAS. Children with OSAS present neurobehavioral disorders like attention deficit and hyperactivity, learning disabilities and daily attitudes due to excessive sleepiness. Materials and methods 195 consecutive young patients suffering from OSAS and recurrent throat infections (control group) underwent AT. All underwent clinical evaluation, polysomnography, Behaviour Assessment System for Children questionnaire (BASC-2), for parents evaluation of behavioural disturbances and nasal functionality tests (before and 6 months after surgery). Results Snoring and nocturnal apnoea were no more present in almost all. In OSAS group before AT 12 children were normal, 4 children were borderline and 2 were clinically significant at the BASC-2. After AT 16 children were normal, 2 children were borderline and none was clinically significant according to the same questionnaire. In the control group 9 children were normal and 1 was borderline both before and after AT. Conclusion Adenoids/tonsils hypertrophy and nasal hypoventilation are frequent causes of snoring and OSAS. AT improves significantly both snoring/apnoeas and OSAS children's behavioural disturbances. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. Nasal functionality tests can be useful for the differential diagnosis between sleep apnoea syndrome and other noises.

Objectives Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of adult population characterized by the collapse of the pharyngeal airway. It is well established that retropalatal region is the most common site of obstruction. Consequently, many surgical techniques have been introduced. The purpose of this study is to present our preliminary results in the anterior palatoplasty (AP) compared with results of uvulopalatal flap (UPF). Methods Thirty-eight consecutive patients with mild-moderate OSA were prospectively enrolled into a randomised surgical protocol. Surgical success was measured primarily by satisfactory reduction in snoring, as reported by snoring assessment questionnaire (SQ) of sleep partners. Secondary outcomes measures included improvement in the Epworth Sleepiness Scale (ESS) scores, changes in the magnitude of pharyngeal collapse, and postoperative pain intensity. Results The ESS after AP improved from a preoperative value 8.5±3.7 to a postoperative mean of 4.9±3.2 (P

Background and aim The aim of our study has been to investigate the perception of aspects related to nasal perforation among experts in Rhinology and ENT surgeons. Our aim was reporting the situations in different Countries to improve the knowledge of colleagues interested in this topic. Methods A panel of experts prepared a 20-question questionnaire regarding nasal perforations and their surgical repair, that were emailed to all the members of SIR (Societa Italiana di Rnologia – Italian Society of Rhinology). Results Data obtained from their answers showed that Cottle technique (64%) is the most common technique to perform septoplasty worldwide. 37% of the sample reported an occurrence of nasal septal perforation in less than 1% of patients and 75% attributed this occurrence to the skill of the surgeon, to infections, to drug use and to septal deformity. Trauma, pressure and Wegener's granulomatosis were also mentioned. The most common closure technique is the mucosal flap (75%), followed by the cartilage grafts (11%). Much less common were oral flaps, septal buttons and others. The majority agreed not to suggest septal perforation surgery in minimal (less than 3–4 mm) perforations (73.5%), or limiting it to symptomatic patients (43.5%). The contraindications to repair surgery were reported to be: Wegener's granulomatosis, drug abuse, non-symptomatic perforation, its dimension and age of the patient. Septal deviation, atrophic rhinitis, smoke epistaxis and systemic diseases were also claimed. Failure in repair surgery has been observed to occur in less than 30% of cases. Discussion and conclusions Given the great difficulty to make random studies about controversial topics and obtain statistically significant data related to that, expert opinion shall be of great value (expert opinion, level of evidence 5)

Objective Lymph nodal disease is one of the most common manifestations of head and neck tuberculosis and is particularly frequent in paediatric patients with an increasing incidence in the last decade. It may represent the manifestation of a systemic tuberculous disease or a clinical entity specific of the neck. Aim of this paper is to retrospectively analyse mycobacterial cervical adenopathies observed in two Paediatric European Centers between 1986 and 2004 and the outcomes of medical or surgical treatment. Methods 353 children were examined for mycobacterial cervical lymphadenopaties since January 1986 to December 2004. Demografic data about the sample are showed. The retrospective evaluation of the sample underlined distribution according to etiologic patterns, head and neck adenopathies localization. Previous or simultaneous medical or surgical treatment were analyzed. Statistical analysis with Chi Square test was performed. Results 281 (79.60%) cases showed a higher localization and 72 (20.40%) a lower localization. In relation to the etiological agent, 8 (2.27%) Mycobacterium tuberculosis (MTB) and 222 (62.89%) mycobacteria other than tuberculosis (MOTT) lymphadenopaties were observed in the upper localization as opposed to 21 (5.95%) MTB and 39 (11.05%) MOTT in the lower plane. Two (0.56%) were detected as upper lymph nodal tumefaction in the median line. In 86 (24.36%) cases at the MRI the so-called “iceberg effect” was noted. 163 (62.45%) patients underwent primary excisional biopsy whereas 74 (28.35%) underwent exeresis after other unsuccessfull therapies, 9 underwent only drainage, and 15 drainage with subsequent antibiotic therapy. Number of relapses after surgery was 16 (6.13%). Conclusions A not homogeneous therapeutic approach to the mycobacterial cervical adenitis arises from literature and WHO guidelines does not give indications for the treatment of the cervical pattern. A therapeutic strategy based on the etiology is mandatory. In case of MBT adenopathy the therapy of choice includes the association, in variable way, of different chemotherapic drugs; surgery is reserved to advanced cases. Conversely, in cases of MOTT adenopathy, surgery is the treatment of choice.

In this study we tried to demonstrate how balloon sinuplasty could be an option in the treatment of the Rhinogenic Headache due to a probably disventilation of frontal sinus recess. 107 patients were included in the study with diagnosis of Rhinogenic Headache. The surgical group underwent bilateral balloon sinuplasty of the frontal sinus. The medical group underwent pharmacological treatment. Headaches characteristics were evaluated by a clinical personal diary. The severity was recorded by Visual Analog Scale 4 and 8 months after treatment. 98 out of 107 patients completed the protocol. In surgical group and in medical one the mean headache score improved at four and eight months follow up. The headache frequency attacks per month decrease from a preoperative frequency of 18 (±4 SD) in surgical group and 17 (±3 SD) in medical group to 3 (±1 SD) and 6 (±3 SD) respectively at 4 months control but increased slightly to 5 (±2 SD) and 12 (±4 SD) after 8 months. We concluded that the balloon sinuplasty should be considered as an effective alternative option after an accurate selection of surgical candidates. However, it is important a 6–8 month follow-up to evaluate the efficacy and stability of the treatment used.

Background/Aims: High mobility group box 1 (HMGB1) is a protein belonging to the class of damage-associated molecular pattern molecules, which activates innate immunity and powerful inflammatory factors. The aim of this review is to show the importance of HMGB1 in the pathogenesis of nasal inflammatory diseases and to suggest that inhibition of HMGB1 may be an innovative therapeutic target. Methods: We used immunohistochemistry to study whether HMGB1 increases in chronic rhinosinusitis with nasal polyps and whether its expression is associated with eosinophils and inflammatory cytokines. Using primary cultures of human nasal epithelial cells, we localised lipopolysaccharide-induced active translocation and release of HMGB1 by immunofluorescence assay and Western blot. Results: Patients with severe symptoms have the highest HMGB1 serum levels. Glycyrrhetic acid inhibits the chemotactic and mitogenic function of HMGB1, binding to the hydrophobic residues that delimit the pockets in box A and B. Conclusions: Chronic inflammatory diseases of the nose and paranasal sinuses are increasingly prevalent and are a financial burden for society. HMGB1 has been shown to play a role in several inflammatory diseases of otolaryngological interest. The inhibition of HMGB1 may be an innovative therapeutic target for patients with chronic upper airway inflammatory diseases having nasal obstruction as a major symptom.

Obstructive sleep apnoea syndrome (OSAS) is a sleep disorder that leads to metabolic abnormalities and increased cardiovascular risk. This study aimed to define the expression and clinical significance of biomarkers involved in oxidative stress in patients with OSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in three groups of subjects. The study involved the recruitment of three groups of subjects, 10 patients with obstructive sleep apnoea syndrome with AHI30; 10 patients suffering from snoring at night with AHI15; 10 patients with nasal respiratory impairment with AHI5. Patients were subjected to skin prick tests for common aero-allergens, nasal endoscopy, active anterior rhinomanometry, fibrolaryngoscopy and polysomnography; and extra-routine diagnostic tests and procedures; analysis of oxidative and antioxidant (plasma thiol groups) biomarkers in blood and urine samples. No statistical differences in age, sex distribution or body mass index were present between the three groups (p0.05). There were significant differences in AHI among the three groups of patients (p0.05). No statistical significance was found in the Analysis of Variance (ANOVA) test (p0.05) between the levels of biomarkers of oxidative stress in the three populations studied. The results of our study show that the nose can play a role in the pathogenesis of OSAS through the production of biomarkers of oxidative stress.La sindrome delle apnee ostruttive del sonno (OSAS) è una malattia che può portare ad alterazioni metaboliche e a un’aumentata incidenza di patologie cardiovascolari. Questo studio ha lo scopo di definire l’espressione e il significato clinico di biomarkers coinvolti nello stress ossidativo nei pazienti con diagnosi di OSAS. I risultati degli esami di laboratorio dello stress ossidativo sono stati confrontai prospetticamente in tre gruppi di soggetti: 10 con sindrome delle apnee ostruttiva del sonno con Apnea Hypopnea Index (AHI)30; 10 con roncopatia notturna e AHI15 e 10 con insufficienza respiratoria nasale e AHI5. I pazienti sono stati sottoposti a test cutanei per aero-allergeni comuni, rinoscopia anteriore, rinomanometria anteriore attiva, fibrolaringoscopia e polisonnografia. Per la ricerca dei biomarkers dello stress ossidativo sono stati effettuati test diagnostici in campioni di sangue e urine. I gruppi sono risultati omogenei per età, sesso e distribuzione del Body Mass Index (BMI) (p0.05). Ci sono state differenze significative nell’AHI tra i tre gruppi di pazienti (p0.05). Nessuna significatività statistica è stata identificata (p0.05) tra i livelli di biomarkers di stress ossidativo nelle tre popolazioni studiate. I risultati del nostro studio hanno mostrato che il naso può svolgere un ruolo nella patogenesi dell’ OSAS, attraverso la produzione di biomarkers di stress ossidativo.

Background: Fencers often complain of progressive difficulty in breathing during matches, which is generally attributed to restricted air, light and heat circulation from wearing a mask. Physiologically, the nasal structure generates airflow resistance that can reach -50% of the total respiratory resistance. Objectives: This study aims to investigate the presence of nasal obstruction in fencers and the relationship with the use of mask. Materials and Methods: An observational study on 40 fencers (18 males, 22 females) was conducted. Fencers perform a usual assault, wearing the mask and standardized physical exercises (running, sprints and obstacles) without the mask. ENT examination with a nasal flexible fiberscope, Anterior Active Rhinomanometry (AAR) and Peak Nasal Inspiratory Flow (PNIF) measurement before and after physical activity with or without the mask was recorded. Results: Before physical exercise, the total nasal airway resistance mean value for AAR was 0.33 ± 0.17 Pa/cm3/s at 150 Pa. After a match with the mask, the mean value was 0.28 ± 0.16 Pa/cm3/s. After normal physical exercises without mask, the mean value was 0.24 ± 0.15 Pa/cm3/s. Using t tests, statistically significant difference between nasal resistance before and after physical activity (P < 0.05) was observed, but no significant difference in nasal resistance between the basal value and that taken after a match wearing the masks (P = 0.1265). PNIF values significantly increase with exercise (P < 0.05). Conclusions: Our study shows that wearing the mask causes increased breathing impairment in fencers, when compared with similar physical activity without the mask.

Summary Objective: to evaluate the relationships between headache and nasal obstruction or nasal allergy on a group of Italian school children. Methods: One hundred twenty-six children suffering from headache, were enrolled in the study. All patients underwent an accurate clinical history, a complete ENT objective examination, an Anterior Active Rhinomanometry, an analysis of nasal mucociliary transport time and a skin test on the inner forearm. Results: Nasal resistances were increased in 101 out of 105 of children (96.2%) affected by severe headache (group A) and in 5 out of 21 (23.8%) of those affected by sporadic headache (P The analysis of mucociliary transport time offered results comparable with those of the Anterior Active Rhinomanometry. Conclusions: Dysfunctions of nasal physiology, as stated by the alteration of nasal resistances and nasal mucociliary transport, seem to be able to affect the development and the characteristics of headaches; specifically we found that children with an altered nasal physiology have more severe and more frequent attacks of headache.

Recurrent or chronic adenotonsillar infections mainly affect children and frequently involve otherwise healthy subjects. Therefore, having excluded systemic immunological deficiencies, this disease may be due to a local dysfunction of the epithelial structures at either the rhino or oropharyngeal level. The aim of the present investigation was to analyze structural and immunological aspects of tonsils and adenoids in subjects who underwent adenotonsillectomy because of recurrent inflammatory episodes with fever. Histological studies and analyses of the cytokine patterns were carried out in palatine tonsils and adenoid samples from 105 patients who underwent adenoidectomy and bilateral extracapsular tonsillectomy for chronic inflammatory hypertrophy of these organs; 46 of the 105 cases examined presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. Scanning electron microscopy revealed a continuous epithelial surface of polygon-shaped flattened cells with fissures towards the cryptic depressions. Titration of interleukin-1β and tumor necrosis factor alpha in serum and tissues demonstrated higher concentrations in the adenotonsillar specimens, whereas the rise in interleukin-6 was more modest.

The aim of the study was to assess the efficacy of sodium enoxaparin in the treatment of autoimmune sensorineural hearing loss. A small number of patients with unilateral sensorineural hearing loss were selected and divided randomly into two numerically equal groups (groups A and B) if they fulfilled the inclusion criteria, i.e. being between 20 and 65 years of age, had been affected by systemic lupus erythematosus, had presented with a hearing loss of at least 30 dB of audibility threshold involving the medium frequencies (2000-4000 Hz), and had provided informed consent. Group A received sodium enoxaparin while group B (control) received placebo. In group A, all patients except one showed an improvement in hearing after sodium enoxaparin treatment. In group B, no patients showed an improvement in auditory function. In conclusion, our results underline the important role of sodium enoxaparin in the therapeutic management of this disease. The low number of patients suggests that further studies are required to confirm this initial data but this study suggests that sodium enoxaparin provides encouraging results in the treatment of autoimmune sensorineural hearing loss.

Purpose : To evaluate modifications of moxifloxacin (MFX) concentrations in tonsillar tissue and plasma up to 24 h after three oral doses of 400 mg, and to assess the safety and tolerability of this drug in adult patients with chronic or recurrent tonsillitis undergoing tonsillectomy. Methods : Twenty-nine patients with normal renal and hepatic function were randomly placed into five groups according to the time between the last moxifloxacin dose administered and the time of sampling (group A: 2 h, group B: 3 h, group C: 6 h, group D: 12 h, group E: 24 h). Plasma, from heparinized venous blood, and tissue concentrations were determined using a validated HPLC assay with fluorescence. Results : Mean levels of moxifloxacin in the tonsillar tissue were on average at least 2-fold with respect to the correspondent values in the plasma. The time profile in tissue seems to be very similar to that in plasma. In particular, the peak concentration in the tissue occurred at the same time (hour 3) as in plasma, having a ratio of about three (2.85) in favour of the tissue mean level. No drug-related adverse effects developed in any of the patients. Conclusions : Moxifloxacin was well tolerated by all patients and achieves a good penetration in tonsillar tissue, which compares favourably with that reported for other fluoroquinolones.

Objective: To evaluate certain infectious, structural and immunological aspects of the adenoids and tonsils in patients submitted to adenotonsillectomy due to chronic inflammation or massive hypertrophy. Materials and methods: In the first phase, bacterial flora and lymphocytic population were analyzed in the tonsils and adenoids removed from 19 children; in the second phase, histological studies and analysis of the cytokine pattern were carried out in palatine tonsils and adenoids from 105 patients submitted to adenoidectomy and bilateral extracapsular tonsillectomy. Results: The presence of Haemophilus influenzae, Streptococcus pneumoniae and S beta-hemolytic was comparable in both tissues; the most frequently isolated pathogen being H. influenzae. A higher percentage of T3 and T4 lymphocytes was observed in adenoids than in the tonsils. Histologically, of the 105 cases examined, 46 presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. A comparison of findings, in serum and tissues, showed a higher concentration of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) in the adenotonsillar specimens, whereas the rise in IL-6 was more modest. Conclusions: The impaired immunological reactivity of the tonsils would appear to be mediated by a change in the epithelial compartment which results in impaired antigen uptake rather than by the lymphatic compartment which only reacts to the repeated stimuli. The high levels of cytokines lead, with repeated infectious stimuli, to activation and proliferation of endothelial cells and fibroblasts which result, with time, in the progressive replacement of immunologically active tissue with fibrotic tissue which is, therefore, immunologically silent.

In the past 130 years, many surgical procedures for turbinate reduction have been developed. We analyzed the long-term efficacy of 6 of these surgical techniques (turbinectomy, laser cautery, electrocautery, cryotherapy, submucosal resection, and submucosal resection with lateral displacement) over a 6-year follow-up period. We randomly divided 382 patients into 6 therapeutic groups and surgically treated them at the Department of Otorhinolaryngology of the University of Siena. After 6 years, only submucosal resection resulted in optimal long-term normalization of nasal patency and in restoration of mucociliary clearance and local secretory IgA production to a physiological level with few postoperative complications (p < .001). The addition of lateral displacement of the inferior turbinate improved the long-term results. We recommend, in spite of the greater surgical skill required, submucosal resection combined with lateral displacement as the first-choice technique for the treatment of nasal obstruction due to hypertrophy of the inferior turbinates.

Although there is an agreement on the increase of the prevalence of allergic rhinitis in last decades, data emerging from various studies appear to be widely dishomogeneous. Another point that needs a clarification is the relationship between allergic rhinitis and lower airways pathologies such as asthma or bronchitis. In this study, we followed the evolution of allergic rhinitis in a group of patients in the last 20 years to highlight the efficacy of different treatments in the prevention of complications, specifically asthma. Patients who didn't receive any kind of treatment experimented a remission of symptoms in 4 cases, a stability of the disease in 6 and the development of complications in 11. In the group treated with symptomatic drugs we highlighted a recovery in 11 patients, a stability of symptoms in 2 and complications in 2. At last, patients undergone immunotherapy considered their symptoms improved in 60 % and stable in 40 % of cases. In conclusion, Immunotherapy guarantees, in a large number of patients, remission of local symptoms and valid protection against district and bronchial complications. Symptomatic treatment with antihistamines and/or cortisones represents a valid alternative, and it's always to be preferred to abstention from any treatment.

The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily be based on the correct identification of the microbiological agents involved in causing the sinus affection. In our experience, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the germs responsible for most of the acute forms found in our country, in adults and children alike. In 1997, the FDA approved the use of antibiotics such as amoxicillin/clavulanic acid, clarithromycin, cefuroxime axetil, loracarbef and levofloxacin for acute forms. According to our experience, the administration of amoxicillin/clavulanic acid would appear to be particularly effective, also in the relapse of chronic forms. Regarding the duration of antibiotic treatment, consensus is practically unanimous. In acute rhinosinusitis, the therapy should be given for at least 10 days at full dosage. The duration of treatment may be extended up to 14 days at the physician’s discretion in the more serious cases of infection and in the case of debilitated patients. In the chronic forms, the common literature indicates a therapy targeted at eradication of coagulase-positive and coagulase-negative staphylococci and anaerobes having a duration of less than 5 weeks. In our opinion, chronic histological modifications of the sinoidal mucosa represent conditions of risk for the appearance of acute episodes, which should necessarily be treated with medical therapy. When the acute episodes recur with incessant regularity, leading to important problems and causing a decrease in quality of life, then functional surgery should be considered.

Headache attributed to rhinosinusitis, commonly called sinus headache (SH), is probably one of the most prevalent secondary headaches. The purpose of our study was to examine further sinus headache comparing the effect of conventional functional endoscopic sinus surgery and the balloon sinuplasty.Eighty-three consecutive patients were enrolled from 2009 to 2012, who were diagnosed sinus headache according the diagnostic criteria of AAO-HNS and of HIS. 40 patients were randomized to Conventional Endoscopy Sinus Surgery for frontal sinus (ESS Group), 35 to balloon sinuplasty of frontal sinus (BS Group).The mean operative time was 65 ± 15 min for ESS group patients and 32 ± 7 min for 23 patients (BS1 Group) and 55 ± 18 min for 12 treated with hybrid technique (BS2 Group). The preoperative mean of SNOT-22 scores improved from 28.6 ± 1.2 in ESS group and 27.3 ± 0.8 in BS group to a 1-month postoperative scores of 14.5 ± 0.6 in ESS group and 10.3 ± 0.5 in BS group and to a 6-month postoperative scores of 7.8 ± 0.6 and 5.3 ± 0.3, respectively (p0.0001). The headache scores base on analog visual scale improved from a preoperative mean of 6.5 ± 0.3 in ESS group and 7.1 ± 0.4 in Bs group to a 1-month postoperative scores of 5.4 ± 0.4 in ESS group and 5.5 ± 0.4 in BS group and to a 6-month postoperative scores of 2.7 ± 0.5 and 1.2 ± 0.1, respectively, representing a statistically significant reduction in headache score in both group.Our data prove that improvement in headache can be expected in patients treated with balloon catheter.

Glutathione transferases (GSTs) are a superfamily of detoxifying enzymes over-expressed in tumor tissues and tentatively proposed as biomarkers for localizing and monitoring injury of specific tissues. Only scarce and contradictory reports exist about the presence and the level of these enzymes in human saliva. This study shows that GSTP1-1 is the most abundant salivary GST isoenzyme, mainly coming from salivary glands. Surprisingly, its activity is completely obscured by the presence of a strong oxidizing agent in saliva that causes a fast and complete, but reversible, inactivation. Although salivary alpha-defensins are also able to inhibit the enzyme causing a peculiar half-site inactivation, a number of approaches (mass spectrometry, site directed mutagenesis, chromatographic and spectrophotometric data) indicated that hypothiocyanite is the main salivary inhibitor of GSTP1-1. Cys47 and Cys101, the most reactive sulfhydryls of GSTP1-1, are mainly involved in a redox interaction which leads to the formation of an intra-chain disulfide bridge. A reactivation procedure has been optimized and used to quantify GSTP1-1 in saliva of 30 healthy subjects with results of 42±4 mU/mg-protein. The present study represents a first indication that salivary GSTP1-1 may have a different and hitherto unknown function. In addition it fulfills the basis for future investigations finalized to check the salivary GSTP1-1 as a diagnostic biomarker for diseases.

Haddad et al. analyzed the effect of nasal abnormalities in adherence to continuous positive airway pressure (CPAP) therapy [1]. The findings of that study underline the fact that nasal parameters such as the degree of septal deviation, the hypertrophy of the inferior turbinate, and nasal peak inspiratory flow do not predict CPAP adherence in subjects with moderate or severe obstructive sleep apnea (OSA). However, there are some aspects that may be of interest in performing an analysis as several papers documenting the role of the nose on OSA syndrome have been published in the literature. Combining the fact that the ideal method or test for the correct evaluation of nasal functions in OSA does not exist yet and that adherence to CPAP is the consequence of many factors, we suggest an explanation why it is so hard to demonstrate the role of the nose in CPAP adherence.

Background Nasal obstruction is a primary symptom of common upper respiratory tract disorders. In clinical practice nasal saline solutions are recommended for the cleansing of nasal cavities and relieving nasal symptoms. Methods 55 patients (aged 25–70 years) suffering from obstructive rhinopathy, with nasal obstruction/congestion of moderate severity persistent since at least 10 days in advance of recruitment with/without rhinosinusitis was randomly treated with an hypertonic solution composed by Silver Sucrose Octasulfate and Potassium Sucrose Octasulfate (SILSOS) or isotonic solution for 20 days. At baseline (T0), ten days (T10) and twenty days (T20) after SILSOS treatment, study participants were evaluated subjectively with VAS and SNOT-22, objectively by Active Anterior Rhinomanometry (AAR) and MCC/MCTt determination. Forty-four patients were followed-up 30 days after the end of treatment by a phone interview. Results The AAR analysis showed in SILSOS group a significantly (p