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The aim of this study was to assess the role of oropharingoesophageal scintigraphy (OPES) in the management of neurological patients, investigating the clinical value of semiquantitative analysis.We enrolled 39 neurological patients clinically evaluated and scored according to the Dysphagia Outcome Severity Scale (DOSS) scale who underwent fibrolaryngoscopic swallowing examination (FEES) and OPES using a 99mTc-nanocolloid-radioblabelled semiliquid bolus. We calculated the following semiquantitative parameters: Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER10s). Differences in OPES semiquantitative parameters between patients classified according to the DOSS scale were performed using the nonparametric Mann-Whitney U test. Optimal semiquantitative parameters cut-off values that correlated with DOSS classification were investigated with ROC curves. The agreement between OPES, FEES and DOSS results was measured using Cohen's Kappa test (K).A significantly higher OTT (p=0.028), PTT (p=0.011) and ETT (p=0.030) and lower EER10s (p=0.016) values were identified. Moderate agreement resulted between OPES and DOSS results (k=0.429, 95%CI: 0.143-0.715, p=0.002).Our study revealed a significant correlation between clinical dysphagia graded using DOSS scale and semiquantitative parameters obtained by OPES evaluation. Despite reliable and reproducible OPES results, allowing an adequate study also of the esophageal phase, nowadays scintigraphic study remains an underestimated method to be considered in the diagnosis of dysphagia and related complications.

Summary Objective The purpose of our study was to investigate the impact of surgical mask on some vocal parameters such as F0, vocal intensity, jitter, shimmer and harmonics-to-noise ratio in order to understand how surgical mask can affect voice and verbal communication in adults. Methods The study was carried out on a selected group of 60 healthy subjects. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask. Voice samples were recorded directly in Praat. Results There were no statistically significant differences in any acoustic parameter between the masked and unmasked condition. There was a non-significant decrease in vocal intensity in 65% of the subjects while wearing a surgical mask. Conclusions The statistical comparison carried out between all the acoustic voice parameters observed, extracted wearing and not wearing a surgical mask did not reveal any significant statistical difference. Most of the subjects, after wearing the surgical mask, presented a decrease in vocal intensity measured. Our conclusion was that wearing a mask is likely to induce the unconscious need to increase the vocal effort, resulting over time in a greater risk of developing functional dysphonia. The reduction of intensity can affect also social interaction and speech audibility, especially for individuals with hearing loss.

Objective Dysphagia is a life-threating manifestation of idiopathic inflammatory myopathies (IIM). However, we lack a univocal protocol for its treatment. The aim of this retrospective analysis was to evaluate the effectiveness of a step-up strategy by adding a 1-day pulse of IVIGs to immunosuppressants in IIM patients with refractory dysphagia diagnosed by Eating Assessment Tool (EAT)-10 and fibreoptic endoscopic evaluation of swallowing (FEES). Methods Dysphagia was defined as a pharyngo-oesophageal disturbance associated with EAT-10 score ≥3 and at least one FEES abnormality among propulsion failure, solid or liquid stasis. Eighteen out of 154 IIM patients had FEES-confirmed dysphagia and underwent 1 day IVIG 2 g/kg repeated 1 month apart for 3 months, because of dysphagia refractory to high-dose glucocorticoids with methotrexate and/or azathioprine. Clinical characteristics along with myositis-specific antibodies and muscle histopathological findings were studied in FEES-dysphagia IIM and IIM control patients. Results After three monthly doses of IVIG, EAT-10 score dropped with complete recover of defective propulsion and progressive decrease in percentage of both solid and liquid stasis. At 52-weeks’ follow-up, reached in 12 patients, all these parameters were stable or further improved. An improvement in manual muscle strength test and a steroid-sparing effect of IVIG were also observed. Anti-PM/Scl 75/100 antibodies were much more frequent in the FEES-dysphagia group, while anti-Jo1 antibody was rarely detected. Conclusion Our treatment schedule with 2 g/kg IVIG was effective for IIM-associated refractory dysphagia assessed by the combination of EAT-10 and FEES. These findings need to be prospectively tested in a larger cohort of IIM patients.

Deep neck space infections (DNSIs) are a group of infective suppurative diseases involving deep neck spaces and cervical fascia. Necrotising and septic evolutions are rare, but severe complications can dramatically affect the prognosis and should be promptly managed. Clinical examination often has low sensitivity, although instrumental diagnosis may delay te treatment. We investigated two laboratory tools, LRINEC (Laboratory Risk Indicator for the Necrotizing fasciitis) and NLR (neutrophil to lymphocyte ratio), in the expectation to find a rapidly available predictive indicator that may help in distinguishing necrotising complications and/or systemic septic involvement.A retrospective observational cohort study was performed on 118 patients who had underwent surgical treatment for DNSIs at our Surgical Unit. LRINEC, NLR and the product LRINEC x NLR were calculated.Statistical analysis showed that these scores may have utility in rapidly predicting the risk of necrotising fasciitis and systemic involvement at an early diagnostic stage.Further studies with a larger cohort may be necessary in order to increase the sensitivity and specificity.Nuovi indicatori biochimici predittivi di infezioni suppurative cervicali.Le infezioni suppurative del collo sono un eterogeneo gruppo di patologie a carico degli spazi profondi del collo e delle fasce cervicali. Al suo interno meritano particolare attenzione le temibili fasciti necrotizzanti, caratterizzate dall’elevato tasso di mortalità e di compromissione settica. Risulta pertanto indispensabile una loro pronta diagnosi e un altrettanto tempestivo trattamento. La semeiologia clinica risulta spesso poco sensibile, mentre l’esame TC comporta un inevitabile ritardo nella presa in carico terapeutica. Abbiamo quindi valutato l’applicabilità di due indicatori basati unicamente su parametri laboratoristici, quindi rapidamente disponibili: LRINEC score e NLR ratio.Abbiamo condotto uno studio retrospettivo su 118 pazienti che erano stati sottoposti a drenaggio chirurgico di ascesso cervicale c/o la nostra U.O., calcolando per ciascuno di essi LRINEC, NLR e il loro prodotto di moltiplicazione LRINEC x NLR.L’analisi statistica dimostra un loro possibile ruolo nella diagnosi tempestiva delle fasciti necrotizzanti e/o delle loro complicanze settiche.Ulteriori studi con una maggiore numerosità campionaria potrebbero essere necessari per rafforzare sensibilità e specificità di tali score.

The evaluation of Health-Related Quality of Life (HRQoL) in patients with chronic otitis media COM has gained attention over the past years and several questionnaires have been developed to evaluate it in affected patients. The Chronic Otitis Media Questionnaire 12 (COMQ-12) is a widely used disease-specific tool that evaluates the severity of symptoms, the specific impact on work and lifestyle, the effects on the health service, and general impact of the disease in patients with COM. The COMQ-12 questionnaire has been translated and validated into different languages; however, an Italian version is not yet available. The aim of this original study was to translate the COMQ-12 questionnaire into the Italian language and validate this new Italian language version in Italian-speaking patients with COM. The COMQ-12 was translated into Italian (COMQ-12-It) following international guidelines. Validation was performed comparing and correlating COMQ-12-It with (1) a question that addresses HRQoL, and (2) the results of a generic questionnaire assessing HRQoL, namely the EQ-5D-5L questionnaire. Forty-eight patients with COM were included in the study. Cronbach’s alpha was 0.80 indicating a high reliability. There was a strong positive correlation between the question that directly addressed HRQoL and total score (correlation coefficient = 0.62), while the regression analysis between total score of COMQ-12-It and EQ-5D-5L showed a positive relation but only a weak positive correlation (correlation coefficient 0.36). Our study showed evidence that the Italian version of the COMQ-12 questionnaire is a valid and reliable tool to evaluate HRQoL in Italian-speaking patients with COM.

Among the different procedures used by the ENT, acoustic analysis of voice has become widely used for correct diagnosis of dysphonia. The instrumental measurements of acoustic parameters were limited during the COVID-19 pandemic by the common belief that a face mask affects the results of the analysis. The purpose of our study was to investigate the impact of surgical masks on F0, jitter, shimmer and harmonics-to-noise ratio (HNR) in adults.The study was carried out on a selected group of 50 healthy subjects. Voice samples were recorded directly in Praat. All subjects were trained to voice a vocal sample of a sustained /a/, at a conversational voice intensity, with no intensity or frequency variation, for the Maximum Phonation Time (MPT), wearing the surgical mask and then without wearing the surgical mask.None of the variations in acoustic voice analysis detected wearing a surgical mask and not wearing a surgical mask were statistically significant.Our study demonstrates that the acoustic voice analysis procedure can continue to be performed with the use of a surgical mask for the patient, even during the COVID-19 pandemic.L’analisi acustica della voce in era COVID-19.Tra le diverse procedure diagnostiche di competenza otorinolaringoiatrica, l’analisi acustica della voce si rivela utile alla valutazione quantitativa della disfonia ma la misurazione strumentale dei parametri acustici è stata limitata durante la pandemia da COVID-19 essendo la mascherina chirurgica considerata comunemente come da ostacolo nella registrazione della voce. Lo scopo del nostro studio è stato quello di analizzare l’impatto della mascherina chirurgica su parametri vocali quali F0, jitter, shimmer e harmonic-to-noise ratio (HNR).È stato studiato un campione di 50 soggetti eufonici utilizzando il programma Praat. I soggetti sono stati istruiti a fonare la vocale /a/ tenuta ad intensità di voce di conversazione, senza variazioni di intensità o frequenza, per il Tempo Massimo Fonatorio (TMF), con e senza mascherina chirurgica.L’analisi acustica eseguita con le due diverse modalità non ha rivelato differenze statisticamente significative nei parametri vocali considerati.Il nostro studio dimostra come la procedura diagnostica di analisi acustica della voce può essere eseguita sul paziente che indossa la mascherina chirurgica.

To report our experience in performing cochlear implantation under local anesthesia in a group of patients who were deemed unfit for general anesthesia. A retrospective chart review was performed to analyze undesirable events and any other discomfort complained by patients during cochlear implantation. Analysis of patient’s satisfaction was performed by means of a survey instrument. We have also compared the duration of surgery and hospitalization time with a control group that was implanted under general anesthesia. Twenty-one cochlear implantation in 20 patients were performed under local anesthesia. Age of patients ranged from 38 to 85 years. All interventions were successfully completed without any conversions to general anesthesia. Discomfort during surgery was reported in five cases: vertigo triggered by electrode insertion in two patients, pain during the round window approach in two patients and distress during the use of drill in one case; no patient experienced agitation. During the postoperative period, no complications or unpleasant experiences were reported. Only two patients stated that they would not perform cochlear implantation again under local anesthesia. Lower duration surgery and hospitalization time were found in the local anesthesia group. Local anesthesia with conscious sedation is a safe and effective alternative for cochlear implant candidates considered unfit for general anesthesia. Fundamental for a successful procedure are preoperative counselling, accurate selection of the patients and constant intraoperative assistance. Unfeasibility of facial nerve monitoring and minor detrimental effect on training are the principal disadvantages in performing cochlear implantation under local anesthesia.

We explored the associations of age-related central auditory processing disorder (CAPD) with mild cognitive impairment (MCI) and dementia in an older population-based cohort in Apulia, Southern Italy (GreatAGE Study).Cross-sectional data from a population-based study.Castellana Grotte, Bari, Italy.Between 2013 and 2018, MCI, dementia, age-related CAPD (no disabling hearing loss and50% score on the SSI-ICM test [Synthetic Sentence Identification-Ipsilateral Competing Message]), neurologic and neuropsychological examinations, and serum metabolic biomarkers assays were investigated on 1647 healthy volunteers aged65 years.The prevalences of age-related CAPD, MCI, and dementia were 14.15%, 15.79%, and 3.58%, respectively. Among the subjects with MCI and dementia, 19.61% and 42.37% had age-related CAPD. In the regressive models, age-related CAPD was associated with MCI (odds ratio, 1.50; 95% CI, 1.01-2.21) and dementia (odds ratio, 2.23; 95% CI, 1.12-4.42). Global cognition scores were positively associated with increasing SSI-ICM scores in linear models. All models were adjusted for demographics and metabolic serum biomarkers.The tight association of age-related CAPD with MCI and dementia suggests the involvement of central auditory pathways in neurodegeneration, but it is not clear which is the real direction of this association. However, CAPD is a possible diagnostic marker of cognitive dysfunction in older patients.

Kikuchi-Fujimoto's disease (KFD) is a rare, benign condition characterized by histiocytic necrotizing lymphadenitis predominantly in the cervical region and prolonged fever. It has a higher prevalence in the Japanese and Asian populations although it may be seen in a wide geographic distribution, but rare are the cases reported in Europe. While symptoms resolve spontaneously between 2 weeks and 2 months, complications are described in: CNS, eyes, respiratory tract, kidney and liver. KFD also described an association with systemic lupus erythematosus. This paper describes a rare case of Kikuchi-Fujimoto lymphadenitis and discusses the features of the disease. A 24-year-old man presented with fever and a swollen 3-cm lymph node in the left side of the neck. The definitive diagnosis was established, after excision of level VB nodes on the left, by histologic examination. It revealed structurally intact tissue with scalloping in the paracortical area presenting activated T cells, focal monocytoid B cells, sinus histiocytosis and normally polarized follicles. Other two samples presented focal alterations of the tissue structure due to broad areas of necrosis, conspicuous nuclear debris, large lymphoid cells as well as numerous histiocytes. Immunohistochemistry revealed CD3+ and CD8+ T lymphocytes and histiocytes expressing CD68/PGM-1 (specific for macrophage lineage) and myeloperoxidase (MPO, specific for myeloid lineage). Correct, prompt diagnosis should be established through the findings of imaging and pathologic studies to avoid unnecessary investigation and ineffective therapies.

Background: A 17-year-old boy was referred to our center with ahistory of brain abscess (BA) recurring after 9 years. The patientreported 2 previous treatments for pulmonary arteriovenous mal-formations, sporadic nosebleeds, and familial history for epistaxis.Clinical investigations revealed arteriovenous malformations inlung, brain, and liver, as well as mucocutaneous telangiectases. Adefinite diagnosis of hereditary hemorrhagic telangiectasia wasmade based on clinical criteria and confirmed by genetic analysis.This is the first report of BA recurrence at the end of pediatric age.Conclusions: The present case and the literature review of all casesof BA thus far reported highlight the need to raise the suspicion ofa pulmonary arteriovenous malformations, both isolated and in thecontext of a possible hereditary hemorrhagic telangiectasia, for anycase of BA of unexplained etiology, in children as well as in adults.Key Words: hereditary hemorrhagic telangiectasia, Rendu-Osler-Weber disease, recurrent brain abscess, pulmonary arteriovenousmalformation, diagnostic delay

The pathogenesis of rhinosinusitis (RS) is related to inflammation, caused by infections in the acute form of the disease but also by other agents in the chronic forms. Cytology allows to evaluate the defensive components, such as hair cells and muciparous cells, while the presence in the nasal mucosa of eosinophils, mast cells, bacteria and/or fungal hyphae, or spores indicates the nasal pathology. The anatomic and physiologic characteristics of the otorhinosinusal system account for the frequent concomitant involvement of the different components. The pivotal pathophysiologic sites are the ostiomeatal complex, the spheno-ethmoidal recess, and the Eustachian tube. The latter is the link with acute otitis media (AOM), which is the most common disease in infants and children and has major medical, social, and economic effects. Moreover, because of the strict relationship between upper and lower airways, nasal sinus disease may contribute to asthma and sinusitis may be considered as an independent factor associated with frequent severe asthma exacerbations. Concerning the role of allergy, the available data do not permit to attribute a central role to atopy in sinusitis and thus allergy testing should not be a routine procedure, while an allergologic evaluation may be indicated in children with OM, especially when they have concomitant rhinitis.

Determination of time since death is one of the most difficult and crucial issue in forensic medicine. Apart from body cooling, which is commonly used in the early postmortem interval (PMI), supravital reactions are the most interesting postmortem changes for time of death estimation. Nasal ciliary motility has been occasionally observed in postmortem period although no studies have focused on this phenomenon for forensic purposes. We aimed to evaluate the diagnostic usefulness of ciliary motility as a potential tool in estimating the time of death. Specimens of ciliated epithelium from 100 consecutive cadavers were obtained by scraping the nasal mucosa at three different postmortem intervals. The samples were then smeared on a slide, and an in vitro evaluation of ciliary movement was analyzed by phase-contrast microscopy. A postmortem nasal ciliary motility was observed, and a statistically significant relationship between decreasing ciliary movements and increasing postmortem interval was detected even in presence of putrefactive changes of nasal ultrastructure integrity. Some peculiar causes of death seem to influence ciliary motility in the early PMI, while no significant correlations with sex or age were observed. According to the results of this study, postmortem evaluation of nasal ciliary motility may be a bona fide and a feasible option for estimating the time of death.

Background Rhinitis, either allergic or non-allergic, is frequent in athletes, particularly in swimmers. In this latter case, exposure to chlorine in swimming pools seems to play a relevant role, since it can exacerbate a pre-existing allergic rhinitis (AR) or produce a non-specific irritation. The aim of this study was to detail the clinical and cytological characteristics of rhinitis in swimmers, and to assess the possible role of chlorine-induced symptoms. Methods Elite swimmers with rhinitis symptoms underwent a complete diagnostic work-up, including allergy testing, nasal cytology and anterior rhinomanometry. Those evaluations were repeated after 1 month of use of a nasal clip during swimming. A matched group of asymptomatic swimmers was also studied. A total of 74 swimmers (54 symptomatic and 20 controls), with an age range of 9–21 years, were studied. In the control group, only mild and non-specific findings were observed, and only two had a positive skin test. Results In the symptomatic group, 24 (44%) had AR, and 19 (35%) had a predominant neutrophilic inflammation. The use of a nose clip reduced cellular infiltration and nasal resistances only in the subjects with neutrophilic rhinitis, whereas a clinical improvement was seen also in AR. Conclusion A neutrophilic rhinitis occurs in a large proportion of swimmers. This seems to be irritative in its nature and can be prevented by avoiding the direct contact with chlorinated water.

Background.Salivary glands tumours are uncommon, frequently benign lesions, prevalently located in the parotid gland (80%). Surgical decision making is based on the patient’s history, examination findings, imaging and fine needle aspiration (FNA). FNA is a pre-operative method with good ability in detecting malignancy. During surgery, therefore, Frozen section (FS) can differentiate benign lesions from malignant tumours, to reduce incorrect treatments, to increase the chances of conservative surgery and to better evaluate surgical margins. The aim of our study is to demonstrate the accuracy of the FS procedure in surgery of the salivary glands and to stress the need for dedicated pathology units specialized in lesions of the oral cavity.Methods. The study included 499 patients who underwent surgery from May 2005 and October 2014. An intra-operative frozen section procedure was done for 288 of them. All frozen sections were compared with the final results. The cases were classified by site, nature of the lesion and histotype, according to the WHO classification. Comparison was made between the intra-operative and the definitive diagnosis.Results.Of the 288 FS procedures, 259 were for neoplastic lesions, 199 of which benign and 60 malignant, and 29 for non-neoplastic lesions. Of the 259 neoplastic FS results, 2 were shown to be false positives and 2 were diagnosed as different malignant types. Of the 29 non-neoplastic FS results, 4 were false negatives.Conclusions.Our results showed that the accuracy of frozen section procedure is 98% for salivary glands tumors. The highest concordance between frozen section and the definitive diagnosis was for inflammatory processes (99%), pleomorphic adenoma (98%), Warthin’s tumor (97%) and malignant neoplasms (96%). In conclusion, based on these findings, frozen section of the salivary glands may be proposed as a routine procedure and should be used in decision-making.

The observation of the ciliated cell dynamics by phase-contrast microscope has allowed a profound study of some parameters of the cellular components. The aim of this preliminary study is to assess the surviving time of ciliary cells using the phase-contrast microscope. Nasal cytology was carried out on 50 healthy volunteers. The ciliary beat time was assessed by a video-camera connected with a PC. The time of ciliary beat persistence was extraordinarily long (mean 210 minutes, with range 74–1260). The ciliary activity remained valid as rhythm, synchronism and metachronality. In conclusion, this preliminary study demonstrated that cilia has an energetic autonomy of great importance, able to allow a valid functional activity also in the case of partial sufferance of the cellular unit.

Few cytological studies have investigated the morphologic changes occurring during lymphocyte differentiation in the nose. The aim of the study is to investigate lymphocyte and plasma cell morphology in patients with allergic rhinitis. Nasal cytology was performed in 110 patients (61 men, 49 women) of ages ranging from 12 to 47 years (mean age, 27), 72 of whom were affected by pollen allergic rhinitis (32 allergic to olive, 21 to Parietaria, 13 to grasses, and 6 to cypress) and 38 by perennial allergic rhinitis (allergy to house dust mites). Cytological samples were obtained by scraping with Rhino-Probe™. The samples were collected from the inferior middle turbinate. After fixing and drying, the samples were stained and counted. Cells belonging to the lymphocyte-plasma cell lineage were analyzed. Within this population, 5 different cellular types were identified displaying particular morphologic features of the nucleus and the cytoplasm. These morphological variants constitute various functional stages of B lymphocytes. In allergic inflammation, antigen stimulation induces B lymphocytes to differentiate and become plasma cells. The findings from this strictly morphological study will need to be confirmed by immunohistochemical and immunophenotypic studies.

A faringometria acústica representa um método atual baseado no principio físico da reflexão acústica, útil à análise volumétrica do espaço orofaringolaringotraqueal. OBJETIVO: Este estudo se propõe a avaliar as variações dos parâmetros faringométricos em indivíduos portadores de distúrbios respiratórios do sono (DRS), para estabelecer uma relação entre as variações morfovolumétricas do espaço orofaringolaríngeo e a existência e gravidade da patologia. FORMA DE ESTUDO: Clínico e experimental. MATERIAL E MÉTODO: Foram examinados 110 pacientes, 70 com DRS e 40 normais, durante o período de Junho/04 a Junho/05. Todos os pacientes foram submetidos à faringometria acústica que permitiu uma avaliação da área oro e hipofaríngea através de um gráfico explicativo. RESULTADOS: Os parâmetros obtidos nos pacientes com DRS mostraram uma importante diferença com respeito ao grupo controle, principalmente na amplitude da I onda (significantemente menor nos pacientes com macroglossia), na extensão do segmento OF, na amplitude do segmento OF e na área hipofaríngea. COLCLUSÃO: A faringometria acústica, mesmo não sendo uma técnica padronizada, pode auxiliar no diagnóstico das síndromes obstrutivas do sono, na localização dos possíveis pontos de obstrução e da gravidade da patologia, e no monitoramento dos pacientes submetidos a cirurgias desobstrutivas das vias aéreas superiores.Acoustic Pharyngometry is a modern diagnostic method based on physical principle of acoustic reflection. It is useful for volume analysis of oro-pharyngo-laryngeal spaces. AIM: To evaluate variations of pharyngometric parameters in patients with sleep disorders and to establish a correlation between morpho-volumetric variations of oro-pharyngo-laryngeal spaces and the presence and severity of disease. STUDY DESIGN: a clinical and experimental study. MATERIAL AND METHOD: 110 patients, of which 70 with sleep disorders and 40 healthy patients as a control group, were analysed between June 2004 and June 2005. All patients underwent acoustic pharyngometry to evaluate the mouth and hypopharynx based on an explanatory chart. RESULTS: A significant difference in parameters was observed between sleep disorder patients and the control group, especially in the amplitude of the I wave (significantly lower in patients with macroglossia), the extension of the O-F segment, and the amplitude of the O-F segment and hypopharyngeal area. CONCLUSION: Although not a standardized test, acoustic pharyngometry was proved to be a useful method both in the diagnosis and severity of obstructive sleep apnea, and in post-operative monitoring of upper airway surgery in patients with sleep disorders.

No optimal treatment modality is currently available for the treatment of recurrent epistaxis in HHT. In this review, different therapeutic concepts are discussed together with their pathophysiologic background. Patients often profess a preventive effect for nasal ointments and use packings which can be self-administered in the case of bleeding. An effective first-line treatment for physicians is the endonasal laser coagulation or argon plasma coagulation. A second line surgical procedure is septodermoplasty according to Saunders which can provide long-lasting relief if performed correctly. There have been reports on antifibrinolytic agents and hormones, but their efficacy has yet to be determined.

Background: Allergic rhinitis is characterized by inflammatory cell infiltrate and increased nasal airflow resistance. Objective: The aim of this study was to evaluate the relationship between sensitization type, inflammatory cell pattern, and nasal airflow resistance in a group of rhinitics with monosensitization. Methods: Seventy-seven subjects (40 males and 37 females, with a mean age of 33 ± 4.4 years) suffering from allergic rhinitis were studied. Skin prick test, nasal cytology and electronic rhinomanometry were assessed in all subjects. Results: The number of subjects monosensitized to house dust mites was 23, to grasses 20, to cypress 17, to Parietaria 11, and to olive tree 6. Significant differences were observed between each type of allergen sensitization concerning both the nasal airflow resistance (p = 0.002) and the nasal cytology pattern: eosinophils (p = 0.004), degranulated eosinophils (p = 0.002), mast cells (p = 0.006) and degranulated mast cells (p = 0.008). Furthermore, goblet cells were higher in house dust mite-sensitized subjects compared with the pollen-sensitized group (p = 0.018), in which a prevalence of eosinophils, degranulated eosinophils, mast cells and degranulated mast cells was observed (p = 0.049, p < 0.001, p = 0.022 and p = 0.007, respectively). Nasal resistances were higher in the pollen group (p = 0.001). Conclusions: This study provides evidence that inflammatory cell pattern and nasal resistance depend on the type of allergen sensitization.

Objectives/Hypothesis: Septal dermoplasty has been recommended as the treatment of choice for life-threatening epistaxis in patients with hereditary hemorrhagic telangiectasia. The purpose of the study was to evaluate the effectiveness and outcomes of septal dermoplasty for management of transfusion-dependent epistaxis. Study Design: Retrospective study. Methods: Between 1994 and 2004, septal dermoplasty was performed on 67 consecutive patients with severe epistaxis attributable to hereditary hemorrhagic telangiectasia. The numbers of units of blood received 1 year before and 1 year after septal dermoplasty were obtained. A subjective appraisal of the results of the surgery as well as second procedures after septal dermoplasty was determined. Patients were screened for pulmonary and cerebral arteriovenous malformations, gastrointestinal tract bleeding, and symptomatic liver disease. Results: Data were obtained in 66 of 67 (98%) patients with a mean age of 61.5 years (mean follow-up, 3.9 y). Accurate transfusion requirements 1 year before and 1 year after septal dermoplasty were available in 32 of 66 (48%) patients. In these 32 patients, the mean units of blood received decreased from 21 units (range, 2–100 units) 1 year before septal dermoplasty to 1 unit (range, 0–10 units) in the year after septal dermoplasty (P < .001). Improved quality of life was claimed in 57 patients. Second therapies, ranging from cautery to repeat partial septal dermoplasty, were required in 15 patients during follow-up. Among the 67 patients, 31 (46%) had pulmonary arteriovenous malformation, 14 (21%) had gastrointestinal tract bleeding, 7 (10%) had symptomatic liver disease, and 5 (7%) had cerebral arteriovenous malformation. During the follow-up, 14 patients died of other complications of hereditary hemorrhagic telangiectasia (11 patients) and unrelated causes (3 patients). Conclusion: Septal dermoplasty remains an effective way of reducing transfusion requirements in patients with hereditary hemorrhagic telangiectasia and subjectively improves their quality of life. The otolaryngologist caring for patients with hereditary hemorrhagic telangiectasia should be familiar with other organ involvement by hereditary hemorrhagic telangiectasia to prevent complications during surgery.

A grading into four classes of hypertrophied adenoid rhinopharyngeal obstructions in children on the basis of fiberendoscopic findings to outline an effective therapeutic program according to this classification.Ninety-eight children with chronic nasal obstruction and oral respiration were examined by anterior rhinoscopy, and fiberendoscopy. During the investigation, the fiberendoscopic images of the choanal openings were divided into four segments from the upper choanal border to the nasal floor. In view of clinical findings, 78 patients also underwent active anterior rhinomanometry.In eight patients (8.2%), the fiberendoscopic imaging revealed that the adenoid tissue occupied only the upper segment in the rhinopharyngeal cavity (25%). Therefore, choanal openings were free (first degree obstructions). In 20 patients (20.4%), the adenoid tissue was confined to the upper half (50%) of the rhinopharyngeal cavity (second degree obstructions) and in 63 patients (64.3%) the tissue extended over the rhinopharynx (75%) with obstruction of choanal openings and partial closure of tube ostium (third degree obstructions). Only in seven cases (7.14%), the obstruction was almost total. As a consequence, both the tube ostium and the lower choanal border could not be observed (fourth degree obstructions).In the first two classes of obstructions, characterized by moderate or discrete adenoid hypertrophy, adenoidectomy should not be performed. In these conditions, the causes of possible nasal obstructions are usually due to either dysmorphic, allergic or phlogistic pathologies. For the fourth degree adenoid obstructions, surgery is always recommended. The most important therapeutic problems occur in the third degree obstructions which include most patients who suffered from hypertrophied adenoids. Moreover, the therapeutic strategy can be conditioned not only by nasal respiratory difficulties but also by frequent concomitant complications such as otitis, sinusitis, sleep apnea, etc. These disorders may be caused by both nasal obstruction and/or phlogistic problems (adenoiditis).

Nasal cytology is a diagnostic tool currently used in rhinology, with the aim of assessing cell changes in the nasal epithelium exposed to irritant or inflammatory agents. Its rationale is based on the knowledge that nasal mucosa of healthy individuals is constituted by four cytotypes (ciliata, mucipara, striata, and basalis) and does not show other cells except, rarely, neutrophils and, very rarely, bacteria. In this view, the detection of a given cell type different from these is a sign of possible pathology. The advantage and the diffusion of nasal cytology were increased by a number of factors such as the easiness of performance, the non-invasiveness allowing repetition (which is often needed in the efficacy monitoring of medical or surgical treatment of nasal diseases), and the low cost. This makes nasal cytology particularly feasible for application in children. The cytological feature characterizing infectious inflammation is the presence of abundant bacteria, which may be found in extracellular tissue and also inside neutrophils as a result of phagocytosis. In such clinical condition it is important to monitor the disease with cytological controls to verify the significant decrease, or the disappearance of inflammatory cells, which indicates the resolution of the pathology.

Objectives:Investigate the effects of ischemic preconditioning (IPC) plus resveratrol on the viability of epigastric rat flaps for reconstructive microsurgery.Methods:Fifteen Sprague-Dawley rats were used from September 2011 to December 2011. Superficial epigastric artery- and vein-based island flaps (control flap and resveratrol flap) were used. IPC was applied to both flaps for 60 minutes. Therefore we administered 0.2 cc of resveratrol in the artery of the resveratrol Flap. On day 14, viable flap areas were measured, and taken for histological examinations with hematoxylin-eosin staining and CD34+ hematopoietic progenitor cells analysis.Results:We described destruction of skin and subcutaneous tissues in all control flaps, with hypoxic and ischemic areas and exudative phlogosis. The CD34 analysis was negative. The resveratrol flaps description was completely different. The necrosis and the acute inflammation were minimal. Instead, there was an important angiogenesis. Three rat flaps failed. However, th...

International audience; The purpose of this study was to describe some "morphological-chromatic" patterns (i.e. spots of cyan colour) identified during the study of nasal cytology in patients with both bacterial and fungal infectious rhinological disorders. These peculiar aspects strongly suggest the presence of a microscopic biofilm. We retrospectively examined 1,410 nasal cytology specimens from subjects who underwent clinical-instrumental investigations (history, ENT visit, nasal endoscopy and nasal cytology) from January to August 2010. The control samples were represented by 30 subjects not suffering from infectious rhinological diseases. The presence of particular spots of "cyan" was found in colour in 107/1,410 rhinocytograms (7.6%), within which bacterial colonies and/or fungal spores were found. We called these coloured spot formations "infectious spots" (IS). The positivity to periodic acid Schiff (PAS) staining confirmed the polysaccharide nature of the coloured spots and allowed us to relate them to biofilms. This study demonstrates, for the first time, that nasal cytology performed by optical microscope can play an important role in detecting biofilms.

Background In clinical practice it can be observed that some patients with seasonal allergic rhinitis (AR) continue to have symptoms even when the exposure to allergens is expected to be low or absent. We studied the clinical and cytological characteristics of these atypical forms of (AR) in a large population of patients. Methods Consecutive patients with symptoms of rhinitis and with positive skin test to pollens only were interviewed for the duration of symptoms, correlation with sensitization pattern, and presence of reactivity to nonspecific stimuli. All underwent rhinoscopy and nasal scraping for cytology. Results Five hundred nineteen patients with AR were studied. Of these 519 patients 60 (11.5%) had an atypical or mixed form of rhinitis, with symptoms independent of the exposure and also elicited by nonspecific stimuli. These patients clearly differed from typical forms, especially for the nasal inflammation. They had a greater number of eosinophils and mast cells out of season (p < 0.05). Moreover, these atypical forms had, more frequently, asthma and eosinophilic polyps. Conclusion In ∼12% of patients with AR, other mechanisms of inflammation seem to intervene. Nasal cytology can be helpful in discriminating these atypical forms.

Luca Pastore and colleagues discuss the differential diagnosis and management of a 62-year-old man who presented with a 6-cm fungating mass on the dorsum of the tongue.

Three main types of inflammatory Non-Allergic Rhinitis (NAR) have been defined: NAR infiltrated by eosinophils (NARES), by mast cells (NARMA), and by neutrophils (NARNE). A new particular type has been characterized with current infiltration by eosinophils and mast cells (NARESMA). The aim of this study is to evaluate the clinical and functional characteristics in patients with NARES, NARMA, NARNE, and NARESMA and to define the latter. One hundred and seventy-six NAR patients were prospectively and consecutively evaluated:52 patients with NARES, 38 with NARMA, 36 with NARNE, and 50 with NARESMA. Clinical features, Quality of Life (QoL), and rhinomanometry were evaluated in all of them. QoL was significantly different in the 4 groups. NARESMA patients had the worst QoL. Nasal function and QoL in NARESMA patients were significantly correlated. Significant associations were shown with both nasal polyps and asthma in NARESMA patients. This study provides the first evidence that NARESMA constitutes a new type of NAR and is a particularly severe disorder.

A faringometria acústica representa um método atual baseado no principio físico da reflexão acústica, útil à análise volumétrica do espaço orofaringolaringotraqueal. OBJETIVO: Este estudo se propõe a avaliar as variações dos parâmetros faringométricos em indivíduos portadores de distúrbios respiratórios do sono (DRS), para estabelecer uma relação entre as variações morfovolumétricas do espaço orofaringolaríngeo e a existência e gravidade da patologia. FORMA DE ESTUDO: Clínico e experimental. MATERIAL E MÉTODO: Foram examinados 110 pacientes, 70 com DRS e 40 normais, durante o período de Junho/04 a Junho/05. Todos os pacientes foram submetidos à faringometria acústica que permitiu uma avaliação da área oro e hipofaríngea através de um gráfico explicativo. RESULTADOS: Os parâmetros obtidos nos pacientes com DRS mostraram uma importante diferença com respeito ao grupo controle, principalmente na amplitude da I onda (significantemente menor nos pacientes com macroglossia), na extensão do segmento OF, na amplitude do segmento OF e na área hipofaríngea. COLCLUSÃO: A faringometria acústica, mesmo não sendo uma técnica padronizada, pode auxiliar no diagnóstico das síndromes obstrutivas do sono, na localização dos possíveis pontos de obstrução e da gravidade da patologia, e no monitoramento dos pacientes submetidos a cirurgias desobstrutivas das vias aéreas superiores.

A faringometria acústica representa um método atual baseado no principio físico da reflexão acústica, útil à análise volumétrica do espaço orofaringolaringotraqueal. OBJETIVO: Este estudo se propõe a avaliar as variações dos parâmetros faringométricos em indivíduos portadores de distúrbios respiratórios do sono (DRS), para estabelecer uma relação entre as variações morfovolumétricas do espaço orofaringolaríngeo e a existência e gravidade da patologia. FORMA DE ESTUDO: Clínico e experimental. MATERIAL E MÉTODO: Foram examinados 110 pacientes, 70 com DRS e 40 normais, durante o período de Junho/04 a Junho/05. Todos os pacientes foram submetidos à faringometria acústica que permitiu uma avaliação da área oro e hipofaríngea através de um gráfico explicativo. RESULTADOS: Os parâmetros obtidos nos pacientes com DRS mostraram uma importante diferença com respeito ao grupo controle, principalmente na amplitude da I onda (significantemente menor nos pacientes com macroglossia), na extensão do segmento OF, na amplitude do segmento OF e na área hipofaríngea. COLCLUSÃO: A faringometria acústica, mesmo não sendo uma técnica padronizada, pode auxiliar no diagnóstico das síndromes obstrutivas do sono, na localização dos possíveis pontos de obstrução e da gravidade da patologia, e no monitoramento dos pacientes submetidos a cirurgias desobstrutivas das vias aéreas superiores. Acoustic Pharyngometry is a modern diagnostic method based on physical principle of acoustic reflection. It is useful for volume analysis of oro-pharyngo-laryngeal spaces. AIM: To evaluate variations of pharyngometric parameters in patients with sleep disorders and to establish a correlation between morpho-volumetric variations of oro-pharyngo-laryngeal spaces and the presence and severity of disease. STUDY DESIGN: a clinical and experimental study. MATERIAL AND METHOD: 110 patients, of which 70 with sleep disorders and 40 healthy patients as a control group, were analysed between June 2004 and June 2005. All patients underwent acoustic pharyngometry to evaluate the mouth and hypopharynx based on an explanatory chart. RESULTS: A significant difference in parameters was observed between sleep disorder patients and the control group, especially in the amplitude of the I wave (significantly lower in patients with macroglossia), the extension of the O-F segment, and the amplitude of the O-F segment and hypopharyngeal area. CONCLUSION: Although not a standardized test, acoustic pharyngometry was proved to be a useful method both in the diagnosis and severity of obstructive sleep apnea, and in post-operative monitoring of upper airway surgery in patients with sleep disorders.

A 21-year-old man presented with nasal obstruction of the right nasal fossa of 1 year duration. Nasal endoscopy revealed in the right inferior turbinate head a rounded neoplasm about 1 cm in diameter. Cytologic study of a nasal scraping specimen disclosed numerous clusters containing columnar cells with cytomegaly, prominent multinucleation, markedly sparse shortened cilia; the cytoplasm contained an acidophil area and a small round area that stained poorly; cells with a large intracytoplasmic vacuole that was acidophil and PAS+. Serology tests using the nested polymer chain reaction (PCR) technique on serum, nasal and pharyngeal smears revealed an Epstein-Barr virus (EBV) infection that was confirmed at electron microscopy. The clinical and cytological features resolved 19 months after the initial evaluation. Conclusion The authors advise carrying out clinical (endoscopy, serology, etc.) evaluation of all endonasal neoplasms and to routinely perform cytological study on nasal scraping specimens. When samples test positive for EBV, nasal and nasopharyngeal endoscopy should be performed regularly to detect possible evidence for nasopharyngeal carcinoma (NPC).

Summary Objective This study aims at defining the incidence of rhino-bronchial syndrome (RBS) in children in order both to verify the influence of nasal obstructions on the disease and to determine therapeutic strategies which may cure the syndrome effectively at its early stage. Methods The investigation includes 128 non-allergic children with obstructive disorders (adenoid hypertrophy, septal deviation, etc.) and rhino-sinus inflammations associated with bronchopulmonary diseases (asthma, chronic cough, bronchopulmonary infections). Medical and/or surgical treatment was chosen in consideration of the type and entity of the patients’ main nasal pathology. At least 1 year follow-up was provided for each case to establish the improvement in the disorders affecting both the lower and upper airways. The results were statistically assessed. Results Medical and mainly surgical treatment always cured the upper airways disorders in patients with chronic nasal obstruction and rhino-sinus inflammation. Improvement of bronchopulmonary disease was reported in about half of the patients (49.4%). Statistically significant results were obtained only in the group with recurrent bronchopulmonary infections (80.9%, p Conclusions The study confirms that RBS may be quite frequent in childhood. This disorder has a multifactorial pathogenesis prevalently due to nasal obstruction and rhino-sinus infections. In the population studied, among the lower airways disorders, only infective bronchopulmonary inflammation showed a significant correlation in the assessment between lower and upper airways disorders. In order to prevent the progression of the syndrome to serious pathologic events of the lower airways, a prompt and effective treatment of children's nasal disorders is thus recommended.

The examination of a large series of cervical lymph nodes in patients with head and neck cancer revealed the presence of incidental metastases of occult thyroid carcinoma in eight patients, of which six cases were squamous cell carcinoma of glottic and supraglottic sites of the larynx and two cases were pyriform sinus and tongue carcinomas. Three patients had two lymph nodes and the remaining patients had one lymph node each involved. The nodal chains affected were the jugular (n=5; level IV), Kuttner (level II), supraomohyoid (level III) and supraclavicular (level VI). In four cases, a subtotal thyroidectomy or unilateral lobectomy was performed during laryngectomy (for surgical reasons) or after histologic nodal examination; a minimal focus of thyroid papillary carcinoma was detected in one patient. Three of eight patients died from recurrence of the squamous cell carcinoma; no case presented clinical evidence of thyroid malignancy. The differential diagnosis from benign thyroid heterotopia was based on the presence of minimal nuclear atypia. The choice of treatment of patients with a coexisting neoplasm characterized by poor prognosis is difficult, and contrasting opinions exist regarding the use of radical thyroidectomy and the subsequent management. As reported in the literature (66 cases), the more aggressive squamous cell carcinoma will determine the prognosis of these patients; in fact, only one of the referred cases died of cerebellar metastases of the thyroid cancer. Our results emphasize the importance of an accurate re-evaluation and follow-up of patients with incidental occult metastases for detection of a primary thyroid tumor. In the general population, this incidental nodal involvement may be related to a minimal occult thyroid carcinoma.

Objectives To define when laser resection of early-stage glottic carcinoma is indicated and to compare the results obtained by laser surgery with other therapeutic options. Study Design Retrospective study of 151 patients treated from April 1982 to June 1996 in the Department of Otorhinolaryngology at “La Sapienza” University. We provide analysis of indications, techniques, and oncologic results of this study. Methods Glottic tumors were treated with type III, type IV, and type Va cordectomies according to the classification of endoscopic cordectomies proposed by the European Laryngological Society in 2000. Results The results are summarized as follows: all patients with carcinoma in situ Tis are free of disease with local control rate at 3 years of 100%; 2 died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 83.2%. Of the 117 patients with stage T1a cancer, 110 are free of disease at 3 years with local control rate of 94%; 4 patients died of other causes without evidence of local recurrence with an overall survival rate of 96.5%. Of the 22 patients with stage T1b cancer, 20 are free of disease at 3 years with a local control rate of 91%; 1 patient died of other causes without evidence of local recurrence with an overall survival rate at 3 years of 95.4%. Conclusions According to our experience, we can conclude that endoscopic laser surgery is an efficacious and cost-effective treatment for early stage glottic cancer.

Extramedullary (EM) involvement occurs infrequently in acute promyelocytic leukemia (APL) and usually involves skin and CNS. We describe seven patients (four observed at a single institution) who relapsed in various sites of the auditory apparatus, including the external canal and middle ear (temporal bone). Front-line treatment included ATRA and chemotherapy (six patients) or chemotherapy alone (one patient). Three patients had concomitant hematologic relapse, two had molecular relapse and two were in hematologic and molecular remission when ear localization was documented. Local symptoms that stimulated further diagnostic studies included ear bleeding/discharge in the first patient, but were mild in the others (hypoacusia, five patients; earache, two patients). Ear involvement by leukemia was documented by histological and/or molecular studies after local surgery in five cases, and by CT scan or NMR in the remaining patients. We suggest that the ear might represent a specific sanctuary for disease involvement in APL.

The aim of this study was a retrospective analysis of the oncological results in a group of patients treated by frontolateral laryngectomy using clinical and histopathological correlations in order to review the indications for surgery. In all, 150 patients underwent frontolateral laryngectomy as described by Leroux-Robert. All were staged according to the 1992 UICC TNM classification. Factors examined were clinical T, histopathological T, tumor infiltration of the anterior commissure and the vocal cord muscle, survival without disease and the percentage of local relapses. Twenty-one patients had local relapses (14%), while four patients developed second primary tumors (2.7%). Among the different correlations examined, microscopic infiltration of the anterior commissure was related to a greater number of local relapses (25.5% vs 5%) and a 55% survival with with no evidence of disease (NED). The crude 5-year NED survival was 66% and was influenced by second primary tumors and metastases (7.4%) and non-oncological diseases (14.6%). These data show the need for a re-evaluation of the indications for frontolateral laryngectomy because subtotal reconstructive laryngectomy could be performed more safely in the more advanced cases. In contrast, cases with more limited tumors might be better treated by laser for a more functional and cost-beneficial result.

Background The ARIA document introduced a new classification of allergic rhinitis, based on its duration and severity, which is graded on the basis of the impact of AR on daily activities and quality of life. Nasal cytology is a simple and reliable diagnostic tool to identify the presence and type of inflammation in rhinitis. Thus, we assessed severity of AR by nasal cytology on the basis of the ARIA classification. Methods Patients suffering from AR caused by grass pollen only, and healthy subjects were studied. The severity of rhinitis was defined according to ARIA. All subjects underwent nasal cytology, using a Rhino-probe. Scrapings were air-dryied and stained by May-Grunwald-Giemsa. Differential cell count was expressed as % of the total leukocytes. Unpaired t test was used for comparisons. Results Sixty-two grass-allergic patients (34 men, mean age 35.2 years) and 18 healthy subjects (10 men, mean age 32) were studied. 67.8% of patients had intermittent AR (33.9% mild and 33.9% moderate-severe) and 32.2% had persistent AR (14.5% mild and 17.7% moderate-severe). The patients with moderate-severe AR had significantly more mast cells and lymphocytes than those with mild AR, with a relatively smaller number of neutrophils and eosinophils. Mast cells and/or lymphocytes could be detected in only 3/30 patients with mild rhinitis, and in 19/32 patients with moderate/severe rhinitis. No difference in cell counts was found when comparing intermittent and persistent AR. Conclusions Moderate/severe allergic rhinitis displays a cytological inflammatory pattern different from mild rhinitis.

Background Several ultramicroscopic studies have confirmed the presence of biofilms in ENT diseases, such as chronic rhinosinusitis, nasal polyposis or adenoid hypertrophy. Recently, it has been reported that light microscopy nasal cytology can identify biofilms, which appear as cyan-stained “Infectious Spots.” Methods Subjects suffering from a wide spectrum of nasal disorders, after a detailed clinical history and ENT examination, underwent nasal fibroendoscopy, skin prick test, rhinomanometry and nasal cytology. Results 1410 subjects were studied. The infectious spot was present in 107 of them (7.6%) patients; this percentage reached 55.4% in 193 patients who had clear cytologic signs of infectious rhinitis. Biofilms were largely more frequent in patients with adenoid hypertrophy (57.4%), followed by nasal polyposis (24%), chronic rhinosinusitis (9.5%) and non-allergic “cellular” rhinitis (7.6%). Nasal cytology was normal in the remaining patients, with no infectous spot detectable. Statistical analysis showed that nasal resistances were significantly higher in presence of biofilms in patients affected by adenoid hypertrophy (P = 0.003), nasal polyposis (P < 0.001), chronic rhinosinusitis (P = 0.018) and septal deviation (P = 0.001). Conclusions The results demonstrate that biofilms are not present only in infectious rhinopathies, but also in inflammatory and/or immune-mediateddiseases. Biofilms were more frequent in patients with higher degree of nasal obstruction as assessed by nasal endoscopy (grade III and IV adenoids and stage-3 polyposis) and rhinomanometry. Nasal cytology, by allowing the identification of biofilms represents a useful diagnostic tool with promising research implications.