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Human papillomavirus is a sexually transmitted virus that is responsible not only for uterine cervical cancer, but also for the oral and oropharyngeal cancers. In this latter case, the virus indiscriminately affects both sexes at any age. Vaccination plays a key role in preventing infection and its possible consequences. Therefore, this study aimed to assess the degree of awareness of papillomavirus infection and its possible prevention in the Sicilian population. A prospective observational study was carried out on the Sicilian population through a self-administered questionnaire, consisting of 10 multiple-choice questions. The survey lasted from June 2021 to December 2021. A total of 844 respondents were included: 60.90% were female and 53.55% were aged between 21 and 30 years. Most of the surveyed population knew about the virus and the existence of the vaccine, however, many of them did not know about virus’s effects on the oral and oropharyngeal sites (49.17%), or about the indication for vaccination for males (39.69%). Oral and oropharyngeal papillomavirus-related cancers are an increasingly frequent finding, especially in young adults. Therefore, it is necessary and quite mandatory to educate the population about the risks that certain voluptuous habits may cause, with the help of general practitioners, schools, social media, and social networks.

Narrow-band imaging (NBI) represents a valid aid in laryngeal squamous cell carcinoma (LSCC) diagnosis for detecting vascular changes. However, LSCC and laryngeal papillomatosis (LP) show similar vascular patterns that may lead to misdiagnosis and improper treatment. This review aims to deepen this NBI limit in order to stress a careful preoperative evaluation of laryngeal lesions. The research was carried out on PubMed, Web of Science and Scopus databases using specific keywords. The topic of research was assessed by these parameters: accuracy, sensitivity, specificity, and positive and negative predictive values. This review included only five articles: they demonstrated that NBI is better than white-light endoscopy in detecting LSCC and LP. They also reported that LP is frequently mistaken for LSCC, resulting in high rates of false positives using NBI. This is the first review that emphasized this NBI limitation in distinguishing between LP and LSCC in cases of a type V pattern of intraepithelial papillary capillary loop. Although NBI application increased the rate of early cancer detection, LP reduces NBI accuracy. This drawback may lead to misdiagnosis and improper treatment. Our advice is to be careful in cases of type V pattern on NBI and to research LP epithelial and clinical features because it could be a pitfall.

The American Academy of Sleep Medicine and the American Academy of Otolaryngology–Head and Neck Surgery recommend surgery as an option for the treatment of OSAS, when noninvasive treatments such as CPAP or oral appliances have not been successful or are not tolerated. A gradual and logical approach must be taken into account when a patient seeks a surgical solution, and it is a fundamental requirement that the patient find a surgeon who understands both the pathophysiology of sleep apnea and anatomy of the upper airways (UA) to guarantee the best chances of success. The surgical options aim to solve the obstructive problem according to two ways, the first is the reduction of the content, and then acts through the volumetric reduction of soft tissues at the level of UA, most often at the level of palate, uvula, tonsils, adenoids and tongue. The second option aims at enlarging the container, and therefore on more complex interventions to adapt the bony structures of the skull. The soft palate in the snore-surgery is the anatomical site on which most of the attention has always been concentrated since it is responsible for most of the phenomena of snoring and most of the obstructive ones and has undergone the greatest innovations. The rationale for palatal surgery is to reduce volume and stiffen a structure that vibrating with the passage of air causes snoring and collapsing causes an obstruction of the UA. In general, interventions on the palate can be broadly divided into two groups, the first is represented by interventions that have the aim of reduce snoring, and in this case are less invasive surgeries, as the goal is that of stiffening the palate and reducing the excess mucosa that vibrating causes snoring. The second group consists of interventions that have the aim of reducing above the snoring especially the apnoic episodes, so they are interventions that have a greater invasiveness, since they must stiffen and reconstitute the functionality of a segment of the UA.

One of the most important complications of OSAHS in children is growth delay. The aim of this study was to investigate changes in clinical body growth, and laboratory growth in children with OSAHS after adeno-tonsillar surgery.In our study, among 102 children suffering from sleep-disordered breathing, 70 met the inclusion criteria because they were affected by OSAHS and adenotonsillar hypertrophy. In total, 96 children affected by adeno-tonsillar hypertrophy (55 males and 41 females) underwent nocturnal cardiorespiratory monitoring with Embletta MPR, monitoring for post-operative 24 hours. Patients underwent blood sampling to evaluate preoperative GH and IGF-1 serum levels, "placement" in Cacciari's growth charts and adenotonsillectomy and saturation monitoring for post-operative 24 hours. According to auxological parameters, 82.86% of the patients were below the fiftieth percentile of BMI Cacciari's growth charts and IGF-1 preoperative serum levels were below the normal range. All patients underwent adenotonsillectomy.All 70 patients recovered from OSAHS according to the results of nocturnal cardiorespiratory monitoring after six months. IGF-1 serum levels significantly increased after three months and one year after. All the auxological parameters showed a significant increase after surgery. We calculated the average annual growth in height of the patients before and after adenotonsillectomy (AT): the growth rate was impaired by OSAHS (5.4±1.3 cm/year), while in the following year post-surgery we found a significant growth speed acceleration (9.9±1.7 cm/year, P=0.001).In conclusion, growth delay in children can be caused by OSAHS, and when it is due to adenotonsillar hypertrophy, adenotonsillectomy is to be considered as the therapy of choice.

Purposes Reporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution. Methods Prospective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 months via phone interview, to understand whether patients had developed any further symptoms after the treatment. Results This study included 26 patients. All the patient without sialolithiasis have not reported any symptoms during the follow-up period. Two of those with sialolithiasis have not shown any signs of recurrence. The remaining three patients with non-resolved sialolithiasis had a recurrence of symptoms which were treated again with 1 intraductal administration of betamethasone, gentamicine and NAC, showing immediately a regression of the symptoms. Conclusions Intraductal administration of gentamicin + NAC + betamethasone seemed effective for the therapy of chronic obstructive sialoadenitis. Our protocol seemed effective also in that cases where it was not possible to remove or detect endoscopically an obstruction. In all these cases we have noticed an increase in the symptom-free time even in cases where it was not possible to remove the stones.

Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors. Results: 45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR = 5.043; p = 0.015) and recurrence (HR = 11.586; p = 0.012). Resection margin did not result an independent predictor (HR = 0.757; p = 0.653). Conclusions: Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices. Resumo: Introdução: O tratamento do carcinoma de células escamosas de laringe necessita de uma estratificação precisa do risco, para a escolha da terapia mais adequada. O significado prognóstico da margem de ressecção ainda é motivo de debate, considerando-se os resultados contraditórios obtidos em vários estudos sobre a taxa de sobrevida de pacientes com margem de ressecção positiva. Objetivo: Avaliar o papel prognóstico da margem de ressecção em termos de sobrevida e risco de recorrência de tumor primário através da análise de sobrevida. Método: Entre 2007 e 2014, 139 pacientes com carcinoma de células escamosas de laringe foram submetidos à laringectomia parcial ou total e foram acompanhados por um tempo médio de 59,44 ± 28,65 meses. O status de margem de ressecção e outras variáveis, como sexo, idade, grau do tumor, pT, pN, técnica cirúrgica adotada e radio- e/ou quimioterapia pós-operatória, foram investigados como fatores prognósticos. Resultados: Dos pacientes, 45,32% foram submetidos à laringectomia total, enquanto os demais foram submetidos à laringectomia parcial. As margens de ressecção em 73,39% das amostras estavam livres, enquanto em 21 pacientes (15,1%) a avaliação anatomopatológica encontrou uma das margens próxima e 16 indivíduos (11,51%) apresentaram margem de ressecção comprometida. Apenas seis pacientes (4,31%) apresentaram recidiva, o que ocorreu em 83,33% desses pacientes no primeiro ano de seguimento. A sobrevida doença-específica foi de 99,24% em um ano, 92,4% em três anos e 85,91% em cinco anos. A análise multivariada de todas as covariáveis mostrou um aumento na taxa de mortalidade apenas em relação à pN (HR = 5,043; p = 0,015) e recidiva (HR = 11,586; p = 0,012). A margem de ressecção não demonstrou ser um preditor independente (HR = 0,757; p = 0,653). Conclusões: Nosso estudo não identificou a margem de ressecção como fator prognóstico independente; a maioria dos artigos publicados anteriormente não tem escolhas metodológicas unânimes e as coortes de pacientes analisados não são fáceis de comparar. Para chegar a uma concordância unânime em relação ao valor prognóstico da margem de ressecção, seria necessário fazer metanálises em estudos que compartilham a definição da margem de ressecção, metodologia e escolhas terapêuticas pós-operatórias. Keywords: Laryngeal cancer, Resection margin, Local recurrence, Palavras-chave: Câncer de laringe, Margem de ressecção, Recidiva local

Background: The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps. Objectives: To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery. Methods: We prospectively evaluated data of patients undergoing middle ear surgery for chronic otitis media with and without cholesteatoma. All patients completed the SNOT-22 and ETDQ-7 questionnaires. They underwent surgery for their pathology, as appropriate. Results: The SNOT-22 score was higher in patients with retraction pocket and in patients whose retraction pockets recurred after surgery (p < 0.05). Patients with higher score at SNOT-22 questionnaire, were more likely to show recurrence of atelectasis aftersurgery. Conclusions: The SNOT-22 questionnaire, administrered before surgical procedure, can help in the identification of patients who are at risk of failure in the post-operative period, as well as ETDQ-7.

Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies of the neck, and for the majority of these patients the cause of death is a compromised airway, metastatic disease, superior vena cava syndrome, asphyxiation, or exsanguination. In case of the airway being compromised, emergency treatment is mandatory but not well defined. We report 4 different kinds of acute presentation of complications. Anaplastic thyroid cancer; diagnostic, clinical and prognostic indication, evaluation of choice of treatment are discussed. The spectrum of treatment varies from observation and preservation of the airway from a tracheostomy to extensive surgery. When a potentially curative resection is not feasible, the major challenge for the surgeons is the management of airway due to tracheal compression, unilateral or bilateral vocal cord paralysis and direct infiltration of the tumor in the tracheal lumen. Tracheostomy is indicated only in cases of insufficient respiratory glottic space and has the possible purpose of avoiding urgent tracheostomy. In cases of respiratory failure, after urgent tracheostomy it is also useful to perform a thyroid biopsy to make a diagnosis. PEG positioning is always indicated for the purpose of better nutrition in dysphagia patients. Any further surgical therapy, in cases of non-urgency and with a confirmed diagnosis, is, in our opinion, contraindicated due to the poor prognosis of the neoplasm.

(1) Background: Inferior turbinates&rsquo, hypertrophy is often associated with Eustachian tube dysfunction (ETD), radiofrequency turbinate reduction (RTR) may provide a long-term improvement of nasal obstruction and ETD-related symptoms. (2) Aim: The study aimed to compare ETD in atopic and non-atopic patients before and after RTR and to investigate the correlation between tympanometry and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). (3) Methods: Ninety-seven patients, ranging from 33 to 68 years old, were screened by skin tests and divided into atopic (G1) and non-atopic (G2). Eustachian tube function (ETF) was evaluated through tympanometry, William&rsquo, s test and ETDQ-7. (4) Results: A moderate to severe subjective ETDQ-7 was found in the 35.42% of G1 and in the 22.45% of G2 patients before RTR. William&rsquo, s test resulted normal in 141 ears (72.68%), partially impaired in 15 (7.73%), and grossly impaired in 38 (19.59%) before surgery. A grossly ETD was evidenced in the 19.59% of cases before surgery and decreased to 6.18% after surgery with a significant difference among atopic patients (p &lt, 0.001). (5) Conclusion: RTR may be considered a treatment option in patients suffering from ETD and inferior turbinates&rsquo, hypertrophy, RTR reduced the percentage of grossly impaired ET function (p &lt, 0.001). ETDQ-7 and William&rsquo, s test may represent valuable tools to assess ET function before and after surgery.

Respiratory epithelial adenomatoid hamartoma is a rare lesion of the nasal cavity whose etiology and pathogenesis are unknown and symptoms are unspecific. It can be isolated or associated with inflammatory process, first of all nasal polyposis. It’s considered a rare lesion because it’s poorly known and consequently correctly diagnosing is important to a right surgical treatment and follow-up. A 54-year-old man presented with a 10-year history of epistaxis, rhinorrhea and anosmia. Computed tomography showed soft tissue densities in all sinus cavities consistent with nasal polyposis and without bilateral widening of the olfactory cleft >10 mm and without bone erosion. Functional endoscopic sinus surgery was performed and the histopathologic diagnosis was respiratory epithelial adenomatoid hamartoma associated with nasal polyposis. There was no evidence of recurrence one year after the initial surgery. Respiratory epithelial adenomatoid hamartoma is a particular type of hamartoma of the nasal cavity. Etiology and pathogenesis of this disease are still unknown. Though, the close association between this lesion and nasal polyposis or asthma supports the correlation to inflammatory process. It has a male prevalence with a mean age of 50-60 years. It’s characterized by unspecific symptoms and a macroscopic aspect that could be confused with other pathological entities. For this reason correctly diagnosing is important to a proper treatment and to avoid a more aggressive surgical resection.

CPAP treatment decreases BP in OSA patients, especially in severe OSA, and in patients with poorly controlled BP. OSA adversely affects heart function and remodelling, but its role in the pathogenesis of HF remains unclear. Similarly, the impact of CPAP is uncertain, and results of the ongoing ADVENT-HF trial will provide more information. Several experimental studies in animals and humans indicate a central role of intermittent hypoxia in atherogenesis through multiple mechanisms. However, randomised controlled trials (RCTs) in patients with CAD and OSA found no difference in outcomes between CPAP-treated and untreated patients. The negative results of secondary prevention RCTs may be the result of exclusion of severely sleepy patients and poor compliance with CPAP treatment. In addition, room for improvement after substantial cardiac interventions may be very limited. Knowledge on arrhythmias in OSA has expanded in recent years, especially regarding AF and ventricular arrhythmias including sudden cardiac death. However, studies on the effects of CPAP are limited and controversial.

Objective: Tumours of the nasal septum are a rare and heterogeneous group of lesions in the sinonasal tract. The management of the different lesions of this site is debated. The aim of this study is to share our experience on a rare clinical condition and stimulate other centres to publish theirs. Methods: We retrospectively analysed the databases of sinonasal tumours treated at the Sections of Otolaryngology (ENT) of two University Hospitals (Palermo and Genova) between 2012 and 2020. Results: From the two databases, a cohort of 32 patients with tumours of nasal septum were selected. All patients underwent an endoscopic examination. Large tumours underwent preoperative computed tomography (CT) scan without contrast medium. In 22 (68.7%) cases, the preoperative radiologic evaluation also included magnetic resonance imaging (MRI) with gadolinium to obtain a better differentiation of the lesions and study the vascular pattern. All the large lesions were biopsied under endoscopic guidance using local anaesthesia; the same approach was used to remove the tumours and their attachment with safe resection margins. Conclusions: While malignant lesions require an excision of the mass with resection of all layers of the nasal septum, benign lesions must be typed according to histological considerations in order to plan the most appropriate type of surgical resection.

To evaluate whether EBV-DNA can be used as a diagnostic and follow-up parameter for nasopharyngeal tumors in a non-endemic population. The study was carried out in a university hospital. A retrospective study was conducted on 40 paraffin samples of histological preparations. EB-DNA was detected by real-time PCR technique. A prospective study was also conducted on a group of 30 patients who underwent nasopharyngeal biopsy for suspected nasopharyngeal carcinoma (NPC) by comparing EBV-DNA concentrations between the histological specimen and the serum. Quantification of genomic copies of EBV-DNA in serum and detection of anti-EBV antibodies was performed. In both groups the presence of high viral load of EBV-DNA was found in nonkeratinizing squamous cell carcinomas, in three cases of lymphepitomyoma and in 4 out of 6 cases of non-differentiated non-carcinoma lymph node metastases. squamous keratinizing cells. In all cases of NPC, an antibody pattern typical of reactivations (IgGVCA+, IgG-EA+, IgG-EBNA+) and IgA-EA-D, frequently positive in cases of NPC, has been highlighted. A good correlation between the high EBV-DNA charges and the histological diagnosis was highlighted. Our study also found that the assessment of viral EBV load can also be considered in the prognostic evaluation and in the follow-up of patients with NPC.

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

Obstructive sleep apnoea syndrome is a chronic condition characterized by frequent episodes of collapse of upper airways during sleep. Prevalence of the disease is settled at about 3–7%. Today, palatal surgery is a reference point in OSAHS treatment and there are many different surgical techniques. The purpose of our work is to compare post-operative results of palate surgery techniques used in our practice in OSAHS patients, studying the degree of patients’ satisfaction with a recent score recommended by Rashwan et al. called PPOPS (Palate Post-Operative Problems Score). A retrospective study was performed on a sample of 40 patients subject to different palate surgery techniques for OSAS. Analysed surgical techniques were: Expansion Sphincter Pharyngoplasty (ESP), Uvulopalatopharyngoplasty (UPPP), Anterior Pharyngoplasty (AP), Barbed Reposition Pharyngoplasty (BRP). Patients answered the PPOPS and the results for each of the four techniques were compared. Group differences in the questionnaire total score were evaluated through Tukey’s honest significance test for multiple (pairwise) comparisons. Overall average scores in the four groups were: AP 2.21, ESP 5.92, UPPP 2.8 and BRP 2.4. Comparing ESP with the other techniques (BRP, AP and UPPP) the scores were significantly higher (P < 0.05). Pairwise comparisons between the other three techniques (FA, UPPP and BRP) had a P value higher than 0.05, allowing to state that questionnaire results, in these cases, were similar to each other. Our work shows that different surgical techniques, even with the same purpose, could have different characteristics during follow-up. PPOPS is useful in post-operative for a better surgical practice.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of “CPAP usage data.” Upper airway optical fiber endoscopy with Müller’s maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

The aim of this study is to evaluate the efficacy and safety of prolonged therapy with low-dose clarithromycin in patients with chronic rhinosinusitis with polyps (CRSwP) after endoscopic sinus surgery (ESS). A total of 10 patients with CRSwP were identified and subjected to bilateral ESS. In post-operative patients they were treated with nasal wash with saline solution and steroid sprays (beclomethasone). During follow-up, after 30–40 days after the operation (M = 35.4 SD = +4.33), patients reported a worsening of symptoms with onset of nasal obstruction; reduction/loss of smell; headache; onset of viscous secretions and therefore all patients continued therapy with saline nasal irrigation, topical steroid therapy and started macrolide (clarithromycin 500 mg/pill: 1 pill/day for 3 days a week for 1 month). 22-item SinoNasal Outcome Test (SNOT-22) and a score to the endoscopic evaluation (endoscopic appearance score, EAS) before and after treatment were performed to evaluate efficacy of treatment. The results of the SNOT-22 and EAS showed statistically significant improvements (p

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

Background Reduced innate immunity responses as well as reduced T regulatory activities characterise bronchial asthma. Objectives In this study the effect of budesonide on the expression of TLR4 and TLR2 in T regulatory lymphocyte sub-population was assessed. Methods TLR4 and TLR2 expression in total peripheral blood mononuclear cells (PBMC), in CD4+/CD25+ and in CD4+/CD25− was evaluated, by flow cytometric analysis, in mild intermittent asthmatics (n = 14) and in controls (n = 11). The in vitro effects of budesonide in modulating: TLR4 and TLR2 expression in controls and in asthmatics; IL-10 expression and cytokine release (IL-6 and TNF-α selected by a multiplex assay) in asthmatics were also explored. Results TLR4 and TLR2 were reduced in total PBMC from asthmatics in comparison to PBMC from controls. CD4+CD25+ cells expressed at higher extent TLR2 and TLR4 in comparison to CD4+CD25− cells. Budesonide was able to increase the expression of TLR4, TLR2 and IL-10 in CD4+/CD25highly+ cells from asthmatics. TLR4 ligand, LPS induced Foxp3 expression. Budesonide was also able to reduce the release of IL-6 and TNF-α by PBMC of asthmatics. Conclusions Budesonide potentiates the activity of Treg by increasing TLR4, TLR2 and IL-10 expression. This event is associated to the decreased release of IL-6 and TNF-α in PBMC treated with budesonide. These findings shed light on new mechanisms by which corticosteroids, drugs widely used for the clinical management of bronchial asthma, control T lymphocyte activation.

// Agostino Serra 1 , Rosario Caltabiano 2 , Giacomo Spinato 3 , Salvatore Gallina 4 , Salvatore Caruso 5 , Venerando Rapisarda 6 , Paola Di Mauro 1 , Veronica Castro 1 , Angelo Conti 1 , Luisa Licciardello 1 , Luigi Maiolino 1 , Salvatore Lanzafame 2 , Salvatore Cocuzza 1 1 Department of Medical and Surgical Sciences and Advanced Technologies “G. Ingrassia”, ENT Section, University of Catania, Catania, Italy 2 Department of Medical and Surgical Sciences and Advanced Technologies “G. Ingrassia”, Section of Anatomic Pathology, University of Catania, Catania, Italy 3 ENT Department, Rovigo Provincial Hospital, Rovigo, Italy 4 Department of Experimental Biomedicine and Clinical Neurosciences, Otolaryngology Unit, University of Palermo, Palermo, Italy 5 Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic and Research Group for Sexology, University of Catania, Catania, Italy 6 Department of Clinical and Experimental Medicine, Section of Occupational Medicine, University of Catania, Catania, Italy Correspondence to: Salvatore Cocuzza, email: s.cocuzza@unict.it Keywords: paranasal sinuses, inverted papilloma, human papilloma virus, hormonal receptor expression, immunohistochemistry Received: January 13, 2017 Accepted: April 03, 2017 Published: April 17, 2017 ABSTRACT Inverted papilloma (IP) is a locally destructive, benign neoplasm of the nose and paranasal sinuses with a high tendency for recurrence, a significant potential for malignancy, and an etiology that today is still uncertain. The expression of hormonal receptors in neoplastic tissues has been the focus of intensive research for its potential diagnostic, prognostic, and therapeutic significance. The aim of this study was to assess the potential estroprogestinic receptor expression in patients undergoing sinus surgery for IP. A retrospective study was carried out, on surgical specimens of 73 patients who underwent endoscopic sinus surgery for first manifestation of sinonasal IP (primitive IP group) and in 21 subjects who had developed a recurrence (relapsed IP group). The results of the immunohistochemical analysis of the first group showed the absence of receptor expression for PGR in all cases analyzed and the presence of a low positivity for ER in 11 cases ( P > 0.082). Similarly, in the second group the results showed a low presence of ER receptors in 3 of the 21 cases ( P > 0.068), while there was no evidence of PGR receptors in the examined samples. In addition, in 11 of the cases only 3 were considered positive (27.2%) showing a recurrence during follow-up ( P > 0.068). Our results suggest that the sinonasal IP is a benign tumor independent of estrogen and progesterone, and the receptors for these hormones are therefore unsuitable as predictors of relapse or possible prognostic indicators and therapeutic targets.

Cigarette smoke represents the major risk factor for chronic obstructive pulmonary disease (COPD). Cigarette smoke extracts (CSE) alter TLR4 expression and activation in bronchial epithelial cells. Carbocysteine, an anti-oxidant and mucolytic agent, is effective in reducing the severity and the rate of exacerbations in COPD patients. The effects of carbocysteine on TLR4 expression and on the TLR4 activation downstream events are largely unknown. This study was aimed to explore whether carbocysteine, in a human bronchial epithelial cell line (16-HBE), counteracted some pro-inflammatory CSE-mediated effects. In particular, TLR4 expression, LPS binding, p21 (a senescence marker), IL-8 mRNA and release in CSE-stimulated 16-HBE as well as actin reorganization in neutrophils cultured with supernatants from bronchial epithelial cells which were stimulated with CSE and/or carbocysteine were assessed. TLR4 expression, LPS binding, and p21 expression were assessed by flow cytometry, IL-8 mRNA by Real Time PCR and IL-8 release by ELISA. Actin reorganization, a prerequisite for cell migration, was determined using Atto 488 phalloidin in neutrophils by flow cytometry and fluorescence microscopy. CSE increased: (1) TLR4, LPS binding and p21 expression; (2) IL-8 mRNA and IL-8 release due to IL-1 stimulation; (3) neutrophil migration. Carbocysteine in CSE stimulated bronchial epithelial cells, reduced: (1) TLR4, LPS binding and p21; (2) IL-8 mRNA and IL-8 release due to IL-1 stimulation; (3) neutrophil chemotactic migration. In conclusion, the present study provides compelling evidences that carbocysteine may contribute to control the inflammatory and senescence processes present in smokers.

BACKGROUND: Allergic rhinitis (AR) is characterized by a remodeling of nasal epithelium. Leptin adipokine has been already identified as a marker of homeostasis in human bronchial epithelial of asthmatics. TGF-β is a multi-functional cytokine and conflicting findings exist regarding its role in the remodeling responses of the upper airways in allergic rhinitis. OBJECTIVE: We sought to investigate ex-vivo the expression of leptin/leptin receptor pathway and TGF-β in human nasal epithelium. METHODS: 41 biopsies of inferior turbinates obtained from allergic patients with AR (A, n = 20) and from healthy control subjects (C, n = 21) were analyzed for leptin/leptin receptor and for TGF-β 1, 2, 3 expression by immunohistochemistry and immunofluorescence staining and quantitative real-time PCR. RESULTS: In allergic turbinates the expression of leptin and its receptor significantly decreased in comparison to healthy controls (p= 0.01 and p= 0.0006 respectively), whereas TGF-β expression did not. Accordingly, leptin receptor mRNA was reduced in AR. Leptin mRNA was not detected in all recruited subjects. Immunofluorescence showed a prevalence of co-localization of leptin and its receptor in basal epithelial cells, whereas TGF-β was mainly localized in apical epithelial cells. CONCLUSION: Leptin/leptin receptor pathway may play a role in epithelium homeostasis also in allergic rhinitis and despite TGF-β is not representative of epithelial nasal remodeling, it is not co-localized with leptin/leptin receptor pathway.

BACKGROUND: The aim of this study was to determine the long-term (> 6 month) outcome of patients suffering from obstructive sialadenitis treated by sialoendoscopy. METHODS: Between 2009 and 2013 seventy-six subjects underwent sialoendoscopy under local anesthesia at the University Hospital P. Giaccone of Palermo. RESULTS: The mean age of presentation was 50.5 years for male (56.6%) and 44.7 years for female (43.4%). The presenting symptoms were frequent pain in 72% of cases, frequent purulent secretions in 65% of cases, frequent swelling in 62% of cases and frequent bitter taste in 44% of cases. Affected glands were in 54 cases the submandibular unilaterally, in 21 cases the parotid unilaterally and in 1 case the submandibular bilaterally. Preoperative ultrasound showed in 30 cases a sialolitiasis and in 19 cases a ductal stenosis, in 3 cases were both associated. In 46 cases showed a ductal dilatation, variably combined with the previous two and in 13 cases ultrasound gave no indication. Average operating time was 60.7 minutes (range 35-125 min). In 35 cases it was necessary to perform a papillotomy. Presence of stones was shown in 36 patients, in 3 cases these stones were multiple. Endoscopic removal of stones was achieved in 72.2%, with a mean size of 3.6 mm (range 0.7-5.5 mm), only two were larger than 5 mm. In five of this cases was performed a trans-oral combined approach. In 15 cases was highlighted a ductal stenosis, in 6 cases associated with mucus plugs, that were treated with daily irrigations with Thiamphenicol glycinate acetylcysteinate. A percentage of 64.8% of patients had complete resolution of symptoms after sialendoscopy, with 25% having partial resolution of symptoms and 6.6% required the removal of the gland. CONCLUSIONS: Sialendoscopy is the procedure of choice for the diagnosis and treatment of chronic non-lithiasic sialoadenitis, but unlike its apparent simplicity has a significant learning curve, and need appropriate selection of patients.

Leptin is involved in the lung epithelial homeostasis. Its role in the nasal tract is largely unknown. Allergic rhinitis (AR) is induced by the allergen exposure leading to consequential structural abnormalities in the nasal epithelium. Topical corticosteroids are recommended as first-line therapy in AR. Parietaria pollen is one of the most important allergenic sources in the southern Europe. In vitro, in human nasal epithelial cell line RPMI 2650, we aimed to determine whether allergen stimulation acts on leptin/leptin receptor pathway and how fluticasone furoate (FF) influences this pathway. The effects of the major allergen recombinant Par j 1 (rPar j 1), of FF, of leptin, and of TGF-b1 on cell proliferation, on leptin/leptin receptor expression and modulation (by clonogenic test, by RT-q- RT-PCR, by immunocytochemistry and by flow-cytometry), and on STAT-3 activation (assessing nuclear translocation by western blot analysis) were assessed. We found that rPar j 1 and TGF-b1 significantly decreased cell proliferation and down-regulated the leptin/leptin receptor pathway, whereas FF and leptin reverted them, both alone and in combination. Furthermore, rPar j 1 reduced, while leptin and FF increased STAT-3 activation. In conclusion, FF and leptin itself are able to preserve nasal epithelial homeostasis restoring the leptin/leptin receptor pathway altered by rPar j 1 exposure.

Salivary gland tumors, most of which are rare benign tumors, represent a histologically heterogenous group with the greatest diversity of morphological and cellular features. The aim of this study is to analyse the expression and possible interactions between gelatinases (MMP-2, MMP-9) and cyclooxygenases (COX-1, COX-2) in some benign salivary gland tumors. We investigated the expression of gelatinases and cyclooxigenases in control salivary gland, Pleomorphic adenoma and Warthin's tumor through immunohistochemistry and Reverse Transcription – Polymerase Chain Reaction (PCR). We identified the expression of both classes of enzyme in normal samples and in the two types of pathological samples without any quantitative differences. From the present data no significant differences emerge in the expression of these enzymes among the different pathologies examined. Nevertheless, due to the small number of samples included in this study, general statements regarding correlation between the degree of severity of the tumoral pathology and the quantitative expression of these potential tumoral markers can not be made.

Objective The aim of the study was to evaluate the true incidence, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this type of posttraumatic vertigo from other types of dizziness complained after trauma. Methods This was a retrospective study comprising patients referred to our center after whiplash injury. The patients were evaluated with neurotologic examination including bedside and instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was submitted before and after treatment and was evaluated. The BPPV patients were separately evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic BPPV was done. Results Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2 years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases. The instrumental neurotologic assessment did not show any alteration of either vestibulospinal reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3 to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning maneuver. The Dizziness Handicap Inventory score improved in all patients treated with repositioning maneuvers, but no difference emerged with idiopathic BPPV data. Conclusion BPPV after whiplash injury could be unveiled with a simple bedside examination of peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more maneuvers to achieve satisfactory results.

Objective The aims of present research were to analyze the visually guided eye movements of subjects suffering from the consequences of whiplash injury and the possibility to differentiate patients from feigning subject. We analyzed the role of video-nystagmography for clinical and forensic aspects. Methods It was a prospective case–control study. Detailed history was taken and patients were thoroughly investigated. Smooth pursuit and saccadic eye movements were assessed in 33 patients affected by imbalance following a whiplash injury. A control group of 20 subjects was also evaluated. All tests were executed in neutral neck position and after left and right trunk rotation. Results The t -test, applied to all parameters showed that difference of the parameter between the groups was not statistically significant. Conclusion The visually guided eye movement evaluation does not seem to offer a clinically relevant method to differentiate patients suffering from the effects of whiplash injury from normal subjects.

The aim of this study was to verify the efficacy and the safety of transtympanic dexamethasone to treat sudden sensorineural hearing loss as first and single drug method. Considering ethical implication of performing a mininvasive procedure on middle ear, we matched such proposed treatment with systemic prednisone administration that represents the widest adopted protocol. Randomized prospective study was conducted. The inclusion criterion was a sudden sensorineural hearing loss of at least 30 dB across three contiguous frequencies over a period of 24 h. Group A received transtympanic steroid injections; Group B received oral administration of steroids. 25 patients were treated with transtympanic therapy whereas 21 underwent systemic treatment. The mean of initial PTA was 59 dB for the whole series: 65 dB for group A and 51 dB for group B. The recovery better than 10 dB was obtained in 80% of patients of group A and in 17 81% of patients of group B, with a total of 80.5%. The mean relative gain in PTA was 41.16% in the group A and 44.7% in the group B. In the frequencies tested (0.5, 1, 2, and 4 kHz) PTA improvements after transtympanic treatment were higher than after systemic treatment, but these differences were not statistically significant (P = 0.61). Both transtympanic and systemic treatment had similar clinical recovery times. This prospective randomized clinical study showed good result in terms of hearing recovery, better than the expected results of the simple observation without treatment. We can consider transtympanic administration as a first line treatment, because of the statistical analysis confirmed similar results with systemic therapy, reducing possible side effects of systemic drug administration. The delay of treatment does not influence the outcome, allowing treating patients within 10 days of onset.

Purpose: Evaluation and discussion of the procedure of the gufoni manoeuvre and its advantages in the treatment of BPPV of LSC Matherial and methods:Prospective study of 58 patients affected by LSC BPPV who where office-treated with Gufoni manoeuvre Results:Seventy-nine percent of ptients so treated had complete resolution of symptons, and 6,9% did not show any improvement in their symptons.The remaining 13,8% had a conversion into posterior semicircular BPPV Conclusions:Gufoni''s manoeuvre is effective in treating patients suffering from BPPV of LSC;it is simple to perform;there are not many movement to execute, it needs low time of positioning, and positionsare confortable to the patient Conclusion

During the last 20 years, various conservative surgical techniques have been proposed to treat larynx cancer. On the basis of our various experiences and of the ultrastructural data on the tissues treated with radiowaves, we decided to also use radiosurgery in operations under direct microlaryngoscopy. We select 18 patients suffering from epidermoid carcinoma. These patients had been referred to our ENT clinic at the Polichnico of Palermo between 1999 and 2001. The authors describe the surgical procedures used and emphasize the advantages of radiosurgery in the treatment of larynx cancer.

Kabuki syndrome (KS), also identified as Kabuki make-up syndrome or Niikawa-Kuroki syndrome, is a multiple malformation/mental retardation syndrome that was described initially in Japan but is now known to occur in many other ethnic groups. The syndrome is characterized by varying degrees of mental retardation, postnatal growth retardation, distinct facial characteristics resembling the Kabuki actor's make-up, cleft or high-arched palate, brachydactyly, scoliosis, and persistence of finger pads. There is no definitive laboratory diagnostic test for KS, thus diagnosis is based on phenotypic presentation and the exclusion of other known syndromes. Familial cases have been reported and autosomal dominant inheritance has been suggested. The most common otolaryngologic abnormalities in KS are large and protruding ears, preauricular fistula, mixed hearing loss, cleft lip, cleft palate. We report a case of KS associated with relapsing cholesteatoma and its management.