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Background Myringotomy with ventilation tube (VT) insertion is one the most performed procedures in children and adolescents worldwide. VTs usually remain in the eardrum between 6 and 12 months and during this period otorrhoea is the most frequent complication. For years, parents have been advised to protect the ears of children with VTs from contact with water, as water exposure in the middle ear is likely to cause acute otitis media. However, there is a growing evidence that water should not traverse VTs unless under significant pressure, so routine water precautions should not be prescribed. Despite these recommendations, many otolaryngologists and paediatricians continue to prescribe earplugs during bathing or swimming or advise against aquatic activities. There are already two reviews in the current literature on this topic: the first used strict selection criteria and included only 2 high-quality studies, while the second presented evidence up to 2005. The aim of this review is to identify, summarize and critically appraise the current evidence concerning water precautions for children with VTs. Methods Two independent reviewers separately searched for related scientific papers. A qualitative synthesis analysis was performed considering the selected studies regarding the effects of water exposure on paediatric subjects with VTs. Results Four randomized clinical trials (RCT) and five prospective cohort studies were included, for a total of 1299 patients aged from 3 months to 14 years. No statistically significant difference in otorrhoea incidence between water exposure with and without ear protection in children with VTs, and between water exposure and no water exposure in children with VTs, was found. Therefore avoiding water is at best inconvenient and at worst may delay learning to swim. The decision to protect the ear when exposed to water should be individualized and protection should be recommended during the first month after surgery and in cases of recurrent otorrhoea. Conclusion Based on the literature available, allowing water surface activities with no ear protection seems to present a minimum risk, so it is not necessary to prohibit patients from swimming. However, some recommendations should be followed.

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is typically characterized by Type 2 inflammation. Several biomarkers of eosinophilic inflammation, including Galectin-10, also known as Charcot-Leyden crystal protein (CLCP), have been identified to establish eosinophilic infiltration of polyps, a reliable predictor of recurrence. Objective: We aimed to evaluate the Galectin-10 expression in nasal polyps of patients with CRSwNP and to assess the correlation of Charcot-Leyden crystals expression to the severity of CRSwNP according to Clinical-Cytological Grading (CCG). Methods A double-label immunofluorescence was performed to evaluate the expression of Gal-10, CD15, Tryptase, and CD63 and their eventual co-localization on histological samples of 18 patients with CRSwNP. Double-positive Gal-10+CD15+ and Galectin-10+Tryptase+ inflammatory cells were counted by confocal microscopy. Results Galectin-10 was detectable in all examined tissues from CRSwNP patients, and its expression increased as low, medium and high CCG tissues were examined, respectively. Galectin-10 was extensively present in inflammatory cells, while limited Galectin-10 deposits were detected around mucosal epithelial cells. Conclusion We showed the strong correlation between CCG and Galectin-10 expression, mainly colocalized with infiltrating eosinophils and mast-cells, in patients affected by CRSwNP.

ObjectiveSodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media.MethodA systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted.ResultsFrom 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application.ConclusionMesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.

Gli idrocarburi (HC) sono uno dei principali inquinanti ambientali. Una tecnologia promettente per il trattamento di siti contaminati si basa sulla biodegradazione degli inquinanti da parte di popolazioni microbiche capaci di utilizzare HC come fonte di carbonio ed energia (Biorisanamento). La necessità di risanare siti contaminati richiede da una parte la caratterizzazione delle comunità microbiche coinvolte nella biodegradazione, dall’altra lo sviluppo di interventi volti a migliorare il potenziale metabolico dei microrganismi degradatori. La nostra attività di ricerca ha avuto come obiettivo quello di caratterizzare e analizzare la biodiversità di comunità microbiche di un suolo contaminato da HC, verificarne il potenziale di biorisanamento, e valutare in microcosmo l’efficacia di un trattamento di biorisanamento. La comunità microbica di un suolo proveniente dal centro Italia contaminato da idrocarburi (HC) è stata caratterizzata mediante tecniche colturali e molecolari. La stima della contaminazione da n-alcani (C10-C40) è stata effettuata mediante analisi GC-FID. Batteri idrocarburo-ossidanti sono stati isolati su C16 e identificati mediante sequenziamento del gene 16SrRNA. L’intera comunità microbica è stata identificata tramite sequenziamento Illumina Miseq. Le potenzialità degradative delle comunità sono state valutate mediante amplificazione del gene alkB. Il suolo contaminato è stato sottoposto ad un trattamento di biorisanamento in microcosmo per 120 giorni, tramite biostimulation con C, N, P (10:10:1). Contestualmente i microcosmi sono stati areati con due sistemi differenti: landfarming o bioventing. L’efficacia è stata valutata tramite analisi degli HC residui (GC-FID) e identificazione delle comunità batteriche (sequenziamento Illumina) al termine dell’incubazione. Il suolo presenta elevati livelli di HC (4532,722 mg/ Kg). 26 ceppi batteri capaci di crescere su HC sono stati isolati, l’identificazione tassonomica di 18 ceppi mostra una predominanza di Proteobatteri, seguiti da Actinobacteria. Gli isolati appartengono a generi degradatori di idrocarburi policiclici aromatici (IPA) o alifatici (Pseudomonas, Nocardia, Hydrogenophaga, Stenotrophomonas, Delftia, Rhodococcus). L’analisi metagenomica mostra una comunità microbica HC-degradante piuttosto ricca e diversificata. I phyla più rappresentati sono costituiti da Acidobacteria, Actinobactera e Alphaproteobacteria; a livello di genere i più abbondanti degradatori di alcani sono Parvibaculum, Flavobacterium, Pseudoxantamonas, e Solimonas; i più abbondanti degradatori di IPA appartengono al genere Streptomyces e Ralstonia. La presenza del gene alkB conferma il catabolismo degli alcani alifatici nel suolo. Gli esperimenti di biorisanamento in microcosmo mostrano non solo un abbattimento del 30-35% di HC ma anche uno shift nella struttura e composizione delle comunità microbiche rispetto al suolo non trattato. Si osserva un aumento dell’abbondanza di batteri del Phylum dei Actinobacteria e Proteobacteria; questi ultimi diventano la componente predominante nel microcosmo sottoposto a bioventing. A livello di genere si osserva una maggiore diversità di batteri idrocarburo ossidanti, noti per degradare soprattutto IPA, rispetto al suolo non trattato. In termini di composizione e abbondanza le comunità microbiche dei microcosmi appaiono distinte tra loro. Nel microcosmo sottoposto a landfirming si osserva la predominanza del genere Enhydrobacter, Propionibacterium, Staphylococcus, Methylobacterium, mentre nel microcosmo sottoposto a bioventing si osserva la predominanza di Phenylobacterium, Gordonia, Ralstonia, Pseudoxanthomonas, Sphingobium. I risultati ottenuti mostrano che il suolo analizzato presenta un potenziale intrinseco di biorisanamento, dato dalla presenza di batteri idrocarburo-ossidanti altamente efficienti. I trattamenti di biorisanamento basati sulla tecnologia del landfarming e bioventing risultano efficaci per la rimozione degli HC da suolo e hanno un effetto sulla biodiversità delle comunità batteriche idrocarburo-ossidanti. L’abbattimento di HC osservato è da attribuire alla comunità microbica che cambia composizione e struttura quando il suolo è sottoposto a biorisanamento; favorendo i membri della comunità con metabolismo più attivo nelle condizioni testate, e portando alla formazione di un microbiota altamente specializzato nella degradazione di HC e adatto a crescere, prosperare e degradare in quelle condizioni ambientali.

Obstructive sleep apnea syndrome (OSAS) is common in childhood and is characterized by recurrent upper airway obstructive events during sleep. It is associated with significant morbidity, potentially influencing long-term neurocognitive and behavioral development, as well as cardiovascular sequelae. Children differ from adults with respect to etiology, clinical presentation, and medical and surgical management. A comprehensive review article concerning the pathophysiology, diagnosis, and treatment of OSAS was undertaken. To date, OSAS is a very common problem in children and is primarily caused by adenotonsillar hypertrophy, and adenotonsillectomy remains the first-line surgical treatment. Clinical and epidemiological studies show that OSAS is a multifactorial and complex disease with a strong genetic basis. OSAS should be recognized as a public health problem due to the increasing incidence of this condition secondary to rising rates of obesity in children. It has a significant impact on the growth and development of a child from a behavioral and neurodevelopmental perspective. This is particularly important in children with secondary medical conditions. It is therefore a crucial tailored approach to pediatric OSAS patients in order to diagnose and treat early this condition with a multidisciplinary team including otolaryngology, respiratory medicine, pediatrics, and clinical nutrition services.

Adenoid Cystic Carcinoma (ACC) is a rare malignant tumor, accounting for about 1% of head and neck malignancies and 10% of salivary gland cancers. The laryngeal localization of ACC is particularly rare because of the paucity of accessory salivary glands in this anatomical district. Prevalence is highest in the fifth and sixth decade of life with a slight female predilection and aetiology is unknown. Since laryngeal ACC characteristically grows slowly and occurs in the subglottis, the diagnosis, which is based on the combination of physical examination with fiberoscopy and neck-chest Computerized Tomography (CT), is often delayed. Nowadays the debate is still open about which is the best comprehensive therapy of this tumor. We present the case of a laryngeal ACC in a 68 year-old-woman, treated with total laryngectomy together with bilateral neck dissection and a literature review made with the purpose to point out the most recent advancements towards the definition of a gold-standard therapy. Laryngectomy results as the first choice treatment, while chemotherapy has minimal effects on this neoplasm and radiotherapy alone does not show the capacity to lead to complete resolution, but there is still the need of further studies to clarify the usefulness and the role played by neck dissection and postoperative radiotherapy.

The use of barbed sutures (BS) for the treatment of retropalatal collapse and vibration in patients suffering from snoring and obstructive sleep apnea (OSA) has significantly increased in the last few years. Many surgeons have discovered the advantages and unique properties of the BS and allowed the popular surgical pharyngoplasty techniques to be updated and improved. A systematic review was performed to identify all the clinical studies concerning the different barbed pharyngoplasty (BP) techniques used for the treatment of palatal collapse in snoring and OSA patients. A qualitative analysis of data extracted was conducted. We included 12 studies of which 10 are prospective and 2 retrospective: 9 single-arm studies on the efficacy of a specific BP technique, 1 randomized clinical trial on the comparison between BP and control groups, and 2 studies on the correlation between two different BP techniques. To date, in the literature, 5 different types of BP techniques have been described: barbed snore surgery, barbed reposition pharyngoplasty, barbed expansion sphincter pharyngoplasty, barbed suture suspension, and barbed soft palate posterior webbing flap pharyngoplasty. All the studies showed an overall improvement in the primary efficacy parameters investigated (apnea-hypopnea index, oxygen desaturation index, and Epworth sleepiness scale) in each of the surgical techniques performed without any major complications. Given the extreme heterogeneity of the studies analyzed, it is necessary to perform more randomized and control studies on large samples aimed to define the best BP technique based on its effectiveness, surgical success rate, patient’s compliance, and complications.

Introduction The management of parapharyngeal space (PPS) tumors is surgical, but the approach remains a challenge. Attention should be paid to avoid intra-operative bleeding, cranial nerves damage, and external scars. Presentation of case The authors report a case of a 23-year-old female, with complaint of progressive, painless swelling just below the right angle of the mandible of 6-month's duration. Magnetic resonance imaging images reported the presence of an oval-shaped expansive lesion (maximum diameter 3 cm), from the lower polar region of the parotid gland while fine needle aspiration cytology (FNAC) was not diagnostic. We performed a Trans Oral Robotic surgical excision of the tumors with Da Vinci Robot. Discussion Thanks to a detailed magnification, the authors were able to reach the PPS region through the tonsillar fossa saving the palatine tonsil without any significant bleeding or nerve lesions. The histological examination confirmed the diagnosis of pleomorphic adenoma of parotid gland. The decision on which surgical approach to be used is determined by site, size vascularity, histology of the tumor, and knowledge of radiological images. Conclusion There is not only 1 surgical approach for PPS tumors but the surgeon must know all the different options and possible outcomes. Transoral Robotic Surgery approach with Da Vinci could represent a valid option with a good knowledge of Robot surgical instruments and a detailed preoperative plan.

Background In response to the coronavirus pandemic 2019 (COVID-19), Italy established the national school closings from March 5, 2020. It has been shown that during school closures, there are significant decreases in the diagnoses of the respiratory infections. This has brought as well to a reduction in all those symptoms related to adenotonsillar hypertrophy. Methods The study included 162 children, aged between 3 and 13 years, waiting for adenoidectomy and/or tonsillectomy, eventually combined with tympanocentesis or tube insertion. Parents have been called to answer a telephone interview aimed at detecting how the symptoms related to adenotonsillar hypertrophy were changing during lockdown. Results There was an improvement in the overall symptomatology of children during the lockdown period. The value attributed by parents to the children's general assessment during the lockdown period decreased significatively during the quarantine (p = 0,0000). Conclusions The present study demonstrates that lockdown can have a positive impact on those specific diseases derived from precocious socialization and that it results to be particularly effective for the most vulnerable children. Indeed, lockdown has resulted to be so efficient that it has caused a modification in a medical and surgical therapeutic indication.

Introdution. In order to prevent or slow down the transmission of COVID-19, various public health measures have been introduced, including social distancing, environmental disinfection and the use of personal protective equipment (PPE). In this perspective, the clinical practice of healthcare professionals has changed dramatically. As a matter of fact, the use of surgical masks and N95 has significantly worsened the job performance of workers who deal directly with COVID-19 disease. Methods. The study included 116 health workers employed in the pulmonology, intensive care and infectious diseases departments of Bari and Foggia Hospital, directly involved in the healthcare of patients affected by COVID-19. Between May 1, 2020 and May 31, 2020, each participant completed an online questionnaire aimed to investigate the impact of the COVID-19 pandemic on workers’ lifestyle changes and job performances. We compared the results based on the type of mask used by each participant (surgical mask vs N95). Results. Although disturbances related to the use of the mask arose earlier in subjects who wore the N95 (p = 0.0094), healthcare workers that wore surgical masks reported a statistically higher average score for a greater number of disorders. Conclusions. This is the first study that compares the effects of the two most used PPE on the quality of life of health workers and which highlights the greater discomfort caused by surgical masks. This result brings to light a serious social problem, being surgical masks widely used in everyday life by ordinary people and non-healthcare workers. (www.actabiomedica.it)

Chronic rhinosinusitis (CRS) includes two main phenotypes: without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP). CRSwNP may be associated with comorbidity, mainly concerning asthma, aspirin intolerance, and allergy. CRSwNP patients may also be evaluated by clinical-cytological grading (CCG). The current study investigated the prevalence and characteristics of the different CCG and phenotypes in CRSwNP outpatients examined in clinical practice. This retrospective cross-sectional study enrolled 791 consecutive CRSwNP outpatients (424 males, mean age 48.8 years). In the total population, asthma was a common comorbidity (30.8%) as well as aspirin intolerance (24.8%), and allergy (50.8%). As concerns CCG-grading, 210 (26.5%) outpatients had low-grade, 366 (46.3%) medium, and 215 (27.2%) high. As regards cytological phenotypes, 87 (11%) had neutrophilic type, 371 (46.3%) eosinophilic, 112 (14.2%) mast cell, and 221 (27.9%) mixed. High-grade CCG was significantly associated with more frequent asthma, aspirin intolerance, allergy, recurrent surgery, and mixed cytological phenotype. Low-grade CCG was characterized by fewer comorbidities and operations, and neutrophilic phenotype. Therefore, the present study confirmed that CCG is a useful tool in the management of outpatients with CRSwNP. CRSwNP is frequently associated with asthma, aspirin intolerance, and allergy comorbidity. High-grade CCG is frequently characterized by a mixed cytological phenotype, thus, by more severe progress. These real-world outcomes underline that CRSwNP deserves adequate attention for careful management and optimal identification of the best-tailored therapy; CCG and cytological phenotyping could be fruitful tools in clinical practice. Asthma and aspirin intolerance should be adequately investigated in all CRS patients.

The majority of clinical studies on endothelial progenitor cells (EPCs) focuses on the role of these cells in cardiovascular diseases and no systematic studies exist regarding their variations in healthy subjects. In order to define the burden of angiogenesis in physiological conditions we assessed the frequency of peripheral blood endothelial colonies (PB-ECs) and their relation with other factors possibly involved in their function such as high-sensitivity C-reactive protein (hs-CRP), endothelial cell-specific mitogen factor (VEGF) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in a highly selected healthy population. A PB sample was obtained from 37/47 healthy subjects (age 40.2+/-15.0yrs; M/F 15/22) without known cardiovascular risk factors. The serum level of hs-CRP, VEGF, TIMP-1, the frequency of PB-ECs by clonogenic assay, and the number of early EPCs and late EPCs by flow cytometry analysis were evaluated. PB-ECs were formed by 40.5% of studied subjects with a mean of 0.40+/-0.82 colonies/10(6) cells. The differences in the frequency of colony formation between genders were not statistically significant. The subjects with PB-ECs were characterized by higher values of hs-CRP, when compared with those not forming colonies, 0.276+/-0.230 vs 0.095+/-0.077 mg/l (p=0.003) respectively, and of VEGF, 328.3+/-162.9 vs 202.68+/-118.53 pg/ml (p=0.02). No significant differences were found in TIMP-1 values. The EPC clonogenic potential seems to be related to hs-CRP and VEGF levels even in healthy population supporting the concept that these mediators are involved in physiological ECs function.