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Background: In patients with Gastroesophageal Reflux Desease (GERD), the digestive enzyme pepsin can reach the esophagus and extraesophageal sites and cause damage with inflammation and other tedious symptoms. Methods: In this work, a number of biocompatible, non-toxic, and hypoallergenic compounds were tested in vitro as pepsin inhibitors. The residual enzyme activity in the presence of the investigated compounds was measured through a convenient and reliable UV-vis method based on the cleavage of hemoglobin. This method is applicable even if the investigated additives are scarcely soluble in water and the test mixtures are dispersions rather than solutions. Results: A few negatively charged saccharides showed the highest effect among the investigated compounds. The inhibitory activity of pepstatin and lovastatin was also tested with the same method in a wide range of concentrations. These compounds turned out to be effective even if present in extremely low amounts. A docking/molecular dynamic investigation providesuseful insights into the binding site and the mechanism of action of pepstatin as an inactivating agent toward pepsin. Conclusion: In particular, the computational study indicates that the binding with this compound significantly increases the mobility of the active site residues and prevents them from cooperating in the reactive event.

The COVID-19 pandemic era is causing a relevant issue for the health. There is no specific drug able to antagonize the SARS-CoV-2 infection. As a consequence, there is growing interest about potential molecules able to contrast infection. In this regard, HMGB, an alarmin, may play a relevant role in pathogenic mechanisms induced by SARS-CoV-2. As HMGB1 is antagonized by glycyrrhizin, this substance could be potentially useful as ancillary treatment in COVID-19.

Children with recurrent respiratory infections (RRI) represent a social issue for the economic burden and the negative family impact. Local Bacteriotherapy is an attractive therapeutic strategy that could be potentially effective in preventing infections. The current article remarks on the existing evidence of preventing RRI by Local Bacteriotherapy.The literature search methodology was based on the articles cited by PubMed from 1980 to 2020. Respiratory infections include rhino-pharyngitis, otitis media, rhinosinusitis, pharyngo-tracheitis, bronchitis, and pneumonia. Several studies were performed to investigate the effects of Local Bacteriotherapy in children with RRI. Both intranasal and oral Local Bacteriotherapy were evaluated. The findings showed that Local Bacteriotherapy significantly reduced the number of RI episodes, their severity, the use of antibiotics, and school absences.Local Bacteriotherapy is a promising approach to RRI prevention and could be a profitable strategy to contrast infections in the future.

Tonsil hypertrophy (TH) and adenoid hypertrophy (AH) are very common in children. Adenoid is visible only by endoscopy. This study investigated the possible relationship between the tonsil and adenoid volume and the possible prediction of adenoid size. Globally, 991 children (461 females, 530 males, mean age 6.2 ± 2.3 years), complaining persistent upper airway obstruction, were consecutively visited at an otorhinolaryngological unit. TH was significantly (p

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a frequent disorder. From a clinical and an immunopathological point of view, different phenotypes and endotypes have been identified. The frequent comorbidity with asthma allowed to pave the way to the use of biological agents for the treatment of CRSwNP. Biological agents are targeted to antagonize IgE, interleukin (IL) 4, IL-5, and IL-13 at present. However, a correct and appropriate workup is mandatory, mainly concerning the exact definition of the specific pheno-endotype. The preliminary outcomes are promising, even though there is a need for well-established indications, criteria of responsiveness, duration, and safety. On the other hand, this personalized medicine could be fruitfully integrated with gold-standard medications, such as intranasal corticosteroids. As CRSwNP is a chronic disorder, treatment should be long-lasting, so complementary anti-inflammatory treatments could be opportunely integrated and/or alternated to steroids. (www.actabiomedica.it)

Introduction Acute otitis media (AOM) is the most common childhood disease leading to antibiotic use. More than 80% of children under three years of age experience at least one episode, and about one-third of these report significant recurrence of episodes. In recent years, several studies reported that normal nasopharyngeal flora inhibits growth of common otopathogens, suggesting that maintenance of an “adequate” nasopharyngeal flora might prevent occurrence of upper respiratory tract infections, including AOM. This study aims to determine whether five-month treatment with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray prevents recurrence of AOM and prescription of antibiotics in children with diagnosis of recurrent AOM. Methods Observational prospective cohort study including children aged 1–6 years with diagnosis of recurrent AOM registered with 31 Italian family pediatricians. 81 children were enrolled in the study from September 2016 to the end of the five therapeutic cycles of the Streptococcus salivarius 24SMB and Streptococcus oralis 89a supplied 7 days each month for 5 consecutive months. For each treated child, one untreated control was randomly selected, 1:1 matched for gender, age, and follow-up. Results 158 children (79 treated and 70 untreated) were included into the analysis (mean age, 3.9 years; 47% female). Univariate analysis showed a statistically significant 34% (95% CI 1%–56%) reduction in number of AOM episodes in treated children compared with those not treated. Significantly fewer antibiotics were dispensed among treated children (24%, 95% CI 1%–41%). Conclusions Our findings suggest that intermittent treatment of children with diagnosis of recurrent AOM with nasal spray containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a for a period of five months might be effective in preventing antibiotic use associated with recurrent episodes of AOM. Additional larger studies to address this important clinical problem are recommended.

Allergic rhinitis (AR) underlies many symptoms and complications which severely affect children's quality of life. This two-arm study aimed at evaluate the efficacy and safety of the medical device Narivent(®) versus topical corticosteroids in the symptomatic management of allergic rhinitis in paediatric patients. A randomized study was conducted. Forty subjects with a diagnosis of allergic rhinitis were randomized to receive one puff of Narivent(®) into each nostril twice daily for 30 days (n = 20) or to receive one puff of topical intranasal corticosteroid into each nostril twice daily for 30 days (n = 20). In both treatment arms, severity of major symptoms related to AR, including nasal congestion, rhinorrhoea, sneezing and nasal itching, was assessed subjectively on a 0-100 mm visual analogue scale. Nasal congestion, rhinorrhoea and sneezing improved significantly after 30 days of treatment with Narivent(®). Similarly, in topical steroids group severity of all subjective symptoms decreased significantly. Narivent(®) appears to be efficacious in treating nasal congestion and other major symptoms in children with AR over a 30-day period, showing comparable results to intranasal corticosteroids therapy but with a better safety profile.

Rationale and aim: Nasal congestion is a common symptom in allergic and non-allergic rhinitis, rhinosinusitis and nasal polyposis. Although various pharmacotherapy options exist, no agent is universally efficacious. The aim of this study was to evaluate the clinical effectiveness efficacy of Narivent, which is an osmotically acting medical device with anti-oedematous and anti-inflammatory effects, in a long-term (30 days) treatment. Methods: A single-centre prospective study with a pre-post design was conducted with consecutive enrolment in an Italian Otolaryngology Department of 56 both genders patients with persistent nasal congestion. Patients received 2 puffs of Narivent into each nostril 2 times a day over the course of 4 weeks. The severity of symptoms was assessed subjectively as measured by a 0 to 10 visual analogue scale (VAS) and the presence/absence of symptoms and signs. Differences in subjective and objective severity measures before and after treatment were compared using Paired-Sample Wilcoxon Signed Rank Test. Results: A significant improvement after treatment (p

Rationale and aim: Allergic rhinitis (AR) is a common disorder that affects people of all ages, peaking in childhood and in the teenage years. Although AR is not a serious disease, it is clinically relevant because underlies many symptoms and complications which severely affect children's quality of life. The aim of this study was to evaluate the clinical effectiveness of Narivent ® , an osmotically acting medical device with anti-oedematous and anti-inflammatory effects, in the treatment of symptoms associated with allergic rhinitis in a paediat- ric population. Methods: A single-centre prospective study with a pre-post design was conducted with consecutive enrolment in an Italian Otolaryngology Department of 20 both genders children with allergic rhinitis. Patients received 1 puff of Narivent ® into each nostril 2 times a day over the course of 4 weeks. The severity of major symptoms associated with AR, such as nasal congestion, rhinorrhoea, sneezing and nasal itching, was assessed subjec- tively as measured by a 0 to 10 visual analogue scale (VAS). Differences in subjective severity measures before and after treatment were compared using Paired-Sample Wilcoxon Signed Rank Test. Results: Nasal congestion, rhinorrhoea and sneezing significantly improve after treatment (p

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

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

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

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

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

Summary To date, several aspects of allergic rhinitis remain controversial. In particular, data concerning its epidemiological evolution are extremely contradictory and vary between negation and assertion of an increased prevalence within the last decade. In the study discussed in this paper, our aim was to follow the evolution of allergic rhinitis in three different territorial areas of Central Italy in the last 20 years and to analyse the long-term efficacy of treatment. Between 1980 and 1981, 1620 children, attending seven state schools (four elementary and three lower secondary), were screened for allergic rhinitis. All children underwent a skin test on the inner forearm. Positive-skin-test children were examined to specify the exact nasal allergy. Between 1998 and 1999, positive-skin-test patients were contacted and re-examined. The results revealed that elementary school children showed lower degrees of skin positivity, a better nasal patency, a more efficient nasal clearance and less frequent anomalous radiological findings. Seventy-three children were positive to skin tests (4.5%). Forty-six positive-skin-test subjects were re-examined: 21 recovered, 12 were unchanged, 10 developed complications, three become asthmatics. Twenty-one subjects had not received any treatment, 15 were treated with symptomatic drugs, and 10 with immunotherapy. Our study showed an increased prevalence of allergic rhinitis in the last 20 years of the 20th century, with a jump from 4.5 to 10–20%; moreover, it showed that immunotherapy guarantees remission of local symptoms and valid protection against localized and bronchial complications. Symptomatic treatment with antihistamines and/or corticosteroids, although not always resolutive, represents a valid alternative.

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

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

Chondrosarcoma of the larynx is a relatively rare malignant tumor. In the world literature, only 600 cases of laryngeal chondrosarcoma (LCS) have been reported. It is the most frequent non-epithelial tumor of the larynx (0.07–2 % of all cancers), usually occurring on the cricoid. We present six cases of well–intermediate differentiated grade chondrosarcoma of the larynx, diagnosed between the fifth and seventh decades of life, in the absence of relevant risk factors. All cases were subjected to a conservative surgical approach, either endoscopic using remodeling transoral laser surgery, or open neck via a supratracheal partial laryngectomy (STL), sparing laryngeal function. All patients are free from recurrence with a minimum follow-up of 31 months. All were ultimately decannulated, are able to tolerate a quite normal diet and to speak satisfactorily. Conservative laryngeal surgery is effective because chondrosarcoma is often a low-grade tumor showing slow growth. The criteria for choosing the type of surgery was based on the age of the patient (elderly patient > favoring an endoscopic approach), on the rate of involvement of the cricoid and on the involvement of the cricoarytenoid joints (if possible to save a cricoarytenoid unit > favoring a STL). By extending the inferior limit of the resection to include a large part of the cricoid cartilage, supratracheal partial laryngectomies expanded the indications to some LCSs not involving the entire cricoid lamina sparing laryngeal function and avoiding the need for total laryngectomy.

Rationale and aim: Upper airway disorders, like allergic and non-allergic rhinitis, are common nasal conditions affecting millions of individuals worldwide. The prevalence of allergic rhinitis (AR), in particular, has been increasing in the last decades. The pervasiveness of this disorder therefore imposes a large burden both on individual patients and the society. A wide range of drugs exists for symptomatic treatment of rhinitis, such as corticosteroids, decongestants, and an- tihistamines, but standard therapies are often associated with several side effects. A new class of medical devices, based on bio-mechanically innovative triggers, has been proven to have a good clinical effectiveness with lower adverse reac- tions, particularly over prolonged administration periods. The present study aims at evaluating the economic impact of rhinitis, with respect to direct and indirect costs, and analys- ing the use of the medical device Narivent ® compared to standard therapies to manage the symptoms of this illness. Methods: Via a Monte Carlo simulation study, data on disease prevalence, drug prescription and cost of both the specific therapeutic approach and the adverse events treatment will be combined to provide an estimate of the overall cost of the pharmacotherapy as compared with Narivent ® . Results: Lowering the impact of adverse reactions related to standard therapy through the use of novel therapeutic ap- proaches like Narivent ® , might reduce the overall burden of rhinitis by about 5 billion per year. Conclusion: The use of the medical device Narivent ® , as an alternative approach to manage symptoms associated with rhinitis, may contribute to bring down its costs by about 3.5% yearly as compared to the standard therapy.

Objective: Nasal congestion is a common symptom in allergic and nonallergic rhinitis, rhinosinusitis and nasal polyposis. The present study evaluated the clinical effectiveness of Narivent®, an osmotically-acting medical device with anti -oedematous and anti-inflammatory effects, in nasal congestion. Methods: A single-centre, prospective study with a pre- post design and consecutive patient enrolment was conducted in an Italian otolaryngology department. Patients with persistent nasal congestion were allocated to treatment groups as follows: group 1 ( n = 36) treated for 7 days; group 2 ( n = 56) treated for 30 days. In each group, patients received two puffs of Narivent® into each nostril twice daily. Symptom severity was assessed subjectively on a 0 - 10 visual analogue scale, and objectively by the presence/absence of signs and symptoms. Differences in subjective and objective severity measures before and after treatment were compared using Wilcoxon's signed rank test. Results: All symptoms and objective scores improved after treatment with Narivent® for 7 or 30 days and no adverse effects were reported by the patients in either group. Conclusion: Narivent® appears to be efficacious in treating nasal congestion over a 7- or a 30-day period.

Objective The aim of the present study is to discuss the basics of atopy in children in relationship to the principal ENT allergic disorders such as allergic rhinitis, rhinosinusitis and their impact on lower airways, allergic otitis media, and oral cavity focusing on their natural history. Methods An updated and exhaustive review of principal literature on these topics is performed, underlining the constant but growing interest evoked by these disorders most of all the possible sequelae or complications. Considering the different districts which can be selectively or simultaneously affected by the allergic sensitisation, diagnosis can be a really hard task; in this paper, we tried to draw an integrated diagnostic approach to atopic children and some guidelines for a correct therapeutic approach. Conclusions Atopic disorders could expose young patients to years of chronic diseases that interferes with their development and with many important aspects of their lives. For these reasons, and considering the high social and medical costs of this disease, it is extremely important to adequately treat allergic pathologies from the early phases of its natural history. Moreover, we cannot forget that an appropriate therapy of allergic pathologies should not be only able to decrease symptoms but, it should also be able to improve patients health related quality of life.

To evaluate the efficacy of the atomized nasal douche in the restoration of physiological nasal functions in patients affected by acute viral rhinosinusitis, when compared with nasal lavages with isotonic sodium chloride solution.Randomized clinical trial.The ENT Department at the University of Siena Medical School.Two hundred patients affected by acute viral rhinosinusitis were included in the study.Patients were randomly divided into 2 groups: group 1 patients received an atomized nasal douche, and group 2 patients received nasal lavages with isotonic sodium chloride solution. Patients underwent treatments 4 times per day for 15 days in our institution under our direct control.Atomized nasal douches significantly improved inspiratory and expiratory rhinomanometric resistance (P.01) and nasal volumes measured by acoustic rhinometry (P.001). Nasal lavages were unable to modify these variables significantly (P.3). Only atomized nasal douches were able to normalize mucociliary transport time to a physiological level (P.001).The atomized nasal douche demonstrated a better efficacy than traditional nasal lavages with isotonic sodium chloride solution in restoring all the physiological nasal functions. For this reason, and considering ease of use, painlessness, cheapness, and manageability of the instrument, we suggest the use of the compressor-micronizer chamber system (Rinoflow Nasal WashSinus System) as a routine adjuvant to every treatment of acute rhinopathies.

To evaluate the presence of IgG autoantibodies against the P0 antigen in patients affected by sudden hearing loss and Meniere's disease (MD).All patients underwent a tonal audiometric evaluation, tympanometry, evaluation of the stapedial reflex threshold with decay time, determination of auditory brainstem responses and a complete vestibular assessment involving evaluation of spontaneous and positional nystagmus (Frenzel glasses), a head thrust test and a caloric test (Fitzgerald-Hallpike technique). Blood samples were drawn from all patients for the immunologic assessment of IgG antibodies against the P0 antigen (30-kDa protein) of guinea pig inner ear extracts using a Western blot assay.Ten patients affected by sudden hearing loss showed specific IgG antibodies against the P0 protein. Specifically, the P0 positive band was detectable in 5/45 patients with unilateral auditory impairment and in 5/5 of those with bilateral forms of auditory impairment. Among MD patients, the P0 positive band was detectable only in those with bilateral audiovestibular impairment (n = 10). Interestingly, in none of the 35 patients affected by monolateral MD were specific IgG antibodies against the P0 protein detectable.The positive reactions to P0 in all bilateral MD and bilateral sudden hearing loss patients found in this study strongly indicate that these pathologies are the result of an ongoing autoimmune process directed against specific antigens of the inner ear.

When approaching to middle ear pathologies, clinician has not only to manage the audiological and auricular problems, but he necessarily has to consider the multiple and complex etiopathogenetic links that exist among the organs constituting the rhinopharyngotubal unit. According to our 20 years experience in the field of the Rhinology, and bearing in mind the emergent role of nasal allergy in the pathogenesis of otitis media, we suggest a three step diagnostic approach for the evaluation of the rhinopharyngotubal district in both adults and children.

Upper airways pathologies represent extremely common medical problems in children, and from the daily clinical practice clearly emerges that alterations of rhinopharyngeal homeostasis can produce nasal symptoms and otitis media as well. Nose and middle ear are, in fact, not independent entities, but they belong to a system of contiguous organs including the nose, Eustachian tube, palate, rhino- pharynx, middle ear and mastoid cells, the so called rhinopharyngotubal unit The key element of this anatomo-physiological unit is, considering its multiple functions, certainly the Eustachian tube.

The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4+/-4.97 min (normal value: 13+/-3 min; P0.0001). The average MCTt for the skier group was 19.58+/-1.92 min ( P0.0001); the mean value of total basal nasal resistance was 0.37+/-0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P0.001). After NDT, total nasal resistance was 0.18+/-0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64+/-0.05 Pa/ml per s ( P0.001); the mean cross-sectional area at the nasal valve level was 0.57+/-0.04 cm(2) (normal value =0.55+/-0.05 cm(2)) and at the inferior turbinate level 0.83+/-0.05 cm(2) (normal value =0.4+/-0.04 cm(2); P0.001); the TMC average time was 27.35+/-2.21 min ( P0.0001). Finally, for the runners, the mean MCT time was 20.56+/-2.35 min ( P0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways.

To evaluate the relationship between airbag-induced noise and individual metabolic risk factors in determining persistent hypoacusia in drivers after road accidents.We selected 22 patients previously involved in a car accident with deployment of airbags. Patients underwent general and audiological clinical history, tonal audiometric examination, vocal audiometric examination, impedance meter examination and blood tests.We divided patients, according to audiometric data, into 2 groups: group A with no residual otological disturbances (6 subjects) and group B with persistent hypoacusia (16 subjects). Blood parameters were into physiological levels in all group A patients; on the contrary 12 (subgroup B1) out of 16 group B patients had altered blood levels of glucose, urea and cholesterol, with mean values of 155.8 +/- 38.6 mg/dl, 48.2 +/- 8.3 mg/dl and 250.8 +/- 28.1 mg/dl, respectively, revealing statistically significant differences in these parameters when compared with the other 4 hypoacusic cases (Sub-group B2) and with the normal subjects (Group A) (p0.01 for glucose, p0.05 for urea and p0.001 for cholesterol).Our findings confirm the transitory otological damage due to airbag deployment: the intensity of the acoustic wave hitting the ear after airbag deployment is responsible for a temporary rise in the acoustic threshold but the persistence of an auditory deficit can be due to co-factors able to interfere with the acute acoustic trauma recovery processes through a metabolic, angiopathic, neuropathic or unknown mechanism. Moreover, also the age of the patients could affect in a significant way the recovery from the acoustic trauma.

Allergic rhinitis is classically defined as an IgE-mediated inflammation of nasal mucosa, characterised by nasal obstruction, rhinorrhea, sneezing and nasal itching. It is certainly a high-prevalence disease and an important social and medical problem in many industrialised Countries, affecting about 20% of the general population; moreover, it is diagnosed with increasing frequency, both in adults and children in many developing countries. In view of the high medical and social costs, a correct diagnostic approach to allergic rhinitis is a fundamental need for the otorhinolaryngologist, also considering the severe complications (asthma, rhinosinusitis, rhino-otitis, rhinosinusal polyposis) which could develop if this disease is not recognised and adequately treated in its early phases. In order to evaluate not only the present epidemiological characteristics of allergic rhinitis in Italy but also the most commonly used diagnostic and therapeutic approaches in the management of this disease, 145 Italian otorhinolaringologists were selected to take part in the investigation. Each was invited to complete a questionnaire, divided into 8 different sections, to be answered according to their daily clinical practice. The significance of the results has been compared with those of the international samples comprised in the ARIA Document and in the epidemiologic survey of the Standing Committee on Rhinology and Allergy of the International Federation of Otorhinolaryngological Societies. A critical analysis of these data leads to some interesting epidemiological and therapeutic considerations.

Objective To demonstrate the long-term efficacy of intranasal furosemide, an inhibitor of the sodium chloride cotransporter channel at the basolateral surface of the respiratory epithelial cell, vs no therapeutic intervention vs intranasal mometasone furoate, a corticosteroid, in preventing relapses of chronic hyperplastic sinusitis with nasal polyposis. Design Randomized prospective controlled study. Patients were examined every 6 months during follow-up (range, 1-9 years). Patients One hundred seventy patients with bilateral obstructive or minimally obstructive chronic hyperplastic sinusitis with nasal polyposis. Intervention All patients were surgically treated in the ENT Department, University of Siena Medical School. One month after surgery, group 1 patients (n = 97) started treatment with intranasal furosemide, group 2 (n = 40) received no therapeutic treatment, and group 3 (n = 33) were treated with mometasone. Main Outcome Measures Clinical and instrumental evaluation of postoperative outcomes. Results Seventeen (17.5%) of 97 patients in group 1, 12 (30.0%) of 40 patients in group 2, and 8 (24.2%) of 33 patients in group 3 experienced nasal polyposis relapses. We noted a prevalence of early-stage relapse in patients treated with furosemide or mometasone, whereas patients who did not receive any treatment experienced more severe grades of chronic hyperplastic sinusitis with nasal polyposis ( P Conclusion Use of intranasal furosemide represents a valid therapeutic treatment in the prevention of chronic hyperplastic sinusitis with nasal polyposis.

Background: Pharyngodynia, or sore throat, is one of the symptoms most frequently reported by patients to primary care physicians. Objective: The purpose of this study was to compare the efficacy and tolerability of mouthwash formulations of ketoprofen lysine salt (KLS), an anti-inflammatory agent, and benzydamine hydrochloride (BH), a local anesthetic, in patients with acute inflammation of the pharyngeal cavity. Methods: In this randomized, multicenter, parallel-group, single-blind study, patients (who were blinded) were assigned to receive undiluted BH 15 mL (22.5 mg) or KLS 10 mL (160 mg) diluted in 100 mL of water. Both agents were gargled twice daily until pain remission or up to 7 days. A physical examination of the oropharyngeal cavity was performed, and severity of edema and hyperemia was assessed after 3 days of treatment and, if symptoms had not resolved, after pain remission. Results: Of the 241 patients (120 KLS, 121 BH), 239 were included in the safety analysis and 232 were in the intent-to-treat population. The differences between groups in the duration of analgesic effect after the first dose of drug and the time course of pain were found to be statistically significant ( P = 0.006 and P = 0.017, respectively), favoring KLS. Adverse drug-related effects reported included numbness of the tissues in the oral cavity, sensation of tingling in the tissues in the oral cavity, dry mouth, thirst, and nausea. A significantly greater proportion of BH-treated patients reported adverse events ( P = 0.001 for all adverse events and drug-related adverse events). Conclusions: KLS mouthwash exerts a significantly longer first-application analgesic action with significantly greater local tolerability than BH in patients with pharyngeal pain of inflammatory and/or infectious origin.

Family-based studies performed to date provide conflicting evidence of linkage/association between autistic disorder and either the “short” [Cook et al., 1997: Mol Psychiatry 2:247–250] or the “long” [Klauck et al., 1997: Hum Mol Genet 6:2233–2238] allele of a polymorphic repeat located in the serotonin transporter (5-HTT) gene promoter region, affecting 5-HTT gene expression [Lesch et al., 1996: Science 274:1527–1531]. The present study was designed to assess linkage and linkage disequilibrium in two new ethnically distinct samples of families with primary autistic probands. The 5-HTT promoter repeat was genotyped in 54 singleton families collected in Italy and in 32 singleton and 5 multiplex families collected in the U.S.A., yielding a total sample of 98 trios. Linkage/association between 5-HTT gene promoter alleles and autistic disorder was assessed using the transmission/disequilibrium test (TDT) and the haplotype-based haplotype relative risk (HHRR). Both the Italian and the American samples, either singly or combined, displayed no evidence of linkage/association between 5-HTT gene promoter alleles and autistic disorder. Our findings do not support prominent contributions of 5-HTT gene variants to the pathogenesis of idiopathic infantile autism. Heterogeneity in pathogenetic mechanisms underlying the disease may require that linkage/association studies be targeted toward patient subgroups isolated on the basis of specific biochemical markers, such as serotonin (5-HT) blood levels. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:123–127, 2000. © 2000 Wiley-Liss, Inc.