Acta Otorhinolaryngologica Italica

Journal Information
ISSN / EISSN : 0392-100X / 1827-675X
Current Publisher: Pacini Editore (10.14639)
Total articles ≅ 124
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Giuditta Mannelli, Massimo Ralli, Marco Bonali, Pasquale Capasso, Pierre Guarino, Valeria Iannini, Niccolò Mevio, Gennaro Russo, Alfonso Scarpa, Giacomo Spinato, et al.
Published: 24 September 2020
Acta Otorhinolaryngologica Italica pp 1-7; doi:10.14639/0392-100x-n0832

Abstract:
Objective. The aim of this study was to provide an accurate picture of the changes which have occurred and contributions given by Italian Otolaryngology Units during the COVID-19 pandemic. Methods. A 28-item questionnaire was completed and returned by 154 Otorhinolaryngology Units across the country. This investigated their geographic distribution involvement, the main changes which occurred in workload management and in clinical and surgical activities, and the screening procedures for COVID-19 in healthcare personnel and patients. Results. Nearly half of the Otolaryngology Units who responded to the questionnaire were merged with other units, while 22% were converted into COVID-19 units or temporarily closed. A reduction of 8.55% in the number of team members was reported, and about 50% of the departments applied uniform work shifts for all staff. All elective activities were uniformly stopped or delayed, passing from 30,295 (pre-COVID data) to 5,684 (COVID data) weekly procedures, with a mean decrease of 81.24% (p
Claudio Vicini, Giovanni Cammaroto, Giuseppe Meccariello, Giannicola Iannella, Marco Fragale, Tommaso Cacco, Claudio Sampieri, Luca Guastini, Eolo Castello, Giampiero Parrinello, et al.
Published: 24 September 2020
Acta Otorhinolaryngologica Italica pp 1-8; doi:10.14639/0392-100x-n0841

Abstract:
Objective. The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract. Methods. Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO2 and pCO2 monitoring values during procedures were recorded in selected cases. Results. All five MFFSM tested were easy to use and gave all operators a sound “feeling” of protection. All clinicians involved had common agreement regarding safety and the userfriendly format. Conclusions. In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements.
Sara Torretta, Lorenzo Maria Gaini, Michele Gaffuri, Lorenzo Pignataro, Remo Accorona, Pasquale Capaccio
Published: 24 September 2020
Acta Otorhinolaryngologica Italica pp 1-3; doi:10.14639/0392-100x-n0884

Abstract:
Dear Editor, airway management is crucial in effective treatment of COVID-19 patients with critical/severe disease. In the literature, the risk of nosocomial SARS-CoV-2 transmission ascribable to increased request for tracheostomy continues to be debated 1,2; in addition, we have to take into account that, once the acute phase passes, we may have to face other problems, such as laryngo-tracheal sequelae following prolonged endotracheal intubation and tracheostomy 3. Now that infectious spreading and contagion has been steadily decreasing in Italy, we observed an escalation in requests for ENT consultation for laryngeal complaints in COVID-19 patients who underwent endotracheal intubation or tracheostomy, independently of age, and were able to overcome the critical stage of disease at our frontline hospital in Milan, located in epicentre of the Italian COVID-19 epidemic.
Marco Molteni, Antonio Mario Bulfamante, Carlotta Pipolo, Paolo Lozza, Fabiana Allevi, Antonia Pisani, Matteo Chiapasco, Sara Maria Portaleone, Alberto Scotti, Alberto Maccari, et al.
Acta Otorhinolaryngologica Italica, Volume 40, pp 282-289; doi:10.14639/0392-100x-n0457

Abstract:
The term odontogenic sinusitis (OS) has proved less and less suitable to describe a series of pathological conditions related to dental procedures. We have introduced the term and classication ‘sinonasal complications of dental disease or treatment’ (SCDDT). This study aimed to review our cases and evaluate whether the classication used is applicable to everyday clinical practice. The sample was composed of patients treated for SCDDT from 2002 to 2018 in our Department of Otorhinolaryngology. All presented signs and symptoms of sinusitis and had a recent history of dental disease or treatment. All patients underwent multidisciplinary evaluation, exible endoscopy and computed tomography (CT) scan. Patients were allocated into three groups depending on the aetiology of the complication, following the classication proposed by Felisati et al. The sample comprised 480 patients (44% men, 56% women) with a mean age of 52.36 years. Of these, 43 patients (9%) belonged to group 1 (class A), 105 (21%) to group 2 (50, 2A; 5, 2B; 27, 2C; 23, 2D) and 332 (70%) to group 3 (119, 3A; 213, 3B). A total of 454 patients (94.5%) had unilateral maxillary opacication, while only 26 cases (5.4%) started as bilateral inammation. Nine of the latter cases (34.6%) presented a bilateral odontogenic focus, while the other 17 (65.4%) had a history of unilateral dental pathology. The results of this study suggest that SCDDT is a complex entity that needs a careful diagnostic approach based on CT scans and presurgical endoscopy.
Hasan Ibrahim Al-Balas, Paolo Farneti, Andrea Bellusci, Francesco Maria Crocetta, Giacomo Sollini, Ernesto Pasquini
Acta Otorhinolaryngologica Italica, Volume 40, pp 290-296; doi:10.14639/0392-100x-n0259

Abstract:
An antrochoanal polyp (ACP) is a benign sinonasal lesion that originates from the mucosa of the maxillary sinus. In order to avoid any recurrence of disease, it is important to choose the best surgical approach for removal of ACP with respect to the site of attachment within the maxillary sinus walls. A retrospective cohort study was carried out by analysing a database of 82patients who were operated on for ACPs in the Ear, Nose and Throat (ENT) clinics of both Sant’Orsola-Malpighi Polyclinic Hospital and Bellaria Hospital in Bologna, Italy from January 2001 to November 2017 to compare the rate of recurrence of ACPs after surgical removal using two different approaches. The first technique was endoscopic antrochoanal polypectomy with middle meatal antrostomy and the second was endoscopic antrochoanal polypectomy combined with both middle meatal antrostomy and a minimal access through the inferior meatus. A total of 49 patients were operated on with an endoscopic polypectomy with middle meatal antrostomy and 18.4% experienced a recurrence. The remaining 33 patients underwent endoscopic polypectomy with combined middle meatal antrostomy and access through the inferior meatus with a recurrence rate of 3%. The difference between the two groups was statistically significant (p=0.0441). The strategy of the authors, namely combining medial antrostomy with a small inferior meatus access, was associated with a lower rate of recurrence and no increased morbidity in the short- or long-term.
Beata Miaśkiewicz, Aleksandra Panasiewicz, Elżbieta Gos, Agata Szkiełkowska, Piotr Henryk Skarżyński, Elżbieta Włodarczyk
Acta Otorhinolaryngologica Italica, Volume 40, pp 262-269; doi:10.14639/0392-100x-n0555

Abstract:
The purpose of this study was to measure the clinical prole of patients with sulcus who had concomitant benign lesions such as polyp, oedema, cyst, nodules, or brous mass of the vocal fold. We reviewed the medical charts of 38 patients who had a diagnosis of sulcus type2 or 3 (according to Ford). The patients were classied into two groups. The study group consisted of 16 subjects who had sulcus and associated benign lesion; 22 patients diagnosed with sulcus alone were enrolled in a control group. We analysed psychosocial
Claudio Parrilla, Ylenia Longobardi, Gaetano Paludetti, Maria Elisabetta Marenda, Lucia D’Alatri, Francesco Bussu, Emanuele Scarano, Jacopo Galli
Acta Otorhinolaryngologica Italica, Volume 40, pp 270-276; doi:10.14639/0392-100x-n0587

Abstract:
Management of late complications represents the main reason for reluctance in using voice prosthesis rehabilitation. The aim of this paper is to report our experience by describing the one-year management of a large cohort of patients in order to clarify how demanding management is in terms of burden on clinicians. Between June 2017 and June 2018, each access made at the Otolaryngology Clinic of our Institute for issues related to prosthesis by 70 laryngectomised patients rehabilitated by voice prosthesis was registered in a specic database. A review of the data provided information on the incidence, management and outcomes of adverse events encountered during the selected time frame. In addition, a T test was used to evaluate the differences between irradiated and non-irradiated patients and between primary and secondary tracheo-oesophageal-puncture. Leakage through the prosthesis was the most common cause for access (51.86%). The median number of accesses per patient per year was 3.47. The speech therapist autonomously managed 18.1% of accesses. The median number of accesses per patient per year needing a physician was 2.84. The median lifetime of the prosthesis was 4.85 months. Radiotherapy or modality (primary or secondary) of the puncture did not inuence the number of accesses per year or the prosthesis lifetime. This retrospective analysis of results highlighted the most frequent issues and the most effective measures to deal with them, which allowed us to dene a systematic algorithm to standardise and ease long-term outpatient management.
Matteo Alicandri-Ciufelli, Matteo Fermi, Giulia Molinari, Elisa Aggazzotti Cavazza, Anna Maria Billi, Giuliano Giliberto, Francesca Cavalleri, Giacomo Pavesi, Livio Presutti
Acta Otorhinolaryngologica Italica, Volume 40, pp 248-253; doi:10.14639/0392-100x-n0503

Abstract:
The position of the pharyngolaryngeal framework is very important in choosing the best surgical approach for cervical spine disease. The aim of the present paper is to investigate the position of the hyoid bone and cricoid cartilage in relation to the cervical spine. Moreover, the surgical implications for anterior transcervical approaches to the upper spine and the prevertebral space are discussed. To minimise complication rates and increase surgical effectiveness, the location and extent of the cervical spine disease should be evaluated in the context of the patient’s specic anatomy. A retrospective analysis of 100 cervical spine MRIs was conducted. Patients with diseases that could alter anatomic relationships of cervical structures were excluded. The mid-sagittal view of the hyoid and the inferior margin of the cricoid cartilage were projected perpendicularly to the anterior surface of the cervical vertebrae. The distance between these two landmarks was measured on the same view. The distribution of hyoid projections ranged between C2-C3 and C4-C5 intervertebral space, while the cricoid cartilage ranged between C4-C5 and C7-T1 intervertebral spaces. The mean distance between these two landmarks was 49.1±7.7mm, with statistically signicant differences between males and females. The position of the cricoid cartilage signicantly inuenced the length of the pharyngolaryngeal framework, while the position of hyoid did not. A wide range of variability in the position of the hyoid bone and the cricoid cartilage in relation to cervical levels exists. This implies that an a priori association of a cervical level to neck structures at risk might be inaccurate. The use of these easily identiable landmarks on pre-operative imaging may help to guide the choice among different anterior surgical approaches to cervical spine and reduce the risk of surgical complications.
Giuseppe Burlon, Michele Tepedino, Michele Laurenziello, Giuseppe Troiano, Michele Cassano, Luigi Romano, Raffaella Rinaldi, Domenico Ciavarella
Acta Otorhinolaryngologica Italica, Volume 40, pp 297-303; doi:10.14639/0392-100x-n0307

Abstract:
The aim of the present study was to evaluate how the features of obstructive sleep apnoea (OSA) and the degree of mandibular advancement influence the outcomes of oral appliance therapy with a fully-customised mandibular advancement device (MAD) in an adult population. A total of 85 adult patients with mild to severe OSA were retrospectively selected. Polysomnography was taken before treatment and after 2 months treatment with overnight MAD. Treatment success was defined as a > 50% reduction in the Apnoea/Hypopnoea Index (AHI) with a residual AHI < 10. Binary logistic regression was used to evaluate the effects of AHI, oxygen desaturation index (ODI), gender and age on the success rate of MAD therapy. MAD therapy was successful in 77.7% of patients, and the ODI was a significant predictor of treatment success. OSA treatment with the MAD was successful in reducing the AHI in adult patients. An ODI value smaller than 33.3 was a significant predictor of treatment success. obstructive sleep apnoea,
Paz Martinez-Beneyto, Sebastiano Franchella, Fabio Alonso Rodriguez, Rafael Navarro-Velasquez, Miguel A. Martinez-Beneito, Alessandro Martini, Jaime Marco Algarra
Acta Otorhinolaryngologica Italica, Volume 40, pp 304-310; doi:10.14639/0392-100x-n0318

Abstract:
The objective of the study is to assess whether a smartphone application (App) designed to improve hearing can improve audiological performance in patients with normal hearing and with varying grades of hearing loss (HL). This is a multicentre prospective analytical study. We performed a battery of audiological tests consisting of pure tone audiometry (PTA) and a word recognition test (WRT) in quiet and in noise at different signal-to-noise ratio (SNR) using or not a smartphone App. Intra-subject results under both conditions were compared to determine the App’s effect on hearing. A survey was also carried out to obtain data on subjective hearing experience with the App. We recruited 55 HL patients and 13 normalhearing controls between June to December 2017. The results show that use of the App in HL patients improved WRT scores by a mean of 30.3% in quiet, 24.3% in noise + 10 dB SNR, and 20.8% in + 5 dB SNR. App use was identified as a factor that increased word recognition (odds ratio = 1.812, p < 0.05) and 61% of subjects rated sound quality when using the App as good or excellent. The use of a smartphone hearing App improved scores in both PTA and WRT in most cases. Patients with binaural hearing impairment < 60% obtained the best results. Subjective user satisfaction was good in both conditions.
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