The use of stem cells in treating xerostomia: a systematic review.

INTRODUCTION: The complex nature of xerostomia prevents the establishment of a definite cure. Recently, research has pivoted towards stem cell transplantation for glandular reconstruction. The aim of this study is to provide an updated review of the existing research, to highlight the encountered challenges and research pathways, potentially enhancing the therapeutic applications of stem cell transplantation. METHODS: This is a systematic review according to PRISMA guidelines, using the following databases: PubMed (PMC), PMC Europe, Scopus, Medline, Research Gate, Elsevier. The main question was whether stem cell therapies can contribute to the treatment of xerostomia. RESULTS: 19 of 226 publications met the criteria for this review, including 'in vivo', 'in vitro' studies and clinical trials. All 19 studies described thoroughly the stem cell source and the transplantation method, and documented results based on analytical and statistical methods of confirmation. Data show that the various sources of stem cells play a significant role, with bone marrow or adipose tissue-derived pluripotent blasts being the most utilized. Human transplants in mice have also been accepted and reversed hyposalivation. The effects have been beneficial especially in models undergone radiotherapy (IR) or exhibit Sjogren Syndrome-like symptoms (SS), suggesting that with appropriate treatment and enrichment techniques, stem cell transplantation seems effective regardless of the cause of the disorder. Extracts and co-cultures of gland and stem cells also seem to improve gland function. CONCLUSION: Although in its initial stages, the use of stem cells seems to be a promising therapy to alleviate xerostomia regardless of its cause.

Unsupervised Screen Exposure and Poor Language Development: A Scoping Review to Assess Current Evidence and Suggest Priorities for Research.

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.

Efficacy of esophageal stents as a primary therapeutic option in spontaneous esophageal perforations: a systematic review and meta-analysis of observational studies.

Background: Spontaneous esophageal perforation traditionally mandates urgent surgical treatment. Lately, esophageal stents have been used to reduce the associated morbidity and mortality. The current systematic review aimed to assess the efficacy of stents as a primary treatment option in this scenario. Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library for studies published in the English language between 2000 and 2023. We included observational studies reporting on the use of stents, alongside conservative measures and drainage procedures, in patients with spontaneous esophageal perforations. Primary outcomes were sealing rate (persistent leak occlusion) and failure rate (mortality or conversion to a major surgical operation). Secondary outcomes included patients' presentation, sepsis, drainage procedures, and reinterventions. Results for primary outcomes were presented as pooled rates with 95% confidence intervals (CIs), using a random-effects model. Methodological quality was assessed using the MINORS score. Results: Eighteen studies involving 171 patients were included. Sealing rate was 86% (95%CI 77-93%) and failure rate was 14% (95%CI 7-22%). Weighted mortality rate was 6% (95%CI 2-13%), while conversion to surgical treatment was 2% (95%CI 0-9%). Late presentation was not related to a statistically significant increase in treatment failure (odds ratio 1.85, 95%CI 0.37-9.30; P=0.72). Drainage procedures were required for the majority of patients, with a high rate of surgical and endoscopic reinterventions. Conclusions: Our results imply that stents may offer an effective and safe alternative treatment for patients with spontaneous esophageal perforations. Additional endoscopic and surgical drainage procedures are frequently needed.

Neuroendocrine and undifferentiated sinonasal and skull base tumors: An up-to-date narrative review.

Tumors located in the nasal cavity, paranasal sinuses and the skull base comprise a wide range of histologic subtypes. Among them, neuroendocrine and undifferentiated tumors are rare but noteworthy, because of their distinctive features, aggressive nature, and diagnostic complexities. A literature search was conducted in the PubMed/MEDLINE and the Scopus databases from 2019 until inception. The keywords "neuroendocrine", "undifferentiated", "nose", "sinonasal", "paranasal", "skull base" were used. Thirty-eight articles referring to neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base were finally included and analyzed. Neuroendocrine and undifferentiated tumors of the nose, paranasal sinuses and the skull base are infrequent malignancies, most commonly affecting middle-aged men. They usually present with non-specific symptoms, even though ocular or neurologic manifestations may occur. Prognosis is generally poor; however, novel targeted and immunological therapies have shown promising results. Sinonasal Neuroendocrine Carcinomas (SNECs) carry distinct histological and immunohistochemical features. Management consists of surgical resection coupled with systematic therapy. Sinonasal Undifferentiated Carcinomas (SNUCs) lack specific squamous or glandular features. They typically stain positive for pancytokeratin and INI1 antibody. Treatment includes induction chemotherapy, followed by a combination of chemotherapy and radiotherapy. Olfactory neuroblastomas (ONBs) have neuroepithelial or neuroblastic features. They show diffuse positivity for various markers, including synaptophysin, chromogranin, and neuron-specific enolase (NSE). Surgical resection plus radiotherapy is considered the treatment of choice. In conclusion, neuroendocrine and undifferentiated tumors arising from the nose, paranasal sinuses and the skull base represent a unique group of malignancies. A thorough understanding of their clinical features, molecular changes, diagnostic approaches, treatment modalities, and prognostic factors is critical for providing optimal patient care. Still, continued research efforts and multidisciplinary collaboration are warranted, in order to improve outcomes for patients diagnosed with these rare and aggressive tumors.

Holmium:YAG laser-assisted intraductal sialendoscopic lithotripsy under local anesthesia.

OBJECTIVES: This retrospective multi-institutional chart review study aims to present results from patients treated with Holmium:YAG laser-assisted sialendoscopic intraductal lithotripsy under local anesthesia. METHODS: Preoperative ultrasound and/or CT were used for location and measurement of the stones. Local anesthesia was applied in all patients, Marchal all-in- one 1.3 mm and Erlangen 1.6 sialendoscopes were used. The laser was used with power settings limited by discomfort or pain. Inclusion criteria were stone size (all >5 mm) and fixed stones. RESULTS: 42 patients, 48 stones were treated (30 males/12 females), 21 submandibular and 21 parotid. Ages ranged from 20 to 70 years (95 % CI: 43.37-51.58). Mean size was 6.2 mm (95 % CI: 5.71-6.72). Complete fragmentation was achieved in 66.7 % and incomplete in 33.3 %. Out of the incomplete fragmented 14 cases, seven (50 %) remained symptom free on follow-up. Maximum duration was 120 min. Minimum power settings of the laser was 4.8 Watts and maximum 18 Watts. Six patients expressed pain or discomfort that limited power increase and duration of the procedure. Total follow up time was 10 years. There were no major complications such as hemorrhage, nerve paresis or skin ulceration. CONCLUSION: The procedure is safe under local anesthesia, well tolerated by most patients and should be used in cases of small fixed and "intermediate-sized" stones as a single modality. Discomfort may limit power settings and duration. The later is the major disadvantage of the method.

Fiberoptic Endoscopic Evaluation of Swallowing Findings in Children With Rett Syndrome.

Feeding abnormalities, swallowing dysfunction, and gastrointestinal issues cause poor weight gain, oral motor dysfunction, and air swallowing in children with Rett syndrome (RTT). Pneumonia is the leading cause of death. Our study describes fiberoptic endoscopic swallowing findings in 11 female RTT children. Each patient was evaluated using the 8-point Penetration/Aspiration Scale (PAS). The average age was 7 years. All patients had tongue dyskinesis and prolonged oral stage. Eight girls exhibited liquid entering the airway without coughing, whereas 6 did well with pureed meal. Three girls had pneumonia. Age was not correlated with pneumonia episodes (P = .18). Pureed material was related with pneumonia (P = .006), whereas liquids were not. Pureed PAS was positively correlated with Liquid PAS (P = .008) and age (P = .004). All aspiration/penetration incidents occurred before the pharyngeal phase. No patient under 7 years experienced pneumonia episodes. Silent aspiration can occur early in infancy, although pneumonia episodes can occur later.

Sinonasal Neuroendocrine Carcinoma in Adult Proteus Syndrome.

Introduction: Proteus syndrome (PS) is a rare genetic disorder usually caused by mutations in AKT1 or PTEN genes, characterized by multiple, asymmetric tissue overgrowth with high clinical variability. Sinonasal neuroendocrine carcinomas (SNEC) are exceptionally rare tumors encountered in the ethmoid sinus, nasal cavity, or maxillary sinus. Case Report: We report a 35-year-old patient with PS, who underwent successful surgical removal of a well-differentiated SNEC obstructing his nasal cavity and highlight the role of the otolaryngologist for safe airway management, minimal surgical intervention and coordination of the multidisciplinary care. Histologically, focally hyperplastic mucosal epithelium of respiratory type of the nasal chamber was noticed along with seromucinous glands and capillary congestion of the subepithelial fibrovascular tissue. The limited presence of neoplastic tissue with histomorphological and immunophenotypic features of a neuroendocrine neoplasm was focally observed. Tumor cells grow in the form of islets within a vascular stroma; these neoplastic cells are immunohistochemically positive for synaptophysin, CD56, EMA, Ki67 (low expression, cell proliferation rate: 2%), CD31, chromogranin and pancytokeratin AE1 / AE3 as well as for S-100 protein (weak intensity). Conclusions: This first description of a SNEC in a PS patient, might hint towards a common basis between the two conditions, due to the mosaic AKT1 variant and an activated AKT/PIK3CA/PTEN pathway.

A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades.

The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients' ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.

Conservative Otosclerosis Treatment With Sodium Fluoride and Other Modern Formulations: A Systematic Review.

Otosclerosis, also known as otospongiosis, is a primary osteodystrophy of the otic capsule of the inner ear and one of the leading causes of deafness in adults. The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. Conservative treatments include sodium fluoride (NaF), bisphosphonates, and other modern medicines. A systematic review of the existing and published articles and books until April 2021 has been conducted in Medscape, Google Scholar, PubMed, and other databases using appropriate terms. According to the results of the research, the administration of NaF for a period of at least six months stabilizes hearing thresholds (HTs), improves vestibular symptoms, and delays the worsening of tinnitus. The administration of bisphosphonates for a period of at least six months showed significant percentage differences in the improvement of hearing loss, dizziness, and tinnitus remission. In the already existing double-blind studies that were evaluated, groups of patients treated with bisphosphonates for at least 24 months showed greater stabilization of the mean air and bone conduction thresholds than groups of patients treated with a placebo. The new modern medications have not yet been widely administered clinically to draw useful conclusions, although the test results of some of their use are quite encouraging.

Silicone Cervical Lymphadenopathy: A Rare Complication After Breast Augmentation.

A 66-year-old female patient, who had undergone breast augmentation 10 years ago, presented with unilateral neck pain, dysphagia, and hoarseness. Subsequent imaging revealed right-sided supraclavicular and axillary lymphadenopathy and a breast implant rupture on the same side. A lymph node core biopsy under sonographic guidance revealed silicone lymphadenopathy. Implant extirpation was offered to the patient. Cervical lymphadenopathy warrants an initial workup to exclude sinister chronic inflammatory or malignant conditions. Nonetheless, in cases of diagnostic uncertainty and a history of breast augmentation, the otolaryngologist should be cognizant of distal silicone lymphadenopathy. This condition is associated with silicone leakage and lymphatic dissemination of silicone particles. Even though silicone-related granuloma formation is a rare entity, its incidence is slowly rising as the population that has undergone breast augmentation grows older.

Fourteen cases of acute invasive fungal rhinosinusitis: is there a place for less aggressive surgical treatment?

PURPOSE: Acute invasive fungal rhinosinusitis (AIFRS) is a rare, fulminant, angio-invasive infection with high mortality rate. Treatment of AIFRS includes aggressive surgical debridement combined with antifungal agents and treatment of the underlying disease. The aim of this study is to report our experience with this often fatal disease and estimate the long-term survival of AIFRS patients with more conservative surgery. METHODS: A retrospective study was performed on immunocompromised adults with AIFRS from January 2011 to December 2020. The diagnosis was histologically confirmed by tissue fungus invasion. We analyze epidemiological and microbiological findings, the underlying disease and discuss our patients' treatment plan and long-term survival. RESULTS: Fourteen patients were included in the study. Mean age was 53.8 ± 18.9 years. The underlying disease was hematologic malignancy in nine patients, diabetes mellitus in three, aplastic anemia in one, and renal/liver failure in one. Leukopenia was not significantly correlated with outcome or survival. Histological and culture findings revealed that Mucor/Rhizopus were the causative organisms in nine cases. All patients received systemic antifungal therapy. Surgery was performed in nine patients (endoscopic for all patients, combined in three with an external approach). Overall survival was 35.7% as five patients survived, two who underwent surgery, and three who were treated non-surgically. Nine patients died, two from AIFRS after central nervous system involvement and seven from their primary disease, free of fungi. Older individuals and patients with hematologic malignancies had a worse outcome. CONCLUSION: Early surgical debridement, antifungal agents, and treatment of the underlying disease remain the cornerstones of AIFRS management. Prognosis is overall defined by the underlying disease and in some selected cases, medical treatment alone could be a reasonable option.

The Prevalence of Dizziness and Vertigo in COVID-19 Patients: A Systematic Review.

Clinical manifestations of COVID-19 include symptoms of vertigo and dizziness, which is rather unsurprising, since SARS-CoV-2 neurotropism may inflict a broad spectrum of neuropathic effects. The widespread nature of central and peripheral audiovestibular pathways suggests that there may be several probable pathophysiological mechanisms. The cytokine storm, CNS infiltration of the virus through ACE 2 receptors, and other systemic factors can be responsible for the significant number of COVID-19 patients reported to experience symptoms of vertigo and dizziness. In this paper, we present a systematic review of clinical studies reporting the detection of dizziness and vertigo as clinical manifestations of COVID-19 and discuss their etiopathogenesis.

Entering the World of Sounds: An Autobiographical Case Report on Ethical Issues Surrounding Cochlear Implants.

Cochlear implants are considered a viable therapeutic option for deaf children and adults who meet the implant criteria. They enable the hearing impaired to deal with the effects of deafness and participate academically, socially, and vocationally with their family and peers, aiding them to live a life with fewer limitations in the world of spoken languages. Most importantly, cochlear implants counteract the impact of profound deafness in early childhood, in which the ability to develop spoken language is severely restricted. For these children, cochlear implants represent the only means of hearing speech, resulting in the development of meaningful oral communication abilities. Over the past decades, there have been intense debates about communication philosophies for deaf or hard-of-hearing children, the nature and concept of deafness, the value and diversity of the deaf culture, the purpose of deaf education, and the best education systems for deaf or hard-of-hearing children. There are two broad camps in the debate over cochlear implantation: those who embrace the technique and those who oppose it. In this paper, we describe my own journey from total deafness to the beginning of a dream career as an otorhinolaryngology resident. We also engage in a discussion about the ethical concerns associated with cochlear implantation.

The long-term need for calcium supplementation after incidental parathyroidectomy.

Objectives: Hypocalcaemia and hypoparathyroidism are the most frequent complications of total thyroidectomy that may result in the need for lifelong calcium supplementation. This study aims to investigate the impact of incidental parathyroidectomy on short- and long-term hypocalcaemia. Methods: This retrospective study was conducted on patients who underwent total thyroidectomy with or without central neck dissection between March 2016 to May 2018. All procedures were performed by three surgeons with similar experience levels. Histopathology reports were reviewed, the number of resected parathyroid glands and the underlying pathology reports were recorded, and the patients were divided into two groups; groups A and B comprised those with and without parathyroid glands respectively. The incidence rates of short- and long-term hypocalcaemia were recorded. The former was obtained through blood tests during hospitalisation and the latter via phone calls to patients 3, 6, and 12 months postoperatively. Results: A total of 116 patients participated, 18 (15.5%) in group A and 98 (84.5%) in group B. No statistical significance was detected between the two groups regarding early postoperative (p = 0.109) or long-term hypocalcaemia (p = 0.48). These results were similar in patients with cancer (n = 40) (p = 0.855, p = 0.08). Conclusion: Incidental parathyroidectomy of one parathyroid gland was not correlated with a higher incidence of hypocalcaemia, even in cases with thyroid cancer.

A Different Era for Malignant Otitis Externa: The Non-Diabetic and Non-Immunocompromised Patients.

BACKGROUND: Τo investigate the differences in regard to the clinical, laboratory, and imaging findings as well as the treatment course between diabetic and non-diabetic, non-immunocompromised patients with malignant otitis externa. METHODS: A total of 36 hospitalized patients diagnosed with malignant otitis externa between January 2011 and December 2020 were divided into 2 groups according to their medical history, blood glucose, and glycated hemoglobin levels. RESULTS: Thirty-two patients were diabetic (group A) and 4 were non-diabetic, non-immunocompromised (group B). Otalgia was present in all patients (100%), followed by otorrhoea (67%) and edema (64%). Polyps were present in 18 patients (50%). Pseudomonas aeruginosa was isolated in 16 out of 25 positive cultures (64%). Four patients of group A and none of group B underwent surgery. Five patients of group A and none of group B had at least 1 cranial nerve involvement. The mean age was 77.22 ± 8.17 for group A and 47.25 ± 3.59 for group B (P < .001). No statistical significance was observed in regards to major symptoms, inflammatory markers (white blood cell, C-reactive protein, and erythrocyte sedimentation rate), positive imaging, and microbiological findings between the 2 groups. The average days of hospitalization were 42.41 ± 31.06 for group A and 10.25 ± 2.63 for group B (P < .049). Four diabetic patients died. CONCLUSION: Non-diabetic, non-immunocompromised adult patients with malignant otitis externa had a better response to antibiotic therapy and a shorter length of hospitalization. A high clinical suspicion for malignant otitis externa should always raise in cases of otitis externa that fail to respond in a topic and/or oral antibiotic treatment for more than a week.

Variation in volumes and characteristics of ENT emergency visits during COVID-19 pandemic. Where are the patients?

The aim of this study is to analyze patterns and volumes of patients visiting ENT emergency departments during periods of community lockdowns given the newness of this situation and to assess the variation in numbers of visits and examine whether their reduction equally affects all categories of visit causation or whether it is limited to diseases not considered as emergencies. A retrospective descriptive study was conducted on prospectively collected registry data on patients of all age groups visited the emergency ENT department during the period of nationwide lockdown. Patients were grouped in 9 categories, according to the cause of visit the ENT emergency department. A total of 201 patients visited the ENT emergency department. The retrospective analysis of the data during the same period in the years 2013-2019 showed a reduction of 73% in total visits (mean total visits number between 2013 and 2019 was 745.29±20.0143). A statistically significant reduction in visitation was found in all categories studied with the exception of foreign body ingestion - aspiration. Patients with General ENT symptoms, mild epistaxis cases, otology cases, vertigo cases, uncomplicated infectious cases showed a statistically significant reduction in numbers and were treated empirically. Swallowing foreign body cases did not show statistically significant reduction. Limitation of movement and the lockdown itself, led to reduction of trauma cases. Surprisingly, there was also a reduction in oncology cases and an increase in numbers of these cases can be expected in the near future.

Ubi pus, ibi evacua: a review of 601 peritonsillar abscess adult cases.

BACKGROUND: Peritonsillar abscess (PTA) is the most common deep neck infection, occurring as a consequence of bacterial acute tonsillitis or as a result of infection of the Weber glands, with frequent and life-threatening complications. AIM: To investigate several factors associated with complications and worse prognosis, such as defining the method of surgical drainage and treatment of a PTA which remains an area of controversy in the literature METHODS: The purpose of this retrospective study is to examine the epidemiological, clinical, and laboratory findings of 601 adult patients and to discuss them along with their treatment plan. RESULTS: Pharyngalgia was the most common reported symptom, followed by trismus, odynophagia, fever, hot potato voice, malaise, and cervical lymphadenopathy. Sixty-eight patients developed complications. Streptococcus species were the most common pathogens. A statistically significant difference was found in days of hospitalization, WBC and CRP levels, age, and the pre-existing systemic diseases between patients with and without complications. A comparison of patients treated with intravenous and oral antibiotics revealed no statistically significant difference. CONCLUSION: Οver 10% of PTA cases may develop complications, the most common of which is extension into deep neck spaces. Comorbid conditions increase the risk of complications. Despite the wide range of treatment strategies, incision and drainage remain the cornerstone of surgical treatment. In patients with no comorbidities, intravenous antibiotics appear to have no advantage over oral antibiotics.