Otolaryngology adverse events following COVID-19 vaccines.

OBJECTIVE: Since the outbreak of COVID-19 pandemic, the international scientific community aimed at developing a vaccine to protect against the infection and prevent serious forms of the disease. To date, various adverse events of COVID-19 vaccines have been reported, mostly mild to moderate. MATERIALS AND METHODS: In this short communication, we reviewed available literature and described the most frequent otolaryngology adverse events reported after COVID-19 vaccination. RESULTS: The most frequent adverse events following COVID-19 vaccine described in the literature are represented by audiovestibular symptoms, such as tinnitus, sudden sensorineural hearing loss, vertigo, and dizziness. Other side effects include facial nerve palsy, epistaxis, and oral manifestations (lichen planus, bleeding, ulcers, and vesicles). CONCLUSIONS: COVID-19 vaccine is of utmost importance in limiting the spread of SARS-CoV-2. Otolaryngology-related side effects have been described, but none was severe or life threatening. The mechanisms underlying these effects are still mostly unknown.

Evaluation of olfactory dysfunction persistence after COVID-19: a prospective study.

OBJECTIVE: Alterations of the olfactory function in patients affected by COVID-19 often have an early onset and a variable duration ranging from a few weeks to months. The aim of this study was to evaluate olfactory dysfunction persistence after recovery from COVID-19, and potential related clinical-demographic conditions. PATIENTS AND METHODS: A total of 76 patients recovered from COVID-19 from at least 20 days with olfactory dysfunction during the infection were included in the study. For the subjective evaluation of olfactory function, a visual analogic scale (VAS) was used. The objective evaluation was performed with the use of the Sniffin' Sticks test. RESULTS: Objective assessment of olfactory function revealed that 48 (63.16%) patients were found to be normosmic (TDI ≥ 30.5), 26 (34.21%) were hyposmic (TDI from 30.5 to 16.5) and two (2.63%) were anosmic (TDI ≤ 16.5) at the time of the evaluation. These results did not show a significant difference between subjective and objective tests (p = 0.45). Most patients recovered their sense of smell within the first two months after recovery while a portion (22.2%) still experienced olfactory alterations 4-6 months after SARS-CoV-2 infection. Patients who had not recovered their sense of smell had a significantly longer period of SARS-CoV-2 positivity compared to patients that fully recovered (36.07 ± 7.78 days vs. 29 ± 7.89 days; p = 0.04). CONCLUSIONS: Our results suggest that the duration of the infection negatively correlates with the recovery of olfactory function.

Effects of COVID-19 pandemic on head and neck oncology activity: the experience of our University Hospital.

OBJECTIVE: The COVID-19 pandemic has severely affected otolaryngology and head and neck activities, also involving diagnosis and treatment of patients with oncology diseases with consequent delays and tumor upstaging. The aim of this study was to describe the experience of our otolaryngology unit during the pandemic on patients with cancer of the head and neck, comparing data on anatomical site of origin and preferred treatment with pre-pandemic data. PATIENTS AND METHODS: This study retrospectively analyzed the clinical records of patients treated for oncology disorders of the head and neck in the Otolaryngology Unit of the Policlinico Umberto I, Sapienza University of Rome, between March 10, 2020, and March 9, 2021. Data were compared with the same period of the previous year (March 10, 2019 - March 9, 2020). RESULTS: During the pandemic, we treated 92 patients with malignant tumor of the head and neck, compared to 101 patients treated during the same period of 2019 (-8.91%). The most common anatomical sites of origin of the neoplasms were larynx, oral cavity, and oropharynx. Surgical approach was preferred in 57 patients (61.95%); non-surgical treatments were performed in 35 cases (38.05%). Compared to the same period of the previous year, we found a 12.90% decrease in the number of oncology patients undergoing surgery, while patients treated exclusively with non-surgical approaches increased by 18.42%. CONCLUSIONS: Despite the impact of COVID-19 on the activity of our otolaryngology unit and on the whole healthcare system, diagnostic and therapeutic procedures for patients affected by malignancy of head and neck region were only minimally impacted.

Staying tuned for post-COVID-19 syndrome: looking for new research to sniff out.

Post-COVID-19 syndrome was defined as a persistent and protracted illness, which follows acute COVID-19 infection. This condition continues for more than 12 weeks and cannot be attributed to other clinical situations. Researchers and clinicians are allied in unraveling the molecular pathogenetic mechanisms and the clinical development of this unexpected SARS-CoV-2 infectious evolution. Anosmia, dysgeusia, fatigue, dyspnea, and 'brain fog' are common symptoms observed in the Post-COVID-19 syndrome, depicting a multiorgan involvement associated with injuries involving mainly cardiovascular, pulmonary, musculoskeletal, and neuropsychiatric systems. This commentary analyzes the state of the art of Post-COVID-19 interdisciplinary studies, confirming that we are facing a truly intricate biomedicine story.

Impact of COVID-19 pandemic on otolaryngology, ophthalmology and dental clinical activity and future perspectives.

OBJECTIVE: Since the COVID-19 outbreak, otolaryngologists, ophthalmologists and dentists have been severely affected, both for the transmission routes and for the diagnostical and therapeutic procedures typical of these disciplines. MATERIALS AND METHODS: In this article, we discuss the transmission routes, the potential risk of contagion for patients and healthcare providers during procedures, and comment on the changes that will affect head and neck clinical practice in the future of outpatient and surgical activities. RESULTS: Otolaryngologists, ophthalmologists and dentists are at high risk for infection contagion and spread because they perform diagnostic and therapeutic procedures that generate aerosol and droplets thus facilitating virus transmission. Furthermore, examination involves close doctor-patient contact and otolaryngologists and dentists have to remove patient's protective devices during the visit. CONCLUSIONS: Special attention to prevention protocols for diagnostic and therapeutic procedures and the use of protective equipment is of utmost importance to limit contagion and prevent a new virus spread in the near future.

Pleomorphic Adenoma of the Parotid Gland and Ipsilateral Thyroid Incidentaloma: Report of A Rare Case With Review of Literature.

BACKGROUND: Pleomorphic adenomas are benign tumors of the salivary glands that mainly affect the lower pole of the superficial lobe of the parotid gland. The term "pleomorphic" refers to the epithelial and connective origin of the mass. The clinical presentation is typically that of asymptomatic swelling which increases in volume. Therapy consists in surgical removal of the tumor mass by parotidectomy with nerve preservation. CASE DETAILS: This clinical case describes an interesting case of pleomorphic adenoma of the parotid gland in a 62-year-old patient. The patient presented with a long history of an asymptomatic mildly worsening swelling of the left parotid region. The peculiarity of the clinical case is the dimension of the adenoma (9x5x9 cm) and the presence of a thyroid incidentaloma (TI), consisting of a thyroid multinodular goiter composed of nodules, the largest of which measured 8 cm in diameter. This mass dislocated the laryngotracheal axis, compressed the larynx and caused the reduction of the respiratory space, making orotracheal intubation difficult and determining the need to perform a tracheotomy. CONCLUSION: Benign pleomorphic adenomas can potentially reach large sizes if untreated. Socio-economic problems may be the reason for late diagnosis.

The effects of oral supplements with Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C in otitis media with effusion in children: a randomized controlled trial.

OBJECTIVE: To evaluate the ability of oral supplements with immune-stimulating molecules (Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C) to reduce the inflammation of the upper airway tract and improve the outcome of otitis media with effusion (OME) in children. PATIENTS AND METHODS: Randomized controlled trial. One-hundred ninety-eight children (CI 95%: 12-96 months) were divided into four groups. Group 1 (48 subjects) received 10 ml of oral supplements (OS) with immune-stimulating molecules for three months (20 days consecutively, then 10 days of suspension - the therapeutic scheme was repeated three times); Group 2 (54 children) underwent treatment with 10 ml of OS for 90 consecutive days; Group 3 (48 subjects) received 15 ml of OS for 45 consecutive days; a control group (48 children) underwent the standard treatment for rhinitis and OME. Outcome measures included otoscopy, tympanometry, fibroendoscopy, and the pure tone audiometry (PTA) at T0 (before treatment), T1 (45 days after treatment), and T2 (90 days after treatment). RESULTS: All children treated with OS showed a reduction of Upper Airway Infection (UAI) episodes and OME compared to the control group independent of the administration method and posology. The three groups treated with OS showed statistically significant differences between T0 and T2 for otoscopy, tympanometry, fibroendoscopy, and PTA. In Group 2, the otoscopy and the tympanometry scores improved at T1. Group 2 and 3 had better PTA results than Group 1. CONCLUSIONS: OS with immune-stimulating molecules should be considered as a supporting therapy in children affected by recurrent episodes of UAI associated with OME due to their capacity to improve the immune response and reduce the inflammatory phenomena. OS can improve the fibroendoscopic findings by restoring middle ear ventilation, in addition to their ability to reduce inflammation in the middle ear.

The role of bacteriotherapy in the prevention of adenoidectomy.

OBJECTIVE: Adenoidectomy is a surgical procedure with potential adverse events. Effective nonsurgical therapy could reduce patient risk and harm. The aim of this study was to evaluate the role of bacteriotherapy to reduce the necessity of adenoid surgery. PATIENTS AND METHODS: This experimental study was conducted as an open study in 44 children (30 males and 14 females, mean age 4.9 years) who were candidates for adenoidectomy and tympanocentesis as treatment for adenoidal hypertrophy and otitis media with effusion. Twenty-two children were treated with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray, administered as 2 puffs per nostril twice a day for a week for 3 months (study group). The other half of the children was treated with hypertonic saline nasal lavage on the same schedule (control group). Tympanometry and adenoid size assessment were evaluated throughout the intervention period. RESULTS: In the study group, 6/22 children required surgery, compared to 20/22 children in the study group (p<0.0001). The clinical change in the treated children was a significant reduction of adenoid size (p<0.0001) and improvement of middle ear effusion measured with tympanometry (p<0.0001). CONCLUSIONS: Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray could significantly reduce the need for adenoid surgery.

Correlation between otitis media with effusion and cranial deformation in children.

OBJECTIVE: Otitis media with effusion (OME), defined as the presence of fluid in the ear without signs of an acute infection, usually occurs after acute otitis media and could result in reduced sound transmission with hearing loss. Several risk factors have been suggested to be associated with OME, as well as the relationships between morphology anomalies of cranial bones and ear infections. The aim of this study is to investigate the correlation between OME and cranial deformation in a pediatric population. PATIENTS AND METHODS: Eighteen children (13 males and 5 females) with a diagnosis of unilateral OME based on otolaryngologic examination, conductive hearing loss and an asymmetric tympanogram type were enrolled in the study. Patients underwent osteopathic and physical examinations to evaluate the presence of cranial deformations. RESULTS: Our study showed a high percentage of skull asymmetry (94%) in the study sample; children were mainly dolichocephalic and with atypical swallowing (72%). Particularly, we observed an occipital flattening, mainly ipsilateral to the ear affected by OME. CONCLUSIONS: The results of the present study indicated that a high percentage of children with OME present a skull asymmetry with concomitant dolichocephaly, known to be associated with high arched palate which is also related to a higher incidence of OME.

Obstructive sleep apnea syndrome in the pediatric age: the role of the anesthesiologist.

OBJECTIVE: Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation; obstructive sleep apnea syndrome (OSAS) is one of the most common causes of SDB in children. The aim of this review is to evaluate the role of the anesthesiologist in pediatric OSAS. MATERIALS AND METHODS: A literature review has been performed on the following topics: clinical aspects of pediatric OSAS, preoperative investigations including questionnaires, clinical parameters, laboratory polysomnography and home sleep apnea testing, anesthesiologic preoperative management, anesthesiologic perioperative management, anesthesiologic postoperative management including postoperative analgesia, postoperative nausea and vomiting (PONV), and post-tonsillectomy bleeding. RESULTS: OSAS in children is a distinct disorder from the condition that occurs in adults; adenoidectomy and tonsillectomy are the first line of therapy in these patients. Even if these surgical procedures are frequently performed, they represent a great challenge for surgeons and anesthesiologists and are associated with a substantially increased risk of morbidity and mortality. CONCLUSIONS: The role of the anesthesiologist is pediatric OSAS is crucial before, during and after surgery, as pediatric patients are at higher risk of preoperative, perioperative and postoperative adverse events including airway obstruction, PONV, and bleeding.

Clinical and immunological effects of a treatment with desentizating low-dose multicomponents in IgE mediated and non IgE mediated food allergies: observational retrospective pilot study.

BACKGROUND: Alimentary allergy has high impact on the quality of life (Qol) of patients and their families: it represents an economic burden for individuals and National Health System. The disease, particularly frequent in pediatric age, recognizes different pathogenetic mechanisms and expresses itself through the production of IgE (IgE mediated form) antibodies or through cell-mediated immunune responses (non IgE mediated forms). The aim of this clinical observational retrospective study is to evaluate the effect of a long-term treatment with Low Dose Medicine (LDM) drugs in pediatric patients affected by IgE and non IgE mediated food allergy. OBJECTIVE: The purpose of the study is to determine the efficacy of the treatment with Allergy Plex (Guna Laboratory, Milan, Italy) to induce clinical and/or immunological tolerance both to IgE mediated and non IgE mediated food allergy; the secondary endpoint is to investigate the treatment tolerability, the reduction of positivity to Skin Prick test and Patch test to food allergens and the decrease on the peripheral blood of the specific IgE to food allergens. The treatment efficacy was measured through a clinical score. METHODS: In this study the immunomodulant activity of Allergy Plex 13, Allergy Plex 7 and Allergy Plex 10 (Guna S.p.A., Milano, Italy) was evaluated. In every patient the state of allergical clinical responses and the immuno-allergological state were evaluated by means of specific parameters letting know the regulatory response to the allergical Th fenotype. RESULTS: Data about Clinical tolerance to food, Symptomatological clinical score, ECP, ACTH, Cortisol; IL-4, IL-10 was collected. There was evidence of improvement of clinical score, reduction of the diameter of cutaneous pomphus obtained through the Prick test and a decrease of IgE specifics values. CONCLUSIONS: The data issued from this study seem to confirm the efficacy of treatment with Allergy Plex in allowing the restoration of immune tolerance and the definite reduction of the clinical score.

Use of balloon catheter dilation and steroid-eluting stent in light and severe rhinosinusitis of frontal sinus: a multicenter retrospective randomized study.

OBJECTIVE: Frontal sinus surgery has an increased rate of re-stenosis, if compared to other sinuses. It depends mainly on recurrent inflammation and abnormal scarring at the frontal recess and its reduction represents one of the keys to therapeutic success. Balloon catheter dilation (BCD) and implantable sinus stents/spacers represent strategies to improve sinus ventilation respecting the integrity of mucosa and reducing abnormal post-surgical scarring. The purpose of this study was to evaluate the effectiveness, safety and correct indication about the use of BCD and a non-absorbable stent (Relieva Stratus™ MicroFlow spacer) in the management of chronic rhinosinusitis (CRS) of the frontal sinus. PATIENTS AND METHODS: In this multicentric retrospective study we included a population of 76 frontal sinuses with non-polypoid CRS. 41 frontal sinuses were treated with BCD alone and 35 frontal sinuses with BCD + Spacer. We analyzed both radiological (Lund-McKay CT scoring modified by Zinreich) and symptomatological results (SNOT-20 questionnaire) before surgery and after 12 months, dividing our population in two main groups: group "L" (light/mild frontal CRS) and group "S" (moderate/severe frontal CRS). RESULTS: Our results confirm a good safety and effectiveness of BCD in the management of frontal CRS and show a good safety but a not significative effectiveness of Relieva Stratus™ MicroFlow spacer when added to BCD in the management of light and severe frontal chronic rhinosinusitis. CONCLUSIONS: BCD is an acclared option in the management of frontal CRS and in the near future, utilization of stents/spacers could become a new and effective weapon in the management of rhinosinusitis, both like an adjunct to standard therapies, and in patient populations where the use of systemic drugs is contraindicated.

Sudden hearing loss as an early detector of multiple sclerosis: a systematic review.

OBJECTIVE: To evaluate whether Sudden Sensorineural Hearing Loss (S-SNHL) may be an early symptom of Multiple Sclerosis (MS). MATERIALS AND METHODS: A systematic review was conducted using the following keywords: "Multiple sclerosis, hearing loss, sudden hearing loss, vertigo, tinnitus, magnetic resonance imaging, otoacoustic emission, auditory brainstem responses, white matter lesions, sensorineural hearing loss, symptoms of MS and otolaryngology, nerve disease and MS". Only the articles that included results of at least one auditory test and MRI were considered. We evaluated the prevalence of SNHL in patients with MS, the presence of different forms of SNHL (S-SNHL and Progressive SNHL (P-SNHL)) and their correlation with the stage of MS, the results of electrophysiological tests, and the location (if any) of MS lesions as detected by white matter hyperintensities in the MRI. RESULTS: We reviewed a total of 47 articles, which included 29 case reports, 6 prospective studies, 6 cohort studies, 4 case-control studies, and 2 retrospective studies. 25% of patients suffered from SNHL. S-SNHL typically occurred in the early stage of the disease (92% of patients) and was the only presenting symptom in 43% of female subjects. Instead, P-SNHL occurred in the late stage of MS (88% of patients). Auditory Brainstem Responses (ABR) were abnormal in all MS patients with S-SNHL. When S-SNHL appeared during the early stage of the disease, MS lesions were found in the brain in 60% of patients and in the Internal Auditory Canal in 40% of patients. ABR remained abnormal after recovery. CONCLUSIONS: S-SNHL can be an early manifestation of MS and should always be considered in the differential diagnosis of this condition, especially in women. The pathophysiology can be explained by the involvement of microglia attacking the central and/or peripheral auditory pathways as indicated by WMHs.

Use of balloon catheter dilation vs. traditional endoscopic sinus surgery in management of light and severe chronic rhinosinusitis of the frontal sinus: a multicenter prospective randomized study.

OBJECTIVE: Chronic rhinosinusitis (CRS) of the frontal sinus is a complex pathological condition and many surgical techniques were described to treat this area endoscopically, like traditional endoscopic sinus surgery (ESS) and balloon catheter dilation (BCD). PATIENTS AND METHODS: We designed a multicenter prospective randomized study to assess the validity and safety of BCD vs. ESS in symptomatological chronic rhinosinusitis of the frontal sinus enrolling a population of 102 adult patients (64 men and 38 women; overall 148 frontal sinuses studied) with non-polypoid CRS. For a better evaluation of the disease, in our study we decided to analyze both radiological (Lund-McKay CT scoring modified by Zinreich) and symptomatological results (SNOT-20 questionnaire). We divided the population affected in two groups, one with light/mild frontal CRS and the other with moderate/severe frontal CRS, basing on radiological findings at Lund-MacKay modified by Zinreich score. Every group was divided in two subgroups, in one we used BCD and in the other we used traditional ESS. RESULTS: The current literature does not support the suggestion that indications for BCD and ESS are identical, and additional research is needed to determine the role for BCD in specific patient populations. The results showed a not statistically significative difference between BCD and conventional ESS of the frontal sinus in patients with light/mild CRS and in patients with moderate/severe CRS at Lund-Mackay modified by Zinreich score. The same not statistically significative difference was observed comparing the results of SNOT-20 questionnaire in the group of light/mild frontal chronic rhinosinusitis. However, we noticed a statistically significant better outcome of SNOT-20 score in patients with moderate/severe chronic rhinosinusitis that underwent BCD of frontal sinus compared to ESS. CONCLUSIONS: BCD and ESS are two alternative weapons in the baggage of every endoscopic surgeon, even because they present similar outcomes, safeness and effectiveness both in light/mild and moderate/severe chronic rhinosinusitis of the frontal sinus. An interesting result of our study was the statistically significant better outcome of SNOT-20 score in patients that underwent BCD of frontal sinus for a moderate/severe CRS, compared to those that underwent a traditional ESS.

D’Andrea’s disease (angiomegaly): a currently well-defined nosological entitys.

In 1997 D’Andrea et al. described a new nosological entity the characteristics of which consisted of lengthening, dilation and tortuosity of blood vessels, arteries or veins, less prominent, but also less circumscribed than an aneurysm. This condition does not necessarily imply specific aneurysm formation although aneurysms at multiple sites are a frequent observation. The term used by authors for angiomegaly of the venous system was venomegaly and the analogous condition of the arterial system was termed arteriomegaly. Although tortuosity and dilation of arteries and veins have been widely reported, suggesting a systemic disorder which affects the structural integrity of all vessels, most papers dealing with this intriguing condition did not describe any alterations in the components of vessel walls. In the present paper, the authors describe a well-defined condition, D’Andrea’s Disease (or DD, in this article), analyzing its salient morphological and clinical features and clarifying this pathological condition as a distinct and now well-defined nosological entity.

Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea: a pilot case-control study.

OBJECTIVE: Sleep apnoea is common after stroke, and has adverse effects on the clinical outcome of affected cases. Its pathophysiological mechanisms are only partially known. Increases in brain connectivity after stroke might influence networks involved in arousal modulation and breathing control. The aim of this study was to investigate the resting state functional MRI thalamic hyper-connectivity of stroke patients affected by sleep apnoea (SA) with respect to cases not affected, and to healthy controls (HC). PATIENTS AND METHODS: A series of stabilized strokes were submitted to 3T resting state functional MRI imaging and full polysomnography. The ventral-posterior-lateral thalamic nucleus was used as seed. RESULTS: At the between groups comparison analysis, in SA cases versus HC, the regions significantly hyper-connected with the seed were those encoding noxious threats (frontal eye field, somatosensory association, secondary visual cortices). Comparisons between SA cases versus those without SA revealed in the former group significantly increased connectivity with regions modulating the response to stimuli independently to their potentiality of threat (prefrontal, primary and somatosensory association, superolateral and medial-inferior temporal, associative and secondary occipital ones). Further significantly functionally hyper-connections were documented with regions involved also in the modulation of breathing during sleep (pons, midbrain, cerebellum, posterior cingulate cortices), and in the modulation of breathing response to chemical variations (anterior, posterior and para-hippocampal cingulate cortices). CONCLUSIONS: Our preliminary data support the presence of functional hyper connectivity in thalamic circuits modulating sensorial stimuli, in patients with post-stroke sleep apnoea, possibly influencing both their arousal ability and breathing modulation during sleep.

Age-related ultrastructural and monoamine oxidase changes in the rat optic nerve.

The aim of this paper is to study the morphology and the distribution of the monoamine oxidase enzymatic system in the optic nerve of 4 month-old Wistar (young) and 28 month-old Wistar (old) rats. The optic nerve was harvested from 20 young and old rats. The segment of optic nerve was divided longitudinally into two pieces, each 0.1 mm in length. The first piece was used for transmission electron microscopy. The second piece was stained with histochemical reaction for monoamine oxidase. The agerelated changes in the optic nerve of rats include micro-anatomical details, ultrastructure and monoamine oxidase histochemical staining. A strong decrease of the thin nerve fibers and a swelling of the thick ones can be observed in optic nerve fibers of old rats. Increased monoamine oxidase histochemical staining of the optic nerve of aged rats is well demonstrated. The increase of meningeal shealth and the decrease of thin nerve fibers of the optic nerve in old rats are well documented. Morphological, ultrastructural and histochemical changes observed in optic nerve fibers of the old rats show a close relation with aging.

Study on the use of focus harmonic scalpel in thyroidectomies: is it useful also in preserving voice function?

OBJECTIVE: The aim of this randomized study is to evaluate the real benefits of the FOCUS Harmonic Scalpel in total thyroidectomies compared with conventional ligation, regarding operative time, postoperative blood loss, length of stay and complications. Furthermore, as never seen in other studies, we studied the effects of using the FOCUS during thyroidectomy analyzing the vocal production of patients before and after surgery. PATIENTS AND METHODS: We enrolled 361 patients who underwent total thyroidectomy from 2008 to 2014. It was a randomized clinical trial in which all the surgical procedures were performed by the same surgeon. Patients were randomized into two groups according to the haemostatic technique: 187 patients were included in a "conventional" group (C) in whom dissection and haemostasis were performed using conventional materials (Vicryl, stitches, V titanium hemostatic clips and monopolar or bipolar electrocautery); 174 patients were included in a group in which the FOCUS was used (F group). RESULTS: Our data show that the FOCUS allows a one-third time-saving vs. classic haemostasis. Moreover, the use of the FOCUS would allow reduced traction and reduced manipulation of the thyroid during surgery. Our data demonstrate that the rate of complications in the Focus group might not be significantly reduced. In our series, we noticed that the quantitative acoustic assessment of voice quality show important alterations in several parameters (Shim, Jitt, sPPQ, sAPQ studied with the Multi Dimensional Voice Program evaluation) between the C group and F group. CONCLUSIONS: The FOCUS Harmonic Scalpel reduces the operative time, post-operative blood loss and length of hospital stay in thyroidectomy. Besides, important vocal alterations after thyroidectomy seem more severe using the conventional technique instead of FOCUS.

Effects of omalizumab therapy on allergic rhinitis: a pilot study.

OBJECTIVE: The use of omalizumab, a humanized monoclonal antibody able to binding Ig-E, is currently authorized only for treatment of severe bronchial asthma. The use of omalizumab in other Ig-E related diseases is off-label, although some studies have provided promising results about it. The aim of this study was to evaluate if therapy with omalizumab in patients affected by asthma and allergic rhinitis has an impact also on allergic rhinitis-related symptoms. PATIENTS AND METHODS: A longitudinal study was conducted on 11 patients affected by severe asthma and a periodic allergic rhinitis. Patients were treated with omalizumab for 24 weeks with a monthly subcutaneous administration at the dosage recommended by the current guidelines. We observed at the start and at the end of treatment: rhinitis symptoms using the Visual Analogue Scale (VAS); the state of nasal mucosa with fiberoptic nasal endoscopy; airways inflammation by measuring the Fractional Exhaled Nitric Oxide (FeNO); asthmatic symptomatology by means of the Asthma Control Test; the amount of total Ig-E in a blood sample; and the use of symptomatic drugs before and after treatment. RESULTS: VAS scores to measure general symptomatology and symptoms including nasal obstruction, rhinorrhea, itching and sneezing were significantly reduced. Turbinate hypertrophy was resolved in six of nine patients. Furthermore, eight patients (73%) reduced or eliminated the use of symptomatic drugs. CONCLUSIONS: Our data confirm the efficacy of omalizumab in the treatment of allergic rhinitis. Controlled studies will now have to be carried out to confirm these preliminary data and will specify indications for a very efficacious but still significantly expensive therapy.

Patients' experiences with HMEs and attachments after total laryngectomy.

OBJECTIVES: The short-term and long-term beneficial effects of HME use by laryngectomees are well described in literature. In this study, we document how laryngectomised patients, who previously did not use an HME, get accustomed to the use of HME and attachments. PARTICIPANTS: Thirty patients, who were at least 3 months post-laryngectomy and previously did not use an HME, were followed for 12 weeks and were asked to complete questionnaires about their experiences with the HME and attachments. RESULTS: Results show that when patients start using an HME, they report some difficulties with breathing resistance during the first 2 weeks of use. However, after 6 weeks, they have become accustomed to the breathing resistance and after 12 weeks over 96% reports that breathing was equal or less strenuous compared with breathing though an open stoma. Only a small proportion of patients experienced problems with increased coughing when starting HME use. CONCLUSIONS: This study provides insight in the way laryngectomised patients are experiencing the use of HMEs in the first weeks. These outcomes can contribute to a better knowledge of HME use by healthcare providers and help them to manage patient expectations and improving support to patients in achieving compliant HME use.