Neurophysiological Assessment in Children with Vocal Fold Paralysis: A Tertiary Center Experience.

OBJECTIVE: The aim of this study is to report on experience acquired during the laryngeal electrophysiological assessment with Co-MEP and L-EMG in pediatric patients with acquired, congenital, and syndromic vocal fold paralysis (VFP), and correlate our findings with patients' characteristics, their comorbidities, and VFP etiology. METHODS: Pediatric patients with suspected or previously diagnosed unilateral or bilateral VFP underwent electrophysiological records under general anesthesia; corticobulbar motor-evoked potentials (Co-MEPs) and laryngeal electromyography (L-EMG) of thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were recorded. RESULTS: Statistical analysis revealed a statistically significant correlation between early gestational age at childbirth and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); tracheostomy presence and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); presence of genetic anomalies with intensity and latency for TA muscle and latency for PCA muscle (TA latency p = 0.015, TA intensity p = 0.021, PCA latency p = 0.035); congenital presentation of VFP and an increased intensity for TA muscle (p = 0.04); latency and intensity for TA muscle (p = 0.024); TA muscle intensity and PCA intensity (p = 0.005). CONCLUSION: Intraoperative Co-MEPs and L-EMG are two complementary tools for evaluating the functional integrity of the structures involved in conveying signals from the motor cortex to TA and PCA muscles in children with vocal fold paralysis. Further studies are needed to establish their ability to predict the recovery of VF mobility, which could potentially lead to decannulation. LEVEL OF EVIDENCE: Level 4 Laryngoscope, 2024.

Correlation between peri-operative complication in middle ear cholesteatoma surgery using STAMCO, ChOLE, and SAMEO-ATO classifications.

PURPOSE: To compare the relationship between the variable "complication" and the other variables of middle ear cholesteatoma classifications (STAMCO, ChOLE, and SAMEO-ATO). METHODS: Retrospective study of 110 patients that underwent 132 middle ear surgeries between the 1 January 2012 and the 31 December 2019 for chronic otitis with cholesteatoma classified according to STAMCO, ChOLE, and SAMEO-ATO classifications in a tertiary health care centre. RESULTS: Older age, male gender, STAMCO-T, and SAMEO-ATO [O1, T, O2, (s -)] and mastoid involvement (STAMCO-M and ChOLE-Ch) were associated with an increased risk of complication report. CONCLUSIONS: In our series, statistical analysis pointed out a relationship between surgical complications and age, gender, site, mastoidectomy type, and ossicular chain status at surgery. The choice of variables to be recorded for cholesteatoma staging should be carefully balanced, considering that "complication" variable could be a repetitive item.

Modified full-face snorkeling mask for thoracic surgery and otolaryngology surgical use: comfort and usability assessment during the COVID-19 pandemic.

BACKGROUND: A worldwide personal protection equipment (PPE) shortage has emerged during COVID-19 pandemic, contributing to the high incidence of SARS-CoV-2 infection among health care providers. To address this lack of PEE, new solutions have been researched. Among those, full-face snorkeling masks demonstrated to be an interesting option. Among surgical specialties otolaryngologists and thoracic surgeons are at high risk of infection, due to the close contact with airway secretions. OBJECTIVES: We tested the comfort and usability of a modified full-face snorkeling mask (Ocean Reef Mask Aria QR+) as a protective device for otolaryngologic and thoracic surgeries. METHODS: The mask was customized with a 3D-printed adaptor supporting many industrial filter types, including FFP3 and heat and moisture ex- changers (HME). We evaluated surgical performances of the mask, both subjectively, with a questionnaire filled in by the surgeons, as well as objectively, monitoring transcutaneous PCO2 and PO2 values of surgeons during surgical procedures. RESULTS: The modified full-face snorkeling mask was tested during 9 otolaryngologic and 15 thoracic surgery procedures. The device demonstrated very good overall vision quality with some limitations regarding lateral vision and almost no difficulties in usability. Water condensation into the mask was absent in almost every case. Both PO2 and PCO2 param- eters remained within normal ranges during every procedure. DISCUSSION: The modified full-face snorkeling mask can be an innovative PPE. In the current COVID-19 pandemic scenario, the worldwide shortage of protective masks and goggles may exploit this ready-to-use and low-cost solution, especially for high-risk surgical procedures.

Cochlear Implantation as a Treatment for Sudden Autoimmune Sensorineural Hearing Loss in a Patient Affected by Eosinophilic Granulomatosis with Polyangiitis: A Case Report and A Review of Literature.

OBJECTIVE: To report presentation, diagnostic process, management and outcome of a case of autoimmune inner ear disease (AIED) related with Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis (EGPA), treated with cochlear implantation, and review of relevant literature. CASE PRESENTATION AND MANAGEMENT: A retrospective case report of AIED associated with EGPA treated with cochlear implantation was described. A multi-step approach for diagnosis and confirmation of AIED and hearing rehabilitation was conducted, eventually leading to left cochlear implantation. RESULTS: The surgery was without complications and postoperative course was uneventful. Two years after surgery, pure-tone and speech soundfield audiometry with left cochlear implant switched on showed a good improvement in pure-tone threshold and a word recognition score of 50% at 60 dB nHL. Literature review does not report any previous case of AIED EGPA-related. CONCLUSIONS: Cochlear implantation in AIED EGPA-related have been shown to be a viable treatment option in a stabilized phase of disease.

Overview of different modified full-face snorkelling masks for intraoperative protection.

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 user-friendly 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.

miR-19a and SOCS-1 expression in the differential diagnosis of laryngeal (glottic) verrucous squamous cell carcinoma.

BACKGROUND: Laryngeal verrucous squamous cell carcinoma (VSCC) is a highly differentiated squamous cell carcinoma (SCC), the diagnosis of which can meet with many pitfalls: benign hyperplastic lesions and conventional SCC are the most important differential diagnoses. The microRNA miR-19a is overexpressed in many solid tumours and regulates the suppressor of cytokine signalling-1 (SOCS-1) expression. AIMS: The main endpoints were to assess miR-19a and SOCS-1 expression in glottic VSCC, and the former's potential role in differentiating between glottic VSCC, conventional SCC and hyperplastic lesions. METHODS: The expression of MiR-19a (by reverse transcription and quantitative real-time PCR) and SOCS-1 (by immunohistochemistry, rabbit polyclonal anti-SOCS-1 antibody) was assessed in 11 consecutive cases of glottic VSCC, 20 of papillary hyperplasia and 42 cases of conventional SCC. RESULTS: Mean miR-19a expression was significantly higher (p = 0.000) in malignant glottic lesions (conventional SCC/VSCC) than in benign conditions. Significant differences in mean miR-19a expression also emerged between conventional SCC and papillary hyperplasia (p = 0.000), and between conventional SCC and VSCC (p = 0.03). miR-19a expression was not statistically associated with SOCS-1 immunoreactivity or immunostaining intensity in VSCC, conventional SCC or papillary hyperplasia. CONCLUSIONS: Our preliminary outcomes suggest the utility of miR-19a in the challenging differential diagnosis of laryngeal VSCC. Although miR-19a has been found to regulate SOCS-1 expression, this evidence was not confirmed by this investigation.