Comfort rules for face masks among healthcare workers during COVID-19 spread.

BACKGROUND: The outbreak of Coronavirus disease 2019 (COVID-19) made imperative the use of protective devices as a source control tool. As there is no definite antiviral treatment and effective vaccine, the only efficient means of protecting and mitigating infectious contagion has been the use of personal protective equipment, especially by healthcare workers. However, masks affect the humidification process of inhaled air, possibly leading to a basal inflammatory state of the upper airways. STUDY DESIGN: This is a single-center observational study conducted at the University Hospital of Catania from April 1, 2020, to June 31, 2020. METHODS: We analyzed the role of protective masks on the elimination of upper airways complaints in healthcare workers of the University Hospital of Catania. We evaluated 277 subjects through a self-administered 17 item questionnaire based on respiratory, work performance and health-related quality of life domains. RESULTS: A higher prevalence of nasal and ocular symptoms, perceived reduced work performance, difficulty in concentrating, and sleep disorders were found. After two weeks adhering to a list of good practices that we recommended, significant reversibility of the symptoms investigated and work performance enhancement were observed. CONCLUSIONS: Despite clinical complaints related to personal protective equipment, effective amelioration through usage rules is easily obtained. Given the essential use of protective masks, healthcare workers have to adhere to appropriate work and safety prevention rules.

A probiotic mixture in patients with upper respiratory diseases: the point of view of the otorhinolaringologist.

Upper respiratory infections are widespread in clinical practice. Antibiotics are frequently used in the management of patients with airways infection. However, antibiotics can induce intestinal and respiratory dysbiosis that, in turn, worsens respiratory symptoms. Moreover, respiratory infections per se can cause dysbiosis. Consequently, probiotics may counterbalance the disturbed microbiota. The current clinical experience evaluated the efficacy and safety of an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii subspecies delbrueckii LDD01 (200 million living cells), in 2928 outpatients with an upper respiratory infection and treated with antibiotics. Patients took one stick/daily for four weeks. Simultaneously, 2877 patients with an upper respiratory infection and treated with antibiotics were recruited as control. This probiotic mixture significantly diminished the presence and the severity of respiratory symptoms at the end of the probiotic course and, more evidently, after a 3-month follow-up. In conclusion, the current clinical experience suggested that this probiotic mixture may be considered an effective and safe therapeutic option in managing patients with an upper respiratory infection and treated with antibiotics.

Probiotics in the add-on treatment of rhinosinusitis: a clinical experience

Rhinosinusitis (RS) affects the nose and the paranasal sinus and is characterized by nasal and systemic symptoms. It may be classified as acute or chronic, based on duration. Rhinosinusitis may be clinically suspected, but the diagnosis is usually based on the endoscopy. Antibiotic therapy is frequently used for RS patients in clinical practice. However, antibiotics often induce intestinal dysbiosis associated with some clinical problems and respiratory microbiota impairment. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).

Probiotics in the add-on treatment of laryngotracheitis: a clinical experience.

Laryngotracheitis is a common disease, mainly characterized by dysphonia, cough, and sore throat. The diagnosis is usually based on the clinical ground, and antibiotic therapy is frequently used in clinical practice. However, antibiotics frequently induce intestinal dysbiosis associated with some clinical problems. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no add-on treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3). Globally, 833 outpatients with laryngotracheitis were enrolled: 425 in Group A and 408 in Group B. All of them were treated with a 7-10-day course of antibiotic therapy. The probiotic mixture reduced the duration of symptoms associated with antibiotic therapy already at the end of the antibiotic cycle. The intergroup comparison showed that probiotic group patients experienced less fever, tiredness, headache, pain, malaise, diarrhea, and nausea (p<0.001 for all) than control patients at T1. The probiotic course reduced the possible clinical relapse, and the use of additional medications at T2 and T3. In conclusion, the present clinical experience demonstrated that a probiotic mixture containing Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, and Lactobacillus delbrueckii subspecies delbrueckii, was able to rapidly reduce symptoms associated with antibiotic therapy in patients with laryngotracheitis.

Probiotics in the add-on treatment of pharyngotonsillitis: a clinical experience.

Pharyngotonsillitis is a common disease, mainly characterized by a sore throat. It may be classified as acute or chronic, based on duration. The diagnosis is usually performed on the clinical ground, and antibiotic therapy is frequently used in clinical practice. However, antibiotics frequently induce intestinal dysbiosis associated with some clinical problems. Therefore, probiotics are commonly prescribed in patients treated with antibiotics. The current clinical experience was conducted in patients with pharyngotonsillitis and treated with antibiotics. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million of living cells), and Lactobacillus delbrueckii subspecies delbrueckii LDD01 (200 million of living cells), was prescribed in the Group A, and was compared with no add-on treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3). Globally, 1118 outpatients were enrolled. Acute pharyngotonsillitis affected 795 subjects: 396 in Group A and 399 in Group B. Chronic pharyngotonsillitis affected 323 outpatients: 158 in Group A and 165 in Group B. All patients were usually treated with a 7-10-day course of antibiotic therapy. In patients with acute pharyngotonsillitis, the probiotic mixture significantly reduced the duration of all the symptoms (p<0.001 for all), except for the urinary tract infection, associated with antibiotic therapy which was already at the end of the antibiotic cycle (T1). The intergroup analysis showed that patients with chronic pharyngotonsillitis in Group A had significantly less tiredness, pain, and malaise (p<0.001 for all) than patients in Group B at T1. The probiotic course reduced the possible clinical relapse, and the use of additional medications at T2 and T3 in patients with both acute and chronic pharyngotonsillitis. In conclusion, the present clinical experience demonstrated that a probiotic mixture containing Lactobacillus plantarum LP01, Lactobacillus lactis subspecies cremoris LLC02, and Lactobacillus delbrueckii, was able to quickly reduce symptoms, possible relapse, and use of additional medications, associated with antibiotic therapy, in patients with both acute and chronic pharyngotonsillitis.

Probiotics in the add-on treatment of otitis media in clinical practice.

Otitis media (OM) affects the middle ear and is typically characterized by earache. OM may be classified as acute (AOM) or chronic (COM), based on symptom duration. OM may be clinically suspected, but the diagnosis is usually confirmed by the otoscopy. Antibiotic therapy is frequently used in clinical practice. However, antibiotics often induce intestinal and respiratory dysbiosis associated with some clinical problems. A one-month course of a probiotic mixture (Abincol® containing Lactobacillus plantarum LP01 (1 billion of living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 million living cells), and Lactobacillus delbrueckii LDD01 (200 million living cells), was prescribed in the Group A, and was compared with no addon treatment, such as the Group B. Patients were evaluated at baseline (T0), at the end of antibiotic treatment (T1), at the end of probiotic course (T2), and at the end of 3-month follow-up (T3).

Prospective multicentre study on barbed reposition pharyngoplasty standing alone or as a part of multilevel surgery for sleep apnoea.

OBJECTIVES: The aim of this study was to demonstrate in a prospective multicentre study that Barbed Reposition Pharyngoplasty (BRP) procedure is safe and effective in management of obstructive sleep apnoea/hypopnea syndrome (OSAHS) patients. DESIGN: Prospective study. SETTING: Multicentre study. PARTICIPANTS: Patients suffering from obstructive sleep apnoea. MAIN OUTCOMES MEASURES: Values of postoperative apnoea-hypopnea index (AHI), oxygen desaturation index (ODI), epworth sleepiness scale (ESS). RESULTS: 111 Barbed Reposition Pharyngoplasty procedures standing alone or as a part of multilevel surgery for OSAHS, performed between January and September 2016, were analysed in 15 different centres. The average hospitalisation period was 2.5 ± 0.5 days. The mean patient age was 46.3 ± 10.5 years. The average body mass index at the time of the procedure was 27.9 ± 3.2, and the majority of the patients were men (83%). The mean preoperative and postoperative apnoea/hypopnea index was 33.4 ± 19.5 and 13.5 ± 10.3, respectively (P < .001). The mean preoperative and postoperative ESS score was 10.2 ± 4.5 and 6.1 ± 3.6, respectively (P < .001). The mean preoperative and postoperative ODI were 29.6 ± 20.7 and 12.7 ± 10.8, respectively (P < .001). CONCLUSIONS: Patients undergoing BRP standing alone or as part of a multilevel approach for the treatment of OSAHS have a reasonable expectation for success with minimal morbidity.

Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study.

OBJECTIVES: To analyse the specificity and sensibility of narrow band imaging illumination technology in the early detection of laryngeal cancer in the patients' population without previous diagnosis of laryngeal cancer in a screening setting. DESIGN: Unicentre, prospective study. SETTING: One tertiary medical centre. PARTICIPANTS: A total of 158 patients completed all protocol steps. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive values of narrow band imaging (NBI) in detecting precancerous lesions and early laryngeal cancer. RESULTS: The blind assessment of NBI patterns concurred in 90% of patients. In identifying laryngeal cancer and its precursor lesions, in-office NBI showed a high sensitivity of 97% (CI, 84.2%-99.9%), specificity of 92.5% (CI, 79.6%-98.4%), PPV of 91.4% (CI, 76.9%-98.2%), NPV of 97.4% (CI, 86.2%-99.9%) and accuracy of 94.5% but intra-operative NBI demonstrated a sensitivity of 97% (CI, 84.2%-99.9%), a slightly higher specificity of 95% (CI, 83.1%-99.4%), PPV of 94.1% (CI, 80.3%-993%), NPV of 97.4% (CI, 86.5%-99.9%) and accuracy of 95.9%. The comparative receiver operating characteristic curves confirmed a slightly higher performance for the intra-operative NBI evaluation without any statistical significance (P = 0.41). CONCLUSIONS: Our results confirm the high values of sensitivity and specificity of NBI system in detecting pre-neoplastic laryngeal lesions or early laryngeal cancer in a patients' population selected only by means of risk factors exposure and confirmed the potential role of NBI evaluation as in-office screening tool.

Combined transnasal transcervical robotic dissection of posterior skull base: feasibility in a cadaveric model.

The current surgical trend is to expand the variety of minimally invasive approaches and, in particular, the possible application of robotic surgery in head and neck surgery. For this purpose, we explored the feasibility of a combined transcervical-transnasal approach to the posterior skull base, using the da Vinci Surgical System in 3 cadaver heads. Superb visualization of the sellar, suprasellar and clival regions was possible in all three specimens. The trocars` placement through a transcervical port made a more cephalad visualization possible, eliminating the need to split the palate. The advantages of robotic surgery applied to the posterior cranial fossa are similar to the ones already clinically experienced in other districts (oropharynx, tongue base), in terms of tremor-free, bimanual, precise dissection. The implementation of instruments for bony work will definitely increase the applicability of such a system in the forthcoming years.

Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach.

The conservative transoral approach to hilo-parenchymal submandibular stones has been proposed as an alternative to traditional sialadenectomy. The main purpose is to preserve the gland and eliminate the risk of a cervical scar and damage to the marginal mandibular branch of the facial nerve. The spread of transoral robotic surgery has favoured its application not only in the oropharynx, but also in the anterior oral cavity. This article describes a transoral robotic approach for hilo-parenchymal submandibular stones. In January 2019, two patients with a right and a left hilo-parenchymal submandibular stone of 15mm and 8mm, respectively, underwent removal of the stone with transoral robotic surgery using the Si Da Vinci surgical robot. The procedure was performed successfully and tolerated well, with a one-night hospitalization. There were no complications such as lingual nerve damage, painful gland swelling, infection, or ranula. The patients were followed up clinically and ultrasonographically for the first 3 months to verify symptom relief and persistence of stones; no symptoms or stones were found. The transoral robotic surgical approach seems to be safe and adequate for the conservative management of large hilo-parenchymal submandibular stones. An adequate diagnosis together with proper docking and an appropriate approach to the oral floor is mandatory.

Adeno-tonsillar surgery in Italy.

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

Defect-oriented reconstruction after transoral robotic surgery for oropharyngeal cancer: a case series and review of the literature.

Transoral robotic surgery (TORS) is a fascinating new technique that has been shown to be a safe and feasible treatment for selected oropharyngeal cancers. Furthermore, TORS might offer some advantages in selected locoregionally advanced cancers. Thus, the patient selection is the keypoint for the useful application of TORS. However, the reconstruction of large oropharyngeal defects is challenging due to the restoration of velopharyngeal competency and swallowing. Moreover, the absence of mandibular splitting increases the difficulties faced by reconstructive surgeons. The paradigm for oropharyngeal reconstruction has undergone changes paralleling reflecting the overall change in the trend of the treatment alternatives over the last few decades. Flap choice and harvesting should be tailored to obtain significant advantages both in functional terms and for easy insetting. In this review, we analyse the strengths and weaknesses of the various flaps used in TORS framework with particular regards on our preliminary experience.

Barbed reposition pharyngoplasty in multilevel robotic surgery for obstructive sleep apnoea.

The surgical treatment of obstructive sleep apnoea in patients who are non-compliant with continuous positive airway pressure therapy still represents a valid alternative. In recent years, the multilevel approach is becoming more diffuse in routine surgical practice, especially since the introduction of transoral robotic surgery. Barbed reposition pharyngoplasty in multilevel robotic surgery for OSA may represent a valid option to surgically approach the soft palate. Herein, we describe the technique and preliminary results of our experience.

Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP).

It has become increasingly clear in the past decade that surgical management of obstructive sleep apnoea hypopnoea syndrome (OSAHS) is most successfully managed with multilevel surgery. We evaluated the outcomes of multilevel interventions comparing three different palatal techniques added to TORS: uvulopalatopharyngoplasty (UPPP), a modified expansion sphincter pharyngoplasty (ESP), inspired by the Pang expansion sphincter pharyngoplasty technique and the latest barbed repositioning pharyngoplasty (BRP). Thirty patients were retrospectively evaluated. Ten patients underwent UPPP by Fairbanks, 10 BRP and 10 a modified ESP already described. All patients underwent TORS, tonsillectomy and septo-turbinoplasty. For all cases, the following data were retrieved and revaluated: preoperative and postoperative apnoea-hypopnoea index (AHI), preoperative and postoperative Epworth Sleepiness Scale (ESS), pain visual analogue scale (VAS; 0-10) for the first 5 days postoperatively, palatal operative time for each surgical technique, discharge date and complication types and rate. Both BRP and ESP resulted in better postoperative AHI values and higher surgical success rates in comparison with UPPP. On the other hand, BRP was not more effective than ESP. ESP surgery time was significantly higher than UPPP, while BRP was the quickest procedure. In summary, ESP and BRP seem to be more effective than UPPP in a multilevel surgical robotic setting. However, being quicker, easy to learn and with a low rate of complications, BRP is a safe, effective and promising option for treatment of OSAHS patients.

Transoral robotic surgery (TORS): a new tool for high risk tracheostomy decannulation.

Tracheostomy decannulation has always been considered a procedure with an attendant risk, especially in patients with a reduced upper airway diameter as is commonly observed in the obstructive sleep apnoea (OSA) population. We report on 4 cases where transoral robotic surgery (TORS) helped in the management of long-term cannulated patients. The aims of our paper are: 1. To demonstrate how the otolaryngology team can help identify patients at high risk for decannulation failure; and 2. To demonstrate how TORS may aid in the decannulation process of patients at high risk for failure due to severe tongue base hypertrophy. From our experience, TORS appears to offer an effective option to aid in the decannulation of patients with a severe hypertrophy of the base of tongue and floppy epiglottis.

Human immunodeficiency virus infection: personal experience in changes in head and neck manifestations due to recent antiretroviral therapies.

Both the incidence and prevalence of human immunodeficiency virus infection are increasing in the world. Diseases of ENT districts are more frequent in human immunodeficiency virus-infected patients and involve all the otolaryngological sites. The otorhinolaryngological manifestations in association with HIV infection are mainly atypical, so common in the clinical practice, really aspecific and very frequent in ENT daily routine (such as sinusitis, otitis, etc.) and, therefore, immunodeficiency may not be suspected. In other cases, ENT evidence is more peculiar or unusual, such as opportunistic infections, rare neoplasm and tumours with an unusual course, giving a very high suspect of a human immunodeficiency virus-related infection. The most frequent malignant neoplasm is Kaposi's Sarcoma which is extremely rare in non-human immunodeficiency virus-infected subjects; the second most frequent is non-Hodgkin's lymphoma with 50% in extranodal sites (oral and maxillary sinus). Following a review of the literature, modifications caused by current antiretroviral treatment on head and neck manifestations of human immunodeficiency virus infection have been evaluated. Highly active antiretroviral therapy is a new therapeutic strategy, based on poly-chemo-therapeutic schemes, providing simultaneously two or more anti-retroviral drugs. We have used highly active antiretroviral therapy in human immunodeficiency virus infection since 1997, substituting previous mono-chemotherapy based on Zidovudine or Didanosine alone. Highly active antiretroviral therapy is extremely efficient in reducing the viral load of human immunodeficiency virus and increasing CD4+ T-lymphocyte count. These biological effects are associated with an improvement in immune functions. To evaluate the effects of highly active antiretroviral therapy on otorhinolaryngological manifestations in human immunodeficiency virus infection, we performed a retrospective study on 470 adults, observed over 14 years (1989-2002) and constantly receiving the same treatment, with follow-up from 7 to 80 months. A total of 250 subjects underwent mono-antiretroviral chemotherapy (1989-1996), while 220 underwent highly active antiretroviral therapy (1997-2002). The results of the retrospective study showed that highly active antiretroviral therapy has greatly improved the control of the immune-deficiency (increasing the range of CD4+), reducing the number of otorhinolaryngological manifestations (also tumours). On the other hand, 2 patients presented sudden unilateral hearing loss following treatment: toxicity due to association of new drugs cannot be excluded.

[The role of clinical history in the evaluation of balance and spatial orientation disorders in the elderly]. / Il ruolo della storia clinica nella valutazione dei disturbi vertiginoso-posturali dell'anziano.

Balance and spatial orientation complaints are very frequent in the elderly. The aetiology of these complaints may be related to specific peripheral or central vestibular disorders or to an extravestibular dizziness resulting from impairment or disease in multiple systems. A preliminary diagnostic orientation, permitting the patient to be referred to the most appropriate specialist (otologist, neurologist, consultant in internal medicine, psychiatrist, physical therapist) would be very useful. We examined 163 patients, referred for balance and spatial orientation complaints to the otoneurological outpatient services of 6 university hospital centres in the northern and central Italy, by a detailed questionnaire about characteristics, frequency, duration of any dizziness symptom and by a bedside vestibular examination. The questions were designed to determine whether the patients suffered from true vertigo, considered to be an expression of a vestibular disorder, or of an aspecific dizziness of multifactorial origin. Comparison of the conclusions of the vestibular examination and the diagnostic hypotheses deduced from the clinical history showed a high degree of concordance (Cohen Index 70.5%). To the patient, vertigo and dizziness are synonymous. By asking appropriate questions, a clearer picture should begin to emerge from the patient complaints so that distinction between psychogenic, nonvestibular and vestibular causes can be made. The importance of obtaining a good history cannot be overemphasized. A correct and rigorous approach by the general practitioner could be of great utility both for the health of the patient and for the efficiency of the national health service. The vestibular examination proved that about half the patients (80/163) suffered from vestibular disorders, mainly of peripheral origin (BPV, Menière's disease, vestibular neuritis).

[The relationship between cognitive impairment, anxiety-depression symptoms and balance and spatial orientation complaints in the elderly]. / Relazione tra decadimento cognitivo, stato ansioso-depressivo e disturbi vertiginoso-posturali nell'anziano.

Balance and spatial orientation complaints, generically defined as "dizziness", are frequent in the elderly. They can cause a greater or lesser degree of handicap, and be associated with a greater or lesser degree of cognitive impairment and anxiety-depression symptoms. We examined 163 patients, referred for these complaints to the otoneurological outpatient services of 6 university hospital centres of the northern and central Italy, performing a bedside vestibular examination. The test allowed to distinguish between subjects with specific vestibular disorders (mainly BVP, Menière's disease and vestibular neuritis) and subjects in who the vestibular examination was not significant, and whose dizziness probably resulted from impairment or disease in multiple systems. The evaluation of the degree of handicap, using the Dizziness Handicap Inventory, showed that in the former group the physical parameters were significantly impaired with respect of a group of 81 age matched healthy controls, whereas the functional and emotional parameters were not. The evaluation of the degree of anxiety-depression, using the Hospital Anxiety Depression Scale, showed that all elderly people with balance and spatial orientation complaints present a degree of anxiety, but not of depression, greater than the controls, irrespective of the vestibular or extravestibular origin of the symptoms. The evaluation of the cognitive level, using the Mini Mental Test, showed that it is similar to the cognitive level in the controls when, according to the results of the otoneurological examination, the balance and spatial orientation complaints are due to vestibular disorders, but it is impaired when these symptoms are related to a dizziness of multifactorial aetiology. The presence of comorbidities is also higher in these patients. It is likely that in the elderly balance and spatial orientation complaints not caused by specific vestibular disorders are due to a dizziness of multifactorial origin, both organic and psychic, that can be classified as a geriatric syndrome.