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OBJECTIVES: Temporomandibular joint (TMJ) arthritis and ankylosis represent unusual but potential complications of ear suppuration, especially in children. We performed a review of the literature of pediatric otogenic TMJ arthritis and ankylosis, discussing their clinical and radiological features, their mechanism of infection spread, and the importance of a prompt diagnosis and treatment. We additionally describe a case of TMJ ankylosis following acute mastoiditis in a 4-year-old female patient. METHODS: A search of English literature from January 1, 1980 to December 31, 2021 was performed on the electronic databases (PubMed, Web of Science and Scopus) in order to identify studies concerning TMJ complication after ear suppuration. RESULTS: Seventeen articles were considered eligible for the review. Eight and nine studies described otogenic TMJ ankylosis and arthritis, respectively. A total of 17 children affected by ankylosis consequent to ear infection and a total of 31 cases of TMJ arthritis concurrent to otomastoiditis were identified. Mean time elapsed between ear infection and diagnosis of TMJ ankylosis was 4.8 years (range 0.5-13). CONCLUSION: TMJ involvement during complicated otitis media should be kept in mind. Its prompt recognition is mandatory to set up appropriate treatment and follow-up and reduce the risk of ankylosis with its functional and psychological complications.
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Anquilose , Artrite , Otite Média , Anquilose/complicações , Anquilose/diagnóstico , Artrite/complicações , Criança , Pré-Escolar , Feminino , Humanos , Otite Média/complicações , Supuração/complicações , Articulação Temporomandibular , Transtornos da Articulação TemporomandibularRESUMO
PURPOSE: To evaluate the outcome of facial nerve (FN) cable graft interposition in lateral skull base surgery. MATERIALS AND METHODS: A group of 16 patients who underwent FN graft interposition procedure was retrospectively considered. Postoperative FN function was evaluated using the House-Brackmann (HB) grading system, the Sunnybrook Facial Grading System (SFGS), the Facial Disability Index (FDI) and the Oral Functioning Scale (OFS) questionnaires. RESULTS: 56.2% of patients had a good postoperative FN outcome (HB grade II-III). Postoperative electromyography (EMG) showed re-innervation potentials in 60% of patients; median age of these patients was significantly lower compared to who did not manifest re-innervation (p = 0.039). CONCLUSION: FN primary reconstruction remains the advisable rehabilitative option when the nerve is interrupted during lateral skull base surgeries, allowing to satisfactory postoperative results in more than half of patients. EMG confirmed the restoring of nerve conduction and it was more frequent in younger patients. The SFGS, the FDI and the OFS are important tools especially in the setting of a rehabilitation program.
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Nervo Facial/cirurgia , Nervo Facial/transplante , Paralisia Facial/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Base do Crânio/cirurgia , Transplante/métodos , Adulto , Fatores Etários , Eletromiografia , Nervo Facial/fisiopatologia , Paralisia Facial/fisiopatologia , Paralisia Facial/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Gravidade do Paciente , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: During the Coronavirus disease 2019 (COVID-19) pandemic a reduction in the diagnosis of many otorhinolaryngological and audiological disorders has been widely reported. The main aim of this investigation was to evaluate the impact of COVID-19 outbreak on the incidence of acute hearing and vestibular disorders. MATERIALS AND METHODS: A retrospective analysis was performed of all patients evaluated in an audiology tertiary referral centre for acute cochleo-vestibular impairment between March 1st 2020 and February 28th 2021 (Pandemic Year Period, PYP). Results were compared to patients presenting with the same disorders during two previous periods (March 1st 2019 to February 29th 2020 and March 1st 2018 to February 28th 2019; First Precedent Year Period, FPYP and Second Precedent Year Period, SPYP, respectively). RESULTS: The annual incidence of total acute audio-vestibular disorders (number of annual diagnoses divided by total number of annual audiological evaluations) was 1.52% during the PYP, 1.31% in FPYP and 1.20% in SPYP. Comparison between the pandemic period and previous periods did not show a significant difference (p > 0.05). The overall incidence of SSNHL and combined acute cochlear-vestibular involvement was significantly higher during the PYP compared to the previous periods (p = 0.022). CONCLUSIONS: There were no differences in the absolute number of acute audio-vestibular disorders during the pandemic compared to previous periods. Although not significant, the SSNHL during the pandemic appeared worse in terms of pure-tone average with a higher incidence of associated vestibular involvement. Further studies are needed to clarify the role of SARS-CoV-2 on audio-vestibular disorders incidence and pathophysiology.
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COVID-19/epidemiologia , Perda Auditiva Súbita/epidemiologia , Doenças Vestibulares/epidemiologia , Feminino , Testes Auditivos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção TerciáriaRESUMO
PURPOSE: Otitis media with effusion (OME) is the most common ear disease in childhood. The hearing loss associated with OME impacts on children's language development and behavior. Eustachian tube insufflation are among possible treatments for OME, but data regarding their effectiveness are scarce. The aim of this investigation was to analyze the effect of inhalatory thermal therapy and Eustachian tube insufflation in a consecutive cohort of pediatric patients with OME. MATERIALS AND METHODS: Seventy-four pediatric patients referred for OME to the thermal medical center "La Contea" (Battaglia Terme, Padova, Italy) were considered. Data from tympanometry and pure tone audiometry performed immediately before (T0), at the end of treatment (T1) and at a follow-up control (T2) were analyzed. RESULTS: Data from 148 ears were available. The pressure values of tympanometry significantly improved from T0 to T1 (p = 0.0001), and further improvement was recorded at T2, when 60.8% of patients had normal tympanograms. A significant gain of the air-conduction threshold in the T0-T2 interval was observed (p = 0.0001). At otoscopy, a significant reduction of tympanic membranes with fluid or air-fluid levels presence (p < 0.00001) and a significant increase of normal tympanic membranes (p = 0.0001) were found. CONCLUSION: Eustachian tube insufflation represented a well-tolerated and effective treatment in children with OME. Further investigations should deepen these results in randomized, double-blind settings, possibly with long-term follow-up periods. A quality-of-life and cost-effectiveness evaluation of this treatment approach for pediatric OME could be helpful for public health decision-making.
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Tuba Auditiva , Insuflação , Otite Média com Derrame , Otite Média , Testes de Impedância Acústica/métodos , Criança , Humanos , Insuflação/métodos , Otite Média/complicações , Otite Média com Derrame/terapia , ÁguaRESUMO
OBJECTIVE: To ensure the safety and quality of vaccines, especially the newest RNA-vaccines against COVID-19, is one of the World Health Organization's current highest priorities. DESIGN: Case description. STUDY SAMPLE: We report three cases of sudden unilateral tinnitus following BNT162b2 mRNA-vaccine injection, which rapidly resolved in 2 out of 3 cases. RESULTS: The mechanism responsible for its development remains unclear. A hypersensitivity reaction with an abnormal autoimmune response or a vasculitic event may be implicated. CONCLUSIONS: Large-scale and well-designed studies are needed to improve surveillance of the COVID-19 vaccine and better define possible adverse reactions involving the cochleo-vestibular system and/or immunisation anxiety-related reactions.
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COVID-19 , Zumbido , Vacina BNT162 , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Humanos , SARS-CoV-2 , Zumbido/diagnóstico , Zumbido/etiologia , Vacinação/efeitos adversosRESUMO
AIMS: In chronic rhinosinusitis with nasal polyps (CRSwNP), tools based on objective evidence, such as histopathology, are needed to assist clinical decision-making. The main aim of this exploratory investigation was to determine whether structured histopathology could be used to classify CRSwNP in homogeneous histological clusters. METHODS AND RESULTS: A cohort of 135 CRSwNP patients was assessed, on the basis of clinicopathological features: allergic fungal rhinosinusitis (17 patients); non-steroidal anti-inflammatory drug-exacerbated respiratory disease (19 patients); intrinsic asthma (18 patients); extrinsic asthma (21 patients); allergy (21 patients); histologically eosinophilic (22 patients); and histologically non-eosinophilic (17 patients). For structured histopathology, we considered: the degree of inflammation; eosinophil count; eosinophil aggregates; neutrophil infiltration; goblet cell hyperplasia; basement membrane thickening; fibrosis; hyperplastic/papillary changes; squamous metaplasia; mucosal ulceration; and subepithelial oedema. Cluster analysis identified four distinct sets of cases. On discriminant analysis, the global error rate was 1.48%, and the stratified error rates were 4.34%, 0%, 0%, and 0% for clusters 1, 2, 3 and 4, respectively. Cluster 1 was characterised by infrequent fibrosis (<4.5% of cases). Cluster 2 mainly featured neutrophil infiltration in 100% of cases, hyperplastic/papillary changes in 70% of cases, and fibrosis in 65% of cases. Cluster 3 showed fibrosis in 100% of cases. Cluster 4 showed hyperplastic/papillary changes in 100% of cases, and fibrosis in 92% of cases. CONCLUSIONS: This study shows that cluster analysis can identify different histotypes among CRSwNP patients. The next step will be to investigate, in a larger series, the clinical (e.g. prognostic) implications of identifying such homogeneous clusters of patients with CRSwNP on the basis of their structured histopathology.
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Fibrose/classificação , Inflamação/classificação , Pólipos Nasais/classificação , Rinite/classificação , Sinusite/classificação , Doença Crônica , Análise por Conglomerados , Estudos de Coortes , Eosinófilos/patologia , Fibrose/patologia , Fibrose/cirurgia , Humanos , Inflamação/patologia , Inflamação/cirurgia , Pólipos Nasais/patologia , Pólipos Nasais/cirurgia , Estudos Retrospectivos , Rinite/patologia , Rinite/cirurgia , Sinusite/patologia , Sinusite/cirurgiaRESUMO
PURPOSE: Allergic fungal rhinosinusitis (AFRS) forms a subset of chronic rhinosinusitis with nasal polyps (CRSwNP) that is mainly characterized by eosinophilic nasal polyps, allergic mucin detected in the sinuses at surgery, and specific features on computerized tomography. Which biological markers predict disease recurrence in AFRS is still not clear, and the role of blood inflammatory cells in predicting recurrent polyps after surgery has yet to be investigated. The aim of this study was to newly investigate the prognostic role (in terms of recurrence rate) of preoperative blood eosinophil and basophil levels in AFRS. MATERIALS AND METHODS: A consecutive series of 17 adult patients who underwent endoscopic sinus surgery for AFRS was retrospectively assessed. RESULTS: Sinonasal polyps recurred in 7 of 17 patients. Considering the whole cohort, a significant positive correlation emerged between blood eosinophil and basophil counts, but not between blood and tissue eosinophil counts. Statistical analysis found significantly higher blood eosinophil and basophil levels in AFRS patients who relapsed than in those who did not. CONCLUSIONS: Considering the current difficulty of identifying more effective, personalized approaches to postoperative disease management in AFRS, our preliminary data support the impression that blood eosinophil and basophil levels warrant testing in further prospective and larger (preferably multi-institutional) investigations as part of the preoperative work-up for patients with AFRS in order to administer dedicated postoperative medical treatments for patients at higher risk of relapse.
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Basófilos , Eosinófilos , Micoses/sangue , Micoses/microbiologia , Rinite Alérgica/sangue , Rinite Alérgica/microbiologia , Sinusite/sangue , Sinusite/microbiologia , Adulto , Doença Crônica , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucinas/análise , Micoses/diagnóstico por imagem , Micoses/cirurgia , Pólipos Nasais/sangue , Pólipos Nasais/diagnóstico por imagem , Pólipos Nasais/microbiologia , Pólipos Nasais/cirurgia , Prognóstico , Recidiva , Estudos Retrospectivos , Rinite Alérgica/diagnóstico por imagem , Rinite Alérgica/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Distinguishing the prodromal nasal polyposis of eosinophilic granulomatosis with polyangiitis (EGPA) from chronic rhinosinusitis with nasal polyps (CRSwNP) is a challenge for rhinologists and rheumatologists. It has recently been reported that angiogenesis and CD105 expressed on vascular endothelial cells could have a role in the pathogenesis and development of nasal polyps. This exploratory study examined the structured histopathology of nasal polyps in patients with EGPA and CRSwNP, comparing CD105 expression in their nasal tissue with that of a control group with no chronic sinonasal inflammation. METHODS: A structured histopathological study was performed on surgical specimens of nasal tissue from 32 adults (13 with EGPA, 14 with CRSwNP, 5 controls), considering CD105 as a marker to determine microvessel density (MVD). RESULTS: The mean eosinophil count was higher in EGPA patients with tissue inflammation (p = .002), and in CRSwNP patients with sub-epithelial edema (p = .009). Neutrophil infiltration was significantly associated with severe tissue inflammation in EGPA patients (p = .04), but with the absence of fibrosis in CRSwNP patients (p = .04). In the EGPA group, CD105-MVD correlated with tissue eosinophil count (p = .05). Mean CD105-MVD was significantly higher in EGPA patients with mucosal ulceration (p = .004). In the CRSwNP group, a CD105-MVD correlated positively and significantly with tissue eosinophil count (p = .01). CONCLUSION: Alongside the known abundance of eosinophils, other cells might contribute to inflammatory processes. Neutrophils may amplify inflammation, eosinophil recruitment and tissue damage. CD105 expression in CRSwNP and EGPA nasal polyps supports the hypothesized involvement of angiogenesis in the pathogenesis and development of nasal polyps.
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Endoglina/análise , Granuloma Eosinófilo/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Pólipos Nasais/diagnóstico , Adulto , Idoso , Biomarcadores/análise , Doença Crônica , Diagnóstico Diferencial , Granuloma Eosinófilo/patologia , Eosinófilos , Feminino , Granulomatose com Poliangiite/patologia , Humanos , Inflamação , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/patologia , Rinite , SinusiteRESUMO
PURPOSE: Limited approach septoplasty (LAS) follows the principle of respecting nasal structures and aims to minimize complications while ensuring proper nasal respiratory function. LAS is only applicable to selected cases of septal deviation. The present study aimed to: (1) compare short- and mid-term complications in two consecutive series of patients with the same type of septal deviation treated with LAS or classical septoplasty; and (2) examine postoperative respiratory function with active anterior rhinomanometry in the two series, and in a group of healthy, non-surgical volunteers. METHODS: The study concerned two groups of 20 consecutive patients who underwent LAS or classical septoplasty for deviation in Cottle's areas 4/5, and a control group of 11 healthy adult volunteers with no sinonasal disorders. RESULTS: The mean operating time did not differ significantly between the two groups. Three patients in each group developed minor complications. In a sitting position, the mean total nasal inspiratory resistance was 0.018 and 0.019 Pa ml/s (p = 0.46) in the LAS and classical septoplasty groups, respectively, and the total expiratory resistance was 0.019 and 0.018 Pa ml/s (p = 0.30). In a supine position, the mean total nasal inspiratory resistance was 0.017 and 0.021 Pa ml/s (p = 0.05), and the total expiratory resistance was 0.017 and 0.019 Pa ml/s (p = 0.14) in the LAS and classical septoplasty groups, respectively. CONCLUSION: In selected cases, LAS achieved much the same short- and mid-term results as classical septoplasty. The mini-invasive approach is certainly more respectful of the nasal mucosa, requiring a less extensive detachment, with consequent faster healing times and less tissue damage.
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Obstrução Nasal , Rinoplastia , Adulto , Humanos , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Rinomanometria , Resultado do TratamentoRESUMO
PURPOSE: Endotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype. The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes. MATERIALS AND METHODS: Pubmed and Scopus electronic database were searched. The main available studies about CRSwNP endotyping published predominantly in the last 5â¯years were critically analyzed. RESULTS: The pathophysiological features of some asthma-related CRSwNP (allergic fungal rhinosinusitis, aspirin-exacerbated respiratory disease) are quite well understood, including them among known endotypes of CRSwNP. On the other hand, because of their known pathophysiological mechanisms, some well-known diseases associated with aggressive forms of CRSwNP, such as eosinophilic granulomatosis with polyangiitis, primary ciliary dyskinesia and cystic fibrosis, should be investigated as potentially related with CRSwNP endotypes. CONCLUSIONS: CRSwNP comprises several inflammatory endotypes defined by different pathogenic mechanisms. These endotypes correlate with the disease's clinical manifestations and behavior. A thorough understanding of CRSwNP endotypes will enable targeted medical therapies and tailored follow-up protocols.
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Pólipos Nasais/diagnóstico , Pólipos Nasais/fisiopatologia , Rinite/fisiopatologia , Sinusite/fisiopatologia , Doença Crônica , Humanos , Pólipos Nasais/complicações , Rinite/complicações , Rinite/diagnóstico , Sinusite/complicações , Sinusite/diagnósticoRESUMO
PURPOSE: The term aspirin-exacerbated respiratory disease (AERD) refers to a combination of asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and acute respiratory tract reactions to nonsteroidal anti-inflammatory drugs. AERD has now been included among the CRSwNP endotypes, and is considered one of the most aggressive in terms of disease recurrence. Cortactin is a multi-domain protein with a part in several cellular mechanisms involving actin assembly and cytoskeleton arrangement. Cortactin seems to have a role in inflammatory responses and to be implicated in human airway secretion and contraction mechanisms. The novel aim of the present study was to examine cortactin expression in nasal polyps of a consecutive cohort of AERD patients and in nasal mucosa of a control group of patients. MATERIALS AND METHODS: Cortactin expression was assessed immunohistochemically in nasal polyps from 18 consecutive AERD patients who underwent endoscopic sinus surgery and in nasal mucosa of 19 patients without chronic rhinosinusitis. RESULTS: Concomitant allergy was found in 11 AERD patients, most of them male (8 cases; pâ¯=â¯0.02). Cortactin expression in nasal polyps was definitely high (+3) in 17 out of 18 cases, in both epithelial cells (cytoplasmic and membranous immunoreactivity) and activated fibroblasts. A higher cortactin expression was seen in female than in male AERD patients (pâ¯=â¯0.05). CONCLUSIONS: Given this preliminary evidence of cortactin upregulation in the polyps of AERD patients, prospective studies could further investigate the role of cortactin in the biology of AERD, and the potential role of cortactin-targeted approaches in integrated AERD treatments.
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Asma Induzida por Aspirina/epidemiologia , Asma Induzida por Aspirina/patologia , Cortactina/genética , Regulação da Expressão Gênica , Pólipos Nasais/patologia , Adulto , Distribuição por Idade , Asma Induzida por Aspirina/genética , Biópsia por Agulha , Estudos de Casos e Controles , Doença Crônica , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/genética , Estudos Retrospectivos , Rinite/complicações , Distribuição por Sexo , Sinusite/complicações , Estatísticas não Paramétricas , Síndrome , Regulação para CimaRESUMO
BACKGROUND: Identifying specific endotypes within the broad picture of chronic rhinosinusitis with nasal polyps (CRSwNP), by using biomarkers for instance, remains a challenge. The prognostic role of the neutrophil-to-lymphocyte ratio (NLR) and the eosinophil-to-lymphocyte ratio (ELR) as potential markers of inflammation has already been discussed. OBJECTIVE: The aim of the present study was to compare NLR and ELR before and after endoscopic sinus surgery (ESS) and nasal mometasone furoate for CRSwNP by stratifying patients by their clinical and histologic features. METHODS: The study included 115 consecutive patients with CRSwNP treated with ESS and nasal mometasone furoate, with a postoperative follow-up of >12 months. Eosinophilic-type CRSwNP was histopathologically defined after hematoxylin and eosin tissue staining. RESULTS: In the subcohort of patients with an histologic diagnosis of eosinophilic-type CRSwNP, the mean ± standard deviation ELR significantly decreased after surgery (0.22 ± 0.16 versus 0.18 ± 0.12; p = 0.04), whereas, among patients with a histologic diagnosis of noneosinophilic-type CRSwNP, the mean NLR significantly decreased after surgery (1.98 ± 0.98 versus 1.90 ± 0.90; p = 0.04). CONCLUSION: Different CRSwNP endotypes are characterized by different biohumoral patterns. It is reasonable to assume that surgery enables clearance of the polyps and polypoid mucosa, which reduces the load of antigens that triggers the inflammation. Consistent with the above-mentioned biologic mechanism, ESS could correspond to a reduction in blood ELR values and eosinophil count in eosinophilic-type CRSwNP. Analysis of the data did not demonstrate an added value of measuring pre- versus postoperative ELR compared with measuring the blood eosinophil count. When used after ESS, topical corticosteroids also had more significant anti-inflammatory effects. As for the subcohort of patients with noneosinophilic CRSwNP, the fact that the mean NLR dropped significantly after surgery was definitely an original finding. Unlike eosinophilic inflammation, the inflammatory patterns seen in noneosinophilic CRSwNP are still poorly understood.
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Eosinófilos , Contagem de Leucócitos , Contagem de Linfócitos , Pólipos Nasais/sangue , Neutrófilos , Adulto , Idoso , Biomarcadores , Biópsia , Doença Crônica , Endoscopia , Humanos , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Pólipos Nasais/diagnóstico , Pólipos Nasais/cirurgia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Rinite/complicações , Rinite/diagnóstico , Sinusite/complicações , Sinusite/diagnósticoRESUMO
Introduction: Anatomical variations of the neck muscles have previously been reported, involving in particular the omohyoid and sternothyroid muscles. We herein report a novel variant neck muscle found during a routine surgical procedure. Case Report: A 63-year-old women underwent a pelvi-mandibulectomy with bilateral neck dissection for a squamous cell carcinoma of the floor of mouth pT3N1. On the right neck dissection, the present peculiar muscle was discovered. It was located in the lateral region of the neck, deeply to the sternocleidomastoid muscle and caudally to the hyoid bone. It took origin from the sixth cervical vertebrae's transverse process and attached caudally to the middle third of the clavicular bone, after having passed superficially to the omohyoid muscle's intermediate tendon. Conclusions: Neck muscles are important during head and neck surgery due to their significance as surgical landmarks and their relationship with noble vessels. Being aware of possible variant that can alter classical anatomical reference points is important to prevent iatrogenic trauma.
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Introduction: Bilateral facial nerve (FN) palsy due to temporal bone fracture is a rare clinical entity, with few cases reported. The choice between conservative and surgical treatment is more complex than in unilateral cases. Materials and Methods: A thorough search of the available literature on trauma-related bilateral FN palsy revealed 22 reports. Our own experience is also described. Results: All bilateral delayed- and unknown-onset cases were treated conservatively, with a good recovery rate (70.5%). Surgery was performed on 6 sides within the immediate-onset group, with a good recovery rate (83.3%). Conclusions: In the management of traumatic FN palsy, the main controversial issue focusses on indications for surgery as well as timing and type of approach. In bilateral cases, it is more challenging to make the right choice, due to lack of facial asymmetry and/or state of unconsciousness following severe trauma. Electro-diagnostic tests and high-resolution computed tomography are essential for decision-making.
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BACKGROUND: The aim of the present study was to investigate how the organisation of healthcare activity during the first wave of the SARS-CoV-2 pandemic affected the timing of diagnosis of oral carcinoma in the Functional Head and Neck Department of Padua (Italy). This study gives an effective temporal dimension of the diagnostic delay that occurred during the pandemic, compared with data from the literature. METHODS: A retrospective analysis of the diagnostic path of a patient affected by oral cancer during COVID-19 pandemic was performed. The time elapsed from the patient's awareness of the problem to the first curative surgical intervention was considered both during the blockage of elective care activities and in the period immediately following. The results were compared to a group of patients treated in the same period of the year 2019. RESULTS: The territorial time was 53.9% longer in the post-lockdown period than in the lockdown period (39.6 days) while the hospital time was 56.6% shorter than in the post-lockdown period (56 days). CONCLUSIONS: The response time of territorial medicine has been longer during the pandemic peak. The unintentional creation of exclusive pathways for oncological patients speeded up the diagnostic process. The organization and accessibility of operating theatres can become particularly problematic during the acute phases of a pandemic.
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COVID-19 , Carcinoma , Neoplasias Bucais , Humanos , SARS-CoV-2 , COVID-19/diagnóstico , COVID-19/epidemiologia , Pandemias , Diagnóstico Tardio , Estudos Retrospectivos , Controle de Doenças Transmissíveis , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/epidemiologia , Teste para COVID-19RESUMO
BACKGROUND: Nowadays, immunosuppressant drugs are widely used to prevent rejection in organ transplantation and to treat autoimmune diseases. Ototoxicity related to immunosuppressant drugs has been anecdotally reported but scarcely investigated. The aim of this investigation was to systematically review the available data on ototoxicity due to immunosuppressant therapy for transplantation or autoimmune disease. METHODS: A search of electronic databases (PubMed, Web of Science, and Scopus) was performed in order to identify studies concerning otovestibular toxicity due to immunosuppressant therapy for transplantation or autoimmune disease between January 1980 and November 2020. RESULTS: Eighteen articles were considered eligible for the review. Totally 131 patients experienced ototoxicity related to immunosuppressive treatment. Hearing loss was the most common clinical manifestation (128 cases) and was mainly bilateral. Tinnitus was reported in 52 cases and vertigo in 2. The immunosuppressant drugs most frequently involved in ototoxic manifestations were calcineurin inhibitors (cyclosporine and tacrolimus), often related to their high serum levels. CONCLUSION: Immunosuppressant-related ototoxicity is clinically relevant in uncommon but definitely challenging situations. Clinicians should be aware of this and inquire about hearing impairment symptoms during therapy and refer symptomatic patients to an otolaryngologist/audiologist. Further large-scale, prospective investigations are necessary to better characterize the ototoxicity of each class of immunosuppressants.
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Doenças Autoimunes , Perda Auditiva , Ototoxicidade , Doenças Autoimunes/tratamento farmacológico , Perda Auditiva/induzido quimicamente , Humanos , Imunossupressores/efeitos adversos , Ototoxicidade/etiologia , Estudos ProspectivosRESUMO
An altered sense of smell and taste was recognized as one of the most characteristic symptoms of coronavirus infection disease (COVID-19). Despite most patients experiencing a complete functional resolution, there is a 21.3% prevalence of persistent alteration at 12 months after infection. To date, magnetic resonance imaging (MRI) findings in these patients have been variable and not clearly defined. We aimed to clarify radiological alterations of olfactory pathways in patients with long COVID-19 characterized by olfactory dysfunction. A comprehensive review of the English literature was performed by analyzing relevant papers about this topic. A case series was presented: all patients underwent complete otorhinolaryngology evaluation including the Sniffin' Sticks battery test. A previous diagnosis of SARS-CoV-2 infection was confirmed by positive swabs. The MRIs were acquired using a 3.0T MR scanner with a standardized protocol for olfactory tract analysis. Images were first analysed by a dedicated neuroradiologist and subsequently reviewed and compared with the previous available MRIs. The review of the literature retrieved 25 studies; most cases of olfactory dysfunction more than 3 months after SARS-CoV-2 infection showed olfactory bulb (OB) reduction. Patients in the personal case series had asymmetry and a reduction in the volume of the OB. This evidence was strengthened by the comparison with a previous MRI, where the OBs were normal. The results preliminarily confirmed OB reduction in cases of long COVID-19 with an altered sense of smell. Further studies are needed to clarify the epidemiology, pathophysiology and prognosis.
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Sinonasal inverted papilloma (IP) is a benign, locally aggressive epithelial neoplasm. In less than 9% of cases it is associated with malignancies, typically conventional squamous cell carcinomas (SCC), while other histological variants have been less frequently reported. We describe the third case of basaloid squamous cell carcinoma (BSCC) arising in nasal IP. An 81-year-old female patient presented with a pinkish irregular lesion on the nasal septum. Biopsy was consistent with IP and carcinoma in situ. Two surgical procedures were needed to obtain radical excision. Histology on the surgical specimen revealed BSCC. Seven months after surgery, there was no evidence of disease recurrence. Although IP is more frequently associated with conventional SCC, other malignancies should be considered. The histological differential diagnosis should be supported by immunohistochemistry. The generally-recommended treatment for sinonasal BSCC is complete surgical resection, although this may be a problem in multifocal distributions, as in the present case.