Added value of 3D printing technology in the manufacturing of customised septal buttons: A scoping review of the literature.

BACKGROUND: In recent years, Three-dimensional printing (3-DP) technology, has had several applications in many fields of medicine, including rhinology. The aim of this review is to evaluate the use of 3-DP buttons as a treatment option for nasal septal perforations (NSP). METHODS: We conducted a scoping review of the literature until June 07, 2022, on the online databases PubMed, Mendeley, and Cochrane Library. All articles referred to treatment of NSP with custom made buttons created by 3-DP technology were included in this study. RESULTS: A total of 197 articles were generated by the search. Six articles met the inclusion criteria. 3 of the articles referred to clinical cases or clinical series. A total of 35 patients used the 3-DP custom made button as a treatment for NSP. The retention rate of this buttons ranged from 90.5 % to 100 %. An overall decrease in NSP symptoms was also observed in the majority of patients, especially regarding the most common complaints such as nasal bleeding and crusting. CONCLUSION: The manufacturing of 3-DP buttons is a complex, time consuming process that requires both special laboratory equipment and trained staff. This method has the advantage of reducing the NSP related symptoms and an improving the retention rate. This could make the 3-DP custom made button a first-choice treatment for patients with NSP. However, as a new treatment option, it needs studies with more patients to determine its superiority over conventional buttons and its long-lasting therapeutic effects.

A "Terrible" Headache in a HIV Patient.

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

Clival Mucocele: A Rare Yet not Forgotten Pathology.

Primary clival mucoceles are a rare clinical entity that usually represents an incidental finding on computed tomography or magnetic resonance imaging scanning. There are only a few reports in the literature of patients who presented with vague symptoms such as headaches, facial paresthesia, and numbness. Clival mucoceles can also be secondary, by extension of a sphenoid mucocele to the clivus. We present a case of primary clival mucocele, aiming to highlight the importance of a multidisciplinary approach.

The outcomes of bilateral bone conduction hearing devices (BCHD) implantation in the treatment of hearing loss: A systematic review.

OBJECTIVES: Bone Conduction Hearing Devices (BCHDs) are a means of improving hearing ability in those that do not receive full benefit from conventional hearing aids. In 2016, the NHS started commissioning bilateral BCHDs. This review aims to evaluate the current literature and identify areas for further research. METHODS: This review was conducted in line with the PRISMA guidelines and registered on the PROSPERO database (registration CRD42020191956). MEDLINE, CINAHL and The Cochrane Library were systematically searched. The full text of relevant titles and abstracts was then reviewed before data extraction was undertaken. Risk of bias was assessed using the ROBINS-1 tool. RESULTS: Searches identified 125 studies. After removing duplicates, 28 full texts were screened. 14 studies were included in the final review. Amongst the audiological outcomes, greater improvements for bilateral compared to unilateral BCHDs were seen in hearing thresholds, understanding speech in quiet, localization, and restoration of binaural hearing. Thus, supporting the addition of a second implant. For speech in noise however, bilateral BCHDs were less effective when the noise was presented from one side. Increases in measures of Quality of Life, including the Glasgow Benefit Index, were seen across all included studies. No studies included complication rates. CONCLUSION: Overall, bilateral BCHDs offer benefits to the recipient's audiological capabilities and QoL. However, more research is required on the complications and the cost of bilateral BCHDs. Further to this, future research should aim to use uniform tests to measure outcomes.

Quality of Life After Total Laryngectomy: A Retrospective Study.

Quality of life is severely affected in laryngeal cancer patients, who have undergone total laryngectomy, particularly with regard to cancer diagnosis and the consequences of total laryngectomy. The aim of the present study is to record and evaluate the problems related with the quality of life in laryngectomized patients. A further goal is to investigate, whether a correlation exists between demographics and clinical characteristics of the patients. Fifty male patients, who underwent total laryngectomy, participated in the study. Two questionnaires were used to test various quality of life parameters, the EORTC QLQ C30 version 3.0 and EORTC QLQ H&N35. Specific demographic and clinical data of the patients were also recorded. The overall quality of life index was similar in both studied patients and the reference group of cancer patients provided by the European Organization for Research and Treatment of Cancer (EORTC). However, the following discrepancies were noted: voice, senses, dyspnoea were more problematic in studied patients, whereas the functional status of cognitive, physical, social and emotional function were better. In most recorded symptoms, the intensity was mild. The demographic and clinical data appeared to have interesting correlations with specific functional aspects and symptoms. Although several quality of life aspects are found to be negatively affected in laryngectomized patients, overall quality of life appears to be satisfactory.

A Case of Clinically Diagnosed ANCA Negative Granulomatosis With Polyangiitis.

SIGNIFICANCE STATEMENT: Granulomatosis with polyangitis (GPA) is a systemic necrotizing vasculitis comprising of inflammation of small and medium-sized vessels.1 It typically presents with involvement of the upper and lower airways as well as the kidneys. If left untreated, end-organ damage may occur. Hematological investigations typically demonstrate the presence of antinuclear cytoplasmic antibodies (ANCA).2 Here, we discuss an unusual presentation of ANCA negative GPA, presenting initially with nasal symptoms.

Human Papillomavirus Vaccine to End Oropharyngeal Cancer. A Systematic Review and Meta-Analysis.

ABSTRACT: Oropharyngeal cancer (OPC) is currently the most frequent human papillomavirus (HPV)-related malignancy in high-income countries. Oral HPV16 infection is the cause of HPV-related OPC in more than 90% of cases and is primarily (90%) linked to oral sex. This systematic review and meta-analysis aimed at comparing the prevalence of oral vaccine-type HPV infection in individuals vaccinated with HPV vaccines and unvaccinated controls. Three databases (MEDLINE, ScienceDirect, and the Cochrane Library), as well as other sources, were searched by 2 independent reviewers. Controlled studies testing the efficacy or effectiveness of licensed HPV vaccines were included. The primary end point was multiple oral HPV infections in one individual with low-risk and high-risk types. Secondary end point was the number of oral HPV16 infections. Six studies-2 randomized controlled trials and 4 cross-sectional studies-with a total of 15,240 participants were included in a meta-analysis, which showed that vaccinated individuals were 46% (risk ratio, 0.54; 95% confidence interval, 0.32-0.91) less likely to develop oral vaccine-type HPV infection (P = 0.02). A second meta-analysis of 4 studies (1 randomized controlled trial and 3 cross-sectional studies) and 13.285 participants showed 80% (risk ratio, 0.20; 95% confidence interval, 0.09-0.43) less likelihood of oral HPV16 infection (P < 0.0001). This study suggests that HPV vaccines can protect against oral vaccine-type HPV infection including high-risk HPV16 infection, thus reducing the incidence of HPV-related OPC. Vaccination against HPV, especially in males, who are predominantly affected by HPV-related OPC, could result in the prevention of this disease.

Lasers in Cholesteatoma Surgery: A Systematic Review.

OBJECTIVES: The mainstay of cholesteatoma treatment is surgical and requires the removal of all squamous epithelium from the underlying normal structure. The application of laser technology in middle ear and mastoid surgery has shown promise in achieving both disease eradication and hearing preservation. This systematic review aims to include studies that have assessed the application of laser to the treatment of cholesteatoma and to review its outcomes in terms of disease eradication as well as hearing results. METHOD: Two independent researchers conducted a systematic review of the literature on MEDLINE and Cochrane library, according to PRISMA guidance. RESULT: The search resulted in 12 papers, reporting on 536 participants that fulfilled the inclusion criteria. The hearing results did not show that using laser surgery improved hearing in cholesteatoma surgery, but neither has the use of laser shown to deteriorate hearing. With regards to the prevention of residual/recurrent cholesteatoma, the current literature reports a residual/recurrent rate of 0% to 33%. The complication rate of facial palsy is 0.6%. CONCLUSION: While there is certainly a role for future studies especially randomised large-cohort prospective comparative studies, the current literature suggests that laser may have a role in prevention or minimizing of residual cholesteatoma and generally have a safe hearing outcome profile.

Lasers in Rhinology-An Update.

OBJECTIVES: A wide and evolving range of lasers and their applications often makes it difficult for a busy surgeon to choose the ideal laser for a specific indication. With this in mind, this article aims to summarize the most recent literature concerning laser application in rhinology. METHODS: A literature search from 2000 to 2020 using the PubMed database was employed. Keywords used included "laser," "rhinology," "endonasal endoscopic surgery," "hereditary haemorrhagic telangiectasia," "rhinitis," "refractory rhinitis," "Inferior turbinate hypertrophy," "dacryocystorhinostomy," "septoplasty," "cartilage reshaping" and "choanal atresia." The most up to date studies published for each rhinology condition that could potentially be treated with laser surgery was included. RESULTS: Rhinological conditions appropriate for laser applications are discussed. We identified articles related to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies and their limitations. CONCLUSIONS: There is currently no one-size-fits-all laser and therefore being up to date on the latest clinical application results can help the clinician decide which are the best treatments to offer their patients.

Endoscopic Denker's Approach for the Treatment of Extensive Sinonasal Tumors: Our Experience.

OBJECTIVES: Surgical management of large sinonasal tumors, spreading to the pterygopalatine, and infratemporal fossae have always been a challenge for the ENT surgeon and the multidisciplinary team. METHODS: Endoscopic Denker's approach allows complete exposure of the anterior, inferior, and lateral recesses of the maxillary sinus, without necessitating a gingivobuccal or a transseptal incision. Moreover, endoscopic Denker's approach facilitates direct, straight entry to the pterygopalatine and infratemporal fossae. RESULTS: Twenty-two patients with extensive sinonasal pathology underwent resection via an endoscopic Denker's approach at our institution, with the majority of them being diagnosed with JNA and inverted papilloma. Denker's procedure facilitated wide exposure of the surgical field and total tumor resection, without significant perioperative complications and good disease-free results in follow up. CONCLUSIONS: Our experience is in accordance with the literature, where this approach seems to be superior to alternative options for accessing the pterygopalatine and infratemporal fossae. We believe that adequate expertise in endoscopic sinonasal surgery is necessary prior to embarking on this technique, but in general, it represents a valuable tool in the surgeon's armamentarium. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1458-1462, 2021.

Endoscopic versus microscopic ossiculoplasty in chronic otitis media: a systematic review of the literature.

OBJECTIVE: The aim of this study was to compare the endoscopic and microscopic ossiculoplasty in patients with chronic otitis media. METHODS: MEDLINE, ScienceDirect, and the Cochrane Library databases as well as other sources were searched by two independent reviewers. Controlled studies comparing endoscopic and microscopic ossiculoplasty in patients with chronic otitis media were included. Mean air-bone gap closure was the primary outcome. Secondary outcomes were operation time and complications. RESULTS: Three studies met the inclusion criteria. No statistically significant differences in audiometric outcomes between endoscopic and microscopic groups in all three included studies were reported. Although endoscopic technique was related to a fewer number of postoperative complications and a shorter operation time, these outcomes did not reach statistical significance. CONCLUSION: Endoscopic ossiculoplasty is associated with similar postoperative hearing results compared to the traditional microscopic approach. A trend towards a shorter operative time and reduced morbidity for the endoscopic approach has been observed, but well-designed randomized controlled trials are warranted to confirm this finding.

5 Years of Diode Laser "Π" Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice.

BACKGROUND: To demonstrate the efficacy of a new laser surgical technique for bilateral vocal fold immobility (BVFI) on postoperative quality of voice and swallowing. METHODS: Prospective study in a tertiary university hospital and a private hospital. Patients with iatrogenic BVFI were included. Outcome measures were Voice Handicap Index 10, 10-item Eating Assessment Tool, flexible laryngoscopy, and success of decannulation. RESULTS: Forty patients with post thyroidectomy BVFI were initially enrolled in our study; only 12 patients returned questionnaires and kept their follow-ups and were included in the study. All patients were successfully decannulated and remain decannulated up to 24-month follow-up. There was a statistically significant improvement in quality of swallowing and no significant deterioration in quality of voice. There was no need for revision up to 24-month follow up. CONCLUSIONS: The "Π" technique using diode laser technology is a new and safe technique for BVFI with excellent long-term decannulation rates and improvement in quality of life and swallowing without significant changes in voice quality.

Diode Laser for Laryngeal Cancer: "980 nm" and Beyond the Classic CO2.

Lasers have been used in otolaryngology for more than 40 years and are widely considered an established way of addressing laryngeal pathology, benign and malignant. Carbon dioxide (CO2) laser is considered a gold standard, but over the last 2 decades, a new technology has been developed and established in other medical specialties, not so much in Ear Nose and Throat (ENT), the diode laser. It consists of a flexible fiber that passes through a hollow guidance system and is capable of reaching certain angled spots easier than straight beam systems. Portability, lower cost, easier setup, and improved photocoagulation are just some of the many features rendering it an excellent choice for the surgeon and the patient. The few studies published worldwide for the usage and efficacy of this system show no major differences related to the oncologic outcome and survival rate of patients having an early glottic tumor between diode laser microsurgery and CO2 laser cordectomy. Nevertheless, the advantages offered by fiber-optic laser surgery render it a worthy and perhaps equal alternative for treating this kind of pathology.

Microdebrider-Assisted Rhinophyma Excision.

Rhinophyma represents a progressive deformity of the nose which leads to cosmetic disfigurement and has a significant impact on the patient's quality of life. This pathological entity originates from hyperplasia of sebaceous gland tissue, connective tissue, and vessels of the nose and is associated with rosacea and more specifically, stage III rosacea. Surgical treatment is the method of choice. We present five cases of rhinophyma that we treated with microdebrider-assisted excision. The procedure was divided in two main steps: scalpel excision of the main bulk of the rhinophyma and then further contouring with the microdebrider. All patients had weekly follow-up for the first four weeks, and then three-monthly. All patients had uneventful recovery and satisfactory cosmetic outcomes. No postoperative infections or other complications were reported in our case series. The use of the microdebrider reduces the operating time, preserves the islands of skin regeneration, and allows finer manipulations than the standard scalpel techniques. Microdebrider-assisted rhinophyma excision is a safe approach, with good aesthetic results. Larger series of patients need to be examined in order to establish the value of the method.

A Case of Invasive Sinonasal Carcinosarcoma: The Importance of Early Detection.

Sinonasal carcinosarcomas represent rare neoplasms, with aggressive character and unfavourable prognosis. We present a case of extensive sinonasal carcinosarcoma extending into the anterior cranial fossa and into the orbit and also a review of the current international literature regarding this rare yet aggressive neoplasm. There is currently a lack of specific guidelines on the optimal management of sinonasal carcinosarcoma and the treatment represents a challenge for the clinician. The key message that we would like to disseminate to our colleagues is the importance of suspicion and early detection, as well as the necessity to adopt a holistic approach when counselling patients.