Effectiveness and safety profile of mepolizumab in chronic rhinosinusitis with nasal polyps: Real life data in a tertiary care.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized by a type 2 pattern of inflammation. Mepolizumab was approved for the treatment of CRSwNP in 2021, it may be useful to evaluate its safety profile in a real-world setting. AIM: This work aimed to prospectively highlight the effectiveness and safety profile of Mepolizumab in patients with CRSwNP enrolled in the Otorhinolaryngology Unit of the University Hospital of Messina. METHODS: An observational cohort study was carried out considering all patients treated with Mepolizumab. A descriptive analysis was conducted reporting all demographic characteristics, endoscopic evaluations, and symptom conditions. RESULTS: A total of 30 patients were treated with Mepolizumab, one patient discontinued the treatment. A statistically significant reduction in the Sino-Nasal Outcome Tests-22 (SNOT-22) and nasal polyp score (NPS) was shown at the 6th and 12th months compared to baseline values (SNOT-22, -33 and - 43, p < 0.001 for both comparisons; NPS, 0 and - 1, p < 0.001 for both comparisons). The median (Q1-Q3) sniffin' sticks test score increased from 7 (6-8) at the 6th month to 11 (10-13) at the 12th month. Seven patients (24.1 %) reported pain at the injection site, accompanied by redness, warmth, and tenderness within the first 24 h post-injection with a median duration of three days from the onset. CONCLUSIONS: Given the optimal treatment response and the minimal adverse effects observed, clinicians should consider Mepolizumab a safe and effective treatment in CRSwNP patients. Further studies in real-life setting are necessary to better understand the long-term effects.

Auditory System Involvement in Psoriasis.

Psoriasis is a systemic inflammatory disorder associated with many other chronic and progressive diseases. There are few studies on the association of psoriasis with alterations in auditory function. A clinical and instrumental pilot study of auditory function was performed with 77 psoriatic patients and 77 age- and sex-matched healthy controls. The main results were: (i) hearing loss, mostly of sensorineural type, was significantly more frequent in patients than in controls; (ii) conductive and mixed hearing loss were more frequent in arthropathic than in non-arthropathic psoriatic patients; (iii) duration of psoriasis > 10 years or smoking were associated with higher frequency of hearing loss; (iv) psoriasis was more severe in patients with hearing loss than in those without hearing loss. Tympanogram abnormalities were found in patients more often than in controls. These data expand the list of extracutaneous conditions associated with psoriasis, and support the need for further basic and clinical research in this field.

Neonatal stridor and laryngeal cyst: Which comes first?

Neonatal stridor is a rare condition usually caused by laryngomalacia. Congenital laryngeal cyst represents an uncommon cause of stridor in the neonatal population and may be misinterpreted as laryngomalacia, leading to serious morbidity and mortality if diagnosis and treatment are delayed. Herein we report the case of a full-term infant with stridor, feeding problems and failure to thrive. Initially, direct laryngoscopy diagnosed only laryngomalacia. As stridor worsened, however, and respiratory distress appeared, repeat laryngoscopy showed vallecular laryngeal cyst, visible macroscopically. The patient was successfully treated with endoscopic marsupialization. There was no evidence of recurrence at follow up after 3 months. This case highlights the importance of laryngoscopic assessment for suspected laryngeal abnormalities in infants with stridor. If symptoms worsen, endoscopy should be repeated, because congenital laryngeal cysts may not be immediately visible macroscopically.

Vocal outcome after CO2 laser cordectomy performed on patients affected by early glottic carcinoma.

OBJECTIVE: The objectives of this study were to assess the influence of the different types of laser cordectomy on vocal outcome and highlight the relationship between some perceptive, acoustic, and endoscopic evaluations. STUDY DESIGN: Retrospective observational study. METHODS: Thirteen patients, staged as having T1a tumor, underwent laser CO(2)cordectomy (1 patient type I and type II, 2 patients type II, 6 patients type III, and 4 patients type IV) between January and June 2010. Grade, roughness, breathiness, asthenia, and strain evaluation scale; voice handicap index-10 questionnaire; multidimensional computer analysis of voice and speech; maximum phonation time; and stroboscopic examination were performed 12 months after the surgery. Correlations between jitter% and R, shimmer% and R, noise-to-harmonic ratio (NHR) and G were studied. Patients were first divided into groups according to type of cordectomy performed and, later, according to stroboscopic findings. Wilcoxon test, Spearman index, and Kruskal-Wallis test, followed by post hoc analysis, were used. RESULTS: No significant differences were found in type III and type IV cordectomy groups. Jitter% and R values showed a correlation as did shimmer% and B values, and NHR and G values in type III cordectomy group. Moreover, shimmer% and NHR values significantly increase in direct proportion to the severity of the endoscopic status. CONCLUSIONS: Results indicate that the type of surgery performed, functional compensation, and outcome measures were related, although for some data, there were no statistical evidence. Individual compliance could strongly influence vocal outcome in these patients.