MR sialographic assessment of the masseter muscle and the ductal kinking in patients with recurrent parotitis.

Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen's duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.

Determination of costs for the CSRwNP pathway. A time-driven activity-based costing experiment.

Objectives: The study aims to define the economic resources needed to manage chronic rhinosinusitis with nasal polyposis (CRSwNP), assuming the hospital perspective, based on different patient characteristics, within a 24-month time horizon. Methods: Real-world data were collected in 3 Italian hospitals. A time-driven activity-based costing approach was implemented to map and assess the pathways for CRSwNP. The following drivers were considered: diagnostic services, drugs, consumables, human resources, equipment and overhead costs based on the length of stay. Costs related to management of comorbidities and adverse events were evaluated. Three main groups of patients were identified: ineligible for surgery; having 1 intervention; having more than 1 intervention. The economic absorption of patients who continued corticosteroid treatment was analysed. Results: Patients experiencing 1 intervention had a cost of 3,453.31 € that increased to 4,705.03 € for those who required additional surgery. The cost of intranasal corticosteroids was 649.20 €, whereas the cost of oral corticosteroids was 37.60 € per patient. Conclusions: The results demonstrate the strategic relevance of analytical cost definitions of the clinical pathway for CRSwNP, which can help to support decision makers in the review of internal procedures and in the definition of proper reimbursement tariffs.

ENT management of children with adenotonsillar disease during COVID-19 pandemic. Ready to start again?

Clinical manifestations of COVID-19 in children are milder, but the real burden of disease is unknown. After the lockdown, in our Region Lombardia we have been requested to progressively resume medical services including outpatient assessment and priority surgery. Therefore, we screened surgical waiting lists with identification of 47 children candidates to priority surgery (among 358). No homogeneous national health surveillance/screening programs are ongoing or have been conceived to test susceptible population among children/healthcare workers in preparation of coming down to routinely daily activities, and diagnostic strategies are not completely accurate in children. So, restoring medical services now might be untimely.

Multidimensional Assessment of the Effectiveness of Group Voice Therapy.

OBJECTIVE: Group voice therapy has been successfully used in patients with dysphonia, but there is little objectively documented evidence of its effects on voice quality and the self-perception of voice fatigue. The aim of this study was to investigate the effectiveness of group therapy in patients with functional dysphonia and minor anatomic vocal fold pathologies linked by appearance and history to voice use in an objective and multidimensional manner. STUDY DESIGN: This is a prospective longitudinal study. METHODS: Before and after treatment, 34 adult women underwent perceptual voice assessments using the grade of dysphonia, roughness, breathiness, asthenia, and strain (GRBAS) scale, Evaluation Vocale Assistée (EVA) system aerodynamic and acoustic assessments, and maximum phonation time measurements, and made subjective evaluations using the Voice Handicap Index. The pretreatment baseline values of the participants were obtained by means of two examinations separated by an interval of 1 week. The parameters belonging to each main dimension were clustered by means of Z-transformation, and the corresponding Z-scores were analyzed. RESULTS: Group therapy was associated with a statistically significant improvement in the perceptual (P = 0.008), acoustic (P = 0.040), aerodynamic (P = 0.009 and <0.001), and self-evaluation parameters (P = 0.011). CONCLUSIONS: Our findings provide evidence that group voice therapy can be associated with improvements in perceptual, acoustic, aerodynamic, and self-evaluated parameters in some patients with dysphonia. Controlled, randomized studies are needed in follow-up. This method of treatment may be a means of reducing the costs and waiting lists associated with rehabilitative treatment, and enhancing patients' motivation and compliance.

Nasal saline irrigation in preschool children: a survey of attitudes and prescribing habits of primary care pediatricians working in northern Italy.

BACKGROUND: It has been shown that nasal saline irrigation (NSI) alone can be effective in children with infectious and/or allergic respiratory problems, but no study has assessed the awareness or clinical use of NSI among practising pediatricians. The main aim of this study was to evaluate the use of NSI in pre-school children by primary care pediatricians working in northern Italy. METHODS: Nine hundred randomly selected National Health Service primary care pediatricians with an e-mail address were sent an e-mail asking whether they were willing to respond to a questionnaire regarding the use of NSI. The 870 who answered positively were sent an anonymous questionnaire by post and e-mail that had 17 multiple-choice items. RESULTS: Completed questionnaires were received from 860 of the 870 primary care pediatricians (98.8%). NSI was used by almost all the respondents (99.3%), although with significant differences in frequency. It was considered both a prophylactic and a therapeutic measure by most of the respondents (60.3%), who prescribed it every day for healthy children and more frequently when they were ill. Most of the primary care pediatricians (87%) indicated an isotonic solution as the preferred solution, and the most frequently recommended administration devices were a nasal spray (67.7%) and bulb syringe (20.6%). Most of the pediatricians (75.6%) convinced parents to use NSI by explaining it could have various beneficial effects, and two-thirds (527/854; 61.7%) thought that most of the parents agreed about the importance of NSI. Analysis of possible associations between NSI prescribing behaviour and the demographic data revealed an associations with age and gender, with pediatricians aged <50 years prescribing NSI more frequently than their older counterparts (p < 0.01), and females prescribing NSI more frequently than males (p < 0.01). CONCLUSIONS: In Northern Italy, most primary care pediatricians prescribe NSI for both the prophylaxis and therapy of upper respiratory tract problems in pre-school children. However, many aspects of the procedure are not clarified, and this reduces parental compliance. Given the medical and economic advantages of NSI, this situation should be changed as soon as possible.

Importance of ENT assessment in stratifying candidates for sinus floor elevation: a prospective clinical study.

OBJECTIVES: The aim of this article was to describe our experience in the field of preoperative ear, nose and throat (ENT) assessment in each candidate for (maxillary) sinus floor elevation (SFE) after the introduction of a systematic protocol. The protocol evaluates the sinus compliance by means of ENT preliminary examination with nasal fiberoptic endoscopy to identify all of the situations that may predispose to post-lifting complications, i.e. potentially irreversible (PIECs) and presumably reversible (PRECs) ENT contraindications to SFE, and to evaluate its impact on SFE success. MATERIAL AND METHODS: Patient candidates for SFE were carefully assessed by means of case-history collection, complete ENT evaluation with nasal fiberoptic endoscopy and imaging to detect PIECs, PRECs, or no ENT contraindications for SFE. In case of PRECs, SFE was postponed until complete clinical recovery. Impact of preoperative ENT assessment on SFE outcome was assessed by means of post-lifting telephonic interview and ENT evaluation. RESULTS: PRECs were detected and resolved before SFE was performed in 38.2% of our 34 patients; no intra- or post-lifting complications occurred in the patients with no ENT contraindications or PRECs. CONCLUSIONS: The results of the study suggest that a careful multi-tasking preoperative management, including an ENT assessment with fiberoptic endoscopy and a radiological evaluation extended to the ostio-meatal complex, is very useful in candidates for SFE.

Clinical assessment of adenoidal obstruction based on the nasal obstruction index is no longer useful in children.

OBJECTIVE: To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy. STUDY DESIGN: Cross-sectional study with planned data collection. SETTING: Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy. SUBJECTS AND METHODS: Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups. RESULTS: A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009). CONCLUSION: Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.