Sleep quality burden in chronic rhinosinusitis with nasal polyps and its modulation by dupilumab.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with a substantial burden on patients' quality of life and impaired sleep quality. The most common CRSwNP endotype is characterized by type 2 inflammation, with enhanced production of interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a monoclonal antibody against IL-4 receptor-α, which inhibits both IL-4 and IL-13 signaling, and was recently approved for treatment of CRSwNP. OBJECTIVE: We investigated the effect of dupilumab on the sleep quality of patients with CRSwNP in a real-life setting. METHODS: Patients were evaluated at baseline and after 1 and 3 months of dupilumab treatment by means of the Epworth sleepiness scale (ESS), insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), and sinonasal outcome test 22 (SNOT-22) sleep domain. RESULTS: A total of 29 consecutive patients were enrolled, and their baseline sleep quality assessment were as follows: ESS of 7.9 (± 4.5); ISI of 13.1 (± 6.2); PSQI of 9.2 (± 3.7); and SNOT-22 sleep domain of 12.1 (± 4.2). Excessive daily sleepiness, insomnia, and globally impaired sleep quality were present in 24.1%, 79.3%, and 93.1% respectively. Treatment with dupilumab was associated with significant improvement in ESS, ISI, PSQI, and SNOT-22 sleep domain with concomitant reduction of the proportion of patients with insomnia and globally impaired sleep quality. CONCLUSION: CRSwNP was associated with a significant impact on global sleep quality, in particular, insomnia, and treatment with dupilumab induced a rapid improvement (after 1 single month of treatment) in all the sleep quality parameters, suggesting that sleep disturbances should be more carefully evaluated as an additional outcome in these patients.

Airways Type-2 Related Disorders: Multiorgan, Systemic or Syndemic Disease?

Chronic rhinosinusitis (CRS) has recently undergone a significant paradigm shift, moving from a phenotypical classification towards an "endotype-based" definition that places more emphasis on clinical and therapeutic aspects. Similar to other airway diseases, like asthma, most cases of CRS in developed countries exhibit a dysregulated type-2 immune response and related cytokines. Consequently, the traditional distinction between upper and lower airways has been replaced by a "united airway" perspective. Additionally, type-2 related disorders extend beyond respiratory boundaries, encompassing conditions beyond the airways, such as atopic dermatitis. This necessitates a multidisciplinary approach. Moreover, consideration of possible systemic implications is crucial, particularly in relation to sleep-related breathing diseases like Obstructive Sleep Apnoea Syndrome (OSAS) and the alteration of systemic inflammatory mediators such as nitric oxide. The trends in epidemiological, economic, and social burden are progressively increasing worldwide, indicating syndemic characteristics. In light of these insights, this narrative review aims to present the latest evidence on respiratory type-2 related disorders, with a specific focus on CRS while promoting a comprehensive perspective on the "united airways". It also introduces a novel concept: viewing these conditions as a multiorgan, systemic, and syndemic disease.

Preoperative systemic inflammatory markers as prognostic factors in differentiated thyroid cancer: a systematic review and meta-analysis.

BACKGROUND: Inflammation has been associated with tumor development and circulating inflammatory biomarkers have been proposed as possible predictors of recurrence of several solid tumors. However, the role of inflammation markers in differentiated thyroid carcinoma (DTC) is still uncertain. OBJECTIVE: This meta-analysis aimed to assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with DTC. METHODS: Studies investigating the association between survival and preoperative circulating inflammatory markers in DTC patients were included. The primary outcome was disease-free survival (DFS). Cumulative logarithms of the hazard ratio (log-HRs) with 95% CI were calculated through the inverse variance method using a random-effects model. RESULTS: A total of 7599 patients with a mean age of 48.89 (95% CI 44.16-53.63) were included. The estimated pooled log-HRs for DFS were 0.07 for NLR (95% CI -0.12-0.26; p = 0.43), -0.58 for LMR (95% CI -1.21-0.05; p = 0.06), and 0.01 (95% CI 0-0.01; p = 0.21) for PLR. CONCLUSIONS: Our meta-analysis showed no association between NLR, PLR, LMR and DFS in DTC; however, more prospective data are needed to better define the association between inflammatory status and prognosis of DTC.

Middle meatus nasal cytology compared to inferior turbinate cytology in non allergic rhinitis.

PURPOSE: Non allergic rhinitis (NAR) comprises different clinical definitions and phenotypes, including non inflammatory non allergic (NINAR) and cellular inflammatory forms. Nasal cytology, usually performed by scraping the inferior turbinate, is a non invasive, cheap and point-of-care tool to distinguish among the different NAR phenotypes, but still a relevant proportion of patients evaluated by nasal cytology receive a non precise definition of NAR phenotype. We hypothesize that collecting nasal cytology samples from middle meatus could increase the diagnostic accuracy. METHODS: Consecutive patients with chronic rhinitis without evidence of allergic sensitization were assessed for nasal cytology by means of scraping both the inferior turbinate and the middle meatus (lateral-inferior wall of the middle turbinate). RESULTS: 107 consecutive patients with NAR were enrolled in the study. According to inferior turbinate cytology, 42.1% were defined as affected by NINAR, 2.8% by bacterial rhinitis, 10.3% by non allergic rhinitis with eosinophils (NARES), 15.0% non allergic rhinitis with neutrophils (NARNE), 19.6% non allergic rhinitis with mast-cells (NARMA) and 10.3% non allergic rhinitis with eosinophils and mast-cells (NARESMA). Middle meatus cytology was in accordance with inferior turbinate cytology in only 37.6% of cases. Eosinophils and mast-cells were detectable more frequently in middle meatus samples (49.5% vs 19.6%, p < 0.01, 59.8% vs 29.9%, p < 0.01, respectively). 93.3% of NINAR patients received an inflammatory NAR phenotype at middle meatus cytology: 26.7% NARES, 24.4% NARNE, 31.1% NARMA and 11.1% NARESMA. CONCLUSION: Middle meatus cytology is more reliable than inferior turbinate cytology in phenotyping patients with NAR. Our study strengthen that nasal cytology should be implemented in clinical practice collecting samples at the middle meatus level.

Complications of pectoralis major myo-cutaneous flap, anterolateral thigh flap and radial forearm free flap after total laryngectomy with partial pharyngectomy: A systematic review and network meta-analysis.

BACKGROUND: No consensus exists regarding the most effective reconstruction after total laryngectomy with partial pharyngectomy (TLwPP). This study aims to compare different reconstructive techniques (pectoralis major myo-cutaneous flap, PMMCF; anterolateral thigh flap, ALTF; radial forearm free flap, RFFF) after TLwPP in terms of pharyngocutaneous fistula (PCF), stenosis and feeding tube dependence (FTD) incidence. METHODS: The Scopus, PubMed/MEDLINE, Cochrane Library, and Google Scholar databases were searched. A single-arm meta-analysis was performed for PCF incidence, stenosis incidence, and FTD incidence on the entire cohort. An arm-based network analysis was conducted to compare three different surgical interventions (PMMCF, ALTF, RFFF). RESULTS: A total of 13 studies and 232 patients were included in the network meta-analysis. The lowest PCF absolute risk was measured for the RFFF (11.7%, 95% CI: 2.8%-33.4%), compared to the ALTF (13.4%, 95% CI: 4.5%-32.1%) and the PMMC (49.0%, 95% CI: 19.2%-79.3%). The RFFF showed a stenosis absolute risk of 0.0% (95% CI: 0.0%-1.1%), while a higher stenosis incidence was measured for the ALTF (5.7%, 95% CI: 0.8%-25.2%) and the PMMCF (11.6%, 95% CI: 0.8%-55.1%). The RFFF showed the lowest absolute risk of FTD incidence (6.8%, 95% CI: 0.5%-28.1%) compared to the other reconstructive techniques (PMMCF: 12.4%, 95% CI: 2.4%-42.1%; ALTF: 17.5%, 95% CI: 6.4%-38.9%). CONCLUSIONS: The RFFF seems the best choice for reconstruction of partial pharyngeal defects after TLwPP due to the lower incidence of PCF, stenosis and FTD compared to the ALTF and the PMMCF.

Clinical outcome and quality of life of lacrimal sac mucocele treated via endoscopic posterior approach.

OBJECTIVE: Dacryocystorhinostomy (DCR) is the surgical treatment for lacrimal sac mucoceles (LSM), yet variants of the procedure are several. Since LSM causes bone remodeling and thinning, especially of the lacrimal bone, osteotomy at that site is reasonably the easiest. The aim of the study is to support treatment of LSM via a posterior DCR approach, in a large cohort of cases, and report patients' quality of life after the procedure with validated questionnaires. METHODS: Single-center observational retrospective study on a specific methodology (endoscopic-DCR via posterior approach). Consecutive patients with LSM were enrolled in 2008-2020; CT scans were reviewed, bone thickness was measured bilaterally and compared. Resolution of mucocele, epiphora and infection were analyzed after 6-months. Patients were administered the Munk Score and Lacrimal Symptom Questionnaire (Lac-Q). Statistical analysis was done to compare bone thickness between the two sides; descriptive analysis of the questionnaires results was presented. RESULTS: Forty-four patients with LSM were enrolled. The LSM side showed frontal process thickness of 4.00 ± 1.06 mm (vs 3.90 ± 1.03 on the unaffected side; p = 0.23) and a lacrimal bone of 0.32 ± 0.12 mm (vs 0.41 ± 0.12; p < 0.001). Resolution of infection was achieved in 97.4% cases, anatomical patency in 87.2%. After 5 years, 84.6% of patients reported no relevant epiphora (Munk score 0-1). Social impact (Lac-Q) due to lacrimal malfunctioning was still noted in 30.8% patients. CONCLUSIONS: Adult LSM is a rare condition and DCR remains the mainstay of treatment. LSM physiopathology may support a preferred surgical choice via a posterior approach. Despite objective patency, some lacrimal way malfunctioning may be experienced in a minority of cases.

Surgical prevention of pharyngocutaneous fistula in salvage total laryngectomy: a systematic review and network meta-analysis.

PURPOSE: To compare the efficacy of different reconstructive techniques in preventing pharyngocutaneous fistula (PCF) after salvage total laryngectomy (STL). METHODS: An arm-based network analysis was conducted using a Bayesian hierarchical model according to the PRISMA-NMA guidelines. RESULTS: A total of 1694 patients with a median age of 64 years (n = 1569, 95% CI: 62-66 years) were included. If compared to primary pharyngeal closure alone, only a pedicled flap onlay (PFO) showed a statistically significant reduction in PCF rate (OR: 0.35, CI: 0.20-0.61). PFO seemed to perform better than other treatments according to the rank probabilities test (39.9% chance of ranking first). CONCLUSIONS: A pedicled flap placed with an overlay technique might be preferred over a patch reconstruction to prevent PCF after STL.

Discrepancies between UICC and AJCC TNM classifications for oral cavity tumors in the 8th editions and following versions.

PURPOSE: To underline discrepancies between the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) classifications in oral cavity cancer. METHODS: Comparison between the UICC and AJCC TNM classifications of oral cavity cancer in their 8th editions and following versions. RESULTS: The most important update was the introduction of the depth of infiltration (DOI), which reflects the proximity of the tumor to the underlying lymphovascular tissues and was associated to the presence of nodal metastases. Since the first publication of the 8th edition of the AJCC Cancer Staging Manual on March 30, 2017, two further versions have been published, while the UICC TNM classification was left unchanged until a document containing modifications to the 8th edition of the UICC TNM Classification of Malignant Tumours was published online on October 6, 2020. CONCLUSION: Different versions of the TNM classification can be confounding for the scientific community. Citing the 8th edition of the UICC TNM Classification of Malignant Tumours or the AJCC Cancer Staging Manual without specifying the precise version used for classification may be insufficient. Clinicians and researchers are invited to always refer to the latest update of each classification.

Long-standing gustatory and olfactory dysfunction in COVID-19 patients: a prospective study.

PURPOSE: Our study aimed to describe recovery of gustatory dysfunction (GD) and olfactory dysfunction (OD) in COVID-19 patients, and to analyze variables associated with early or late recovery. METHODS: Telephone surveys were administered during an 18-month follow-up after COVID-19 diagnosis. One hundred and thirty-two included patients rated olfactory and gustatory function at each follow-up. RESULTS: One hundred and twenty-nine patients reported GD, of whom 91 (70.5%) reported severe GD, and 99 patients reported OD, of whom 84 (84.9%) reported severe OD. Seventy-two/129 (55.8%) and 52/99 (52.5%) patients reported an improvement in GD and in OD during the first 7 days from the onset, respectively. At 3-month follow-up, 110/120 patients (85.3%) recovered from GD, while 80/99 patients (80.8%) recovered from OD. At 18-month follow-up, a total of 120/129 patients (93.0%) recovered from GD and 86/99 patients (86.9%) recovered from OD; while 10 patients (7.0%) still reported GD and 13 patients (13.1%) still reported OD. Severe GD/OD at presentation were associated with late complete recovery of taste/smell (p = 0.019 and p = 0.034, respectively). Improvement over the first 7 days from onset was significantly associated with faster recovery (p < 0.001). CONCLUSIONS: More than 80% of patients reported complete recovery of olfactory/gustatory function in the first 3 months after symptom onset. At 18-month follow-up, patients reporting complete recovery of gustatory and olfactory function were 93% and 87%, respectively. Severity of chemosensory dysfunction at the onset was negatively correlated to recovery, and improvement of taste and/or smell function within the first 7 days from symptom onset was significantly associated with early resolution.

Preliminary experience with exoscope in lacrimal surgery.

BACKGROUND: Endoscopic dacryocystorhinostomy (e-DCR) is the mainstay for lacrimal sac/duct conditions. The purpose is to investigate the role of the exoscope as assisting tool in e-DCR. METHODS: Primary endpoint were symptoms resolution (epiphora/dacryocystitis) and time for surgery. Qualitative features of the exoscope were analyzed: a questionnaire administered to the surgical team allowed to evaluate the perceived quality of this technology. CONCLUSIONS: The exoscope is a new tool that may support e-DCR. It has comparable results on symptoms outcomes and time for surgery than classic e-DCR. This new technology was accepted by all team members and showed great teaching potential.

Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis.

PURPOSE: To perform a meta-analysis evaluating trans-oral robotic surgery (TORS), and intensity-modulated radiation therapy (IMRT) in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). METHODS: This study adhered to the PRISMA guidelines. RESULTS: A total of 5624 patients (IMRT, n = 4322; TORS, n = 1302) were included in this meta-analysis. The majority of patients in the IMRT cohort were treated with concurrent CT (n = 3433, 81.3%). On the other hand, the majority of patients in the TORS cohort was treated with an adjuvant treatment (n = 826, 67.8%). IMRT subgroup showed a cumulative survival rate of 83.6% (99% CI 76.9-89.3%), while it was 91.3% (99% CI 81.2-97.8%) in the TORS subgroup. Disease-free survival was significantly different between IMRT (79.6%, 99% CI 70.6-87.3%), and TORS (89.4%, 99% CI 82.7-94.5%). IMRT subgroup showed a feeding tube dependence rate of 4.0% (99% CI 1.1-8.4%), but it was not significantly different from the TORS subgroup (1.3%, 99% CI 0-4.9%). Tracheostomy dependence rates were similar among the two subgroups (IMRT, 0.7%, 99% CI 0-1.1%; TORS, 0.2%, 99% CI 0-1.1%). CONCLUSIONS: TORS appears to be a consolidated effective surgical approach in the management of OPSCC, according to both oncologic and functional outcomes. Further RCTs comparing TORS and IMRT with homogeneous cohorts in terms of tumor staging and HPV status are advisable.

Applying the Exoscope to Lacrimal Surgery: Preliminary Experience.

PURPOSE: The aim of the study was to investigate the role of the exoscope as an assisting tool in endoscopic dacryocystorhinostomy (e-DCR). MATERIALS AND METHODS: In this observational retrospective study, the application of the VITOM® exoscope was studied in a group of 21 patients undergoing mono- or bilateral DCR. The primary endpoint was to evaluate resolution of symptoms (epiphora/dacryocystitis) at the 6-month follow-up and time for surgery. Qualitative features of the exoscope (intraoperative view of the surgical field) and comparison with the typical setting for DCR were analyzed as secondary endpoints. A questionnaire was administered to surgical team members (ENT surgeon, ophthalmologist, and scrub nurse) to evaluate the perceived quality of this new technology (12 items valued as "good" = 2, "acceptable" = 1, and "not acceptable" = 0). A questionnaire score of 24 out of 24 was valued as "completely approved," score 20-23 as "moderately approved," and score ≤19 as "weakly approved." Patients were divided into 3 consecutive groups, and questionnaire scores by each team member were analyzed for tendencies. Statistical analysis was performed to test significance at p < 0.05. Local Ethical Committee approval was obtained. RESULTS: No significant differences were found between exoscope-set DCR and classic setting for concerned patient outcomes (failure rate: 3.2 vs. 3.8%, respectively, p = 0.896) and mean time for surgery (20' vs. 23', respectively, p = 0.091). The exoscope was valued by surgical team members as "completely approved" in 55.5% of cases, "moderately approved" in 39.7%, and "weakly approved" in 4.8%. Questionnaire scores by the ENT, ophthalmologist, and scrub nurse showed an average increase in the 3 consecutive groups (p = 0.119, p = 0.024, and p < 0.001, respectively). CONCLUSIONS: The exoscope is a new tool that may support e-DCR. It has no effects on symptom outcomes (epiphora/dacryocystitis) and time for surgery compared to classic DCR. Based on self-perception, this new technology was accepted by all team members.

Present and Future of De-intensification Strategies in the Treatment of Oropharyngeal Carcinoma.

PURPOSE OF REVIEW: The treatment of patients with squamous cell carcinoma of the oropharynx (OPSCC) remains controversial. HPV positivity is widely accepted as a favorable prognostic factor, and HPV+ OPSCC is considered a distinct pathological entity with dedicated NCCN guidelines and may deserve a more personalized therapeutic strategy. The possibility to reduce surgical invasiveness and acute and late toxicity of radiotherapy/chemotherapy has led to the new concept of de-escalation treatment strategies. In particular, several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. The aim of the present review is to systematically illustrate the current status of research in de-intensification surgical and non-surgical strategies in the treatment of the OPSCC. RECENT FINDINGS: We categorized all completed and on-going trials on the basis of the specific de-escalated treatment protocol. Several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. Considering the conflicting results reported so far by preliminary studies, it is necessary to wait for the final results of the on-going trials to better clarify which is the best de-intensified strategy and which patients would really benefit from it.

"L" shape technique for endoscopic sinus surgery: An alternative method.

BACKGROUND: Several techniques for performing ethmoidectomy have been reported. We describe a safe, effective and efficient technique during functional endoscopic sinus surgery (FESS). We present text, images and videos to illustrate our preferred technique during an antero-posterior ethmoidectomy and to provide a multimedia tool for educational purpose. METHODS: A description of the technique without prospective or retrospective data is reported. A complete ethmoidectomy with an L-shape approach is described step-by-step, using the backbiting circular and miniature cutting forceps, with safe exposure of the lamina papyracea (LP) and skull base. RESULTS: In our hands, the L-shape approach for chronic rhinosinusitis with or without polyposis, performed with punch circular cutting and miniature cutting forceps, allowed for a reliably safe and efficient ethmoidectomy. CONCLUSION: The technique described can be added to the armamentarium of the endoscopic sinus surgeon.

A systematic review of different treatment strategies for the squamous cell carcinoma of the posterior pharyngeal wall.

OBJECTIVE: To perform a systematic review of the literature available about the posterior pharyngeal wall squamous cell carcinomas, with a special focus on oncologic outcomes. METHODS: A comprehensive research was performed on PubMed/MEDLINE, Google Scholar, and Cochrane Library datasets for published studies meeting the established criteria. The last search was conducted on December 8, 2019. RESULTS: Eleven studies were included in the review, for a total of 534 patients (median age 60.4; male: n = 359, 67.2%). Six of the studies evaluated the oncologic outcomes of primary surgery, while three studies focused on results achieved through primary radiotherapy. Two studies evaluated both surgery and radiotherapy outcomes for the treatment of early or advanced posterior pharyngeal wall carcinoma. CONCLUSIONS: Primary surgery associated with adjuvant radiotherapy would seem to ensure better oncologic outcomes, especially for locally advanced tumors. Moreover, this systematic review showed that oro- and hypo-pharyngeal wall tumors are similar in terms of clinical and biological behavior.

Head and neck soft tissue reconstruction with anterolateral thigh flaps with various components: Development of an algorithm for flap selection in different clinical scenarios.

OBJECTIVES: The antero-lateral thigh free flap (ALT) is conventionally designed as a fasciocutaneous flap (FALT). However, the thickness of the flap can be designed in at least in two more variants: myocutaneous (MYALT), and myofascial (MALT). The aim of this study was to evaluate the use of ALT flap as a universal solution for head and neck soft tissue reconstruction and development of an algorithm for flap selection in different clinical scenarios. PATIENTS AND METHODS: Forty patients, 29 males, 11 females, with mean age of 61.6 years (range 36-77) were enrolled. Thirty-three patients were affected by mucosal squamous cell carcinoma (24 oral cavity, 8 larynx, 1 hypopharynx), four by cutaneous squamous cell carcinoma, two by sarcoma of the orbit, one by adenoid cystic carcinoma of the parotid gland. MALT was used for tongue reconstructions thicker than 2 cm. When vastus lateralis was not thick enough we used MYALT, which was used for bulky head and neck reconstruction requiring mucosa and/or skin. FALT was performed for oral and mucosal defects thinner than 2 cm. We performed 19 MYALT, 11 FALT, and 10 MALT. We proposed ALT reconstruction to all patients requiring soft tissue replacement, for this reason selection bias is excluded. Statistical analysis was conducted to analyze any difference in defect size, flap volume, functional, and cosmetic results. RESULTS: Overall mean follow-up was 18.9 months (range 3-48). Follow-up of single flaps was as follow: MALT 20.3 (range 3-48), MYALT 17.6 (range 4-45), FALT 19.1 (range 3-48), mean time of follow-up was not significant among the three groups (p .82). Mean size of the defect in cm3 was 188.5 (range 25-495), Mean sizes of the defects were: tongue 177.7 (range 48-360), oral floor/check 128.3 (range 25-432), larynx hypopharynx 315.7 (range 184-495), and maxilla 232.0 (range 224-240). Mean volume difference was significantly different between oral floor defects and larynx/hypopharynx (mean volume difference 187.4 95% CI -352.0-2.7 p < .001). Mean sizes of the flaps in cm3 were: FALT 51.5 (range 25-72), MYALT 270.7 (range 90-495), and MALT 250.0 (range 90-495). Mean volume difference was significantly different among the three groups (p < .001). No major complications were experienced, four minor complications were reported (2/19 in MYALT, 1/10 MALT, 1/10 FALT) and results were not significant among the three groups (p .20). Gastrostomy tube dependence occurred in 4/19 (21%) of tongue cases, and none in all the other cases (p < .001). Speech was unintelligible in 3/19 (16%) of patients with tongue reconstruction, 1/7 (15%) of patients with larynx/hypopharynx reconstruction, and none regarding the other defects reconstructed (p < .001). Cosmesis was poor in 2/19 (11%) of tongue cases, and acceptable or higher in the other cases (p < .001). Tracheostomy dependence rate was 27% (7/7 patients submitted to a total laryngectomy with hypopharyngectomy and 4/19 patients submitted to total glossectomy, p < .001). CONCLUSIONS: ALT offers unique advantages in head and neck reconstruction, including adequate bulk when needed, different coating surfaces, and optimal functional results with minimal morbidity. On the base of our case series, which showed that the ALT flap is highly versatile and a successful reconstructive option, we propose a decision making-flow chart in order to choose the best specific flap variant adequate for every specific clinical scenario.

Psychiatric Burden in Chronic Sinonasal Diseases: A Single-Center Cross-Sectional Observational Study.

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis (CRS) and nasal septum deviation (SD) are two widely diffused clinical conditions in otorhinolaryngology clinical practice. Albeit nasal symptoms are the most commonly referred by patients affected by both conditions, recent evidence has explored the impairment of nasal function beyond its local implication. Indeed, the prevalence of psychiatric disorders, specifically anxiety and depression, was found higher in patients suffering from SD or CRS than in the general population. The aim of this study was to evaluate the psychiatric burden of these conditions in terms of anxiety and depression and to assess its relationship with clinical phenotype and age. METHODS: Monocentric cross-sectional observational study. Consecutive patients affected by CRS with or without nasal polyps or by SD were considered eligible. At referral, each patient underwent nasal endoscopy for clinical diagnosis and had to fill in the Hospital Anxiety and Depression Scale (HADS), the Sinonasal Outcome Test-22 (SNOT-22), and the Visual Analogue Scale (VAS) for global nasal symptoms. The population was grouped according to disease and age. RESULTS: One hundred fifty patients were enrolled. We observed a statistically significant difference in mean HADS score between patients affected by CRS with nasal polyps and those suffering from CRS without nasal polyps or SD both in the overall population and by age groups. Nevertheless, there was no significant difference in the HADS score between younger patients affected by CRS and SD. The mean HADS score was significantly higher in younger patients affected by SD compared to older. Furthermore, we observed an inverse correlation between age and HADS score in each disease group, statistically significant for SD. On the contrary, in the overall population, HADS score and patient-related outcomes (PROs) were directly correlated.  Conclusions: In the era of personalized medicine, our work remarks on the critical impact of anxiety and depression on the quality of life (QoL) of patients affected by sinonasal conditions. According to our results, age affects patient-reported outcomes (PROs) and should, therefore, be enhanced in the therapeutic decision process.

Squamous Cell Carcinoma of the Nasal Vestibule: A Multi-Centric Observational Cohort Study.

OBJECTIVES: Squamous cell carcinoma of the nasal vestibule (NV-SCC) is a rare but challenging entity, due to the complex anatomy of the region. Consensus on the best treatment strategy is still lacking, as well as a dedicated staging system. Our aim was to analyze oncological outcomes of surgically treated patients and to investigate possible prognostic factors. METHODS: We performed a retrospective multi-centric observational study including six Academic Hospitals over a 10-year period, including only patients who underwent upfront surgery for primary NV-SCC. Patients were staged according to all currently available staging systems. The Kaplan-Meier method was used to compute overall, disease-free, and disease-specific survival. Logistic regression models were used to correlate between survival outcomes and clinical and pathological variables. RESULTS: Seventy-one patients with a median follow-up of 38 months were included in the study. Partial and total rhinectomy were the most commonly performed procedures, respectively, in 49.3% and 25.4% of cases. Neck dissection was performed on 31% of patients, and 45.1% of them underwent adjuvant radiotherapy. Three years overall, disease-specific and disease-free survival were, respectively, 86.5%, 90.3%, and 74.2%. None of the currently available staging systems were able to effectively stratify survival outcomes. Factors predicting lower overall survival on multivariate analysis were age (p = 0.021) and perineural invasion (p = 0.059), whereas disease-free survival was negatively affected by age (p = 0.033) and lymphovascular invasion (p = 0.019). CONCLUSION: Currently available staging systems cannot stratify prognosis for patients who underwent surgery for NV-SCC. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2634-2645, 2024.

Outcomes of Endoscopic Endonasal Dacryocystorhinostomy in Glaucoma Patients.

BACKGROUND: Anti-glaucoma eye drops have been investigated due to their production of fibrotic changes on the conjunctival surface, undermining the functioning of the upper lacrimal drainage system. We aimed to assess whether these effects may impair the effectiveness of endoscopic endonasal dacryocystorhinostomy (EE-DCR). METHODS: This is a single-center observational retrospective study on EE-DCR via a posterior approach. Resolution of epiphora and dacryocystitis were analyzed after 1 (T1) and 6-months (T2) from surgery. Surgical success was defined as anatomical (patency at irrigation, no recurring dacryocystitis) or complete (zeroing of Munk score). RESULTS: Twenty patients (32 sides) were enrolled. Preoperatively, 93.75% (n = 30/32) presented severe (Munk 3-4) epiphora and 68.75% (n = 22/32) recurrent dacryocystitis. At T1, 50.0% (n = 16/32) were referred with residual epiphora (Munk ≥ 1) and 18.75% (n = 6/32) dacryocystitis. At T2, 31.25% (n = 10/32) still complained of epiphora (Munk ≥ 1) and 6.25% (n = 2/32) dacryocystitis. Difference of outcomes at aggregate and paired timepoints (except for T1 versus T2) resulted in statistical significance (p < 0.05). At T2, 22 (68.75%) complete, 8 (25.0%) anatomical successes and 2 (6.25%) surgical failures were observed. CONCLUSIONS: Despite the chronic uptake of anti-glaucoma eye drops, EE-DCR guaranteed high rates of clinical relief from epiphora and remarkable decreases in the rates of recurrent dacryocystitis.