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1.
Am J Otolaryngol ; 41(6): 102673, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32829060

RESUMO

PURPOSE: To evaluate the effects of increased endogenous Antisecretory Factor (AF) synthesis using specially processed cereals (SPC) in a sample of patients with defined unilateral Meniere's disease (MD), compared to the results of a treatment protocol of intravenous glycerol and dexamethasone. MATERIALS AND METHODS: Twenty-six patients with unilateral MD were divided in 2 groups and treated with SPC and with intravenous glycerol and dexamethasone for 24 months. Audio-vestibular evaluation was performed before (T0) and every six months. The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss, tinnitus and quality of life were administered. RESULTS: EI decreased in the SPC group after 18 (T18) (p = .0017) and 24 (T24) months of therapy (p = .0111). There was a significant reduction for tinnitus score in the SPC group at T24 (p = .0131). No significant differences were found between the two groups at T0 (p = .4723), while a significant difference was found at T24 (p = .0027). Quality of life showed a significant improvement in daily activities in the SPC group (p = .0033) compared to the infusion therapy group. No statistically significant changes in PTA thresholds were found in both groups between T0 and T24. CONCLUSION: The preliminary results of our study show a significant reduction of vertigo spells and a positive effect on tinnitus severity and on quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.


Assuntos
Grão Comestível , Alimentos Especializados , Doença de Meniere/dietoterapia , Neuropeptídeos/biossíntese , Adulto , Idoso , Dexametasona/administração & dosagem , Feminino , Seguimentos , Glicerol/administração & dosagem , Audição , Humanos , Infusões Intravenosas , Masculino , Doença de Meniere/tratamento farmacológico , Doença de Meniere/fisiopatologia , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo
2.
Eur Arch Otorhinolaryngol ; 277(1): 77-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605188

RESUMO

PURPOSE: Specially processed cereals (SPC) that increase endogenous antisecretory factor (AF) synthesis have been proposed to improve symptoms of Meniere's disease (MD) with controversial results. The aim of this study was to evaluate the effects of SPC in patients with definite unilateral MD and compare the results to a treatment protocol with intravenous glycerol and dexamethasone. METHODS: Thirteen patients with unilateral MD were treated with SPC and 13 patients were treated with intravenous glycerol and dexamethasone for 12 months. Audio-vestibular evaluation was performed before (T0) and at the end of the treatments (T12). The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss (HHIA), tinnitus (THI) and quality of life (TFL) were administered. RESULTS: EI decreased in the SPC group in the second semester compared to the first although not significantly (p = 0.6323). There was a significant reduction for THI score in the SPC group at T12 (p = 0.0325). No significant differences were found between the two groups at T0 (p = 0.4723), while a significant difference was found at T12 (p = 0.0041). Quality of life showed an improvement in daily activities in the SPC group compared to infusion therapy group. CONCLUSION: Our study shows a reduced number of vertigo attacks and a positive effect on the discomfort generated by tinnitus and quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.


Assuntos
Grão Comestível/metabolismo , Doença de Meniere/metabolismo , Neuropeptídeos/metabolismo , Fármacos do Sistema Nervoso Periférico/metabolismo , Vertigem/metabolismo , Adulto , Idoso , Dexametasona/administração & dosagem , Feminino , Glicerol/administração & dosagem , Humanos , Masculino , Doença de Meniere/diagnóstico , Doença de Meniere/tratamento farmacológico , Pessoa de Meia-Idade , Fármacos do Sistema Nervoso Periférico/administração & dosagem , Qualidade de Vida , Inquéritos e Questionários , Zumbido/diagnóstico , Zumbido/tratamento farmacológico , Vertigem/tratamento farmacológico , Vertigem/etiologia
3.
Eur Arch Otorhinolaryngol ; 274(11): 3907-3913, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28861603

RESUMO

Although individuals categorize odors according to their pleasantness, experience may also influence odor perception-a phenomenon that partially explains why different populations perceive odors differently. Italy, which comprises 20 regions, is characterized by very different cultures. In the present study, we investigated for the first time how Italian regional differences can affect odor perception. 254 healthy volunteers coming from northern, central, southern Italy, and Sicily, one of the two major Italian islands, were recruited in Padua, Rome, Naples, and Syracuse, respectively. Olfactory function was tested with Sniffin' Sticks identification subtest. Subjects who had a score in the range within the mean identification value ± 1 SD, in accordance with the age classes identified in the literature, were asked to judge the odor pleasantness of 20 substances. The hedonic tone of the odorants was categorized as pleasant, neutral, unpleasant, and very unpleasant. Some odorants were appreciated more in northern Italy than in the other parts of the country, whereas others were appreciated more in the south and in Sicily than in the north. Unpleasant odorants were judged less unpleasant in central Italy. Some odorants such as strawberry and vanilla were perceived similarly in all the regional areas. Our study indicates that in Italy, hedonic perception of odorants differs probably in relation with genetic, cultural, and environmental factors. Further investigation is needed to delve deeper into the factors that influence the quality odor perception amongst humans.


Assuntos
Odorantes , Percepção Olfatória , Adulto , Feminino , Humanos , Itália , Masculino , Sicília , Olfato/fisiologia , Estatísticas não Paramétricas , Gânglio Trigeminal
4.
Minerva Pediatr ; 69(1): 15-21, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27706120

RESUMO

BACKGROUND: This study evaluates endoscopic and quality of life (QoL) outcomes in two groups, composed by both allergic (A) and non-allergic (N-A) adolescents undergoing septoplasty with concurrent turbinate surgery by radiofrequency treated after surgery with nasal spray containing liposomes and vitamins A and E. METHODS: This double-blind randomized study was carried out on 40 patients (22 males, 18 females, mean age 15.5±1.0 years) undergoing septoplasty and volumetric tissue reduction of inferior turbinates by radiofrequency for post-traumatic deformities and severe nasal obstruction. We enrolled 20 subjects with positive skin prick tests and 20 with negative skin prick tests (SPT) to aeroallergens. All subjects underwent the Visual Analogue Scale (VAS) questionnaire and the nasal endoscopy score by Lund and Kennedy (LK) at baseline before surgery (T0) and 15 days (T15) and 21 days (T21) after treatment. After surgery, the nose was not packed and the day after surgery all subjects were randomized into two groups, experimental arm group I (GI) and control arm group II (GII) and given the treatment, nasal spray containing liposomes composed of phospholipids, fatty acids, and vitamin A and E for group I and saline solution (sodium chloride 0.9%) for group II. RESULTS: After therapy, the VAS and LK scores were better (P<0.05) in the investigational than in the control arm in both sub-groups (A and N-A). CONCLUSIONS: Our findings suggested that liposomal, vitamins A and E nasal spray improves the QoL in the early postoperative period, both in A and N-A sub-groups.


Assuntos
Septo Nasal/cirurgia , Rinoplastia/métodos , Conchas Nasais/cirurgia , Vitamina A/administração & dosagem , Vitamina E/administração & dosagem , Adolescente , Método Duplo-Cego , Endoscopia , Feminino , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Lipossomos , Masculino , Obstrução Nasal/cirurgia , Sprays Nasais , Fosfolipídeos/administração & dosagem , Qualidade de Vida , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-25925994

RESUMO

OBJECTIVE: Nonallergic rhinitis (NAR) causes significant functional and emotional impairment, affecting the quality of life (QoL) of elderly patients often suffering from other chronic diseases that require additional therapies to be added to the numerous daily medications. This study aimed to evaluate the effectiveness of crenotherapy with sodium chloride sulfate hyperthermal water rich in mineral salts on the QoL of elderly patients with NAR. METHODS: Sixty elderly subjects with NAR were divided into 2 groups. Group I (n = 30) underwent crenotherapy with sodium chloride sulfate hyperthermal water rich in mineral salts, and group II (n = 30) underwent treatment with NaCl 0.9%. At baseline and after treatment, both groups underwent nasal endoscopy, and we determined their Visual Analogue Scale (VAS) scores for rhinorrhea, respiratory obstruction and sneezing. RESULTS: After treatment, the patients in both groups reported having no adverse reactions. Endoscopic and VAS score results were better in group I than in group II. All subjects showed a good degree of tolerability. CONCLUSIONS: Our data suggest that crenotherapy improves the QoL in elderly patients with NAR. Crenotherapy can prevent elderly patients with NAR from having to take additional medications, which can often cause relevant adverse reactions and considerable health care costs.


Assuntos
Balneologia/métodos , Hipertermia Induzida/métodos , Águas Minerais/administração & dosagem , Rinite/terapia , Administração por Inalação , Fatores Etários , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Qualidade de Vida , Rinite/etiologia , Rinite/patologia , Vapor , Resultado do Tratamento
6.
Gastroenterology ; 145(3): 537-9.e3, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23714381

RESUMO

Little is known about how CO2 affects neural processing of taste. We used functional magnetic resonance imaging to investigate the effects of carbonation on brain processing of sweet stimuli, which has relevance to studies of food selection and satiety. The presence of carbonation produced an overall decrease in the neural processing of sweetness-related signals, especially from sucrose. CO2 reduced the neural processing of sucrose more than that of artificial sweeteners. These findings might be relevant to dietary interventions that include noncaloric beverages, whereas the combination of CO2 and sucrose might increase consumption of sucrose.


Assuntos
Aspartame/farmacologia , Dióxido de Carbono/farmacologia , Bebidas Gaseificadas , Sacarose/farmacologia , Edulcorantes/farmacologia , Percepção Gustatória/efeitos dos fármacos , Tiazinas/farmacologia , Humanos , Imageamento por Ressonância Magnética
7.
Artigo em Inglês | MEDLINE | ID: mdl-25322773

RESUMO

We have analyzed the preoperative diagnosis of cholesteatoma through the use of diffusion-weighted intensity magnetic resonance (DWI-MR) in 16 consecutive patients suffering from chronic otitis media with clinical and radiological (by computed tomography) suspicion of cholesteatoma. In particular, we compared the radiological data with intraoperative ones, verifying the correspondence (in terms of sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy) between what is reported by DWI-MR and what is actually detectable at the time of surgery. Furthermore, we identified the most reliable DWI-MR sequence [single-shot (SSh) echo planar imaging (EPI) vs. multi-shot turbo spin-echo not-EPI] to detect cholesteatoma and reduce the time for examination. The obtained data on computed tomography scans revealed low diagnostic accuracy (56%); DWI-MR, instead, showed higher values, especially using not-EPI sequences (93.75 vs. 68.75% obtained by SSh-EPI sequences).


Assuntos
Colesteatoma da Orelha Média/diagnóstico , Imagem Ecoplanar/métodos , Espectroscopia de Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Criança , Colesteatoma da Orelha Média/cirurgia , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
J Craniofac Surg ; 25(5): 1757-61, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25010834

RESUMO

Only a few reports in the literature have described the use of specific instruments for assessing the quality of life in adolescents and young adults with cleft lip and palate (CLP). This condition markedly affects their lifestyle, even after surgical treatment. In the present study, we aimed to develop a quality-of-life assessment tool specifically designed for such patients with CLP. Our multidisciplinary team created a questionnaire focused on the physical, psychological, and social satisfaction of adolescents and young adults with CLP, which was adapted from 3 dimensions of the 36-item Short-Form Health Survey. The questionnaire was administered to a randomized sample of 40 adolescents and young adults (aged 16-24 years) with CLP who had completed treatment protocols and 40 (aged 16-24 years) who were not affected by CLP. The statistical results stated that the questionnaire had good reliability and validity; the Cronbach α coefficient was found to be 0.944. Moreover, factorial analysis confirmed the presence of 3 subscales that were the fundamental components of this questionnaire, which is consistent with the areas theoretically proposed and from which the items were designed and selected. Thus, we validated our novel questionnaire that was administered in the present study and proved its consistency. However, further investigations on a larger population would be useful to confirm these findings.


Assuntos
Fenda Labial/psicologia , Fissura Palatina/psicologia , Qualidade de Vida , Inquéritos e Questionários/normas , Adolescente , Ansiedade/psicologia , Transtornos da Articulação/psicologia , Atitude Frente a Saúde , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Transtornos de Deglutição/psicologia , Depressão/psicologia , Análise Fatorial , Relações Familiares , Feminino , Humanos , Estilo de Vida , Masculino , Satisfação Pessoal , Reprodutibilidade dos Testes , Autoimagem , Desejabilidade Social , Apoio Social , Distúrbios da Fala/psicologia , Estresse Psicológico/psicologia , Distúrbios da Voz/psicologia , Adulto Jovem
9.
Indian J Otolaryngol Head Neck Surg ; 74(Suppl 2): 1134-1137, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36452517

RESUMO

Septoplasty is one of the most frequent surgical procedures performed by head and neck surgeons. Despite surgical correction, some patients are not satisfied with their postoperative outcomes. Only a few papers report data on the long-term quality of life of patients after septoplasty, and none over 36 months. This follow up study on 68 surgical procedures aims to evaluate the differences between short term and long-term quality of life after septoplasty using a disease specific quality of life questionnaire, the NOSE, and a general health status questionnaire, the SF-36. We found a statistically significant decrease of the total long-term SF-36 scores, but we did not find changes of the NOSE scores compared with the short-term scores. These results indicated that patients perceived a worsening of their quality of life after more than 36 months following septoplasty, even in the absence of specific nasal symptoms. We could speculate that the preoperative general health performance was erroneously attributed to specific nasal symptoms, probably incorrectly emphasized or that patients did not correctly remember the preoperative clinical status. This research pointed out the importance of patients' selection and of a thorough evaluation of their preoperative expectations before surgical planning.

10.
Curr Probl Diagn Radiol ; 50(4): 499-504, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32540138

RESUMO

PURPOSE: Inverted papilloma (IP) is a tumor usually arising from sinonasal cavities, with tendency for recurrence and possible malignant transformation. Along with endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) play a crucial role in defining preoperative staging, tumor origin, and possible differential diagnosis, with significant repercussions on therapeutic planning. However, at present no consensus has been reached concerning IP diagnostic workup. Aim of this study is to assess CT and MRI sensitivity and specificity in identifying IP imaging hallmarks, evaluating their global diagnostic accuracy in order to define a novel diagnostic flowchart. METHODS: We retrospectively analyzed multimodal imaging of patients with histologically confirmed IP and mimics. Two neuroradiologists in consensus retrospectively rated the presence of typical imaging features of IP, both on CT and MRI scans. Sensitivity, specificity and diagnostic accuracy were assessed for both the techniques. Final results were expressed as ROC curves and relative areas under the curve (AUC). RESULTS: The AUC considering CT parameters were 0.42, whereas the AUC considering MRI parameters were 0.54. Combining the 2 techniques and limiting the evaluation to the most distinctive features such as focal hyperostosis and CCP, the AUC was 0.79. CONCLUSION: MRI can provide better tissue characterization and higher diagnostic accuracy in case of suspected IP, whereas CT is more useful in determining bony involvement. Here we propose a possible diagnostic flowchart for IP, based on the assumption that the combination of the imaging techniques allows to optimize the clinical assessment and the subsequent therapeutic planning.


Assuntos
Papiloma Invertido , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Papiloma Invertido/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
11.
Acta Otorhinolaryngol Ital ; 41(3): 277-281, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264922

RESUMO

OBJECTIVE: Chronic suppurative otitis media (CSOM) may result in a serious impairment of the quality of life (QoL). The most relevant characteristics of CSOM are well represented in the "Chronic Otitis Media Outcome Test 15" questionnaire (COMOT-15). The aim of the study was to translate and adapt the COMOT-15 questionnaire into Italian. METHODS: This is a prospective study conducted on 52 Caucasian Italian-speaking patients with CSOM and 52 controls. The linguistic adaptation of the COMOT-15 consisted of the translation of the English version into Italian and reliability assessment of the translation. Psychometric measurements included internal consistency and test-retest reliability. RESULTS: Cronbach's α was 0.95. The test-retest reliability showed a strong positive correlation for total score and all subscales. Age and gender had no influence on the scores. The correlation between the COMOT-15 and the pure tone average showed a significant association for the scale "Hearing Function". CONCLUSIONS: The Italian COMOT-15 questionnaire provides good internal consistency and is suitable for QoL evaluation in Italian-speaking patients suffering from CSOM. In addition, it is able to evaluate the subjective symptoms perceived by patients.


Assuntos
Otite Média , Qualidade de Vida , Comparação Transcultural , Humanos , Itália , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
Ear Nose Throat J ; 100(10_suppl): 1089S-1094S, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32584614

RESUMO

Skull base osteomyelitis (SBO) is an invasive infection refractory to therapy, closely linked with malignant otitis externa (MOE). It is characterized by a mild clinical presentation that can delay cross-sectional imaging considered as the key to revealing it. Skull base osteomyelitis typically affects elderly diabetics and immunocompromised patients (>70 years). It most commonly has an otogenic origin due to an extension of MOE. The prognosis can be very poor without the administration of adequate and timely therapy at an early disease stage. Nowadays, Pseudomonas aeruginosa remains the most common pathogen associated with SBO. Fungi are a rare cause of MOE. This report documents a rare case of otogenic SBO caused by Candida parapsilosis in a diabetic patient, with persistent otologic symptoms as clinical onset and resistance to medical treatment. Fungal MOE has more subtle symptoms and is more aggressive than its bacterial counterpart. When MOE is resistant to antibacterial drugs, this should raise the suspicion of a fungal etiology of MOE. The current guidelines do not exhaustively describe the diagnosis, antifungal drugs of choice, and optimum duration of treatment. The description of these rare clinical cases should help with the multidisciplinary management of this disease in order to optimize the diagnosis and therapeutic protocol.


Assuntos
Candida parapsilosis , Candidíase/diagnóstico , Paralisia Facial/diagnóstico , Osteomielite/diagnóstico , Base do Crânio/microbiologia , Idoso de 80 Anos ou mais , Candidíase/microbiologia , Diagnóstico Diferencial , Paralisia Facial/microbiologia , Humanos , Masculino , Ilustração Médica , Osteomielite/microbiologia
13.
Oncol Lett ; 20(3): 2465-2468, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32782564

RESUMO

Solitary fibrous tumor (SFT) is a rare neoplasm arising from the pleura, although it can sometimes affect extrapleural sites, including the head and neck. The sinonasal involvement is exceptional. Recent literature defines the SFT as a single spectrum of mesenchymal tumors, including hemangiopericytoma, which is currently considered a cellular phenotypic variant. The current case describes a rare case of a nasal septal SFT. The mass was embolized and then removed through endonasal endoscopic surgery. Histopathologic examination demonstrated positive immunoreactivity for CD34, and negative for keratin and S100 protein confirming the diagnosis of benign nasal SFT. After two years of follow-up, no relapse was observed. Diagnostic assessment of SFT requires nasal endoscopy, imaging and histopathological examination and a long time follow up is mandatory.

14.
Case Rep Med ; 2020: 1710271, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32292483

RESUMO

Raoultella ornithinolytica is a bacterium belonging to the family Enterobacteriacae. It is a rare but emergent cause of human pathologies especially in immunocompromised patients. We described the first case in the literature of isolated external otitis sustained by Raoultella ornithinolytica in an immunocompetent host. A 54-year-old Caucasian man with a history of previous myringoplasty came to our attention reporting otalgia and otorrhea. We performed right ear swab for culture examination, meanwhile we started empirical therapy with topic administration of neomycin, without any clinical improvement. The cultural examination showed the presence of a Raoultella ornithinolytica infection. After ten days of treatment with oral ciprofloxacin and topic levofloxacin, there was the complete resolution of pain and inflammation. Raoultella ornithinolytica must be taken into consideration as an emergent cause of human infection, also in case of external otitis. Infection can be severe and can occur both in immunocompromised and in immunocompetent hosts. Culture test is mandatory to choose the proper therapy and avoid potential severe complications.

15.
Eur J Radiol ; 125: 108915, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32114332

RESUMO

PURPOSE: Beside the well-known accuracy of non-EPI DWI techniques and relative ADC maps in detecting cholesteatomatous tissue, ADC can also represent a useful tool for stratifying cholesteatoma risk of recurrence. Aim of this study is to test the role of ADC in determining risk of recurrence for primary middle ear cholesteatoma, proposing stratification based on pre-operative mean (mADC) and normalized (nADC) ADC values. METHODS: In this prospective study, 60 patients with primary unilateral middle ear cholesteatoma underwent a three-years-long follow-up to assess the presence of recurrent disease after macroscopically complete excisional surgery. Baseline MRI examination mADC and nADC values in the group with early evidence of recurrent cholesteatoma were compared to the group with no evidence of recurrence by using T statistics. RESULTS: ADC values on pre-operative MRI examination were lower in cholesteatomas with early evidence of recurrence, and statistical significance was slightly higher for nADC compared to mADC measurements. We also determined a cut-off between the two groups, proposing stratification in high-risk of recurrence cholesteatomas (mADC≤ 1000 or nADC< 1.3) and low-risk cholesteatomas (mADC>1000 or nADC≥1.3). CONCLUSIONS: ADC values resulted discriminating in identifying cholesteatomas with higher risk of early recurrence, both for mean and normalized ADC, with optimized tissue characterization and outcome prediction.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Liberação de Cirurgia/métodos , Adulto , Colesteatoma da Orelha Média/cirurgia , Doença Crônica , Orelha Média/diagnóstico por imagem , Orelha Média/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco
16.
Am J Case Rep ; 21: e925060, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32808601

RESUMO

BACKGROUND Malignant external otitis (MEO) is an invasive infection that can involve the external auditory canal and the skull base up to the contiguous soft tissues. Considering the changing face of MEO, we reviewed cases of MEO treated in our Ear Nose Throat (ENT) clinic - University Federico II of Naples between 2018 and 2019 to evaluate the current epidemiology of the condition and to assess the state of art on diagnosis, therapeutic and follow-up management in our patients. CASE REPORT We present the cases of three male patients with Type 2 diabetes mellitus who complained of long-lasting otorrhea and pain, with clinical suspicion of MEO. In all cases, ear swab was positive for Pseudomonas aeruginosa. All our patients received a 6-week course of intravenous ciprofloxacin, piperacillin, and tazobactam, with rapid clinical symptoms improvement and complete recovery at 1-year follow-up. CONCLUSIONS MEO is difficult to treat due to the lack of standardized care guidelines. Patients with MEO often present with severe otalgia, edema, otorrhea, and facial nerve paralysis. Clinicians must suspect MEO in elderly diabetic and immunocompromised patients with persistent otalgia after external otitis. Imaging (computed tomography and magnetic resonance imaging) can play synergistic roles in the management of MEO. To evaluate eradication of the disease, clinicians have to assess clinical symptoms and signs as well as radiological imaging and inflammatory markers.


Assuntos
Diabetes Mellitus Tipo 2 , Otite Externa , Idoso , Ciprofloxacina , Humanos , Imageamento por Ressonância Magnética , Masculino , Otite Externa/diagnóstico , Otite Externa/tratamento farmacológico , Pseudomonas aeruginosa
18.
Biomed Res Int ; 2018: 7945482, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29854790

RESUMO

OBJECTIVES: Magnetic resonance imaging (MRI) and in particular diffusion-weighted imaging (DWI) have been broadly proven to be the reference imaging method to discriminate between cholesteatoma and noncholesteatomatous middle ear lesions, especially when high tissue specificity is required. The aim of this study is to define a range of apparent diffusion coefficient (ADC) values within which the diagnosis of cholesteatoma is almost certain. METHODS: The study was retrospectively conducted on a cohort of 124 patients. All patients underwent first- or second-look surgery because primary or secondary acquired cholesteatoma was clinically suspected; they all had preoperative MRI examination 15 days before surgery, including DWI from which the ADC maps were calculated. RESULTS: Average ADC value for cholesteatomas was 859,4 × 10-6 mm2/s (range 1545 × 10-6 mm2/s; IQR = 362 × 10-6 mm2/s; σ = 276,3 × 10-6 mm2/s), while for noncholesteatomatous inflammatory lesions, it was 2216,3 × 10-6 mm2/s (range 1015 × 10-6 mm2/s; IQR = 372,75 × 10-6 mm2/s; σ = 225,6 × 10-6 mm2/s). Interobserver agreement with Fleiss' Kappa statistics was 0,96. No overlap between two groups' range of values was found and the difference was statistically significant for p < 0.0001. CONCLUSIONS: We propose an interval of ADC values that should represent an appropriate benchmark range for a correct differentiation between cholesteatoma and granulation tissue or fibrosis of noncholesteatomatous inflammatory lesions.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Colesteatoma da Orelha Média/diagnóstico , Orelha Média/diagnóstico por imagem , Tecido de Granulação/diagnóstico por imagem , Adulto , Idoso , Colesteatoma da Orelha Média/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Orelha Média/patologia , Imagem Ecoplanar , Feminino , Tecido de Granulação/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Laryngoscope ; 128(10): E339-E345, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29570813

RESUMO

OBJECTIVES: Among the predisposing factors implicated in the immune response to airway bacterial infections, genetic variations of the bitter taste receptor TAS2R38, which is expressed in the cilia of the human sinonasal epithelial cells, seem to be associated with susceptibility to chronic rhinosinusitis (CRS) and in vitro biofilm formation. Polymorphisms in TAS2R38 generate two common haplotypes: the nonfunctional AVI (Alanine, Valine, Isoleucine) and the functional PAV (Proline, Alanine, Valine) alleles, with the latter protecting against gram-negative sinonasal infections. The aim of this study is to investigate for the first time the relevance of TAS2R38 genetic variants in the susceptibility to bacterial infections associated with in vivo biofilm formation in chronic rhinosinusitis with nasal polyps (CRSwNP) patients. STUDY DESIGN: A prospective study on 100 adult patients undergoing functional endoscopic sinus surgery (FESS) for CRSwNP. METHODS: Propylthiouracile (PROP) testing and TAS2R38 genotyping were applied to characterize patients for receptor functionality. Sinonasal mucosa samples were processed for microbiological examination and biofilm detection. RESULTS: The nonfunctional genotype is more frequent among CRS patients than in the general population (25% vs. 18.4%, P = 0.034). Airway gram-negative infections are primarily associated with the AVI haplotype (88.9% vs. 11.1% PAV/PAV-functional genotype, P = 0.023). Biofilm formation is prevalent in CRS patients with the AVI nontaster phenotype (62.5% vs. 33.3% PAV taster or supertaster phenotype, P = 0.05). CONCLUSION: Our findings confirm an inverse correlation between TAS2R38 functionality and gram-negative infections in Italian patients with CRSwNP. In addition, for the first time we demonstrated a relationship between in vivo microbial biofilm and TAS2R38 receptor variants. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:E339-E345, 2018.


Assuntos
Infecções por Bactérias Gram-Negativas/genética , Pólipos Nasais/genética , Receptores Acoplados a Proteínas G/genética , Rinite/genética , Sinusite/genética , Adulto , Biofilmes/crescimento & desenvolvimento , Doença Crônica , Estudos de Coortes , Feminino , Predisposição Genética para Doença , Genótipo , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Itália , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Pólipos Nasais/complicações , Fenótipo , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Rinite/complicações , Sinusite/complicações , Paladar/genética
20.
Mol Clin Oncol ; 7(5): 843-846, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29181176

RESUMO

Folate deficiency may be directly associated with carcinogenesis. Folate supplementation may reduce the risk of progression in a mucosa that is already genetically altered. The aim of the present study was to determine the role of folic acid in the treatment of mild and moderate laryngeal dysplasia recurring after surgery. The data obtained by laryngoscopy, measurement of serum folate levels and functional vocal assessment with the GIRBAS scale and VHI questionnaire were compared in patients who had received folic acid with a homogeneous group of patients with dysplasia who had not undergone any therapy. A total of 24 patients suffering from recurrence of mild or moderate laryngeal dysplasia (n=12, group A) were treated with 400 mg folic acid per os, once daily for 6 months. The patients in group B (n=12) received no treatment and were used as the control group. In group A, 7 (58%) patients exhibited a complete response, with clinically evident regression of leukoplakia, 3 (25%) displayed a partial decrease in the lesions with reduced volume of the area involved, whereas 2 patients exhibited no change. As regards patients in control group B, 8 (67%) exhibited no change, in 1 case there was a spontaneous regression, and in 3 (25%) there was disease progression with suspected malignant transformation, leading to repeat surgery. Therefore, folate deficiency may be considered to be a factor predisposing to precancerous lesions, and dietary folate supplementation may prevent and reduce the emergence of cancer.

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