Efficacy of Buffered Hypertonic Saline Nasal Irrigation for Nasal Symptoms in Children with Seasonal Allergic Rhinitis: A Randomized Controlled Trial.

BACKGROUND: Saline nasal irrigation is labelled as an add-on treatment in patients with allergic rhinitis (AR). The primary aim of this study was to compare the efficacy of 21-day use of buffered hypertonic saline (BHS) versus normal saline solution (NSS) on reducing nasal symptoms in children with seasonal AR (SAR). Comparing their efficacy on nasal cytology counts (NCC), quality of life, and sleep quality was the secondary aim. METHODS: In this 21-day, open-label, randomized controlled study, 36 SAR children (aged 6-13 years) with a Total 5 Symptom Score (T5SS) ≥5 received twice-daily BHS or NSS delivered through a nasal douche. Efficacy measures were least square mean changes (LSmc) in T5SS, NCC, Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), and Pittsburgh Sleep Quality Index (PSQI) scores. RESULTS: BHS improved the T5SS total score to a greater extent than NSS (LSmc -6.45 vs. -5.45, p < 0.001). Concerning NCC, BHS significantly reduced the scores of neutrophils (LSmc -0.76, p = 0.004) and eosinophils (LSmc -0.46, p = 0.018), while NSS did not. Similarly, only BHS yielded a significant improvement in the PRQLQ score (LSmc -0.57, p = 0.009), whereas the improvement in PSQI score was comparable between the BHS (LSmc -0.77, p = 0.025) and NSS (LSmc -1.39, p < 0.001) groups. Overall, BHS was well tolerated. CONCLUSIONS: In children with SAR, BHS is effective in improving nasal symptoms and NCC, with an associated beneficial effect on quality of life.

Sudden sensorineural hearing loss: results of intratympanic steroids as salvage treatment.

OBJECTIVE: The aim of the present study was to verify the efficacy and the safety of intratympanic dexamethasone to treat sudden sensorineural hearing loss as salvage therapy. MATERIALS AND METHODS: A prospective study was conducted on patients affected by idiopathic sudden hearing loss who were treated before with some systemic therapy, but without recovery of the hearing The patients able to undergo the study, but who refused salvage treatment were considered as control group. A solution of Dexamethasone 4 mg/ml was then injected through the posterior-inferior quadrant filling completely the middle ear. The follow-up in the following 6 months included an audiogram every month. RESULTS: The number of patients treated with salvage therapy was 36. The patients who refused treatment were further 10. The salvage treatment was done with a mean delay of 24.3 days from the onset of symptoms. Mean hearing threshold after the onset of sudden hearing loss at PTA was 66.5 dB. After the failed treatment the mean PTA was 59.6 dB. The mean PTA after the intratympanic steroid administration was 46.8 dB, with a mean improvement of 12.8 dB. No hearing change was noted in the 10 patients who refused salvage therapy. The patients that assumed systemic steroid as first therapy showed a better PTA threshold after the salvage intratympanic treatment (p<0.01). A significant difference (p<0.05) of hearing recovery was evidenced between non-smoker patients and those with smoking habit. CONCLUSIONS: Our data showed that a salvage treatment with intratympanic dexamethasone should be suggested to all patients who failed the first systemic treatment. The systemic steroid therapy done before the salvage treatment seems to exert a protective role for the inner ear, as shown by our series. On the contrary the smoke habit is a negative prognostic factor in the hearing recovery.

Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury.

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space.

Exploring the effectiveness of the Digital Green Certificate Law as Public Health instrument to increase anti-COVID-19 vaccination in a sample of working-age adult population in the Palermo Metropolitan Area.

Counteracting vaccine hesitancy should be considered an absolute priority for Public Health Authorities. A correct health communication represents one of the best ways to increase adhesion to vaccination among hesitant population. In order to increase vaccination coverage rates against COVID-19, the Italian government has issued a legislative decree with a mandatory "Digital Green Certificate" (DGC) to access workplaces for some categories considered at risk. Methods: We conducted a cross-sectional study with the aim to highlight the factors associated with the anti-COVID-19 vaccine acceptance and to estimate the influence of the introduction by law of the Digital Green Certificate (DGC) on the adhesion to the COVID-19 vaccination campaign in a sample of individual accessing one of the main vaccination centres of the metropolitan area of Palermo, Italy. An anonymous and validated questionnaire was self-administered through the Google Documents® platform, between October 2021 and March 2022. Results: Among the 467 subjects enrolled, 43.3% were influenced on their vaccination choice by the introduction of the DGC. The multivariate analysis showed that among the respondents emerged contrasting feelings with a self-reported significantly higher sense of freedom (Adj-OR = 2.45, 95%CIs = 1.51-3.97, p-value: < 0.001) but a lower sense of safety (Adj-OR = 0.19, 95%CIs = 0.12-0.29, p-value: < 0.001) after vaccine administration. Conclusions: Our findings, in line with the available literature, suggest that the introduction of DGC has led to a significant increase in the immunization rate and, together with an appropriate communicative approach, it could represent an effective strategy to counteract vaccine hesitancy.

Treatment of sudden sensorineural hearing loss with transtympanic injection of steroids as single therapy: a randomized clinical study.

The aim of this study was to verify the efficacy and the safety of transtympanic dexamethasone to treat sudden sensorineural hearing loss as first and single drug method. Considering ethical implication of performing a mininvasive procedure on middle ear, we matched such proposed treatment with systemic prednisone administration that represents the widest adopted protocol. Randomized prospective study was conducted. The inclusion criterion was a sudden sensorineural hearing loss of at least 30 dB across three contiguous frequencies over a period of 24 h. Group A received transtympanic steroid injections; Group B received oral administration of steroids. 25 patients were treated with transtympanic therapy whereas 21 underwent systemic treatment. The mean of initial PTA was 59 dB for the whole series: 65 dB for group A and 51 dB for group B. The recovery better than 10 dB was obtained in 80% of patients of group A and in 17 81% of patients of group B, with a total of 80.5%. The mean relative gain in PTA was 41.16% in the group A and 44.7% in the group B. In the frequencies tested (0.5, 1, 2, and 4 kHz) PTA improvements after transtympanic treatment were higher than after systemic treatment, but these differences were not statistically significant (P = 0.61). Both transtympanic and systemic treatment had similar clinical recovery times. This prospective randomized clinical study showed good result in terms of hearing recovery, better than the expected results of the simple observation without treatment. We can consider transtympanic administration as a first line treatment, because of the statistical analysis confirmed similar results with systemic therapy, reducing possible side effects of systemic drug administration. The delay of treatment does not influence the outcome, allowing treating patients within 10 days of onset.

Functional Nasal Surgery and Use of CPAP in OSAS Patients: Our Experience.

The surgical correction of nasal obstruction is definitely effective and recommended in patients with poor CPAP compliance, often secondary to the high pressures that need to be given in patients with nasal sub stenosis. For this reason, the objective of this study is the evaluation of the effectiveness and effects of the functional nose surgery on adherence to CPAP- therapy in patients (with moderate to severe OSAS with indication of ventilation therapy) poorly compliant with CPAP. The study was performed on a sample of 52 patients, 40 male and 12 female, aged between 29 and 72 years followed by the Otolaryngology Unit of the University Palermo in the period between January 2015 and January 2017. All patients were subjected to the following s iter: anamnesis with Epworth Sleepiness Scale, NOSE scale, evaluation of "CPAP usage data." Upper airway optical fiber endoscopy with Müller's maneuver. We performed various type of nasal surgery (septoplasty, decongestion of the lower turbinates and FESS) 6 months after the surgery, CPAP usage was evaluated and the NOSE scale has been reapplied. All patients had a subjective degree of obstruction classified in severe or extreme by the NOSE scale before surgery. Almost all patients reported a mild degree of obstruction after the surgery. About CPAP usage, the average usage has passed by 2, 3 h at night to 6, 8 h after the surgery. The result is significant because it shows how the nasal functional surgery can make selected patients suitable to ventilation therapy. As our work shows, a better nasal function allows to reduce the CPAP pressure, Therefore, we believe that all patients with medium to severe obstructive apnea syndrome and for whom night-time ventilation therapy (CPAP) is advised should be evaluated with endoscopy and anamnesis oriented to evaluate nasal obstructive pathologies that may reduce effectiveness of CPAP.

Beclomethasone dipropionate hydrofluoroalkane for the treatment of allergic rhinitis.

Allergic rhinitis (AR) is a common respiratory disease, and its prevalence is increasing all over the world, both in adults and in children. Patients experience symptoms that may negatively impact on physical, social and psychological well-being. Hence, if left untreated, allergic rhinitis may significantly affect quality of life. Under current guidelines, intranasal corticosteroids are considered the most effective drugs and they are recommended as first-line therapy. Among the several corticosteroid intranasal sprays available, beclomethasone dipropionate is one of the most prescribed. Recently, new intranasal hydrofluoroalkane-propelled formulations with little or no impact on the ozone layer have been developed for the treatment of AR. The use of these devices might improve patients' adherence to treatment, avoiding some of the most common side effects associated with aqueous formulations. This review provides the most recent evidence for the efficacy and safety of beclomethasone dipropionate hydrofluoroalkane nasal aerosol in the treatment of allergic rhinitis.

On the threshold of effective well infant nursery hearing screening in Western Sicily.

OBJECTIVE: To determine the feasibility and effectiveness of well-infant nursery hearing screening programme for the early identification of hearing impairment, based on transient evoked otoacoustic emission (TEOAE) with a high "screen sensitivity" reducing the number of more expensive secondary level exams. METHODS: The newborns were screened by non-specialist health workers in well babies nursery at the twentieth day of life for 6 years consecutive. Based on PASS/FAIL criteria and presence/absence of audiological risk factors the newborns were divided into four groups each one with its personal step programme: G1 - PASS without risk factor, free to go home; G2 - PASS with risk factor, retest at the age of 7 months; G3 - FAIL without risk factor, re-screening after 2 weeks for a maximum of four times before audiology assessment; G4 - FAIL with risk factor, retest after 2 weeks. RESULTS: The coverage rate increased progressively from 89.8% to 92%. The referral rate was 1.51% after second stage with a specificity value of 98.78%. The four-stage screening performed for G3 reduced the numbers of global audiology assessment to 0.91% with a final global specificity of 99.4 ± 0.4%. CONCLUSION: Less than 1% of infants underwent audiological assessment; the false positives resulted 0.62% with hearing loss global incidence of 2.95/1000 and a mean age of confirmation of 3.5 months of age. It is reasonable to think that this screening programme could be implement to overall 42 Western Sicily birth centres within few years.

Management of laryngeal precancerous lesions.

OBJECTIVE: The identification of precancerous lesions is the basis of an early diagnosis, and of a treatment that allows, in the great part of cases, the preservation of organ functions. The aims of this study were: the evaluation of the less invasive treatment for precancerous lesion of the larynx to minimize the recurrences, the estimation of number of further operation required. METHODS: A prospective study was done on patients with clinical diagnosis of laryngeal precancerosis. The patients were treated by a transoral endoscopic approach with direct microlaryngoscopy (DML) doing an excision-biopsy with cold blade, consisting in excision of the whole visible lesion with vocal ligament preservation. RESULTS: A recurrence of a clinically evident precancerous lesion was present in 13.2% of patients that had a laryngeal intraepithelial lesion (LIN) 1 lesion and in 28.95% of patients that had a LIN 2 lesion. CONCLUSION: In order to achieve a control of a precancerous lesion, we suggest: excisional biopsy/subepithelial cordectomy (type 1 cordectomy) for LIN 1 lesions and subligament cordectomy (type 2 cordectomy) in case of LIN 2 cases. In case of recurrences of LIN 1 lesion we suggest directly a type 2 cordectomy.

Primary non-Hodgkins lymphoma of the parotid gland.

UNLABELLED: Primary malignant lymphomas in the salivary glands are relatively rare. Clinical presentation is not characteristic and the disease is often overlooked resulting in diagnosis and treatment delays. AIM: To stress the importance of the diagnostic process and combined management, we present a series of eight patients with malignant lymphoma of the parotid who were diagnosed only after surgery and managed with radiation and chemotherapy. METHODS: Retrospective series of patients with primary malignant lymphoma of the parotid gland managed with radiotherapy and diagnostic surgical partial resection. RESULTS: After treatment completion we achieved a loco-regional control rate of 87.5%. Toxicity was charted according to the Common Toxicity Criteria and it was seen in six patients (75%). Six patients are still alive without evidence of recurrent disease in their last follow-up. CONCLUSION: Our study confirms that primary early stage Non-Hodgkin Lymphoma of the parotid gland is a disease with an excellent prognosis and a good local control rate, with minimal morbidity.

Primary Non-Hodgkins lymphoma of the parotid gland / Linfomas malignos primários nas glandulas salivares

Primary malignant lymphomas in the salivary glands are relatively rare. Clinical presentation is not characteristic and the disease is often overlooked resulting in diagnosis and treatment delays. AIM: To stress the importance of the diagnostic process and combined management, we present a series of eight patients with malignant lymphoma of the parotid who were diagnosed only after surgery and managed with radiation and chemotherapy. METHODS: Retrospective series of patients with primary malignant lymphoma of the parotid gland managed with radiotherapy and diagnostic surgical partial resection. RESULTS: After treatment completion we achieved a loco-regional control rate of 87.5 percent. Toxicity was charted according to the Common Toxicity Criteria and it was seen in six patients (75 percent). Six patients are still alive without evidence of recurrent disease in their last follow-up. CONCLUSION: Our study confirms that primary early stage Non-Hodgkin Lymphoma of the parotid gland is a disease with an excellent prognosis and a good local control rate, with minimal morbidity.

Linfomas primários das glândulas salivares são relativamente raros. Sua apresentação clínica não écaracterística e, frequentemente, a doença passa despercebida, resultando em atrasos no diagnóstico e tratamento. OBJETIVO: Enfatizar a importância do diagnóstico e tratamento combinado. Apresentamos uma casuística de oito pacientes com linfoma maligno da parótida, que foram diagnosticados somente após a cirurgia e tratados com radio e quimioterapia. MÉTODOS: Estudo retrospectivo de pacientes com linfoma maligno primário da glândula parótida, tratados com radioterapia e ressecção cirúrgica parcial diagnóstica. RESULTADOS: Após a conclusão do tratamento, atingimos uma taxa de controle loco-regional de 87,5 por cento. A toxicidade foi classificada de acordo com os Critérios Comuns de Toxicidade e afetou seis pacientes (75 por cento). Seis pacientes ainda estão vivos, sem evidência de doença na mais recente consulta de acompanhamento. CONCLUSÃO: Nosso estudo confirma que o Linfoma primário Não-Hodgkin em estágios iniciais da glândula parótida é uma doença com excelente prognóstico e boa taxa de controle local, com mínima morbidade.