ChatGPT as a New Tool to Select a Biological for Chronic Rhino Sinusitis with Polyps, "Caution Advised" or "Distant Reality"?

ChatGPT is an advanced language model developed by OpenAI, designed for natural language understanding and generation. It employs deep learning technology to comprehend and generate human-like text, making it versatile for various applications. The aim of this study is to assess the alignment between the Rhinology Board's indications and ChatGPT's recommendations for treating patients with chronic rhinosinusitis with nasal polyps (CRSwNP) using biologic therapy. An observational cohort study involving 72 patients was conducted to evaluate various parameters of type 2 inflammation and assess the concordance in therapy choices between ChatGPT and the Rhinology Board. The observed results highlight the potential of Chat-GPT in guiding optimal biological therapy selection, with a concordance percentage = 68% and a Kappa coefficient = 0.69 (CI95% [0.50; 0.75]). In particular, the concordance was, respectively, 79.6% for dupilumab, 20% for mepolizumab, and 0% for omalizumab. This research represents a significant advancement in managing CRSwNP, addressing a condition lacking robust biomarkers. It provides valuable insights into the potential of AI, specifically ChatGPT, to assist otolaryngologists in determining the optimal biological therapy for personalized patient care. Our results demonstrate the need to implement the use of this tool to effectively aid clinicians.

Is Oral Microflora Related to Development of Malfunction in Patients Using Voice Prosthesis?

Background: this prospective study investigated the correlation between the oral bacterial microflora and the microflora found in voice prostheses (VPs) among 20 patients who had undergone laryngectomy. The aim was to explore the associations between the microflora's presence and the malfunction of VPs, along with the association between the predominant microorganism and the longevity of VPs. Methods: the research process included gathering medical histories, conducting ENT examinations, replacing VPs, and performing check-ups every four months for a period of 15.5 months. Additionally, microbiological examinations, blood tests, and voice change surveys were conducted. Results: a correlation between the microflora isolated from VPs and that from oral rinses was demonstrated in a large percentage of patients who experienced a loss of prosthetic functional efficiency. The correlation analysis between the type of microorganism and the lifespan of VPs showed a non-significant Pearson correlation coefficient (r = 0.043, p = 0.678). Conclusions: there is no significant linear correlation between the predominant microorganism and the average lifespan of VPs.

Tonsillar Kaposi's Sarcoma in HIV Positive Patient with Syphilis Infection.

Introduction: Since the introduction of Highly Active Anti-Retroviral Therapy (HAART), there has been a significant increase in the survival of HIV-infected patients. Consequently, there has been increased attention on the potential neoplastic pathologies, such as Kaposi's sarcoma, associated with AIDS in these individuals. Case Report: In this case report we present, for the first time, a patient affected by Kaposi's sarcoma of the palatine tonsil with a concomitant syphilis infection. The patient underwent enlarged tonsillectomy and continued antiretroviral therapy. There were no signs of disease recurrence at a 12-month follow-up. Conclusions: Despite the rarity of tonsillar localization of Kaposi's sarcoma, it should be suspected in the presence of an HIV-infected patient. Tonsillectomy effectively controls local disease, but comprehensive patient management requires a multidisciplinary team of healthcare professionals, including infectious disease specialists, pathologists, and oncologists who work together to provide high-quality and coordinated care.

Implantable hearing devices in clinical practice. Systematic review and consensus statements.

Objective: Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices. Materials and methods: A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements. Results: Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications. Conclusions: This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.

Benign paroxysmal positional vertigo and asymmetric hearing loss: is the worst hearing ear likely to suffer from otoconial displacement?

PURPOSE: Benign paroxysmal positional vertigo (BPPV) may be found in patients complaining of hearing disorders. The aim of our investigation was to describe audiological findings in BPPV patients, focusing on subjects with asymmetric hearing loss (AHL), to better understand whether otoconial displacement may occur preferentially in the worst hearing ear. METHODS: A prospective study was performed on 112 BPPV patients. We divided the sample into subjects who suffered from AHL (G1) and patients with did not (G2). Data regarding vestibular symptoms, tinnitus, migraine, antivertigo drug therapy, and vascular risk factors were collected. RESULTS: Out of 30 AHL subjects, 83.33% of them were affected by sensorineural hearing loss (SNHL) in at least one ear, with a significant difference in the distribution of hearing loss type between groups (p = 0.0006). In 70% of cases, the ear affected by BPPV was the one with the worst hearing threshold (p = 0.02); threshold asymmetry predicted BPPV in the worst hearing ear (p = 0.03). The predictability depended neither on the hearing threshold gap between ears nor the severity of the hearing threshold in the worst ear (p > 0.05). No differences in vascular risk factors between groups were observed (p > 0.05). We evidenced a moderate correlation between age and hearing threshold (ρ = 0.43). Age did not result a predictive factor for residual dizziness or BPPV in the worst ear (p > 0.05). CONCLUSIONS: Our study supports the likelihood of an otoconial displacement in the worse hearing ear in BPPV patients. Clinicians should start testing the worst hearing ear when managing AHL patients with suspected BPPV.

Dupilumab in chronic rhinosinusitis with nasal polyps: Real life data in a multicentric Sicilian experience.

OBJECTIVE: This study aimed to evaluate the effectiveness and safety of dupilumab during the first year of treatment in a real-life setting, focusing on improvement in nasal polyp score (NPS) as well as specific symptoms, quality of life and olfactory function. METHODOLOGY/PRINCIPAL: A multicentric observational cohort study was carried out. A total of 170 patients were enrolled in the Otorhinolaryngology Unit of the three University Hospitals and considered for dupilumab therapy. All recorder characteristics were age (at the first dupilumab application visit), sex, smoke habits, previous local and systemic corticosteroid therapy, history of endoscopic sinus surgery, number of previous endoscopic sinus surgery, concomitant asthma, history of an allergic condition, immunoglobulin E (IgE), allergy to nonsteroidal anti-inflammatory drugs (NSAIDs), Aspirin Exacerbated Respiratory Disease (AERD), other comorbidities associated, blood eosinophils, nasal polyp score, sinonasal outcome test 22 (SNOT 22), sniffin' stick test, the start date of dupilumab therapy and number of doses of dupilumab and eventually, Dupilumab's adverse events related to administration. The Wilcoxon test for dependent samples was performed to compare variables. Statistical significance was assumed for p values < 0.05. RESULTS: A statistically significant reduction in SNOT-22 and NPS was shown at the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). A statistically significant increase value at the Sniffin' sticks test was shown in the 6th and 12th month compared to baseline values (p < 0.001 for both comparisons). At the 12-month follow-up, according to EUFOREA indications, all patients were considered to remain in treatment with dupilumab and continued the treatment because of a reduced NPS, improved quality of life and a reduced need for system corticosteroids. Dupilumab seemed to be well tolerated by all patients. Any adverse effect of the drug led to the quit of biological treatment. CONCLUSIONS: This multi-centric real-life study supported the effectiveness of dupilumab as an add-on therapy to intranasal corticosteroids in patients with severe uncontrolled CRSwNP in improvement of quality of life, severity of symptoms, polyp size reduction and smell function. Furthermore, our data support the safety profile of monoclonal therapy with dupilumab.

A Rare Case of Solitary Fibrosus Tumor (SFT) of the Nasal Septum.

Introduction: Solitary fibrous tumor (SFT) is a rare mesenchymal tumor that usually arises from the pleura but can also occur in extrapleural sites, such as the sinonasal region. It causes aspecific symptoms, including nasal obstruction and discharge, postnasal drip, anosmia, epistaxis, and headache. It may be difficult to distinguish these symptoms from those caused by other mesenchymal lesions that usually occur in this site, especially when the tissues undergo iatrogenic damage following surgical removal. Case Report: This case report shows a rare right nasal septal solitary fibrous tumor, which was surgically removed using a trans-nasal endoscopic technique. For the first time, the mass was decomposed by a plasma blade, and the implant site was treated by performing a subperiosteal removal of septal mucosa and cartilage. Histopathological examination confirmed the diagnosis of solitary fibrous tumor. Follow-up at three, six, and twelve months showed no signs of relapse. Conclusions: Sinonasal SFT is unusual, and it may be difficult to distinguish it from other mesenchymal lesions in this site. In the literature, cases treated with CO2 laser are usually described; however, due to the high cutting temperatures, this can cause thermal damage of the tissues, making histopathological diagnosis difficult. The plasma blade uses pulsed radiofrequency, creating an effective cutting edge while the blade stays near body temperature. Therefore, this device results in atraumatic, scalpel-like cutting sensitivity and electrosurgical-like hemostasis, with minimal bleeding and tissue injury. Its use could, therefore, help both the surgeon in obtaining surgical radicality and the pathologist in the correct histologic classification.

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders.

Objective: To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods: A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients' details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results: 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions: Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients.

A Prospective Observational Study on the Role of Immunohistochemical Expression of Orphanin in Laryngeal Squamous Cell Carcinoma Recurrence.

To date, histological biomarkers expressed by laryngeal cancer are poorly known. The identification of biomarkers associated with laryngeal squamous cell carcinoma (SCC), would help explain the tumorogenesis and prevent the possible recurrence of the lesion after treatment. For this reason, the aim of this study is to investigate, for the first time, the Orphanin expression in 48 human specimens of laryngeal SCC and evaluate its possible correlation with patients prognosis. We analyzed pathological specimens from 48 patients with laryngeal SCC to detect the presence of Orphanin by using an immunohistochemistry test. We compared the findings with healthy tissue acquired from patients who underwent surgery for mesenchymal benign tumours of the larynx. The specimens were stained with anti-Orphanin monoclonal antibodies. Results were processed through a computerised image analysis system to determine a scale of staining intensity. All the tumoural specimens examined showed a significant immunoreaction for Orphanin when compared with healthy tissues (p < 0.05) but with a different immune reactivity related to clinical-pathological features. A high Orphanin expression was not significantly related to Histological Grading (HG), TNM, and stage (p > 0.05). In the multivariate analysis, the Orphanin expression was significantly related only to the malignant recurrence (p < 0.05). Our study suggests that Orphanin could have a role in tumorigenesis by increasing the recurrence of cancer; therefore, it should be further explored as a possible biomarker for laryngeal cancer.

Diagnostic Role of Combined Electrocochleography and Pure-Tone Audiometry Monitoring During Dehydrating Test in Ménière's Disease: A Case Series.

OBJECTIVES: To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease. STUDY DESIGN: Prospective case series. SETTINGS: University hospital, secondary referral center. PATIENTS: Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification. INTERVENTION: Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone. MAIN OUTCOME MEASURE: Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed. RESULTS: After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted. CONCLUSIONS: The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.

Acute pneumolabyrinth: a rare complication after cochlear implantation in a patient with obstructive sleep apnoea on CPAP therapy.

Pneumolabyrinth is a condition characterised by the presence of air within the inner ear and is a rare complication after cochlear implant surgery. One of the causes of pneumolabyrinth may be the increase in pressure in the middle ear. The use of continuous positive airway pressure (CPAP) is an effective treatment strategy for obstructive sleep apnoea. According to a recent study, the use of CPAP should be delayed by 1 or 2 weeks in subjects undergoing middle ear surgery; however, there is currently no indication to delay the CPAP in subjects undergoing cochlear implant surgery. We report the case of a patient on CPAP who underwent left cochlear implantation and, in the early postoperative period, reported severe vertigo and tinnitus. Cone-beam CT of the temporal bone revealed the presence of pneumolabyrynth. We believe that the use of CPAP should be delayed in subjects undergoing cochlear implantation to avoid the development of acute pneumolabyrinth.

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature.

PURPOSE: Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature. METHODS: Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines. RESULTS: The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review. CONCLUSIONS: Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

Noise-Induced Hearing Loss in Police Officers: Systematic Review.

Introduction: Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers. Results: Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the. Conclusions: Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

The Role of Cartilage-perichondrium Tympanoplasty in the Treatment of Tympanic Membrane Retractions: Systematic Review of the Literature

Abstract Introduction Tympanic retraction is a condition characterized by the displacement of the tympanic membrane toward the structures of the middle ear. Clinically, tympanic retractions can lead to hearing loss, ear discharge and/or ear pain. In most of the cases, however, tympanic retractions are asymptomatic and are found accidentally during an ear, nose, and throat (ENT) examination. This condition has created numerous debates regarding the optimal choice of treatment, especially in the asymptomatic forms. The main controversy is regarding the relationship between retraction and the development of cholesteatoma, which would justify a surgical intervention performed for preventive purposes. Objectives To study the effectiveness of cartilage tympanoplasty in the management of tympanic membrane retractions by analyzing the results of the studies conducted on the use of cartilage as a reconstruction material. Data Synthesis A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Our initial literature search yielded 2,258 references. Applying the PRISMA flow chart, 1,415 duplicates were excluded, and the remaining 843 abstracts were examined. Afterwards, 794 articles were excluded based on the research protocol criteria. Only 8 papers were included in the review by applying the inclusion and exclusion criteria. Conclusions Despite the limitations of the studies taken into consideration, we can conclude that cartilage tympanoplasty may successfully rehabilitate the atelectatic ear especially in the more advanced stages of retraction, unlike the conservative strategies.

Management of pharyngeal collapse in patients affected by moderate obstructive sleep apnoea syndrome.

Objective: This study reports our experience in a selected cohort of patients affected by mild-moderate OSAS, without tonsillar obstruction, and treated with pharyngoplasty. Methods: In a case-control retrospective study, we compared modified expansion sphincter pharyngoplasty (MESP) to modified barbed reposition pharyngoplasty (MBRP) in adult patients with oropharyngeal transversal collapse with a BMI ≤ 30 kg/m2, and mild-moderate obstructive sleep apnoea syndrome (OSAS). A clinical evaluation, including collection of anthropometric data and sleep endoscopy, was performed. Six months after surgery, symptoms recording, clinical evaluation and polysomnography (PSG) were repeated. Results: We enrolled 20 patients: 10 treated with MESP and 10 treated with MBRP. Mean apnoea-hypoapnoea index (AHI) was 22.8 (± 5.63). We observed in both groups a significant reduction of AHI and oropharyngeal obstruction (p = 0.01), with a success rate, according with Sher's criteria, of 90% for MESP and 80% for MBRP, respectively. Post-surgical pain and snoring reduction were significantly lower with MBRP. Conclusions: We recorded similar success rates for both techniques. MBRP may be considered better than MESP due to less surgical time, no potential mucosal damage, absence of knots, and faster recovery with less pain.

The Role of Cartilage-perichondrium Tympanoplasty in the Treatment of Tympanic Membrane Retractions: Systematic Review of the Literature.

Introduction Tympanic retraction is a condition characterized by the displacement of the tympanic membrane toward the structures of the middle ear. Clinically, tympanic retractions can lead to hearing loss, ear discharge and/or ear pain. In most of the cases, however, tympanic retractions are asymptomatic and are found accidentally during an ear, nose, and throat (ENT) examination. This condition has created numerous debates regarding the optimal choice of treatment, especially in the asymptomatic forms. The main controversy is regarding the relationship between retraction and the development of cholesteatoma, which would justify a surgical intervention performed for preventive purposes. Objectives To study the effectiveness of cartilage tympanoplasty in the management of tympanic membrane retractions by analyzing the results of the studies conducted on the use of cartilage as a reconstruction material. Data Synthesis A literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Our initial literature search yielded 2,258 references. Applying the PRISMA flow chart, 1,415 duplicates were excluded, and the remaining 843 abstracts were examined. Afterwards, 794 articles were excluded based on the research protocol criteria. Only 8 papers were included in the review by applying the inclusion and exclusion criteria. Conclusions Despite the limitations of the studies taken into consideration, we can conclude that cartilage tympanoplasty may successfully rehabilitate the atelectatic ear especially in the more advanced stages of retraction, unlike the conservative strategies.

The prognostic value of subjective nasal symptoms and SNOT-22 score in middle ear surgery.

BACKGROUND: The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps. OBJECTIVES: To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery. METHODS: We prospectively evaluated data of patients undergoing middle ear surgery for chronic otitis media with and without cholesteatoma. All patients completed the SNOT-22 and ETDQ-7 questionnaires. They underwent surgery for their pathology, as appropriate. RESULTS: The SNOT-22 score was higher in patients with retraction pocket and in patients whose retraction pockets recurred after surgery (p < 0.05). Patients with higher score at SNOT-22 questionnaire, were more likely to show recurrence of atelectasis aftersurgery. CONCLUSIONS: The SNOT-22 questionnaire, administrered before surgical procedure, can help in the identification of patients who are at risk of failure in the post-operative period, as well as ETDQ-7.

Tumours of Nasal Septum: A Retrospective Study of 32 Patients.

OBJECTIVE: Tumours of the nasal septum are a rare and heterogeneous group of lesions in the sinonasal tract. The management of the different lesions of this site is debated. The aim of this study is to share our experience on a rare clinical condition and stimulate other centres to publish theirs. METHODS: We retrospectively analysed the databases of sinonasal tumours treated at the Sections of Otolaryngology (ENT) of two University Hospitals (Palermo and Genova) between 2012 and 2020. RESULTS: From the two databases, a cohort of 32 patients with tumours of nasal septum were selected. All patients underwent an endoscopic examination. Large tumours underwent preoperative computed tomography (CT) scan without contrast medium. In 22 (68.7%) cases, the preoperative radiologic evaluation also included magnetic resonance imaging (MRI) with gadolinium to obtain a better differentiation of the lesions and study the vascular pattern. All the large lesions were biopsied under endoscopic guidance using local anaesthesia; the same approach was used to remove the tumours and their attachment with safe resection margins. CONCLUSIONS: While malignant lesions require an excision of the mass with resection of all layers of the nasal septum, benign lesions must be typed according to histological considerations in order to plan the most appropriate type of surgical resection.

A conservative treatment for chronic obstructive sialoadenitis by intraductal instillation of mucolytic, steroids and antibiotic solution.

PURPOSES: Reporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution. METHODS: Prospective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 months via phone interview, to understand whether patients had developed any further symptoms after the treatment. RESULTS: This study included 26 patients. All the patient without sialolithiasis have not reported any symptoms during the follow-up period. Two of those with sialolithiasis have not shown any signs of recurrence. The remaining three patients with non-resolved sialolithiasis had a recurrence of symptoms which were treated again with 1 intraductal administration of betamethasone, gentamicine and NAC, showing immediately a regression of the symptoms. CONCLUSIONS: Intraductal administration of gentamicin + NAC + betamethasone seemed effective for the therapy of chronic obstructive sialoadenitis. Our protocol seemed effective also in that cases where it was not possible to remove or detect endoscopically an obstruction. In all these cases we have noticed an increase in the symptom-free time even in cases where it was not possible to remove the stones.

Changes in Speech Range Profile Are Associated with Cognitive Impairment.

BACKGROUND AND PURPOSE: The aim of this study was to describe the variations in the speech range profile (SRP) of patients affected by cognitive decline. METHODS: We collected the data of patients managed for suspected voice and speech disorders, and suspected cognitive impairment. Patients underwent an Ear Nose and Throat evaluation and Mini-Mental State Examination (MMSE). To obtain SRP, we asked the patients to read 18 sentences twice, at their most comfortable pitch and loudness as they would do in daily conversation, and recorded their voice on to computer software. RESULTS: The study included 61 patients. The relationship between the MMSE score and SRP parameters was established. Increased severity of the MMSE score resulted in a statistically significant reduction in the average values of the semitones to the phonetogram, and the medium and maximum sound pressure levels (p<0.001). The maximum predictivity of MMSE was based on the highly significant values of semitones (p<0.001) and the maximum sound pressure levels (p=0.010). CONCLUSIONS: The differences in SRP between the various groups were analyzed. Specifically, the SRP value decreased with increasing severity of cognitive decline. SRP was useful in highlighting the relationship between all cognitive declines tested and speech.