Impact of an educational intervention about healthy lifestyles in teenagers.

BACKGROUND: During the last years, lifestyle has worsened along the entire European population, causing an alarming boom-up regarding overweight and obese people. Pediatric population is also influenced in this sense, which may predispose to suffer from several diseases in adulthood. Educational interventions at early ages could be an effective strategy to face this situation. AIM: To describe the impact of an educational intervention about healthy lifestyle in adolescents. METHODS: A quasi-experimental study analyzing the knowledge of high school students, before and after a brief educational intervention based on a self-elaborated questionnaire including questions from the validated questionnaire CAPA (from Spanish, Conocimientos en Alimentación de Personas Adolescentes). RESULTS: The results of this study show a significant increase in knowledge about healthy lifestyles in the study population after the educational intervention (14.3±3.8 vs. 16.5±4.5; p<0.001). In addition, this improvement presents an asymmetric distribution according to gender (13.2±3.6 vs. 14.9±4.6; p=0.002 in men; 15.6±3 vs. 18.1±3.6; p<0.001 in women) and the type of educational center (14.17±3.6 vs. 16.48±4.17; p<0.001 in public schools and 14.86±4.15 vs. 16.54±5.32; p=0.047 in private schools). Parents' educational level was associated with improvement in knowledge about healthy lifestyles (13.44±2.9 vs. 15.67±5.37; p=0.132 at low level, 14.22±3.42 vs. 16.9±4.68; p<0.001 at medium level and 15.75±3.3 vs. 17.39±4.5; p=0.022 at high level). CONCLUSION: Educational intervention taught by primary health care professionals is a useful and efficient tool for the acquisition of nutritional and healthy lifestyle knowledge in adolescents.

Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study.

BACKGROUND: Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. METHODS: Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. RESULTS: Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. CONCLUSIONS: Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.

Olfactory changes after endonasal endoscopic cerebrospinal fluid fistula repair: long-term outcomes.

OBJECTIVE: This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas. METHOD: Demographic characteristics, cerebrospinal fluid leak location, surgical procedure, aetiology and smell test results were retrospectively reviewed. RESULTS: A total of 27 patients were included. The mean age was 43.52 years. The aetiology was spontaneous in 13 patients (48.1 per cent) and traumatic in 14 patients (51.9 per cent). The skull base defect was at the cribriform plate in 15 patients (55.6 per cent), the frontal sinus posterior wall in 4 patients (14.8 per cent), the sphenoid sinus posterior wall in 4 patients (14.8 per cent), around the anterior ethmoid artery in 2 patients (7.4 per cent), at the ethmoid roof in 1 patient (3.7 per cent) and at the sphenoid sinus posterolateral wall in 1 patient (3.7 per cent). After the comparison of pre-operative and post-operative values in identification, discrimination and threshold categories, a statistically significant difference was seen only in the threshold category (p = 0.014). CONCLUSION: The results demonstrated that endoscopic repair of cerebrospinal fluid leak is safe in terms of olfactory functions.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

EPOS2020: development strategy and goals for the latest European Position Paper on Rhinosinusitis.

BACKGROUND: The European Position Papers on Rhinosinusitis from 2005, 2007 and 2012 have had a measurable impact on the way this common condition with high impact on quality of life is managed around the world. EPOS2020 will be the latest iteration of the guideline, addressing new stakeholders and target users, presenting a summary of the latest literature and evolving treatment modalities, and formulating clear recommendations based on all available evidence. METHODOLOGY: Based on the AGREE II framework, this article demonstrates how the EPOS2020 steering group will address six key areas to ensure consistency in quality and presentation of information in the latest rhinosinusitis clinical practice guideline: scope and purpose; stakeholder involvement; rigour of development; clarity of presentation; recommendations and applicability; editorial independence. RESULTS: By analysing the guidance from AGREE II, we formulated a detailed development strategy for EPOS2020. We identify new stakeholders and target users and ratify the importance of patient involvement in the latest EPOS guideline. New and expanded areas of research to be addressed are highlighted. We confirm our intention to use mixed methodologies, combining evidence-based medicine with real life studies; when no evidence can be found, use Delphi rounds to achieve clear, inclusive recommendations. We also introduce new concepts for dissemination of the guideline, using Internet and social media to improve accessibility. CONCLUSION: This article is an introduction to the EPOS2020 project, and presents the key goals, core stakeholders, planned methodology and dissemination strategies for the latest version of this influential guideline.

Endoscopic anatomy of sphenoid sinus for pituitary surgery.

Endoscopic endonasal transsphenoidal approach to the sellar region yields an alternative to classical microsurgical approaches. Endoscopes provide images that differ from microscopic view. This study aimed to highlight surgical landmarks and their anatomical relationships for pituitary surgery through endoscopic perspective. Ten sides of five adult cadaveric heads with red-colored latex injected arteries were evaluated. Endoscopic dissections were performed and measurements were done in the sphenoid sinuses before and after the removal of bony structures in all the aspects. Endoscopic vision of the sellar region enabled a wide panoramic perspective and detailed inspection. The measurements, in general, indicated the variations in the bony structures and soft tissues. The width of the pituitary, which is the distance between the medial margins of the carotid prominences, was measured as 21 +/- 2.5 mm and the distance between the medial margin of the carotid prominences at the lower margin of the pituitary was 18 +/- 3.1 mm. After the bony structures were removed, further measurements were done. The width of the pituitary, which is the distance between the medial margins of the anterior curvature of the ICA, was measured as 23.2 +/- 3 mm, while the distance between the posterior curvature of the ICA was 19.7 +/- 4.9 mm. Endoscopic view provided superior detailed visualization of the close relationships between pituitary gland, internal carotid arteries, and optic nerves. This facilitated exact evaluation for variations, which could result in more effective and safe surgery. However, these variations again emphasize the necessity of preoperative radiological evaluation in each case.

Flexible versus rigid endoscopy for treatment of foreign body impaction in the esophagus.

BACKGROUND: The use of either flexible endoscopy (FE) or rigid endoscopy (RE) for removal of ingested foreign bodies (FBs) impacted in the esophagus is still discussed controversially. METHODS: We report a consecutive series of 139 patients with FB impaction in the esophagus. During a 6-year period, 69 men and 70 women (median age, 64 [0.7-97] years) requiring removal of an impacted FB underwent either RE (n = 63) in the Otolaryngology Department of our hospital or FE (n = 76) in the Surgical Endoscopy Unit. RESULTS: Foreign body removal was equally effective with FE (success rate 93.4%) and RE (95.2%, p = n.s.). The cases in which foreign body removal failed (5 FE cases [6.6%] and 3 RE cases [4.8%]) were all subsequently successfully managed with "conversion" and use of the other technique. No severe complications occurred when FB removal was attempted with FE (0 of 76 cases; 0.0%), whereas RE was associated with esophageal rupture requiring immediate surgical intervention in 2 of 63 cases (3.2%; p < 0.002). Patient comfort differed significantly between the two procedures (p < 0.0001); RE was always performed under general anesthesia (100.0%), whereas only a minority of patients undergoing FE required general anesthesia (13.0%; p < 0.0001) or mild analgosedation (20.0%). The better patient comfort with FE was also reflected in a significantly lower rate of dysphagia (15%) compared to RE (48%; p < 0.0001). Rigid endoscopy was more frequently used in removal of FBs of the upper esophagus (p < 0.0001), whereas FE was the predominate approach to FBs in the lower esophagus (p < 0.0001). CONCLUSIONS: A tailored approach to treatment of FB impaction is recommended. Because of the lower rate of severe complications, better patient comfort with a lower rate of dysphagia, and lack of requirement for general anesthesia, FE should be the "first line" approach to FBs, although RE has its place as the "second line" therapy.

[How is tinnitus influenced by cochlear implantation?]. / Wie wird der Tinnitus durch eine Kochlearimplantation beeinflusst?

INTRODUCTION: Tinnitus is one of the most common symptoms in patients with profound sensorineural hearing loss (SNHL). Cochlear implantation (CI), which has become a standard method to rehabilitate profound SNHL, has been also observed to effect tinnitus in many cases. In the Salzburg Cochlear Implant Center,more than 230 profoundly deaf patients, mainly children,have been provided with CI between 1992 and 2000. PATIENTS AND METHOD: In a retrospective study, 39 adult patients were assessed by questionnaire for the frequency of tinnitus, subjective loudness sensitivity, and tinnitus-specific impairment before and after the CI. RESULTS: Before implantation 26 patients had tinnitus, while 24 patients had the same symptoms after the CI. In 13 patients (50%) tinnitus remained unaffected by the operation. Intensity of tinnitus decreased in seven patients (26.7%), and in four patients (15.4%) it completely disappeared after the implantation.However, intensity increased in two patients (7.7%), and in another two patients, who had not experienced tinnitus before, it began first after the implantation. No correlation has been found between the daily using time of CI and the tinnitus impairment.Also no effect of tinnitus was seen on postoperative hearing assessed by Freiburg numbers, monosyllables, and Innsbruck sentence test scores. CONCLUSION: CI significantly reduces the subjectively perceived impairment, although the reduction in the subjectively perceived loudness of the tinnitus is not significant.

[How is tinnitus influenced by cochlear implantation?] / Wie wird der Tinnitus durch eine Kochlearimplantation beeinflusst?

INTRODUCTION: Tinnitus is one of the most common symptoms in patients with profound sensorineural hearing loss (SNHL). Cochlear implantation (CI), which has become a standard method to rehabilitate profound SNHL, has been also observed to effect tinnitus in many cases. In the Salzburg Cochlear Implant Center,more than 230 profoundly deaf patients, mainly children,have been provided with CI between 1992 and 2000. PATIENTS AND METHOD: In a retrospective study, 39 adult patients were assessed by questionnaire for the frequency of tinnitus, subjective loudness sensitivity, and tinnitusspecific impairment before and after the CI. RESULTS: Before implantation 26 patients had tinnitus, while 24 patients had the same symptoms after the CI. In 13 patients (50%) tinnitus remained unaffected by the operation. Intensity of tinnitus decreased in seven patients (26.7%), and in four patients (15.4%) it completely disappeared after the implantation.However, intensity increased in two patients (7.7%), and in another two patients, who had not experienced tinnitus before, it began first after the implantation. No correlation has been found between the daily using time of CI and the tinnitus impairment.Also no effect of tinnitus was seen on postoperative hearing assessed by Freiburg numbers, monosyllables, and Innsbruck sentence test scores. CONCLUSION: CI significantly reduces the subjectively perceived impairment, although the reduction in the subjectively perceived loudness of the tinnitus is not significant.

[Hydronephrosis associated with elevated serum levels of CA 125 antigen. Report of a case]. / Idronefrosi associata ad elevati livelli sierici dell'antigene CA 125. Descrizione di un caso.

High level of the CA 125 serum antigen is typically associated with ovarian malignancies. However the CA 125 antigen can also be found in association with inflammation or neoplasms of tissues other than ovaries, i.e. mesothelial cells, mullerian duct derivatives and gastroenteric tract. Therefore the marker is not specific for ovarian neoplasms. In childhood there is not a large experience about clinical meaning of high CA 125 serum levels. We report a case in a 14-year-old patient, female, affected by hydronephrosis. Our case confirms that high CA 125, especially in childhood, is not necessarily associated with ovarian or pelvic diseases. Moreover the review of literature suggests the opportunity to investigate CA 125 serum levels in children affected by hydronephrosis.