The aging effect on upper airways collapse of patients with obstructive sleep apnea syndrome.

PURPOSE: To evaluate, using drug-induced sleep endoscopy (DISE), sites of upper airway obstruction and pattern of collapse in patients over 65 years old affected by obstructive sleep apnea. To compare sites and pattern of collapse of elderly patients with a group of patients younger than 65 years. METHODS: A group of 55 patients aged over 65 years were enrolled in this prospective study. Fifty patients under 65 years old were collected in the control group. Polysomnographic data and clinical parameters such as the daytime sleepiness, and body mass index were evaluated for both groups of patients. All patients underwent DISE examination with VOTE classification. RESULTS: The AHI value increased with aging whereas elderly patients presented a reduction in daytime sleepiness. Elderly patients showed a higher incidence of total collapse in the velum region compared to younger patients (90.9% vs 70%;); the older patients showed a lower degree of total oropharyngeal lateral wall collapse with respect to younger patients, (20% vs 50%). No difference in tongue base collapse emerged between the two subgroups of patients. CONCLUSION: Elderly patients showed a higher incidence of total collapse in the velum and a lower incidence in the oropharyngeal lateral wall compared to younger patients.

Is Peripheral Oxygen Saturation a Reliable Predictor of Upper Airways Air-Flow Limitation?

BACKGROUND: Dyspnea secondary to acute upper airways airflow limitation (UAAFL) represents a clinical emergency that can be difficult to recognize without a suitable history; even when etiology is known, parameters to assess the severity are unclear and often improperly used. OBJECTIVES: The aim of this study was to assess the role of peripheral oxygen saturation (SpO2) as a predictor of severity of upper airway obstruction. METHODS: The authors propose an experimental model of upper airway obstruction by a progressive increase of UAAFL. Ten healthy volunteers randomly underwent ventilation for 6 min with different degrees of UAAFL. SpO2, heart rate, respiratory rate (RR), tidal volume, accessory respiratory muscle activation, and subjective dyspnea indexes were measured. RESULTS: In this model, SpO2 was not reliable as the untimely gravity index of UAAFL. Respiratory rate, visual analogue scale (VAS), and Borg dyspnea scale were statistically correlated with UAAFL (p < 0.0001 for RR and p < 0.05 for VAS and Borg scale). No significant changes were observed on heart rate (p > 0.05) and tidal volume (p > 0.05); a RR ≤ 7 breaths/min; VAS and Borg scale showed statistically significant parameters changes (p < 0.05). CONCLUSIONS: RR, VAS, and Borg dyspnea scales are sensitive parameters to detect and stage, easily and quickly, the gravity of an upper airways impairment, and should be used in emergency settings for an early diagnosis of a UAAFL. SpO2 is a poorer predictor of the degree of upper airways flow limitation.

Evolution of soft palate surgery techniques for obstructive sleep apnea patients: A comparative study for single-level palatal surgeries.

OBJECTIVES: To compare the results of tissue preservation techniques of soft palate surgeries including expansion sphincter pharyngoplasty (ESP) and barbed reposition pharyngoplasty (BRP) for patients suffering from obstructive sleep apnoea (OSA) with the traditional uvulopalatopharyngoplasty (UPPP). DESIGN: Interventional comparative study. SETTING: Morgagni-Pierantoni Hospital. PARTICIPANTS: Seventy-five patients were included in the study, divided into three groups with 25 patients per group: UPPP, ESP or BRP. MAIN OUTCOMES MEASURES: Polysomnography was carried out for all patients pre- and postoperatively; the postoperative results were recorded at least 6 months after surgery. All patients were assessed preoperatively using drug-induced sleep endoscopy. Epworth Sleepiness Scale and body mass index (BMI) were registered for all patients before and after surgery. RESULTS: The mean of pre- and postoperative differences of apnoea-hypopnoea index values was higher in BRP group than ESP: 15.76 ± 14.5 Vs 10.13 ± 5.3; P < .05 and UPPP groups: 15.76 ± 14.5 vs 6.08 ± 5.5; P < .0005. The mean of differences of oxygen desaturation index values was higher in BRP group than UPPP group: 15.09 ± 17.6 vs 7.13 ± 6.8; P < .0005, but not significantly higher than ESP group: 15.09 ± 17.6 vs 6.48 ± 7.9; P > .05. The mean of differences of ESS values was higher in BRP group than ESP group: 5.52 ± 4.1 vs 4.84 ± 3.3; P < .005 and UPPP groups: 5.52 ± 4.1 vs 1.36 ± 1.9; P < .005. Finally, the pre- and postoperative means of differences of lowest oxygen saturation values were not statistically significant among the three groups (P > .05). CONCLUSION: Barbed reposition pharyngoplasty (BRP) can be considered an effective procedure on the basis of the postoperative outcomes. ESP still proves to be a good technique especially when performed by experienced surgeons. Both techniques proved to be superior to UPPP.

Metastasis to parotid gland from non Head and Neck tumors.

PURPOSE: Most primary tumors spreading metastasis to the parotid gland are usually located in the head and neck region, nonetheless, rarely, parotid gland can also be the target of metastatic localization site of distant primary tumors. The purpose of this study was to describe a clinical series of metastasis to the parotid gland from distant primary tumors (non Head & Neck). METHODS: The clinical databases of parotid tumors in two academic centers have been analyzed and 11 cases of parotid metastatic cancers from distant primary tumors were found. RESULTS: Primary tumor was lung cancer in 8 cases, and breast cancer, gastric carcinoma and pancreatic carcinoma in one case each. CONCLUSIONS: Parotid metastases can be the first clinical manifestation of a malignant tumor from a distant site and can manifest years after curative-intent treatment of the distant primary. Histopathology and immunohistochemistry can help in the identification of the primary site. Parotidectomy with complete excision of the parotid lesion may have diagnostic and/or loco-regional control and/or curative intent, however there is still no international consensus about the therapy of parotid malignant metastasis.

Secondary malignant tumors of the parotid gland: not a secondary problem!

PURPOSE: To present the clinical features of patients with parotid gland metastasis, and compare the results with previously published series. Most of the relevant literature arises from case reports, while there are only few series reported, as secondary neoplastic lesions of the parotid gland are uncommon. METHODS: The medical records of patients with parotid gland metastasis, treated at the ENT Department of the University Hospital of Ferrara, between January 1st 1965 and December 31th 2014, were retrospectively reviewed. Fine needle aspiration cytology (FNAC) and biopsy results were compared. Localization of the primary tumor was searched in all cases. Lymphomatous lesions have been excluded from the study. RESULTS: A total of 66 patients with parotid gland metastasis were evaluated. There were 53 males and 13 females with mean age 68.2 ± 13.5 years. Histopathologic analysis of the lesions revealed that 47 (71.2%) were parotid gland metastasis from cutaneous head and neck tumors, 8 (12.1%) from the upper aero-digestive tract, 7 (12.1%) from locations out of facial-cervical region, 1 from a conjunctival melanoma, while in 3 (4.5%) cases the primary tumor origin remained unknown. FNAC results were compared with the final histopathologic diagnosis, showing an overall concordance of 71.9%. CONCLUSION: The present study is one of the largest series of parotid gland metastasis available so far. During the diagnostic work-up of a parotid tumor, the possibility of a metastasis should also be considered. FNAC can be a useful tool for the preoperative assessment of parotid lesions.

Head and neck cancer patients: impact of diabetes mellitus on surgical outcomes.

PURPOSE: Cancer patients with significant comorbidities undergoing major surgical intervention are at high risk for peri/postoperative complications and a prolonged hospital stay. Diabetes mellitus is a prevalent chronic metabolic disease, reported to affect surgery outcomes of malignancies. The purpose of this article was to evaluate the impact of diabetes mellitus on the development of local and systemic complications as well as the length of the hospital stay, after major surgery for Head and Neck (H&N) cancer. METHODS: A total of 168 patients suffering from H&N cancer, surgically treated between 2004 and 2013 at our ENT Department, were included. Clinical records were examined, particularly focusing on the onset of local and systemic complications and on the length of the hospital stay. The subjects considered as diabetics were the ones with a history of physician-diagnosed diabetes or those who were taking oral hypoglycemic drugs or insulin. For those without a diagnosis of diabetes and not taking any antidiabetic medications, the value of fasting blood glucose was used to assess the presence of diabetes, according to the American Diabetes Association guidelines (glycaemia >126 mg/dl). The occurrence of local and systemic postoperative complications, as well as the length of the hospital stay, were statistically compared between the diabetic and non-diabetic group of patients. RESULTS: 31 of 168 (18.5%) patients, surgically treated for H&N cancer, had also been diagnosed with diabetes mellitus. Episodes of postoperative complications in non-diabetic patients were 50.4%, whereas in diabetics 45.2%. The mean length of hospital stay for non-diabetics was 28.1±14.8 days and for diabetics 32.2±24. In univariate and multivariate analysis, no statistically significant differences were found when comparing the diabetic to the non-diabetic group, in terms of occurrence of postoperative complications in respect to cancer stage and length of hospitalization. In univariate and multivariate analyses none of the variables studied was a risk factor for postoperative complications. CONCLUSIONS: This study provides evidence that a good metabolic control of diabetes mellitus does not have impact on the occurrence of peri/postoperative complications and therefore on the length of hospital stay of H&N cancer patients.

Supracricoid partial laryngectomy: oncological and functional results.

PURPOSE: The purpose of this study was to evaluate the oncological and functional results of patients affected by laryngeal squamous cell carcinoma (SCC) and surgically treated by supracricoid partial laryngectomy (SCPL) at the ENT Department of the University Hospital of Ferrara. METHODS: In this retrospective study a total of 155 patients (149 males/l96.1% and 6 females/3.9%), have been included. All patients were treated between January 1st 1998 and December 31st 2010, by SCPL, including 126 cricohyoidopexies (CHP) and 29 cricohyoidoepiglottopexies (CHEP). RESULTS: The overall survival (OS) at 3 and 5 years was 88.77 and 83.24%, respectively and the disease-free survival (DFS) at 3 and 5 years was 84.4 and 81.55%, respectively.The recurrence rate was 17.5%, with local recurrences in 12.1% of the cases, regional in 4.7% and distant metastasis in 0.7% of the cases. Synchronous second primary tumors were 0.7% and metachronous second primary cancers (MSPCs) 5.4%. Removal of nasogastric feeding tube (NGT) or percutaneous endoscopic gastrostomy (PEG) was performed in 98.7% of the patients and lasted 22 days on average after SCPL (range 9-60), while decannulation was performed in all of patients at the 27th day on average after surgery. CONCLUSIONS: Oncological outcomes of this series are consistent with those of the literature, showing that SCPL is an effective and safe procedure in terms of survival rate and disease control. Functional outcomes confirmed that SCPL allows a good organ preservation and recovery of laryngeal functions.

Acute mastoiditis in cochlear implanted children: A single-centre experience.

BACKGROUND: Acute mastoiditis (AM) is the most common complication of acute otitis media and primarily affects children under the age of two; current data on its prevalence in paediatric patients with cochlear implant (CI) are still scant. Proper management of AM in CI children is crucial in order to avoid the implications (financial and emotional) of an explant. Aim of this paper is to describe the cases of AM occurred among young patients with CI in follow up at our department, also in order to evaluate its prevalence, potential predisposing factors, clinical course and therapeutic strategies. PATIENTS AND METHODS: Retrospective study. Medical records of all paediatric patients with CI, who had at least one year of follow-up, were searched aiming to identify those who developed AM, from January 1st 2002 to January 31st 2022. The following data were collected and analysed: demographic features, implant type and side, interval between CI surgery and AM, treatment, laboratory tests, clinical course, vaccination history, associated diseases. RESULTS: AM was developed by six (1.3%) of the 439 children with CI (541 implanted ears). In total, 9 episodes (2.05 %) were recorded, as three patients reported two consecutive infections. Average time interval between CI surgery, to the first or only AM diagnosis, was 13.8 months (range 3-30 months). Furthermore, 3/6 of patients had a history of recurrent acute otitis media; 2/6 an autism spectrum disorder, associated to a combined immune deficiency in one case. All patients were hospitalized and promptly treated by intravenous antibiotic therapy; 4/6 also underwent a mastoidectomy. CI was not explanted in any cases of this series. CONCLUSIONS: Over a 20-year period, AM rate in CI children was 1.3%, which is consistent with the current literature rates of 1-4.7%. All cases were successfully treated, preserving the integrity of the device. In our experience, the early parenteral antibiotic therapy and, when necessary, surgical treatment were adequate to eradicate the infection.

Immediate effects of the semi-occluded bubble mask technique using VocalFeel® device as vocal warm-up in singers.

OBJECTIVE: The present study aims at investigating the immediate effects of the Semi-Occluded Bubble Mask Technique (SOBM) performed with the device VocalFeel® as a vocal warm-up in a group of professional singers. STUDY DESIGN: A randomized controlled study was carried out. METHODS: Forty-four vocally healthy professional singers were randomly divided into two groups on recruitment: an experimental group and a control group. The same vocal warm-up exercise was performed by the experimental group with the SOMB technique and by the control group without semi-occlusion. Self assessments, acoustic analysis and aerodynamic analysis of Peak Nasal Inspiratory Flows (PNIF) and Peak Oral Inspiratory Flows (POIF) were performed. RESULTS: Significant improvements after the SOBM technique were detected in the experimental group concerning some acoustic parameters (Jitt%; Shimm%) and aerodynamic measures (PNIF and POIF). No significant improvements after the warm-up exercise were observed in the control group. Significant differences between the experimental and the control group were found for ΔJitt%, ΔShimm%, ΔNHR, ΔPOIF and self assessments. CONCLUSIONS: The results of the present study support the efficacy of a vocal warm-up performed with the SOBM technique using VocalFeel® device in terms of acoustic quality, aerodynamic measures and perceived phonatory comfort in professional singers.

Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience.

Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.

Analysis of Tracheoesophageal Voice after Total Laryngectomy: A Single Center Experience.

Background/Objectives: Tracheoesophageal voice is the most commonly used voice rehabilitation technique after a total laryngectomy. The placement of the tracheoesophageal prosthesis can be performed at the same time as the total laryngectomy (primary placement) or in a second procedure after surgery (secondary placement). The purpose of this study is to analyze the substitution voice in patients with a tracheoesophageal prosthesis, considering the influence of radiotherapy and timing of prosthesis placement (primary or secondary) on voice quality. Methods: A retrospective analysis was conducted of all patients who received a tracheoesophageal phonatory prosthesis after a total laryngectomy was performed. We assessed whether patients received radiotherapy and whether they had a primary or secondary tracheoesophageal prosthesis. For the voice analysis, maximum phonation time (MPT), INFVo, SECEL, AVQI, CPPS, harmonic to noise ratio (HNR), unvoiced fraction (UVF), and number of voice breaks (NVB) were evaluated. Results: A total of 15 patients (14 males and 1 female) with a mean age of 71.8 years (SD ± 7.5) were enrolled. Eight had a primary prosthesis placement and five did not receive radiotherapy. INFVo parameters I and Vo were higher in patients with a primary placement of the phonatory prosthesis (p = 0.046 and p = 0.047). Patients who received the prosthesis secondarily had a higher mean CPPS and lower mean AVQI. Conclusions: A secondary placement of the prostheses seems to result in a minimal advantage in voice quality compared to a primary placement. Radiation therapy, on the other hand, has no effect on voice quality, according to these preliminary data.

Laryngomalacia and Obstructive Sleep Apnea in Children: From Diagnosis to Treatment.

The aim of this review is to investigate the state of the art among the association between Obstructive sleep apnea (OSA) and laryngomalacia, analyzing the epidemiology, the diagnostic tools, and the possible treatments available to affected patients. Laryngomalacia, characterized by the malacic consistency of the epiglottis with a tendency to collapse during inspiratory acts, producing a characteristic noise known as stridor, is a common condition in infants and particularly in those affected by prematurity, genetic diseases, craniofacial anomalies, and neurological problems. Congenital laryngomalacia, presenting with stridor within the first 15 days of life, is often self-limiting and tends to resolve by 24 months. OSA is not only a consequence of laryngomalacia but also exacerbates and perpetuates the condition. Currently, the treatments reported in the literature are based (i) on medical therapies (including watchful waiting) and (ii) on surgical treatments. Among the surgical techniques, the most described is supraglottoplasty, performed with the use of cold instruments, CO2 LASER, transoral robotic surgery, or the microdebrider.

Unilateral Hearing Loss and Auditory Asymmetry in Mitochondrial Disease: A Scoping Review.

Background/Objectives: Mitochondrial transfer RNA mutations are one of the most important causes of hereditary hearing loss in humans. In most cases, its presentation is bilateral and symmetrical; however, there are numerous cases of single-sided presentation or asymmetrical onset described in the literature that may represent a diagnostic challenge. The aim of this review is to present the evidence of auditory asymmetry in mitochondrial diseases, highlighting the possible presence of cases with atypical presentation. Methods: A review of the English literature to date on hearing loss and mitochondrial diseases was performed using PubMed, Scopus, and Google Scholar databases. The literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for scoping review. Results: A total of 10 full-text articles were included in this review, comprising 25 patients with single-sided or asymmetrical hearing loss associated with mitochondrial disease. Conclusions: Sensorineural hearing loss due to mitochondrial disease can represent a complex diagnostic challenge in cases of asymmetric or unilateral presentation. It is critical to recognize this clinical variant and to diagnose it in daily clinical practice.

[Chronic cough and worsening dyspnea: a case of idiopathic tracheal stenosis]. / Tosse cronica persistente e dispnea ingravescente: un caso di bronchite difficile.

We report a case of idiopathic tracheal stenosis in a 75-year-old woman, who presented to our observation with a diagnosis of asthmatic bronchitis characterized by cough and exertional dyspnea, later complicated by the appearance of tirage. Biopsy of the lesion showed focal squamous metaplasia of the epithelium lining, multiple sclerosis and chronic inflammatory infiltration of the corium. The patient was treated with endoscopic destruction via rigid bronchoscopy, through the combined action of YAG laser and mechanical debulking.

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination.

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

Basal cell adenoma and pleomorphic adenoma of the parotid gland: a single center experience.

BACKGROUND: Basal cell adenoma (BCA) and pleomorphic adenoma (PA) are among the most common benign neoplasms of the salivary glands. The aim of this study was to analyze and compare the diagnosis, treatment, and recurrence rate of these two different types of parotid benign tumors. METHODS: A retrospective analysis of all cases of parotid gland BCA and PA surgically treated between January 1, 1990, and December 31, 2019, was performed at our university. RESULTS: A total of 349 patients were enrolled in the present study, 311 of which (89.1%) were affected by PA, and 38 patients (10.9%) by BCA. The most frequently performed surgery was partial parotidectomy for both groups (85.9% in PA and 65.8% in BCA). Perioperative complications - often transient and of short duration - occurred within 48 hours of surgery and were observed in 30.6% of PA patients and in 18.4% of BCA patients; furthermore, recurrences were noticed in 19 PA patients (6.2%) and in 3 BCA patients (7.9%) (rates in range with the available literature data). CONCLUSIONS: To the best of our knowledge, this study is one of the largest single-center series in the literature comparing diagnosis, treatment, recurrence rate and clinical-pathological features of two different types of benign parotid gland tumors, BCA, and PA.

Immunonutrition in head and neck cancer: have a look before surgery!

The purpose of this paper is to investigate the possible role of immunonutrition in head and neck cancer patients. Malnutrition frequently occurs in head and neck oncological patients, due to mechanical obstruction, such as tumour induced cachexia, poor dietary habits, as well as excessive alcohol consumption. These defects combined with the immune suppressive effects of surgery have been claimed to contribute in increasing the postoperative complications rate, such as poor wound healing and higher incidence of infections. Immunonutrition has been proposed to provide specific benefits to the immune system; several clinical trials, also in head and neck cancer patients, are already present in the literature, even if methodological differences impede comparisons and firm conclusions so far. Nutritional oncology is a new and interesting field and requires the use of standardised intervention protocols in order to evaluate its clinical efficacy.

Giant dedifferentiated liposarcoma of the right hemifacial area involving the oral cavity.

Although liposarcoma is a reasonably common soft tissue sarcoma in adults, its occurrence within the head and neck region is very rare. The following report presents the case of a giant dedifferentiated liposarcoma initially located in the temporal region and then extending to the entire right maxillofacial region. Clinical as well as histopathological features and therapeutic approaches of dedifferentiated liposarcoma are discussed, and a literature review is presented.

Sensorineural Hearing Loss Post-COVID-19 Infection: An Update.

The course of COVID-19 infection may be complicated by a variety of neurological manifestations. Since the inner ear is vulnerable to viruses, sensorineural hearing loss (SNHL) has been reported to occur following the SARS-CoV-2 infection, often resulting in long-term morbidity and worsening the quality of life. The interest in how the virus affects the inner ear has gradually increased since the pandemic's spread, but little is still known about the SNHL potentially caused by SARS-CoV-2. The aim of this paper is to evaluate the possible association between SNHL and COVID-19 infection, through a systematic literature review. Currently available data suggest that SARS-CoV-2 may hamper cochlear function; however, available reports are still limited. Large cohort and prospective studies are necessary to evaluate the long-term effects of this viral infection in the inner ear.