Bruno Galletti

Internal Carotid Artery Transposition as Risk Factor in Pharyngeal Surgery

Objective/Hypothesis Injuries to the internal carotid artery during simple pharyngeal surgical procedures can be catastrophic for the risk of massive bleeding. The aims of the study were 1) to report five cases of congenital and asymptomatic anomalies of the internal carotid artery with a review of the literature, 2) to assess the relationships between these anomalies and the possible risk in “routine” pharyngeal surgery, and 3) to determine the most accurate imaging techniques to evaluate these anomalies.

Vocal Outcome After CO2 Laser Cordectomy Performed on Patients Affected by Early Glottic Carcinoma

OBJECTIVE The objectives of this study were to assess the influence of the different types of laser cordectomy on vocal outcome and highlight the relationship between some perceptive, acoustic, and endoscopic evaluations. STUDY DESIGN Retrospective observational study. METHODS Thirteen patients, staged as having T1a tumor, underwent laser CO(2)cordectomy (1 patient type I and type II, 2 patients type II, 6 patients type III, and 4 patients type IV) between January and June 2010. Grade, roughness, breathiness, asthenia, and strain evaluation scale; voice handicap index-10 questionnaire; multidimensional computer analysis of voice and speech; maximum phonation time; and stroboscopic examination were performed 12 months after the surgery. Correlations between jitter% and R, shimmer% and R, noise-to-harmonic ratio (NHR) and G were studied. Patients were first divided into groups according to type of cordectomy performed and, later, according to stroboscopic findings. Wilcoxon test, Spearman index, and Kruskal-Wallis test, followed by post hoc analysis, were used. RESULTS No significant differences were found in type III and type IV cordectomy groups. Jitter% and R values showed a correlation as did shimmer% and B values, and NHR and G values in type III cordectomy group. Moreover, shimmer% and NHR values significantly increase in direct proportion to the severity of the endoscopic status. CONCLUSIONS Results indicate that the type of surgery performed, functional compensation, and outcome measures were related, although for some data, there were no statistical evidence. Individual compliance could strongly influence vocal outcome in these patients.

Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy

BackgroundSeveral guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review.MethodsThe survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value.ResultsThe frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied.ConclusionsThe recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

Ear, nose and throat (ENT) involvement in zoonotic diseases: a systematic review

INTRODUCTION Zoonoses are infections transmitted from animal to man, either directly (through direct contact or contact with animal products) or indirectly (through an intermediate vector, such as an arthropod). The causative agents include bacteria, parasites, viruses, and fungi. The purpose of this review is to make an accurate examination of all zoonotic diseases that can be responsible of ear, nose, and throat (ENT) involvement. METHODOLOGY A PubMed search was performed combining the terms (otorhinolaryngology OR rhinology OR laryngology OR otology OR mastoiditis OR otitis OR sinusitis OR laryngitis OR rhinitis OR pharyngitis OR epiglottitis OR dysphonia OR ear OR larynx OR nose OR pharynx) with each one of the etiological agents of zoonoses for the period between January 1997 and August 2012 without language restrictions. RESULTS A total of 164 articles were selected and examined. Larynx was the most commonly involved ENT organ, followed by oral cavity, pharynx, and neck. Bacteria were the most representative microorganisms involved. Nose and major salivary glands were affected most frequently by protozoa; paranasal sinus, oral cavity, ear, neck, nerves and upper airway by bacteria; and larynx by fungi. CONCLUSIONS ENT symptoms and signs may be present in many zoonotic diseases, some of which are also present in industrialized countries. Most zoonotic diseases are not commonly encountered by ENT specialists. Appreciation of the possible occurrence of these diseases is important for a correct microbiological approach, which often requires special culture media and diagnostic techniques.

Neonatal stridor and laryngeal cyst: Which comes first?

Neonatal stridor is a rare condition usually caused by laryngomalacia. Congenital laryngeal cyst represents an uncommon cause of stridor in the neonatal population and may be misinterpreted as laryngomalacia, leading to serious morbidity and mortality if diagnosis and treatment are delayed. Herein we report the case of a full‐term infant with stridor, feeding problems and failure to thrive. Initially, direct laryngoscopy diagnosed only laryngomalacia. As stridor worsened, however, and respiratory distress appeared, repeat laryngoscopy showed vallecular laryngeal cyst, visible macroscopically. The patient was successfully treated with endoscopic marsupialization. There was no evidence of recurrence at follow up after 3 months. This case highlights the importance of laryngoscopic assessment for suspected laryngeal abnormalities in infants with stridor. If symptoms worsen, endoscopy should be repeated, because congenital laryngeal cysts may not be immediately visible macroscopically.

Mandibular advancement devices vs nasal-continuous positive airway pressure in the treatment of obstructive sleep apnoea. Systematic review and meta-analysis

Background Obstructive sleep apnoea (OSA) is a common disorder that may affect at least 2 to 4% of the adult population. Nasal-Continuous Positive Airway Pressure (N-CPAP) is today considered the gold standard for the treatment of OSA. The development of oral appliances (OAs) represents a new approach for the management of this pathology. The aim of this systematic review is to compare the efficacy of OAs and N-CPAP in the treatment of patients with mild to severe OSA. Material and Methods A PubMed-MEDLINE and Cochrane databases search of articles published between 1982 and 2016 comparing the effect of N-CPAP and OAs in OSA patients was conducted during July 2016. The studies were selected and stratified according to PRISMA and SORT criteria. The main outcome measure was post-treatment Apnoea-Hypopnoea Index (AHI) while secondary outcomes included post-treatment Epworth Score Scale (ESS) score and lowest Oxygen Saturation level. Results N-CPAP was significantly more effective in suppressing AHI than OA. Moreover, N- CPAP was significantly more effective in increasing post-treatment lowest Oxygen Saturation level than OA. However, no significant different in decreasing ESS values was found between the two treatments. Conclusions On the basis of evidence in this review it would appear appropriate to offer OA therapy to those who are unwilling or unable to persist with CPAP therapy. N-CPAP still must be considered the gold standard treatment for OSA and, therefore, OAs may be included in the list of alternative options. Key words:CPAP, obstructive sleep apnoea, oral appliances.

Trans-oral robotic surgery (TORS) for the treatment of lingual tonsillitis. When conventional therapies fail.

Lingual tonsillitis is an underestimated but serious health problem. This paper describes the feasibility and efficacy of the trans‐oral robotic surgical approach in cases of lingual tonsillitis.

Technetium-99m (99mTc)-labelled sulesomab in the management of malignant external otitis: is there any role?

We report two cases of malignant external otitis (MEO) evaluated with Technetium-99m(99mTc)-labelled sulesomab. Two patients affected by MEO are presented, together with a literature review. Both patients were studied with clinical examination, ear discharge culture, radiological imaging, blood exams, 99mTc Sulesomab, and treated with antibiotic therapy. 99mTc-Sulesomab would appear to be an useful tool for diagnosis and follow-up of MEO, highlighting the site and extension of the inflammatory process, and evaluating course and treatment efficacy. 99mTc-Sulesomab shows promise as a rapid, effective and safe imaging agent for treatment response evaluation and follow-up of patients with MEO. Further studies are warranted to validate the inclusion of 99mTc-Sulesomab scan in the imaging follow-up of patients with MEO.

Improved outcomes for papillary thyroid microcarcinoma care: active surveillance and case volume

Disease-specific clinical pathways and care delivery interventions can only be developed if supported by sufficient clinical volume. Disease-specific multidisciplinary clinics are an example of one such care delivery intervention that enables coordinated and comprehensive patient evaluation that can result in improvement of the quality of care provided.1 As an example, the proficiency of a thyroid cancer multidisciplinary board led to changes in therapeutic recommendations.

Phonosurgery debulking and pharmacological treatment of human papillomavirus patient with recurrent respiratory papillomatosis and vocal outcomes

We are presenting this case, a 56-year-old woman, with laryngeal papillomatosis involving both vocal cords and anterior commissure, treated with cold phonosurgical debulking and laser CO 2 surgery, with respect to the mucosa of anterior commissure, and cidofovir and indolo-3-carbinolo, in order to explain the physiopathological principles of the treatment, the surgical methods and the long term results (8 years and 6 months) in absence of sequelae and vocal outcomes.