Francesco Freni

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.

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.

Penetrating foreign body in the nasal floor through nasolacrimal duct

Clinical otolaryngologists frequently encounter nasal foreign bodies (FBs) particularly among children. The removal of nasal FBs is a common otolaryngological practice. However, occasionally trauma results from FBs being lodged in the nasal cavity especially through the nasolacrimal duct. In this article we present an unusual case of a FB that from the left medial canthus went inside the nasolacrimal duct, then through the inferior turbinate and stuck in the floor of the nose. We describe the transnasal endoscopic approach used and we recommend that the treatment be done as soon as possible to avoid complications.

The role of temperament in traumatic hearing loss: a single case study of a cochlear-implanted patient.

Abstract Introduction: The majority of existing research regarding cochlear-implanted patients focuses on acoustic perception and language skills in children and adolescents, or on the postoperative quality of life in adults. Purpose: We hypothesized that a patient’s psychological reaction to a cochlear implant (CI) may be influenced by the temperament of the implanted subject. This case study aims to assess whether temperament plays a role in the adaptation to CIs and if certain temperamental and character traits may be risk or protective factors for surgery and rehabilitation outcomes. Method: We evaluated a 21-year-old male patient presenting a history of traumatic hearing loss. The Temperament and Character Inventory (TCI) was employed to obtain a psychological evaluation. Results: The findings suggest a connection between the scores obtained on the TCI questionnaire and the patient’s behavior toward the CI. The effects of the operation may be mediated by some temperamental and character traits. Conclusion: In the field of clinical psychology and hearing rehabilitation, psychological evaluation may contribute a more profound understanding of the personality dynamics that influence the patient’s reaction toward traumatic hearing loss, compliance, and CI surgery outcomes.

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.

Functional MRI and laser-evoked potentials evaluation in Charcot-Marie-Tooth syndrome

Charcot-Marie-Tooth (CMT) disease is a genetically heterogeneous group of disorders. Pain is a less common symptom complained by CMT patients. We described a case of a 39-year-old male patient affect by Charcot-Marie-Tooth (CMT) disease compared to five healthy controls (HC), to assess the sensory and the nociceptive pathways by using LEPs recording associated to fMRI examination, to find an “objective” marker which could be used in the management of CMT patient. The nociceptive system was evaluated by laser-evoked potentials (LEPs). Moreover, fMRI (functional magnetic resonance imaging) examination, by using laser stimuli, was performed. LEPs’ examination showed an increase of latency and an amplitude reduction respect to HC. The laser stimulation during fMRI showed a decreased cortical activations if compared to HC. The originality of this paper, although limited to a single case, resides in a detailed evaluation of CMT1 patient performed by using neurophysiologic and neuroimaging methods to investigate extensively the sensory nociceptive pathways.

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.

Continuous and intermitted nerve monitoring in thyroid surgery: two complementary devices

Intraoperative neural monitoring (IONM) is a constitutive procedure in the management of the recurrent laryngeal nerve (RLN) in thyroid surgery. Progress in IONM currently includes devices that intermittently (I-IONM) evaluate RLN functionality and accessories that continuously assess the entire RLN route by permanent vagal nerve stimulation, i.e., continuous intraoperative nerve monitoring (C-IONM) (1). I-IONM is achievable through a monopolar or bipolar hand probe stimulator.

Therapeutic efficacy of the Galletti–Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects

ObjectiveTo compare the Galletti–Contrino manoeuvre with the more widely used Semont–Toupet in overweight subjects presenting with benign paroxysmal positional vertigo (BPBV) of vertical semicircular canals (posterior and anterior canals).Study designProspective cohort study.Patients204 patients (BMI range 25–30) with a diagnosis of BPPV of vertical semicircular canals were randomly divided in two groups treated with two different maneuvers: Galletti–Contrino (Group A) and Semont–Toupet manoeuvre (Group B). The results were compared with those obtained from a control group (204 non-overweight subjects with BPV of vertical semicircular canals.)InterventionGalletti Contrino/ Semont Toupet manoeuvres.Main outcome measure(s)Liberatory nystagmus or vertigo after maximum 2 maneuvers. Vertigo and dizziness intensity scores (Visual analogue scale VAS 0–10) from day 0 to day 5 following the repositioning manoeuvre were also recorded in responsive patients.ResultsWhile in non-overweight subjects no significant difference comparing the effectiveness of the two manoeuvres was found, liberatory nystagmus and vertigo were more frequently observed after Galletti Contrino manoeuvre in overweight subjects; this difference was statistically significant when posterior canals were involved (P < 0.03). Vertigo and dizziness VAS scores reduced significantly from day 0 to day 5 after therapy in all groups. A more significant reduction of dizziness VAS was recorded in patients undergoing Galletti–Contrino manoeuvre at days 4–5 (P < 0.005).ConclusionGalletti–Contrino manoeuvre seems to be significantly more effective than Semont–Toupet manoeuvre in the treatment of BPPV of posterior semicircular canal and may be preferential in patients with limited body movements.