Giovanni Motta

CO2 laser surgery in the treatment of glottic cancer

The aim of the study was to assess the effectiveness of CO2 laser endoscopic surgery in the treatment of glottic carcinoma limited to the true vocal cords or involving the adjacent regions.

T1-T2-T3 Glottic Tumors: Fifteen Years Experience with CO2 Laser

This research aims at reporting the results of endoscopic treatment of glottic carcinomas by CO2 laser. The cases cited concern 516 patients with glottic T1-T2-T3 carcinomas. The patients have been divided into 5 groups: a) T1a: 194 patients with monolateral carcinoma involving the true vocal cord who underwent simple cordectomy; b) T2a: 104 patients with monolateral cordal carcinoma involving the ventricle and the false cord; c) T1b: 127 cases of monolateral or bilateral carcinoma involving the anterior commissure; d) these patients underwent bilateral cordectomy; T2b: 54 cases of monolateral or bilateral carcinomas involving the anterior commissure and extending to the hypoglottic or supraglottic region; in these patients a bilateral extended cordectomy was performed; e) T3: 37 selected cases of monolateral or bilateral cordal carcinoma with fixed vocal cord, fixity was due to the substantial size of the tumor or to the infiltration of the paraglottic space; these patients underwent a monolateral or bilateral extended cordectomy. The following are the results at 5 years: group a: overall observed survival rate (OSR) was 79% and the adjusted survival rate (ASR) 94.5%; group b: OSR 67% and ASR 77%; group c: OSR 88.4% and ASR 96.5%; group d: OSR 82% and ASR 90%; group e: OSR 55% and ASR 67%. The above data are evidence of the fact that our surgical techniques offer similar or better advantages in terms of survival rate compared to the traditional procedures. It must be noted that endoscopic surgery of glottic tumors carried out by CO2 laser offers relevant benefits when compared with traditional surgery: i) rapidity of operation and reduced surgical trauma; ii) the possibility of avoiding tracheotomy; iii) the respect of the integrity of the cartilaginous skeleton; iv) short postoperative course and low incidence of complication; v) better functional results; vi) a shorter stay in hospital with positive psychological effects on the patients and lower social costs.

Occult metastases in cancer of the larynx and their relationship to clinical and histological aspects of the primary tumor: A Four-Year multicentric research.†‡

The authors have tried to verify whether some clinical or pathological features of laryngeal cancer may favor the occurrence of occult metastases in the lymphnodes of the neck in No cases. The purpose of the investigation was to define the possible existence of tumors, where elective neck dissection, in the absence of palpable nodes, could be done without, thus contributing to settlement of a long debated problem.

Occult Lymph Node Metastases in Supraglottic Cancers of the Larynx

Occult cervical lymph node metastases may often be associated with cancers of the supraglottic larynx. The aims of this investigation were: (1) to determine the incidence of occult lymph node metastases in patients with cancer of the larynx; (2) to assess whether the presence of such metastases was related to the extent of the primary tumor (T) and its grading (G); and (3) to discuss which therapeutic approach should be followed in treating clinically occult lymph node metastases. Our investigation included 97 patients who underwent supraglottic horizontal laryngectomy and elective cervical lymph node dissection. The incidence of occult lymph node metastases in the series considered was 27%. Based on the preoperative staging of the tumor, 14% of the cases had metastatically involved lymph nodes in the T1 tumors, 21% in the T2 tumors, 35% in the T3, and 75% in the T4. In the statistical analysis, a significant difference was shown to exist when T1 + T2 and T3 + T4 (P = 0.04) were compared. In terms of grading, occult metastases were found in 16% of the G1 tumors, 27% of the G2, and 42% of the G3. The statistical analysis demonstrated a significant difference between G1 and G3. In brief, the incidence of occult metastases was higher for the less differentiated tumors and for the ones with a higher T value; the effects of both factors are combined thereby increasing the rate of occult metastases (P = 0.05).

A multicenter trial of specific local nasal immunotherapy

Objective: To assess the efficacy and safety of specific local nasal immunotherapy (LNIT) in powder form in patients with allergic rhinitis, using subjective and objective parameters.

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.

Surgical treatment of acute recurrent throat infections in children

OBJECTIVE The purpose of this study was to define the contribute of surgery and watchful waiting in the treatment of feverish episodes and other clinical manifestations related to acute recurrent throat infections in children. METHODS An observational, retrospective and multi-centric study was carried out on 407 subjects, aged 2-11, with a minimum two-year follow-up. Chi square test and Fishers test were used for the statistical analysis. RESULTS Watchful waiting prevented, similarly to surgery, recurrences of feverish episodes, but did not favourably impact on other clinical manifestations (respiratory obstruction, otitis media, group A beta hemolyticus streptococcus positive laboratory findings) as compared to surgery (p<0.001). CONCLUSIONS The higher effectiveness of surgical treatment, as compared to watchful waiting, was documented in the study patients, considering all the clinical manifestations related to acute recurrent throat infections.

Aerodynamic findings and Voice Handicap Index in Parkinson’s disease

ObjectiveTo verify possible relations between vocal disability and aerodynamic measures in selected Parkinson’s disease (PD) patients with low/moderate-grade dysphonia.MethodsFifteen idiopathic dysphonic PD male patients were examined and compared with 15 euphonic subjects. Testing included the following measures: Voice Handicap Index (VHI), maximum phonation time (MPT), mean estimated subglottal pressure (MESGP), mean sound pressure level (MSPL), mean phonatory power (MPP), mean phonatory efficiency (MPE) and mean phonatory resistance (MPR).ResultsStatistical analysis showed: a significant reduction in MPR and MSPL in PD subjects compared to the healthy ones; a significant positive correlation between VHI score and MSPL, MPR, MPP, MESGP and a significant negative correlation between VHI and MTP within PD subjects. Test for multiple linear regression showed a significant correlation between VHI score, MPT, MPR and MSPL.ConclusionsA relationship between VHI and aerodynamic measures was shown in the present study. Compensatory mechanisms may aggravate vocal disability in PD subjects.