Lorenzo Sabatino

The potential role of hyaluronan in minimizing symptoms and preventing exacerbations of chronic rhinosinusitis.

Background This study was designed to prospectively evaluate the role of nebulized hyaluronic acid (HA) given for 10 days/mo over 3 months as adjunct treatment to minimize symptoms and preventing exacerbation of chronic rhinosinusitis (CRS). Methods Thirty-nine eligible patients were randomized to receive nebulized 9-mg sodium hyaluronate nasal washes plus saline solution (21 patients) or 5 mL of saline alone (18 patients), according to an open-label, parallel-group design, with blind observer assessment. A questionnaire about main CRS discomfort and nasal endoscopy for mucous discharge and/or mucosal edema of nasal cavities was used to assess primary outcomes of treatments. Secondary outcome measures included side effects and satisfaction. Results HA significantly improved quality of life in CRS patients according to the CRS questionnaire (16± 3.72 versus 11.52 ± 4.28; p < 0.001), contrary to saline group scores (18.92 ± 3.09 versus 18.21 ± 3.21; p = 0.55). The HA group showed significantly reduced osteomeatal edema (2.42 versus 1.52; p < 0.001) and secretions (0.95 versus 0.42; p < 0.001), whereas there was no statistically significant difference in the saline group he compliance to the treatment was similar in both groups and no side effects were recorded. Conclusion The results of this study suggested that intermittent treatment with topical 9-mg sodium hyaluronate plays a role in minimizing symptoms and could prevent exacerbations of CRS.

Hyaluronic Acid: Perspectives in Upper Aero-Digestive Tract. A Systematic Review

Background To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the mucosa of the upper aerodigestive tract (UADT). The use of topical drugs, which are able to reduce mucosal inflammation and to improve healing tissues, can represent a relevant therapeutic advance. Topical sodium hyaluronate (SH) has recently been recognized as adjuvant treatment in the chronic inflammatory disease of the UADT. Aims The aim of our work was to review the published literature regarding all the potential therapeutic effects of SH in the chronic inflammatory disease of UADT. Methods Relevant published studies were searched in Pubmed, Google Scholar, Ovid using keywords (“sodium hyaluronate” and “upper airways”) or Medical Subject Headings. Results At the end of our selection process, sixteen publications have been included. Six of them in the post-operative period of nasal-sinus surgery, 2 of them in pediatric patients affected by recurrent upper respiratory tract infections, 4 of them in reducing symptoms and preventing exacerbations of chronic upper airways in adult population, 4 of them in patients with chronic inflammatory disease of UADT, including gastro-esophageal reflux disease (GERD). Conclusions Topical administration of SH plays a pivotkey role in the postoperative phase of patients undergoing FESS and nasal surgery, and positive results are generally observed in all the patients suffering from UADT chronic inflammatory disease.

Hyaluronic acid and upper airway inflammation in pediatric population: A systematic review

BACKGROUND Inflammatory disease of upper airway in pediatric population represents a social problem for both the pharmaco-economic impact and a burden for the family. To date, the use of topical therapies represents a significant therapeutic progress because they are able to reduce mucosal inflammation and improve tissue healing. Topical Hyaluronic Acid (HA) is a promising molecule that has been recently proposed as adjuvant treatment in the inflammatory disease of the upper aerodigestive tract (UADT) infections. AIMS The aim of our work was to review the published literature regarding all the potential therapeutic effects of HA in the inflammatory disease of upper airway in pediatric population and evaluate the effectiveness of HA, alone or in combination, in children affected by cystic fibrosis. METHODS Relevant published studies about use of HA in UADT in pediatrics were searched in Pubmed, Google Scholar, Ovid using various keywords with no limit for the year of publication. Studies based on the use of HA with nasal packing and with invasive administration of HA were excluded. RESULTS At the end of our selection process, four publications have been included: one of them in children with recurrent upper respiratory tract infections, one of them in children with bacterial acute rhinopharyngitis, two of them in children affected by cystic fibrosis. CONCLUSIONS Topical administration of HA plays a pivotal role in all the children suffering from UADT inflammatory disease, and positive results are generally observed in children with cystic fibrosis.

Hyaluronic acid: Perspectives in dentistry. A systematic review

To date, topical therapies guarantee a better delivery of high concentrations of pharmacologic agents to the soft periodontal tissue, gingiva, and periodontal ligament as well as to the hard tissue such as alveolar bone and cementum. Topical hyaluronic acid (HA) has recently been recognized as an adjuvant treatment for chronic inflammatory disease in addition to its use to improve healing after dental procedures. The aim of our work was to systematically review the published literature about potential effects of HA as an adjuvant treatment for chronic inflammatory disease, in addition to its use to improve healing after common dental procedures. Relevant published studies were found in PubMed, Google Scholar, and Ovid using a combined keyword search or medical subject headings. At the end of our study selection process, 25 relevant publications were included, three of them regarding gingivitis, 13 of them relating to chronic periodontitis, seven of them relating to dental surgery, including implant and sinus lift procedures, and the remaining three articles describing oral ulcers. Not only does topical administration of HA play a pivotal key role in the postoperative care of patients undergoing dental procedures, but positive results were also generally observed in all patients with chronic inflammatory gingival and periodontal disease and in patients with oral ulcers.

Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction?

The objective of this article is to systematically review the evidence on the effectiveness of vestibular rehabilitation (VR) in patients with benign paroxysmal positional vertigo (BPPV). Relevant published studies about VR in BPPV were searched in PubMed, Google Scholar and Ovid using various keywords. We included trials that were available in the English language and did not apply publication year or publication status restrictions. Studies based on the VR in other peripheral and/or central balance disorders are excluded. Primary outcome was the effect on vertigo attacks and balance. Of 42 identified trials, only 12 trials fulfilled our inclusion criteria and were included in this review. Three of them investigated the role of VR in patients with BPPV comparing with no treatment, two of them evaluated the efficacy of VR versus medications, seven of them have highlighted the benefits of the VR alone or in combination with canalith repositioning procedure (CRP) compared to CRP alone. The studies differed in type of intervention, type of outcome and follow-up time. VR improves balance control, promoting visual stabilization with head movements, improving vestibular–visual interaction during head movement and expanding static and dynamic posture stability. CRP and VR seem to have a synergic effect in patients with BPPV, especially in elderly patients. VR does not reduce the recurrence rate, but it seems to reduce the unpleasantness. So VR can substitute CRP when spine comorbidities contraindicate CRP and can reduce the uptake of anti-vertigo drugs post CRP. Further studies are needed to confirm these encouraging results.

A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland

The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with “Warthin tumor.” We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications.

Unilateral Blepharoptosis from Renal Cell Carcinoma

Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharoptosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC); however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to metastatic RCC. We describe the different causes of blepharopstosis, the path that led to the diagnosis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.

Neck fat volume as a potential indicator of difficult intubation: A pilot study

Background: Direct laryngoscopy is the gold standard of the airway management in patients without predicted difficulties. If unpredicted difficulties are encountered instead, different algorithms to follow have been developed. To date, no single predictor is sufficiently valid. In clinical practice, it is used a combination of them to enhance the estimate, and despite the variety of parameters used, not all the difficult intubations are predicted. The aim of this work is to retrospectively analyze neck computed tomography scans of 37 patients who have had tracheal intubation and search for anatomic neck fat compartments that correlate with the intubation difficulty, and eventually find a suitable, clinical parameter that can potentially enhance the prediction of a difficult airway when used in combination of the preexisting scores. Materials and Methods: the patients are divided by direct laryngoscopy view into two groups: Group A (n = 31): Normal airway, with a Cormack Lehane, Score I or II; Group B (n = 6): Difficult airway, with a Cormack Lehane Score III or IV. In the zone of interest, it was measured the neck volume parameter and other subparameters. Results: Despite a positive trend is shown for anterior fat volume (AFV) (P = 0.23) and fat volume (FV) (P = 0.28), statistically significant differences (P < 0.05) were not found between Group A and B in any of the measurements acquired. Conclusions: According to the literature, our results confirmed that there is still no single element that can predict a difficult intubation. Although no statistical significance was found, the AFV and FV have shown to have a potential predictive role for difficult intubation. Further studies with bigger samples are advisable to confirm this encouraging result.

“Canalolabyrinthine Schwannoma,” A Rare Variant of Intralabyrinthine Schwannoma: A Case Report

Canalolabyrinthine schwannoma is a rare subtype of neuroma. Only 1 case has been described in the literature. We report the clinical case of a 51-year-old Caucasian female with Menieres disease-like symptoms. Magnetic resonance imaging showed right VIII cranial nerve schwannoma that had different characteristics from the classical described types. The peculiar features of our case of intralabyrithine canalolabyrinthine schwannoma directed the surgeon and radiologist to tailored considerations for follow-up and therapy.

Personal Sound Amplification Products for Hearing Loss

for Hearing Loss To the Editor Dr Reed and colleagues1 compared personal sound amplification products (PSAPs) with a conventional hearing aid for speech understanding in noise in patients affected by mild to moderate hearing loss. In an audiologist’s practice, the hearing aid gain is largely influenced by hearing loss type (transmissive, sensorineural, or mixed) or the area of abnormality in the auditory system (middle ear, inner ear, or brain), but these were not specified in the Research Letter. In the inclusion criteria, the loudness discomfort level, which is variable among patients affected by hearing loss, was omitted. It is well known that if the hearing aid does not take into account loudness discomfort level, sound distortion, impaired speech comprehension, and patient discomfort can occur.2 Also, the ear insert of a hearing aid should be customized because the distance between ear insert and tympanic membrane influences the hearing aid gain.3 That 80% of deaf and hearing-impaired people live in lowand middle-income countries and that 1 in 7 individuals 50 years and older with hearing loss in Western countries use hearing aids suggest the study has significant implications for public health.4 However, among adults aged 50 to 59 years, the rate of hearing aid use declines to less than 1 in 20. Factors that may contribute to low hearing aid use include cost, low consumer awareness of the benefits of amplification, and an inadequate hearing aid customization.5 The variability of hearing loss is great among patients, and only a careful hearing evaluation and a customized hearing aid fitting can guarantee adequate hearing rehabilitation. Future research should focus on the development of specific interventions designed to increase hearing aid use among the hearing loss population.