Lorenzo Salerni

Ingested foreign bodies causing complications and requiring hospitalization in European children: Results from the ESFBI study

Background:  In young children, particularly those aged 1–3 years, aerodigestive tract foreign bodies (FB) are a common pediatric problem. The aim of the present study was therefore to characterize the risk of complications and prolonged hospitalization due to FB in the upper digestive tract in terms of the characteristics of the injured patients (age, gender), typology and features of the FB, the circumstances of the accident and hospitalization details.

Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use

Nasal decongestants are the most powerful drugs in the reduction of nasal obstruction. Despite their large use, local and systemic adverse reactions are frequent. The authors focus on the pharmacology of these kinds of drugs in light of the most recent knowledge on nasal pathophysiology. The ultrastructural anatomy of nasal mucosa explains the complexity of the possible interactions between the sympathomimetics and imidazoles derivates, and the submucosal layer. Nasal obstruction is one of the most frequent clinical problems that otorhinolaryngologists encounter daily, both in adults and children. All possible predisposing conditions to nasal obstruction are documented along with the better ways to diagnose them through nasal functionality tests. Active anterior rhinomanometry, acoustic rhinometry and the determination of mucociliary transport time represent, together with nasal endoscopy, the gold standard for an accurate diagnosis and the follow-up of the patient to cure. An updated review of the most significant works in this field and the best treatment protocol to avoid adverse effects, such as rhinitis medicamentosa, are reported.

Lateral Canal Paroxysmal Positional Vertigo Revisited

The first reports of an involvement of the lateral canal (LC) in paroxysmal positional vertigo (PPV), were published in 1985, by Luciano Cipparrone et al., from Italy and Joseph McClure from Canada. The increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder regarding its epidemiological, physiopathological, clinical, and therapeutic aspects. According to the most recent data, LC–benign PPV accounts for 17% of all PPV patients, regardless of gender and between the two labyrinths. The LC–PPV syndrome is characterized by intense positional vertigo and direction‐changing geotropic horizontal nystagmus, both caused by rotation of the head in the supine position. Less frequently, it presents with apogeotropic nystagmus. In some patients nystagmus is also detectable in the sitting position, mimicking a spontaneous nystagmus. In most cases nystagmus is caused by displaced otoconia floating in the semicircular canal. The pathological side, which must be identified for successful treatment, is usually indicated by nystagmus intensity: the more intense positional nystagmus beats toward the affected ear. In a few cases, where there is no difference in nystgmus intensity, other indicators are necessary to determine the pathological side. Vestibular neuritis and posterior fossa lesions should be considered in the differential diagnosis. Treatment of LC–PPV relies on some physical maneuvers, the objective of which is to allow the otoconial debris to exit from the LC by centrifugal inertia and/or by gravitation.

Atopy: pediatric ENT manifestations in children.

OBJECTIVE The aim of the present study is to discuss the basics of atopy in children in relationship to the principal ENT allergic disorders such as allergic rhinitis, rhinosinusitis and their impact on lower airways, allergic otitis media, and oral cavity focusing on their natural history. METHODS An updated and exhaustive review of principal literature on these topics is performed, underlining the constant but growing interest evoked by these disorders most of all the possible sequelae or complications. Considering the different districts which can be selectively or simultaneously affected by the allergic sensitisation, diagnosis can be a really hard task; in this paper, we tried to draw an integrated diagnostic approach to atopic children and some guidelines for a correct therapeutic approach. CONCLUSIONS Atopic disorders could expose young patients to years of chronic diseases that interferes with their development and with many important aspects of their lives. For these reasons, and considering the high social and medical costs of this disease, it is extremely important to adequately treat allergic pathologies from the early phases of its natural history. Moreover, we cannot forget that an appropriate therapy of allergic pathologies should not be only able to decrease symptoms but, it should also be able to improve patients health related quality of life.

Use of mammalian inner ear antigens for the diagnosis of autoimmune sudden loss of vestibular function

It has been postulated that bilateral sensorineural hearing loss (SNHL) may be the result of an ongoing autoimmune process against the inner ear and a pattern of progressive bilateral SNHL linked to an autoimmune inner ear disorder has been reported. Various attempts have been made to develop an assay to confirm the diagnosis of autoimmune inner ear disease. In this study we used a Western blot assay to determine the presence of IgG antibodies directed against a PØ antigen (30 kDa) of the guinea pig in the sera of patients affected by sudden loss of vestibular function (SLVF). Ten patients affected by vestibular neuritis were enrolled: eight with unilateral vestibular loss and two with sequential bilateral impairment. We also tested nine patients with sudden unilateral hearing loss, five with benign paroxysmal positional vertigo and six normal subjects. In the present study only one patient, a woman affected by bilateral vestibular impairment, had IgG antibodies against the PØ protein. Our results indicate either that the antigen PØ marker for autoimmune unilateral SLVF or that our patients did not have an immunological basis for their disease. However, we can suggest that bilateral impairment of vestibular function and bilateral progressive SNHL are more likely to be immune-mediated disorders and that PØ could be a valid marker for these diseases. As bilateral vestibular neuritis is an uncommon disease, a multicentre study is required to confirm our suggestions.

Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with tonsil colonisation by Streptococcus pyogenes.

The involvement of pathogenic bacteria in obstructive sleep apnoea syndrome (OSAS) has yet to be elucidated. We investigated the possible role of group A streptococcus (GAS) in OSAS pathogenesis. In 40 tonsillectomized patients affected by OSAS and 80 healthy controls, significant (p < 0.0001) association of GAS with paediatric OSAS was found. Supernatant from streptolysin O (SLO)-producing GAS induced production of cysteinyl leukotrienes (CysLTs) in tonsil mononuclear cells (TMCs). CysLTs-treated TMCs showed significant (p < 0.05) proliferation of CD4+ T, CD19+ and CD19+CD27+CD38+ B lymphocytes. We discovered a SLO-dependent activation of CysLTs production through a pathway involving TOLL-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon-β (TRIF), Myeloid differentiation primary response gene 88 (MyD88), and p38 MAP Kinase. In conclusion, we hypothesise that GAS may contribute to paediatric tonsillar hyperplasia through CysLTs production induced by SLO, and this might explain its association with OSAS.

Surgical treatment of nasal septal perforations: SIR (Italian Society of Rhinology) experts opinion

BACKGROUND AND AIM The aim of our study has been to investigate the perception of aspects related to nasal perforation among experts in Rhinology and ENT surgeons. Our aim was reporting the situations in different Countries to improve the knowledge of colleagues interested in this topic. METHODS A panel of experts prepared a 20-question questionnaire regarding nasal perforations and their surgical repair, that were emailed to all the members of SIR (Società Italiana di Rnologia - Italian Society of Rhinology). RESULTS Data obtained from their answers showed that Cottle technique (64%) is the most common technique to perform septoplasty worldwide. 37% of the sample reported an occurrence of nasal septal perforation in less than 1% of patients and 75% attributed this occurrence to the skill of the surgeon, to infections, to drug use and to septal deformity. Trauma, pressure and Wegeners granulomatosis were also mentioned. The most common closure technique is the mucosal flap (75%), followed by the cartilage grafts (11%). Much less common were oral flaps, septal buttons and others. The majority agreed not to suggest septal perforation surgery in minimal (less than 3-4mm) perforations (73.5%), or limiting it to symptomatic patients (43.5%). The contraindications to repair surgery were reported to be: Wegeners granulomatosis, drug abuse, non-symptomatic perforation, its dimension and age of the patient. Septal deviation, atrophic rhinitis, smoke epistaxis and systemic diseases were also claimed. Failure in repair surgery has been observed to occur in less than 30% of cases. DISCUSSION AND CONCLUSIONS Given the great difficulty to make random studies about controversial topics and obtain statistically significant data related to that, expert opinion shall be of great value (expert opinion, level of evidence 5).

Radioactive Merano SPA Treatment for Allergic Rhinitis Therapy

Allergic rhinitis is a common nasal disorder with a high impact on quality of life, high social costs in therapies, and a natural development towards asthma. Pharmacological therapy is based on several genres of medications, of which intranasal corticosteroids are currently the most widespread. Thermal water treatment has traditionally been used as adjunctive treatment for chronic rhinitis and sinusitis. The present study was carried out to assess the clinical efficacy of nasal inhalation of radioactive oligomineral water vapours from the Merano hot spring and to compare it with the clinical efficacy of mometasone furoate nasal spray. A comparative prospective study was performed in 90 allergic patients treated at Merano hot springs: a group of 54 subjects treated with radioactive thermal oligomineral water and a control group of 36 subjects treated with mometasone nasal spray. Patients of both groups were assessed before and after treatment by Sino-Nasal Outcome Test questionnaire, active anterior rhinomanometry with flow and resistance monitoring, measurement of mucociliary transport time, and cytological examination of nasal brushing/scraping. The study showed that inhalation treatment with radioactive hydrofluoric thermal water for two weeks produces an objective clinical and cytological improvement in allergic patients, similar to that obtained with mometasone furoate nasal spray.

Effects of a Mask on Breathing Impairment During a Fencing Assault: A Case Series Study.

Background: Fencers often complain of progressive difficulty in breathing during matches, which is generally attributed to restricted air, light and heat circulation from wearing a mask. Physiologically, the nasal structure generates airflow resistance that can reach -50% of the total respiratory resistance. Objectives: This study aims to investigate the presence of nasal obstruction in fencers and the relationship with the use of mask. Materials and Methods: An observational study on 40 fencers (18 males, 22 females) was conducted. Fencers perform a usual assault, wearing the mask and standardized physical exercises (running, sprints and obstacles) without the mask. ENT examination with a nasal flexible fiberscope, Anterior Active Rhinomanometry (AAR) and Peak Nasal Inspiratory Flow (PNIF) measurement before and after physical activity with or without the mask was recorded. Results: Before physical exercise, the total nasal airway resistance mean value for AAR was 0.33 ± 0.17 Pa/cm3/s at 150 Pa. After a match with the mask, the mean value was 0.28 ± 0.16 Pa/cm3/s. After normal physical exercises without mask, the mean value was 0.24 ± 0.15 Pa/cm3/s. Using t tests, statistically significant difference between nasal resistance before and after physical activity (P < 0.05) was observed, but no significant difference in nasal resistance between the basal value and that taken after a match wearing the masks (P = 0.1265). PNIF values significantly increase with exercise (P < 0.05). Conclusions: Our study shows that wearing the mask causes increased breathing impairment in fencers, when compared with similar physical activity without the mask.

Benign Paroxysmal Positional Vertigo and Migraine

Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo in adults and migraine is the most frequent cause of headache in humans. Females are more commonly affected than males in both diseases. Over the last 15 years, interesting, important relationships between the two disorders have been studied and proposed. Here we review the pathophysiology and diagnosis of BPPV both in its simple and linear presentations and in its more complex forms in which the patterns of nystagmus are less easily understood. We also mention the main therapeutic options for treating posterior and lateral canal BPPV. Possible correlations between BPPV and migraine are described. Finally, since migraine can cause vestibular symptoms, including positional vertigo, suggestions are given for differential diagnosis between the two diseases.